Recently in social care Category

by Steve Rogowski, a social worker (children and families) with a local authority in NW England

'Tis the season to be cheerful, and for many children and families it will be. But such a sentiment does not always apply to the children and families social workers are involved with. They are having to pay the price for what the academic George Lambie calls the 'debacle of neoliberalism' (see 'From Recession to Renewal' edited by Joanna Richardson). They had no part in causing the economic and fiscal crisis facing the globalised, capitalist world, and yet are facing cuts in services and welfare benefits. There is also ever more job insecurity and anxiety, even if people manage to find increasingly scarce employment. Christmas will be a stressful time for many, though social workers and others will be doing their best to make a positive difference.

Skeleton staff

Although children and families are facing the brunt of austerity measures, social workers are not immune. Many local authority offices only open with 'skeleton' staff over the Xmas/New Year period. They will have to cope with increases in domestic abuse referrals, often related to the stress caused by the current economic and financial catastrophe. There will also be instances of family breakdown. For example, young people falling out with parents/carers and deciding (not a real 'choice' in the current jargon) to leave home. Because of austerity measures they will be unable to turn to local authorities or charities for assistance. Homelessness always becomes a more important issue over the festive period.

Twist in the tale

More positively perhaps, managers praise the fact that 'everyone' has worked hard over the preceding year - targets have been met, outcomes for children have been positive, and good inspection reports have been written. But there is a twist in the tale - next year is 'going to be challenging' with ever more resource constraints and efficiency savings needed. The need is to 'get more for less'.

The unspoken narrative is that there will be continued job losses and reductions in services. While social workers might feel secure, thinking that support and other staff are in the firing line, this should not be overstated or taken for granted.

An ideological problem

The key problem is ideological. The Conservative-led coalition is using the economic crisis as a front to reduce the role of the state in meeting citizens' needs unless they happen to be 'troubled' families needing 'trouble-shooters'. Other than this, people are expected to rely on themselves, family, friends and charity. If this project succeeds the danger is it will take us back to Victorian times.

But perhaps all is not lost. Ed Miliband has spoken about what comes after the neoliberalism, this echoed by academics who talk about the 'post-liberal world', one where notions of social justice and equality will be more to the fore. Then there is the Social Work Action Network conference in Spring of next year focussing in 'cuts, crisis and resistance', together with the need to build alliances in social work and social care. This is with a view to working towards a different world.

A season to be cheerful it may well be and, despite the doom and gloom, there may be hope on the horizon.   

A few weeks back I led a tour of voluntary sector organisations providing social care locally. With shrinking public services, these providers are central to the delivery of adult care and this excursion was a response to requests from statutory professionals - from the local authority, primary care and mental health trusts - who wanted to know what voluntary sector resources were available locally.
 
We stopped off at six projects for around 20 minutes each on a circular tour that took us no further than half a mile from the town hall (much to the chagrin of those who were hoping to journey farther afield). What we found was truly inspiring: voluntary sector organisations providing some great services with limited resources.

But much of what we discovered was disheartening. Our tour started at an advice centre where staff reported that enquiries had nearly doubled in recent years, with precious little increase in their resources. We also met with a learning disability provider who had lost a number of supported housing projects through competitive tendering processes. While they had picked up a few new contracts in their place, the unintended consequence of these changes in providers was that many service users had endured a protracted period of instability and insecurity.

The greatest challenges were perhaps faced by an older people's project. Earlier this year, they lost a large day-care contract with a neighbouring local authority. A further blow came when they failed to retain a home care service they provided; the contract was re-tendered and they were outbid by cut-price provider. Faced with a 65% drop in annual income they had just completed an agonising restructure which had made many of their highly-skilled staff redundant.

Like others on this tour, this provider saw little cause for optimism about the current climate in social care where brutal cuts are being introduced and commissioners favour ever-cheaper providers.

By Helen Bonnick

The notion of social work as vocation is an old one; the idea of an occupation to which someone feels called and to which they are suited by skills or personality. The pioneers of social work often made great personal sacrifices in their service to the community, whether from a church or political background. Most of the social work codes of ethics or conduct speak of protecting the dignity and rights and interests of service users, as well as personal integrity and honesty. Student applications often refer to a sense of debt to society, or a deep, long held determination to serve others. The old reasons that individuals were drawn to social work hold good today.

And yet here social work stands, not with a sense of a lifetime calling, but with an average retention rate of eight years.

It often seems remarkable that people continue to stream to social work in the face of the much-publicised frustrations of those already in the field. What started out as a noble profession all-too-soon starts to feel like a technical task: driving a computer, the setting and measurement of targets, swamped by paperwork so that there is no time for face to face contact with service users. Within social care, we are familiar with the great pendulum swings: care or control, generic work or specialist teams, the alignment of children's services with adults or with education.

