Less than zero

Violence
against social workers has at last been officially recognised. But why did the
government stop short of "zero tolerance", and have employers done
enough to stop it, asks Ray Braithwaite.

In
November 1998, a highly skilled and experienced social worker was murdered by a
service user. Jenny Morrison was an approved social worker, a mother and a
grandmother. Her tragic death was not the first in social care at the hands of
a service user. Hopefully it will be the last – although this was the same hope
expressed by Dr Victor Schwarz following the murder of his social worker
daughter, Isabel in 1984. Since then Norma Morris, Francis Betteridge, Audrey
Johnson, Katie Sullivan, Jonathan Newby and Jenny Morrison, all social care
workers, have been murdered by their clients. Today there are estimated to be
almost 900,000 staff employed within social care. Of these, 300,000 are
employed by councils with social services responsibilities. So what is to prevent
another addition to this list, when hope is not enough?

First
of all, it must be emphasised that the majority of users social care staff have
contact with are not aggressive nor violent most of the time. However, in 1997
the National Institute for Social Work¹ identified disturbing
information which echoed that provided by Colin Rowett² 11 years
earlier. The NISW report found:

–
About half of male staff and a third of the female staff had been physically
attacked in their present job.

–
More than two thirds of staff working with adults with severe learning
difficulties had been attacked.

–
Half of the staff working with children had been attacked.

–
Two thirds of residential workers had been attacked.

–
Nearly a quarter of field workers had been attacked.

–
In addition, similar or even higher proportions of staff have been on the
receiving end of various forms of threat.

The
much more common occurrence of being verbally abused by some service users is
equally disturbing. Recorded comments from social workers include: "Every
day, oh definitely every day", and "It has become like almost normal
to me"³

The
National Task Force on Violence to Social Care Staff was set up in September
1999 with one distinct aim "to reduce substantially the incidence of
violence against workers – staff and volunteers – in social care settings, and
put in place systems that will sustain this reduction into the future."

To
date many of its recommendations to the government and to employers have not
been implemented (see below).

In
its final report the task force provided a definition of violence that included
shouting, swearing, intimidation, harassment and so on, as well as physical
incidents and relates to violence from members of the public but not between staff
where other management arrangements exist.

The
Task Force also stated that "violence, threat and abuse to staff are
unacceptable" and were not part of the job.

Yet
those involved were more cautious about giving staff and service users a
"zero tolerance" message. "We believe that, in some
circumstances, a zero tolerance approach to violent behaviour will be right.
But this cannot be a universal approach in social care settings."1 I fear
that this somewhat ambiguous stance may provide some individuals with the
implicit message that, in some social care settings, violence is acceptable and
behaviour has to be tolerated rather than managed. This approach may
unfortunately compound the "part of the job" culture which the Task
Force was attempting to remove. Furthermore, this ambiguity may give some
employers an excuse to tolerate the current levels of abuse and violence
experienced by their staff.

The
NHS has not been so reticent and is giving unambiguous messages to its staff.
It has a policy of zero tolerance which explicitly states "aggression,
violence and threatening behaviour will not be tolerated any longer". The
NHS website states: "The government is determined to ensure that staff who
spend their lives caring for others are not rewarded with intimidation and
violence."

The
social care task force failed to take on board the point that zero tolerance
need not focus solely upon sanctioning behaviour, it can also focus upon the
educative function of helping staff identify and service users make use of
alternative ways to express behaviour. By adopting a zero tolerance approach
within social care we can ensure that imaginative ways for allowing for the
expression of emotion are considered by every employee and employer. Less
dynamic employers must not be offered the excuse that their workplace is, or
their clientele are, an exception.

The
policing of the recommendations concerning employers (see below) is also a
concern. The task force concluded "that external scrutiny of agency
performance is vital in this area,"1 yet left the prime responsibility for
monitoring with the employer. Intervention to force employers to comply with
the recommendations would be taken only as a last resort if employers
persistently failed to achieve basic standards of staff safety. This is too
lenient as it provides those who fail to ensure safety with the opportunity to
continue to do so for whatever time-span constitutes persistent failure. A
clearer stance is needed. After all, what is expected is a compliance with
health and safety legislation.

