‘Post Adoption Placement Breakdown’ – a gripping whodunnit!

K (A Child: Post Adoption Placement Breakdown), Re [2012] EWHC B9 (Fam) (27 July 2012)

If this were a whodunnit, I guessed the plot by chapter 15. Paragraph 15 actually since it is a judgement, but that’s still pretty early on given that the judgement runs to over 200 paragraphs. I still read it to the end, it was a real can’t-put-down page turner with a breadth of plot and elements of tragedy that gripped. And it had some unexpected twists to the plot to keep you reading, like a good whodunnit. And it kept you guessing until the very last paragraphs what the solution was, again like a good whodunnit.

Of course, the title was badly chosen: “A Child: Post Adoption Placement Breakdown” gives away too much of the plot. But what was it about paragraph 15? It reads:

MG and FG are committed Christians. They are Roman Catholics (the significance of which will become apparent later in this judgment). Their decision to adopt was borne out of a desire to help a child less fortunate than their own children. They approached Coventry City Council in February 2000. In their Form F it is recorded that they ‘do not feel able to take a child who has been sexually abused or who displays sexualised behaviour because of the effect this might have on Chloe and Rachel.’ It was recommended ‘that they are approved as adopters for one child of either sex aged between 4 and 6 years with no major health or emotional problems.’

So, I imagined, Katie is going to be adopted in ignorance of a past which certainly includes sexualised behaviour on the part of siblings (I had read that much in paragraph 2); such behaviour is going to emerge with Katie also; the adoptive parents are going to be unable to manage; there are going to be allegations made against them; there will be issues relating to either contraception or abortion because they are Roman Catholics; it will all end in acrimony; and the local authority will get a care order.

How far was I right, and if I was, how did I guess? The answer to the first question is that I was only partly right. Yes, there were questions raised about whether the adopters had full information [paragraph 28]. Yes, the adoptive parents were unable to manage – that forms the bulk of the judgement. Yes, there were allegations made [paragraph 55]. Yes, there was an issue relating to contraception [paragraph 82]. Yes, a care order was made [paragraph 206].

My imagination overplayed some features, drawing too heavily on apparent clues in the early paragraphs. But my imagination did not fail me. I want to pause for a moment and reflect on that. I could imagine how difficult it would be to take on a late adoption of someone with such a traumatic background. I could imagine what it must be like for Katie, after practically feral early years, to be expected to slot in as the younger sibling in a middle class family. I could imagine the clash between intrinsic and extrinsic motivators on behaviour, the parents struggling with wanting to inculcate the former, feeling they had to use the latter. I could imagine the inevitable rows, the deteriorating relationship…

And it is imagination. I can’t draw on personal experience of adoption, nor relevant professional experience. But if I, by imagining myself into other peoples’ situations, could understand what it must have been like, then my guess is that many other parents could imagine it too.

The shocking twist in the plot, therefore, for me, was to read the perspective of most of the professional involved. Almost without exception, they blamed the parents for the breakdown. And I was so disappointed in my professional colleagues for their lack of imagination. While bringing up their own children with comparative success, was it likely that the adoptive parents wanted an adoptive placement to go so badly? Isn’t it inevitably going to be frustrating if over many years you offer love and encouragement, only to have it thrown back at you? Surely it is not a leap of the imagination too far to imagine the despair that arises when there is no escape route because you have committed indefinitely, and repeated requests for respite and support are turned down; to appreciate the different pressures between adoptive parents committed 24/7 and professionals whose professional role regulates and protects from the consequences of contact? Did none of these professionals ask themselves the question, “Could I really do better with a child this damaged, and so little support?” Did they console themselves that while they couldn’t do better, their professional expertise still gave them the right to sit in judgement – “we’re not talking about me, we’re talking about you”?