But while there are, sadly, plenty of unhappy social workers, as I travel around the country I also meet those whose teams are fully staffed and well-managed, where the work is calm and fulfilling and where a sense of purpose - and even of vocation - prevails. We need to be honest with those coming into the profession about what they face. But I am heartened, as I read the placement applications of prospective students, to see that the notion of calling and vocation remains.

Helen Bonnick is a social worker and practice educator

By Stuart Ayris

In 2009 I was given the opportunity to manage a community mental health team, having spent the previous 12 years of my career as a psychiatric nurse working on the wards.  

Although I have been a nurse for 14 years, I have never defined myself by my profession. The first thing that struck me about my social work colleagues was how important being a social worker was to them; their passion for what they do, the oft expressed belief that all decisions should be considered within an ethical and moral framework. Phrases such as "in the spirit of the Act," and "the best interest of the client" echoed around the walls of my newly inhabited office. These people were proud of their profession.  

The first time I was told, "you should have been a social worker," I was a little bemused. All I had done was remark that medication isn't always the answer. Did that imply nurses only consider pharmacological interventions and that social care has a monopoly over right and wrong? When a student nurse asked me what it was like being a social worker, I began to look deeper at what was going on. Me, being mistaken for a social worker? The cheek.

Working with my social work colleagues has been very much a learning experience. Not only have I had to learn the language but, in my role as team manager, I have had to negotiate the labyrinth that is the council HR and payroll policies. More importantly though I have also been obliged to let go of the years of pre-conceptions that had crept into my consciousness as I toiled away in the acute admission ward.

About a year into my new post, I began to see that what underpins our professions is nothing more complicated than values. The austere economic conditions have forced us, due to increased referrals and reduced budgets, to bridge those historical gaps between the professions. I am not talking about generic working but of one shared value - that of compassion.

If I were a client, I would not care if I were shown a name badge stating "social worker" or a name badge stating "community psychiatric nurse". What I would want to be shown is compassion. And compassion is not the proviso of any one profession. It is beholden upon all of us, social workers, nurses, psychologists, doctors and allied health professionals so show compassion for each other and for those whom we try so hard to help.

So I guess being mistaken for a social worker isn't such a bad thing after all. Not any more. Now that is one hell of a compliment.

Stuart Ayis is a community mental health team manager

 

(Does your manager use jargon? Pic posed by model: Image Source/Rex Features)

by John*, a care worker

Anyone who works in a care setting will be used to those higher up the pecking order talking in 'jargonese.' However a director's 'innovative and exciting' service may feel totally different to those working on the front line. So here's a guide to what those jargon words may actually mean to front line care workers.

An exciting period of transition: your job may be disappearing

Reviewing terms and conditions: the management are looking to save money by increasing 'flexibility' and making the organisation 'leaner' and more 'efficient' (see below). Often involves a cut in front line workers' wages.

Realigning terms and conditions: the management have done their review (see above) and now you will have to do more work for less money.

Flexible: You'll be expected to work any hour of the day and night but you won't be getting any extra money for working those anti-social hours

Efficiency savings: we're going to save money by cutting the pay of care workers or by making them work longer hours or by making them work more flexibly (see previous entry) or by sacking some workers and making the ones who are left work even harder or by a combination of all of these things.

A lean service: you're going to need the body and the stamina of a marathon runner because there won't be enough staff or allocated hours to do the job properly. Especially applicable to home help services for the elderly.

Competitive rates of pay: you'll be paid just as poorly for doing the job as other care workers in other organisations but we don't wan't to actually spell out the poverty wages in this advert.

Offering competitive rates of pay to attract the best candidates: this only applies to those in senior positions and it doesn't apply to front line care workers. Attracting and retaining the best candidates to do the job is obviously not that important when the job involves caring for the vulnerable in our society.   

Downbanding: on a recent television programme this was said to be a new thing but anyone who works in social care will have been familiar with this concept. Jobs in social care are continually being 'rebranded', terms and conditions are being changed and wages are being cut. This has been going on for at least the last 20 years which has resulted in a relentless downward pressure on wages as well as on terms and conditions.

In due course: If something's going to happen 'in due course' it means it's either going to happen in the dim and distant future or never.

We're looking into it: you'll recieve an answer to your question or query 'in due course'(see above).

Work/life balance: you'll need to be an expert at juggling both your money and your time if you want to have any kind of life as you're likely to be working long, anti-social hours for low wages.

*Name changed

by Mark Drinkwater

Social care professionals are often afraid to admit their mistakes. This is understandable as errors can have long-lasting negative consequences for service users. But one recent conversation I've had with a social care commissioner from a neighbouring borough proved refreshing in this regard.

The commissioner confided that they had been going through a process of tendering out some reconfigured social care services. In accordance with good practice they had gone through consultations with various stakeholders.