Make
no mistake, the work and report of the national task force will increase the
safety of many in social care. Also, the very fact that violence to staff has
become an issue has raised awareness and this too will reduce the chances of
another tragedy. But the task force should have gone that extra mile by
ensuring agencies complied with its recommendations, by adopting the zero
tolerance approach and by ensuring swift action was taken against employers who
fail to act swiftly to protect their staff. 

–
Ray Braithwaite’s book Managing Aggression (Routledge/Community Care,
September, 2001) describes how social work employers should respond to violence
against social workers and offers examples of best practice. To order the book
see page 39 of this week’s magazine.

If
you have suffered violence in your workplace and would like to ask Ray
Braithwaite a question, or any take issue with any of the points he has made,
please e-mail to comcare.haveyoursay@rbi.co.uk  . Ray’s answers will appear on the Community
Care website www.community-care.co.uk
by Friday 4 January.

Ray
Braithwaite is a freelancer trainer who specialises in training for the
management of violent and aggressive behaviour.

References

¹
DoH, A Safer Place, Report of the Task Force and National Action Plan,
2000

²
Rowett C, "Violence in Social Work", Cambridge Institute of
Criminology Occasional Paper No 17, Cambridge University, 1986

³
David Oser, Violence Against Social Care Staff, National Task Force
Against Violence to Social Care Staff, 2000

Background
Reading

1
Community Care campaigned for more action on violence against social
workers and ran a series of articles on this theme in issues published between
July and December, 1999

Websites

www.nhs.uk/zerotolerance

Selected task force recommendations

The
Department of Health should:

–
Commission an advisory service to help small social care employers tackle the
issue of violence (many have no policy nor procedures).

–
Publish a protocol for sharing information about (dangerous) service users.

–
Continue research into the causes of aggression.

–
Maintain and update resource materials on the Task Force website.

–
Take a lead role in promoting common comparable definitions and reporting
categories for all social care employees (under reporting of violence is rife).

–
The Home Office should encourage chief constables to make violence to care
staff a greater priority area for the police.

–
Ministers should encourage a proper valuing of social work and social care by
the public.

–
The General Social Care Council should make clear the responsibility of
employers for the safety of their staff. The National Care Standards Commission
should inspect employers with regard to this.

–
The Social Services Inspectorate should include the aspect of violence to staff
in its assessments.

–
The training support grant allocated for training in this field in 2000-1
should be increased by 50 per cent to £3m next year, and continue at that level
for a two more years.

Every
employer should:

–
Have completed an audit and action plan regarding violence across the
organisation by 31 October 2001.

–
Have completed a training needs analysis in respect of violence for the whole
workforce by 31 October 2001.

–
Have included firm action to remedy any significant deficits emerging from the
audit by 31 March 2002.

–
Have begun to implement a comprehensive and urgent training strategy for staff
by 31 March 2002.

–
Achieve full and accurate baseline data on violence to workers by 31 March
2002.

–
Achieve a reduction in this baseline of violence to staff by 31 March 2005 of
up to 25 per cent.

—————————————————————————

Home choice

People with learning difficulties want the same choices
about how they live as everyone else. Alicia Wood, a development officer with
Mencap, explores why they so seldom get those choices, and how local
authorities can overcome the obstacles to change.

The government’s recently published strategies for people
with learning difficulties, Valuing People¹ and From Words
into Action…,² challenge the status quo in providing housing and
support for people with a learning difficulty. This article describes one
collaborative approach to meeting this challenge in London by giving choice in
housing and support to people with learning difficulties.

Michael Jones (not his real name) has a learning difficulty
– he was still living in his family home at 27 years of age, sharing a bedroom
with two younger brothers. He was incredibly frustrated and started taking out
his frustration on his family. They had tried their best to get Jones a flat
through the council but he didn’t have enough points to make him a priority.
They had asked social services to help but all they could offer was a place in
a group home because he needed support, and Jones didn’t want to live with a
bunch of people who were strangers to him, he wanted his own place.

Unfortunately, this is pretty standard stuff if you have a
learning difficulty. Unless there is a crisis that stops your family from being
able to care for you, or you have carers who are able to shout loud and play
the system, you will not have the opportunity to do what for most is a rite of
passage – move out of the family home.

Even if your situation dictates that you must move on, there
is all too often little or no choice in terms of where to live, especially as,
like Jones, you are not going to settle for a local group home.