I think the judge’s understated criticism of the way in which counsel for the local authority summed up was the highlight of this judgement:

If there was any remaining doubt about the local authority’s attitude towards these parents that doubt was removed by Miss McGrath in her closing submissions…  She said ‘I don’t know how any local authority could be expected to work with parents who show those attitudes’… Having urged me to avoid rhetoric and proceed only on fact, she asked me, rhetorically, why it is that stones have been thrown at a local authority that has put Katie’s interests at the forefront of its mind. Why is it, she asked, again rhetorically, that the parents are not able to agree that Katie is beyond parental control? The answer, she submits, is that these parents are entirely adult focussed. How any reasonable person could fail to accept that Katie is beyond parental control is, she said, ‘something the local authority struggles to grasp’. Where, she asked, again rhetorically, is the love that goes with the understanding of attachment disorder? [paragraph 170]

Now, the other significant prediction that I got right by paragraph 15 was that a care order would be made. This did not rely on imagination, here I could draw upon legal professional expertise. There are any number of cases which demonstrate the legal principle that care proceedings are not a forum to punish local authorities for their child protection failings. Remember, for example:

• Bath & North East Somerset Council v A Mother & Ors [2008] EWHC B10 (Fam) (22 December 2008), where the team manager, with a conviction for conspiracy to murder some years previously, tried to instruct the junior social worker (for whom we later acted) to lie to the court in evidence – the local authority still obtained special guardianship and care orders for the children; or
• G, R (on the application of) v Nottingham City Council [2008] EWHC 400 (Admin) (05 March 2008), where the baby was unlawfully removed without the authority of a care order at all, and the court ordered his return – the local authority still obtained a care order two days later.

I knew, therefore, that the welfare principle would guide the court to act in the best interests of the child, irrespective of the force of the arguments put forward by the adults involved, and of the blame being thrown around.

But while I expected a care order, I did not expect it to be such a close thing. It was such a close call, in fact, that at two points I changed my mind and thought a care order would not be made. They were:

• At paragraph 203, by which point, the judge has recorded how the expert – the one with imagination – does not think a care order will be best for either adoptive parents or child, has sympathised with the father’s plaintive question, “if this is the way the local authority treat us when we alone have parental responsibility, how will they treat us if they share parental responsibility with us under a care order?” and has concluded that s/he is “not satisfied that in this case the local authority has convincingly demonstrated how Katie’s situation will improve if I make a care order”; and
• At paragraph 205, where s/he argues “that in this case wardship has more to offer than a care order”.

Indeed, while I expected a care order, I don’t find very convincing the basis upon which it was made. The main argument both against a care order and against no order is the consequences arising from the poor relationship between the adoptive parents and the local authority. But while the judge is unconvinced a care order will improve matters for Katie, s/he thinks no order would be unhelpful. So the best that can be said for the care order that was made is that it will do less harm than no order at all. My concern about this derives from the doctrine of necessity. The doctrine of necessity applies here because Article 8 requires that the making of the order is necessary. And one part of the doctrine of necessity says that the person relying on it should not have themselves created the situation that made the act necessary. This local authority seems to have come perilously close to that.

And all for want of a little imagination. Or maybe because of a need to blame.

When I tweeted this case this morning, I said that the “High Court shows that being out of parental control need not involve blame”. My final observation is about blame. The judge here not only reasoned that blame was not necessary, but drew on statutory guidance to that effect [paragraph 202]. Contentious they may be in both a legal and everyday sense, but surely care proceedings frequently need not involve blame? I have shown that the welfare of the child is more important than the mud slung by the parties; but more generally, this is a protective jurisdiction, and as social workers we have a duty to protect from significant harm whether or not anyone is to blame for that harm.

Whodunnit? No-one dunnit. I guessed that right.

Allan Norman (@CelticKnotTweet) is a registered social worker and a solicitor at Celtic Knot – Solicitors and Social Workers.

UKCP to review handling of Smalley case

Over the past few weeks I’ve been analysing the John Smalley case, a botched fitness to practice hearing by the UK Council for Psychotherapy, which took over 3 years to find seven allegations proven, but decided not to issue any sanction.

