By an adults’ social worker
It’s a break in the usual routine of an adults’ social worker to visit a person with learning disabilities who is cared for a long way from home, ‘out of county’. A long car or train journey provides unusual time to sit and think. In my early days of social work these journeys were filled with anticipation for the highly specialised place I would find at the other end, with their fees of between £3000 and £6000 a week.
But this anticipation has faded with a series of, at best, underwhelming visits. These days I mostly wonder why there is nowhere closer along my route of up to 300 miles that is deemed able to meet the needs of the person I’m going to see.
Arriving at the final destination provokes a variety of feelings. If the visit is to a secure hospital, the towering electric gates provide a stark reminder of the containment occurring within. My own depersonalisation, as I am instructed to leave ‘contraband’ in a locker (the list is so long I leave everything), is an echo of the depersonalised world of the patients. The use of the word contraband itself is a symbol of the institutionalised setting, the parallel with prison is no coincidence.
There is precious little space in these hospitals to be a social worker. You’re shepherded into a meeting room and the patient arrives at a carefully planned time to participate in the part of the meeting professionals feel is appropriate for them. Families may also have made the long journey to attend. Each professional presents a report. The psychiatrist, psychologist, nurse and occupational therapist are the staples. There may be a hospital social worker, but they tend to be spread thinly.
‘What really happens here?’
I want this person to be back in their community. Some have ‘lived’ in these hospitals for 10 years or more. Professional expertise about them has faded from their home community team and been transported here, to these people, in this room. Families, though, are my experts of choice. The rich history of the person (not the patient) is ingrained in the family’s hearts and minds. Their knowledge is no dusty archive, no mishmash of paper files and notes across multiple computerised systems.
In these meetings, I am me, a lowly social worker among the high brow medical professionals in the room, often the sole representative from my local area, grappling with these reports and my gut instinct. To what extent can I confidently challenge the psychiatrist’s view? Or the psychologist’s?
What I want is to spend time on the ward. Talk to the people who really know. Spend time with the person, the health care assistants, the cleaners. What really happens here? I need health colleagues from my community to be here, engaging with their peers in this private hospital, meaningfully probing how their work with the person is leading to a life back in their own community.
There should be no pecking order, I know, and I should not describe my social worker role as lowly. I am secure in my social work practice, but I am not a psychiatrist and the truth is that in this room, and others like it, they wield the power. I will discuss the meeting with my local psychiatry colleagues in our next multi-disciplinary team meeting when I return, but really this person needs their home community psychiatrist looking this one in the eye, taking the lead. Owning their care, and their return.
‘A very different agenda’
The government’s Transforming Care policy, launched in the wake of the Winterbourne View scandal, is working towards closing beds in hospitals and moving people into the community. The premise of our conversation around this table should be that we are all working together to achieve that. However, as the 7 Days of Action report, A Trade in People, recently pointed out, only NHS beds are being closed, the private sector has spotted this and is moving in to fill the gap.
One US-based healthcare company, for example, has been snapping up hospitals for people with learning disabilities in the UK. This seems quite a niche interest for this organisation, but a look at their website offers some clues about this. It states that they ‘build or acquire high-quality hospitals in rapidly growing markets, then invest in the people and equipment needed to allow each facility to thrive and become a dominant healthcare provider’.
I will forgive myself, then, for being distracted in the meeting by thoughts of how this aggressive ambition of market dominance can be reconciled with Transforming Care, my own role and this person’s life and human rights. How can I wield the power here, in the face of contradictory corporate intentions, to get this person home? I don’t want to doubt the professionalism of the people around the table, but these are not my colleagues and we are ultimately not on the same page. Their paymasters have a very different agenda.
‘Step up to the plate’
We file out. I hope I’ve helped move things along, challenged where I should. I’ll hang around for a while. See the person on their own. Try to get into the ward itself. Have a chat with the staff who support hands on, day in day out. I’ll meet the family in more familiar surroundings, another time. Then I’ll go back to my team, urge commissioners to source the accommodation and support the person needs. I won’t let it drop.
But it’s not enough. Under Transforming Care we now have Care and Treatment Reviews, but we all need to step up to the plate, all of the time. Let’s not kid ourselves that we’re commissioning care in these private hospitals (where are the commissioners, the contracts, the holding to account, do we even know what we’re paying for here?), we’re stumbling into this for want of the will to do better in our communities. And the private sector know it.