Things had started well. They had held some useful discussions with potential independent providers and had incorporated their comments into the plans. With these amendments in place, they felt they had tweaked the service specification sufficiently.

Before inviting tenders for this service specification, one final consultation needed to be undertaken. It was with service users.

The users and their carers had a host of searching questions about the nature of the service and how it would be delivered. The commissioner quickly found that they were unable to answer a large number of these concerns and it dawned on them that service users should have been the first interest group that they consulted.

It might have come as little surprise if the commissioner had been tempted to ignore the concerns of service users. Most of us are, by now, familiar with faux-consultations (the recent government consultations on NHS and social care reforms spring to mind) where the act of consultation is more about informing people about predetermined decisions.

But thankfully, this commissioner publicly acknowledged that they had overlooked several factors. They then set about revamping the service specification to address the concerns of the service users.

The key issue was not that they had made a mistake; it was that they were prepared to admit it and make amends.

Mark Drinkwater is a community social worker in south London

by Jane* a home care worker

My local authority is about to start paying home care workers by the minute using an electronic call monitoring system (ECM). I use the service user's home phone to log in or out when entering and leaving their property.

The council claims that Actual Time Invoicing will save money by clawing back precious pennies from unscrupulous care workers who cut calls short. I offer no support to carers who reduce half-hour calls to 20 minutes by rushing. However, there are incidents when reducing visit times is necessary.

My priority on meeting a new service user is to gain their trust and make them feel comfortable with my presence in their home. Sometimes this is simple and they couldn¹t give two hoots about stripping down to their birthday suit to be washed.

It can take time, however, especially if the loss of their independence is still a shock. Recently I started visiting one gentleman who would only let me make his breakfast. After much coaxing he allowed me to wash his feet, then under his arms and now he has full body washes.

Building that relationship was intense work. Leaving when he wished me to and gradually increasing the length of the call was an incremental part of giving him the sense of control he needed. Under the new system I would not have been able to do this without my wages being penalised.

Logging in can be delayed simply because the client is using their phone when I arrive. Once, I walked into a woman's house to find her walking about with her knickers and skirt round her ankles ­ I didn't stop to log in before helping her.

If I finish putting someone to bed in 20 minutes, am I supposed to plonk myself on the sofa with the main carer until the end of the half hour? How fair is that on someone who hasn't had a moment to herself since 6am? What if the family decide to cook tea? After meds and helping the service user to the toilet do I sit at the table with them until the time is up? And what if I feel unsafe in a call? Am I to lose 15 minutes' pay because I put my safety first?

My team leader has told me that if I need to leave a call early she would chase up extra pay for me. I do not know how she will find time for this when she is already struggling with rotas and covering staff sickness.

Although the system could deter carers from cutting calls short it does not address the reasons why they do. Also, an unprofessional carer is unlikely to perform extra duties when forced to stay at a call until the end of the allocated time.

To reward carers according to the length of time spent in one place and not by the quality of our care is to underestimate the complexity of our work and diminish its importance.

*Jane (name changed) is a home care worker who wishes to remain anonymous

(Pic: julianlimjl on flickr)

by Steve Rogowski, a social worker (children and families) with a local authority in NW England

There has been a lively debate on CareSpace recently about the subject of social workers and support workers having friendships with service users. It raises some tricky and complex issues. Is it ok to be friends with someone you work with in such a personal capacity?  And is it different if you are a social worker or a support worker?

One argument is that being a paid worker and having a working relationship with a user does not equate with friendship and ought never to do so. However, another issue is the difficulty of defining friendship and then deciding how to proceed.

Enjoyable chat

I recently met a man in a pub. He is now in his thirties but we both quickly realised that I had been his social worker in his teenage years. We had an enjoyable chat about his partner, family and about the fact I had once taken him to his first 'proper' football match. We agreed that we would probably bump into each other again in the pub.

Is this a friendship and is it appropriate? Such a question can raise complex issues but surely no-one would find fault with a user's former social worker having such a friendly chat. Perhaps if I had arranged to see him again, buy him a pint or two and vice versa, some people would raise their eyebrows.

Different for social workers?

On a different tack, foster carers are encouraged, even expected, to keep in touch/remain friends with the young people they have cared for, so why should that be different for social workers and others?

As for support workers, perhaps maintaining a relationship and thereby a friendship, can be seen as more appropriate simply because it is valued by many users. Such workers are often more intimately involved in people's lives than social workers, and suddenly withdrawing from the relationship could cause anxiety and upset.

Blurred boundaries

There can, of course, be a concern with inappropriate friendships, ones that, for example, lead to sexual relationships. Such situations may occur many years after the social work/support worker relationship has ended. Again there are no easy answers to such scenarios, though most would agree that there is a need for a professional and personal divide because otherwise it can lead to boundaries being blurred. Not least the power imbalance inherent in professional - user relationships must always be kept in mind.