I’ve just heard the welcome news that the UKCP is now to “review the actual processing of the complaint, and in particular the factors that contributed to the complaint taking so long, so we can learn from the findings of the review, and try to improve our systems for the future.” According to the chief executive David Pink, “Our internal review will focus primarily on the management and handling of the case, and the contributory factors that together created an unprecedentedly case that travelled a long and tortuous path that must surely have felt unsatisfactory to all the parties.”

This is indeed good news, though only partially so, as the review will only be of the length of time taken, and will not consider the eventual decision of the panel, which seemed to feel that seven proven allegations did not merit so much as a caution, even after Mr Smalley admitted having destroyed his notes.

Separately to this, other parties have asked the UKCP to investigate how the complaint was initially handled by Smalley’s UKCP member organisation, the Independent Group of Analytical Psychologists. They want to know the IGAP found that there was no case to answer, a decision ruled “perverse and incorrect” by the UKCP Central Final Appeals Panel. Currently, there is no word on whether the UKCP will do this.

Eventually, all the member organisations, including the IGAP, should be subject to the UKCP’s new Central Complaint’s Process. According to UKCP, that should be in place by the end of next year, though the IGAP seem rather off-message on that.

Last week the UKCP responded to the Council for Healthcare Regulatory Excellence’s consultation on Voluntary Assured Registration. This proposed scheme will allow self-regulating professional bodies such as UKCP to obtain a “Quality Mark” from the CHRE (to be renamed the Professional Standards Authority). The Central Complaints Process is a key part of their aim to receive such a Quality Mark.

The CCP was found severely wanting in the Smalley case, and in any case member organisations like IGAP haven’t confirmed that they’ll even sign up to it. If the UKCP is to deserve its rubberstamp from the CHRE, then it still has improvements to make.

 

 

The Olympics – An opening ceremony so good, Aidan Burley MP hated it

You know what? I’ve spent months being cynical about the Olympics, but I’m going to come straight out and say that Danny Boyle’s opening ceremony blew me away. By turns impressive, moving, funny and occasionally slightly deranged, the ceremony packed a broad range of all the different aspects of what it means to be British, from the Industrial Revolution to the landing of the Windrush.

I was expecting the initial scenes of a bucolic, Constable-esque England. I wasn’t expectieng the dancing tribute to the NHS, or James Bond to parachute in with the Queen, or Rowan Atkinson’s hilarious cameo as Mr Bean in an orchestra performing Chariots of Fire. Equally hilariously, reports came in on Twitter that the screening of the famous lesbian kiss on Brookside had resulted in Saudi TV inadvertently broadcasting a same-sex kiss for the first time in history. It’s an ill wind that blows no minds.

But it turns out somebody didn’t like all this. Halfway through the ceremony, Aidan Burley MP tweeted, “The most leftie opening ceremony I have ever seen – more than Beijing, the capital of a communist state! Welfare tribute next?” To be followed later by, “Thank God the athletes have arrived! Now we can move on from leftie multi-cultural crap. Bring back red arrows, Shakespeare and the Stones!” Wow, who would have thought a guy who once hired a Nazi fancy dress costume would have a somewhat narrow view of nationhood?

Burley may have been the most publicised grinch at the Olympic party, but he wasn’t the only one. On Twitter, Toby Young complained that, “I feel like I’ve just watched a £27 million Party Political Broadcast for the Labour Party” The Telegraph’s James Delingpole claimed to like it, “apart from the weird NHS propaganda” while Harry Cole whinged, “Not even communist China were so brazen as to extoll their nationalised stranglehold on their country so blatantly.”

Or, to put it another way, Danny Boyle’s epic display of all things British has done an impressive job of annoying all the right people. He provided a complex tapestry that included not only the likes of Shakespeare and the Red Arrows, but also a diverse and multicultural nation, where difference can be celebrated rather than ignored or denigrated. And yes, a nation that values its healthcare system.