Jones and his family contacted the local Mencap, which was
developing and piloting a home ownership scheme for people with learning
difficulties in Ealing, west London, in conjunction with Notting Hill Home
Ownership and Housing Options. Jones was the first person on this pilot to buy
his own home through special needs shared ownership. His mortgage and rent are
funded by benefits; his family helped him with legal fees and moving costs. He
received a grant to buy furnishings.

Jones chose a flat nearby to where he trains three times a
week for his black belt in the Korean martial art tae kwon do. He has two
bedrooms so that his brothers, sisters and parents can take it in turn to stay
with him while he learns to live more independently.

That was 15 months ago – Jones is now able to stay some
nights by himself as he has slowly built up his confidence. He is cooking his
own simple meals and reheating the home cooking that his mother regularly puts
in his freezer for him. His family have helped him to decorate his flat, which
he has learned to keep clean and tidy. At the moment, Jones is entertaining his
sister and niece and nephew who are on holiday from Hong Kong.

Jones has a pretty good standard of living that compares
well to many people his age. He has a place to call his own, he has freedom, he
has people around him who love him, he makes choices about his own life. These
are the basics that we all expect and take for granted – yet sadly, these are
the things that many people with a learning difficulty have never had and in
some cases, never will have.

There are many reasons why not. It is expensive to support
people with learning difficulties. There is also a lack of affordable housing
in many areas of the UK where priority for public housing will be given to
those considered more in need.

But a lack of funding and resources can always be given as a
reason why people with learning difficulties cannot live independently.
Councils have a statutory duty to support people with a learning difficulty, so
money has to be spent. The point is to find a way to spend and distribute this
money effectively and be more creative with the resources available – after all
vast amounts of money have been spent on residential care and long-stay
hospitals for years.

It would have been much more expensive for Jones to go into
a group home where he may have had a poorer quality of life and not had the
opportunities to develop the skills he needs to be less reliant on others. In
the longer term, if Jones’s family are unable to support him with their time,
he will require support through the local authority – but with the valuable
skills he has gained, this support will be much reduced.

Through the same pilot, several people with learning
difficulties have purchased their own homes. Some have minimal support needs
but there is one who needs support 24 hours a day.

So if money is not the main reason why people with learning
difficulties have so little choice in where they live and how they are
supported, we have to conclude that the problem is cultural – a culture of
over-protectiveness.

Of course it would be easier on commissioners and purchasers
if all people with learning difficulties lived together in nice little houses
in the community. They would be "safe" and supported by a known
provider and, very importantly to the stressed out and overworked care manager,
all packaged up nicely.

It would be much less challenging for us than if they live
in their own homes, with housemates they choose, and do pretty much what they
wanted to do. This could mean "dangerous" stuff like having
relationships, getting into trouble and any number of normal things that we as
human beings must experience in order to learn and grow.

So whom are we protecting? Of course many people who have a
learning difficulty are vulnerable and need more support than most, but this is
no reason to deny people the right to live normal lives. Some people choose to
live this way but this must be an informed choice – not the only choice.

Supposing a young person you know wanted to leave the family
home. There was nothing around that he could afford so he moved into a house
with four other people. He got on quite well with one of his flatmates but
another one had really annoying habits such as talking very loudly and
constantly belching, another never even spoke to him or acknowledged his
presence in a room, and the other flatmate was just not the kind of person he
got along with. His family couldn’t really come to visit properly because there
were always other people around and it was a bit uncomfortable. But even though
he didn’t like it he stayed there for pretty much the rest of his life because
there was no other option.

Valuing People states that the objective for housing
is to enable people with learning difficulties greater choice and control over
where and how they live. From Words into Action… goes into even more
detail, stating that each borough must offer a choice of who to live with and
the type of home to live in. But more than this, the underlying message from
these strategies is the need for a fundamental change in how we think and work
– creating a new value system, which is by far the biggest challenge for most
of us.  

– For information about Ealing Mencap, Housing Options and
Notting Hill Home Ownership’s service to assist London Boroughs in providing a
range of housing choices for people with a learning disability contact Nigel
King, Housing Options 01993 705012.

Alicia Wood is housing development worker, Ealing Mencap.

References

¹ Department of Health, Valuing People,
DoH September 2001

² NHS Executive and Social Services
Inspectorate, From Words into Action, NHS Executive, Spring, 2001