Power imbalance may affect joint work

Yvonne Roberts argues that if joint working is
to succeed then professionals’ opinions must be
challenged.

Angela Cannings, convicted of murder last
week, claims that she lost three children to sudden infant death
syndrome. Her behaviour might be an example of Munchausen’s
syndrome by proxy, recently labelled the more precise, fabricated
or induced illness by carers (FII). Community Care (“How
can you tell”, 6 December, 2001), covered issues raised by FII and
pointed to the Department of Health publishing guidelines this
summer.

They
are likely to echo much of what the Royal College of Paediatricians
and Child Health suggested in its report on FII published last
month. It advocates improved training, professionals working
collaboratively, social workers taking the lead in child protection
procedures, and police heading criminal investigations into FII and
the use of covert video surveillance when necessary.

The
theory is admirable. The Working Together child protection
guidelines have been a major strand in child protection since the
1980s. In practice, however, integrated working, as the new care
trusts are already beginning to discover, unpeels a number of
difficult issues. Chief among these is who is really in control and
which philosophy dominates when it comes to handling the parent or
client?

Ian
Johnston, director of the British Association of Social Workers,
says that social workers are trained to work with people, helping
them to develop a better understanding so they can make their own
decisions. Traditionally, health workers, particularly doctors,
believe they know what’s best.

A
report in Community Care last week (news analysis, page
18) on the progress of the Somerset Partnership NHS and Social Care
Trust, the first mental health and social care provider and now
three years old, is positive in some aspects but not in terms of
staff morale. Ian Johnston suggests this may be because of
structural change and also a sense of powerlessness, exacerbated by
the fact that users say they view social workers as less
independent in the new system.

How
can such professional tensions be eased? Lord Laming will
undoubtedly make recommendations in his report in the wake of the
shambles that passed for “professional collaboration” leading up to
Victoria Climbie’s death. A social worker attached to every
paediatric unit is one practical suggestion. Much tougher is the
right measure to change long entrenched attitudes. At present,
collaboration will always fail if the equal members of the team
each lack the confidence to challenge the professional who
traditionally wields the most power.