And if the likes of Aidan Burley don’t like it, maybe we can set up a tiny little parochial nation where he and his ilk can live unencumbered by any horror of meeting people who aren’t like them. Perhaps we could give them the island of St Kilda, or some other place that none of us are ever likely to want to go.

The Human Cost of Cuts in Social Care

Yesterday I was sent a link to this blogpost by Lucy at The Small Places. I highly recommend everyone involved in social care read this post. It is written by someone who uses and needs support that is provided by the local authority, however their services have been, are being cut significantly.

The narrowing of the eligibility criteria isn’t a ‘paper cut’ made in an office within accounting departments of local authorities, it has a harsh and detrimental effect on the day to day quality of life of another human being who is dependent on the way that provisions are allocated. These are the choices that have been and are being made in the context of cuts and these are the people, actually, we are all the people that Burstow has to justify himself to when he talks about no money being taken out of social care budgets.

The author of the blogpost explains

Yesterday, my care plan was reviewed, and despite the social worker agreeing that I have substantial ‘needs’, to every question that I answered regarding what my carers do for me, the reply was: ‘we don’t fund that any more’. So from now on, no one is allowed to do: laundry, from putting into the washer, putting on a ceiling clothes rail, ironing and putting away…

no shopping allowed or putting it away; paying bills or doing any post office visits; carers aren’t allowed to accompany you out any more either socially, or to hospital/doctors/dentist/opticians or other practical appointments where you need someone to propel your wheelchair; they can’t put the bins out; can’t stack or empty the dishwasher or do any kind of clearing up whatsoever: the list goes on and on. All of the things that I cannot do for myself.Just about anything you can think of that a healthy person would do in the home or outside the home on a day-to-day/week-to-week basis is no longer allowed.

I recognise this. From the ‘other side’ so to speak. I have been, I am, that social worker (well, not in literal terms) but I have to explain that we no longer provide hot meals delivery, we can’t count time for someone to be taken to medical appointments, we deprive people of assistance for some of the tasks we, ourselves, take for granted.

There has always been an issue of resourcing with some user groups benefiting more than others. In older adults services, for example, it was always rare to allow carers time to accompany service users to go to the shops – however, wasn’t the new and wonderful era of personalisation and choice supposed to change this?

We are now able to offer the choice between the hours (and money) spent on someone helping with a bath and use it instead to go out for an hour to the shops. Not necessarily a palatable choice we would expect for ourselves, is it?

The author of the post goes on

I am supposed to have everything delivered now, but they don’t understand the costs of that. Fresh food (and I say that in the loosest sense since they mostly send you stuff that’s about to go out of date), in terms of fruit for example does not last a whole week; you’re lucky if it’s a few days. I can’t eat processed food because I also have IBS. So I’ll have to do an internet shop twice a week which will cost £8 delivery and I will also have to spend a minimum of £25 per shop, that means my four weekly food bill would be £240: I cannot possibly afford that. And since no one is allowed to put it away, what do I do with it when it arrives?

Cost transfers from local authority to user and is the ‘personal budget’ supposed to allow for this? You’d think so.  This was one of the more baffling parts of the post

Ah, now the very helpful social worker had a suggestion for all of this: I can use my D.L.A. to employ someone to do all of the other things now and pay for any transport needs! That’s what D.L.A. is for isn’t it? As I replied however, I pay ALL of the care element and part of my severe disability element back to the local authority for my care, so how can I use that?

Well, exactly. Disability Living Allowance (or Attendance Allowance for over 65s) is non-means tested however it is counted in terms of assessments for charges so there is an expectation in the finance departments within Local Authorities.  This allowance is seen by the local authority as a legitimate  target for charges to be recouped back to the Local Authority for the costs of care – and to be honest, I can see the point. These benefits (at least, the care component) are paid because there are care needs specifically. However for the social worker to lack this information is no doubt rubbing salt into the wound of cuts.  The social worker sounds to have been put in a difficult position and I know the feeling. We are tasked to pass the news of cuts to those who can least afford it and who rely most heavily on the provision of services – but it’s a duty to give fair and honest advice at this point.

