Cracking the code

The
General Social Care Council has been charged with writing the draft code of
conduct for the social care profession, with a remit to consult with all
stakeholders – leading to a unique dialogue with service users. Polly
Neate reports.

One
in every 15 adults in the workforce is a social care worker. It’s an
extraordinary statistic. By the time all social care workers have to be
registered, even more will be needed – and they will all have to agree to the
same standards and values.

That’s why the debate on the draft code of
conduct for social care professionals – and the corresponding code of practice
for employers – goes to the heart of social care itself. Its outcome will
affect an estimated 1.2 million workers and a far larger number of people who
receive social care services.

The organisation charged with writing the
code for England is the General Social Care Council. Chief executive Lynne
Berry describes the process as "a unique opportunity". But it’s not
easy. For a start, nobody knows who all the social care workers are, or even
where they work. Not even the number of qualified social workers is known, with
estimates ranging from 45,000 to 80,000.

Compared with other professions, social care
is diverse, both in terms of the functions of workers, and in terms of levels
of qualification and training. It also, in social work especially, has a strong
ideological base: values help define social care more than is the case with
other professions.

And the history of social care – or of any group
defining itself in similar terms – is far shorter than the history of the other
professions. Unlike medicine, the law or teaching, social care does not have
deep cultural roots. Few outside the profession understand its roles or values.
Defining its code of conduct may be a unique opportunity, but it is also a
unique challenge.

But the job has to be done, and the final
version of the codes is due to be published imminently, following a
consultation which, says Graham Ixer who has managed the process for the GSCC,
has been "pretty amazing".

He’s not referring to the many questions
thrown up by professionals in the well-attended regional meetings the GSCC has
organised, important though they are but to a determined voyage of discovery to
consult meaningfully with people who use social care services.

With hindsight, such a voyage was always
going to be needed, says Ixer. But when the consultation was being planned,
"involving service users" seemed relatively simple. Organisations run
by and for service users were invited to send representatives to the regional
meetings. But they didn’t. When all the regional meetings had been held,
gaining ample feedback from a wide range of professionals, the user
consultation simply hadn’t happened.

"We didn’t have a right to involve
users," Ixer explains. "We have to earn that right. Why should users
be involved in our consultation and come to our events? What’s in it for
them?" It sounds obvious now, as Ixer admits. But there are as many
unsuccessful consultations, up and down the country, as there are services
trying to gauge user views. One man who commented on the codes, who uses a
wheelchair and employs a personal assistant at home, says: "Most
organisations are scared of users. They maintain a barrier because people feel
uncomfortable. If you come to consultations you are seen as the wheelchair
brigade that just comes along to be negative."

The only way to consult properly, and to gain
some sense of ownership of the codes among people receiving services, was to
meet people where they live, at a time convenient to them.

Ixer contacted a range of organisations to
set up meetings with people who use social care. Some were groups organised by
service users themselves, while others were service providers. In the end, Ixer
visited 10 different groups, which varied widely in size. One visit was to an
individual in his own home. Others have involved 25-30 people. After all six
regional consultation meetings, just eight users had expressed their views.
After the 10 meetings with users on their own territory, 138 had been
consulted, and all had been heard.

Ixer says: "Very few people I’ve spoken
to had any experience of consultation even from their local agencies. Some had,
but they had felt marginalised by the experience. Certainly someone going to
them to find out their views was new to them."

Some of the groups included people with
severe learning difficulties and challenging behaviour, people with severe
mental health problems, drug users, young children and frail older people.

Ixer says: "A genuine consultation, I
now realise, means investing time in helping people understand – for example,
people with severe learning difficulties. We had produced a book to explain the
codes using pictures and so on, which I now realise doesn’t work at all, though
I thought it was great before. I spent an hour before we started discussing the
codes, and gained their trust. I had to talk quite a lot about myself – you
have to be comfortable with that, and it wouldn’t fit naturally into the usual
type of meetings. We had a very important conversation. Even people who
couldn’t speak could give their views. It was just slower."

Such informal discussions can accommodate the
unexpected. "For example, one young woman with mental health problems chose
to leave the room when sexual abuse was mentioned." Her key worker could
help her, and nobody had to worry that the process was being disrupted.
"Another really interesting meeting was with a group of older black people
and a group of black drug users, which took place in an alternative therapy
centre offering things like acupuncture. They offered me a free massage
session, aimed at improving general well-being. It seemed good to join in. I
thought, this is so far removed from what I was expecting to be doing when I
started off managing this consultation. There I was being massaged and chatting
away to this group of drug users. Another time, I was in someone’s house and I
had to cook lunch because the personal assistant went out while I was there. You
do whatever is needed to find out what people think. It has been about finding
out their story and helping them feel comfortable in telling their story."