Judge cases individually

Overall, both social workers and support workers need to be aware of the contentious and potentially damaging, as well as positive, issues involved in friendships with users. Perhaps all that can be said is that if such relationships occur the onus is on the practitioner to ensure there are clear boundaries, together with them needing to reflect on the imbalances of power that are involved. Maybe the best you can do is judge cases on an individual basis simply because you cannot be dogmatic.

by Agne Zindziute, a supported living service assistant manager

In social care today it seems we are called upon to provide the best services for the least reward. Working in care can take a lot from staff, emotionally and psychologically, and what do they get back? Rewards are minimal now because all I hear about is cuts, cuts, cuts.

For staff the situation might be heading towards exploitation but it is the clients who also suffer.

I recently worked at a project for people with epilepsy and associated disabilities. Because of their disabilities they were pretty dependent on staff. Many things were done for them, with as much input as they could provide.

Menus cut

Unfortunately I saw many cuts that were made at the cost of clients' well-being.

For example, we were asked to create a menu for our clients, which should be compiled based on their personal choices, using nice ingredients. Person centred planning should be followed daily when working with clients in health and social care, including making a menu.

For this group of clients a well-balanced diet is one of the crucial ingredients in their lives. Having epilepsy and taking large amounts of medication means a person's food intake and quality are very significant. If they sleep well, eat well and take their medication with proper food then the seizures seem less frequent and less serious.

But following the cuts, we were told to prepare this menu for £3 a day. How could we do it with such a small amount? It was expected to cover three meals and snacks.

Clients stay indoors

I appreciate that Tesco, Sainsbury's and other stores have introduced their basic food lines but good practice in care should be based on the idea "do not treat others like you would not like to be treated".

How can I buy a day's food from supermarkets for £3 when a single lunch meal deal costs £2.99?

If any of the clients wants something else, like a pack of crisps or chocolate, they have to get out themselves and buy it. Fair enough if they can talk and walk. If not, they rely on deliveries. But then the clients do not get out of the house. And because staff hours are reduced now, workers cannot get out either if there is no one to stay in the house to look after those clients who stay indoors.

I remember the days when clients and staff would get in the house car or ask the transport department to take them to the local shop to get food. This still happened last August.

But transport is no longer available for "luxuries" like going to the shop, meeting a hospital appointment, or taking a holiday.

The reality of the cuts in social care is that the money saved translates to a cut in somebody else's well-being and possibly health.

by Nigel Leaney, manager of a mental health residential service

The government may have been forced to rethink its Health and Social Care Bill by endorsing the main proposals of the Future Forum report but they have quickly regrouped and re-emerged as the government which is all listening, all caring. It's a sickening spectacle, especially when nothing much has changed. But sorry there are no sick bowls available; they've disappeared amongst the stink of efficiency savings.

The reforms to the legislation will now require the NHS regulator, Monitor, to soft focus its role in introducing more competition to the NHS while hyping its duties to promote choice, collaboration and integrated provision between health and social care.

Choice or quality

The rhetoric sounds laudable yet increased choice does not necessarily mean a better service. My cable TV offers more choice of channels than I know what to do with. But why bother when most of them are crap? Quality was better when we had a choice of just three or four channels.

Health and social care would be better served if we concentrated less on choice and more on quality. Yet the legislation and proposed reforms don't seem to grasp this.

Extending local commissioning consortia to include other health and social care professionals as well as GPs is clearly an improvement on the original proposals but hardly worthy of hanging out the bunting and issuing three cheers for enlightened reform.

Privatisation obsession

At the heart of the legislation, with or without reforms, lies the government's ideological obsession with privatisation. And the plans to fully embrace the private sector to meet our health and social care needs will continue as before, with the reforms just slowing the pace a little.

The most telling outcome of the government drive is that vulnerable adults will remain exposed to the risk of abuse of the type recently exposed at Winterbourne View. The Financial Times revealed that sub-standard care is far more likely to occur in homes ran for-profit than in charitable institutions.

Left floundering

Spouting the benefits of consumer choice is a smokescreen to ensure as many private care companies as possible get to dip their bread in an £80 billion gravy train. Good for them, good for all the Tories with personal shares in private healthcare companies and future seats on their boards.

The less profitable, more difficult services, not so attractive to the private sector, such as mental health and the elderly, will be left floundering in a financially bereft NHS after £20 billion is stolen in so-called efficiency savings.

No cherry picking, announce the reforms. And how exactly will the government stop this? Of course! In the same way stern, no nonsense way they reined in the bankers - excuse my cockney rhyming slang.

(Pic: Kreative Eye - Dean McCoy)