If the extent of the marginalisation of
service users became frighteningly clear, the way in which black users and even
workers are shut out was even more striking. The black workers Ixer met had not
been told about the codes beforehand, for example. One said: "We are
excluded from the mainstream, which is why we have our own networks. But then
those black groups are generally stereotyped as a reactionary, negative
movement."

Ixer says: "We can’t assume that black
people are integrated into social care and will just come along if we invite
them. They have to set up their own networks, so we have to access those
networks. Most black user groups are outside statutory funding and most local
authorities wouldn’t even know about them – they might be around churches, for
example."

There could be no preciousness about
timetables: indeed, the deadline has been extended. But the views service users
expressed have profoundly influenced the end result. One of the main concerns
raised by private sector home owners and home care agencies, for example, was
that many part-time staff see their work as a job rather than a career, and
might feel threatened by the code’s reference to their responsibility for their
own learning and development. "But users say categorically no, even if the
person is only working one hour a week, everyone deserves investment in their
training and should take responsibility for being part of a profession,"
says Ixer.

Another big issue for users was the
injunction to "respect the independence of service users and protect them
as far as possible from danger or harm". Users know all too well the tension
at the centre of that one sentence. One group gave the example of a man who had
fallen off his bike and hurt himself, with the result that the staff no longer
let him ride it.

Language also posed problems. To many users,
the term "carers" referred, in the words of one disabled man, to
"anyone who comes into contact with us", and not solely to friends
and family members. "Service user" was even more unpopular.
"Client" was preferred, along with "resident" for those in
residential settings.

Another controversial point was the ban on
workers accepting gifts from those who receive services. One woman living at
Drummonds in Essex, a unit for people with cerebral palsy run by Scope, who was
only able to communicate with Ixer through her key worker, expressed anger at
this, and had been upset at Christmas when she wasn’t allowed to give her key
worker a present.

"Because staff work so closely with us,
we can’t avoid building up friendships with them," said another resident
in the same meeting. "What about when we want to pay for staff to come on
holiday with us?" People felt this rule insulted their common sense.

The ban on workers drinking alcohol at work
was also considered too harsh, with many service users believing workers could
have a social drink at Christmas, especially in residential settings.

Those who use services have brought the
complexity of social care into sharp relief. Intense relationships with staff,
particularly in residential settings, mean dilemmas are commonplace. When
people who are highly intelligent but severely disabled can’t make themselves
understood without you, where exactly do their needs end and your
responsibilities outside of those needs begin? It’s a difficult question, but
nobody disagreed with the need to answer it.

One woman, described as having a mild
learning difficulty and violent behaviour, counted off on her fingers,
recalling tens of staff who had breached the codes. A manager at Drummonds
recalled a new resident who had expected to pay 50p each time he was taken to
the toilet.

The same manager says: "As a profession,
we’ve never told people what to expect, so they don’t know when to complain."

Some concerns

Some
of the concerns raised by professionals at the GSCC’s regional consultation
meetings, which were attended by a total of 1,168 people:

–
The codes should be written in more accessible language.

–
Since it is up to employers to insist on registration, it will still be
possible for a worker who has been "struck off" the register to gain
employment.

–
It is not always easy to define who is a social care worker. There are many
individuals who work at the boundaries of different disciplines, such as
wardens in sheltered housing.

–
How will the GSCC work with the Criminal Records Bureau – is it possible to
ensure that people only have to be checked once?

–
Social workers were concerned that the majority of GSCC members are lay people
– professionals are not to be judged by their peers.

–
Private sector employers said many of their employees did not see themselves as
"professionals" and would not want the degree of scrutiny the code of
conduct implies. Nor would they want the degree of training implied in the
codes.

–
The registration charges are not yet known, but the possible level of these
raised some concern. The plan is for them to be affordable so they do not
become a barrier to anyone being registered.

–
Workers should have the right to see all information held about them by an
employer when their conduct is in question.

–
The codes should include the need to be non-judgemental and respect cultural
diversity.

Code of conduct

Draft
code of conduct for social care workers in England.

Social
care workers must to the best of their ability:

–
Safeguard and promote the interests of service users and carers.

–
Strive to maintain the trust and confidence of service users and carers.

–
Respect the independence of service users and protect them as far as possible
from danger or harm.

–
Balance the rights of service users and carers with the interests of society.

–
Take responsibility for their practice and learning.

–
Justify public trust and confidence in social care services.

See
www.gscc.org.uk for more detail on the
code of conduct and for the code of practice for employers.