It does make it clear though that ‘better information’ and shiny web sites providing directories of services or new ‘Trip Advisor’ type sites rating services are all very well and good but the real thing that social care needs is funds to meet basic needs. The focus needs to be on quality of life not ‘how much can we slice off budgets’. There no easy answer but being disingenuous about the nature of ‘choice’ available and being honest about the realities of decisions being made is significant.

This post speaks the truth of many others who cannot speak up – and this is someone who has been able to use a direct payment positively. There are many many more who haven’t.

As a social worker this post spoke the realities I see every day and highlights the benefits of social media to improve my personal practice – it shows me how social workers are perceived with an honesty I rarely get in terms of feedback on a day to day basis due to the power differentials which exist.  I hope I don’t respond to people in the way that social worker did but I will be more aware of my responses and how they are interpreted when I am in people’s homes.

And I will continue to fight against the cuts agenda all the harder. We have a powerful collective voice as social workers and we have to use it to tell the stories that we say, to not passively accept some of the hardships and injustices we see on a daily basis.

We can and must do so much better.

Winterbourne, South Gloucestershire Council and Responsibility

Winterbourne View and the systematic abuse of those people with learning disabilities who were placed there uncovered by BBC Panorama programme last year has had significant repercussions.

That countless attempts by whistle-blowers  were ignored until the BBC took up the mantle that should have been taken by the regulating authorities was a particular failing in the system that should protect those who are most dependent on robust and good quality care.

The CQC was actively moved into ‘defensive’ mode and instituted a number of new inspections of similar type facilities around the country. I’m not sure that anyone in the CQC took particular responsibility for a lack of response to the initial concerns raised.

I saw this story on the BBC this morning that two managers at South Gloucestershire Council have been dismissed.  The two dismissed were a team manager, Kevin Haigh,  and the council’s safeguarding manager, Brian Clarke  – as the story says

It is understood that a-year-and-a-half before the whistleblower came forward and the programme was filmed, Mr Haigh and Mr Clarke were alerted to other allegations of serious abuse.

In their defence, a Unison statement reads

‘We believe that there may be wider failures in safeguarding procedures in South Gloucestershire in relation to Winterbourne View which go far beyond the involvement of any two individuals.

Which is a fair point but I think that there has to be some level of responsibility taken within a local authority when safeguarding procedures fail so badly. Particularly concerning to me are two issues – firstly why it takes a BBC documentary to uncover abuse that had been flagged up clearly and secondly, knowing about how safeguarding investigations are conducted, how this was able to ‘slip past’ what are, in my experience, fairly robust procedures.

Either way, whilst I don’t welcome scapegoating, I think it’s right that those who are responsible for management within public services take responsibility  for things when they clearly don’t work to protect those who need safeguarding.

As for the serious case review, which is due to be published later this year, I can only hope many lessons are learnt so we become less reliant on the press and more able to rely on robust preventative work by commissioning authorities and inspection regime to stamp out institutional abuse and/or to spot it as a priority.

Care Home Kids, Some reflections on caring for children

Care Home kids on BBC3 last night presented an accurate and honest examination of the issues facing young people who are involved in the care system. The experience of the presenter provided a thoughtful commentary on the issues that the system faces today.

I wanted to consider three particular aspects of the programme. The first was a phrase used by a young woman care leaver. When asked what she thought of the support she had received since leaving care she was positive about many aspects of it, however she was critical of what she termed the “emotional support” that was available to her.

It seemed tragic to me that the most vulnerable of young adults are deprived of the understanding and empathy that is crucial to their ongoing personal, social and emotional development. I wonder why this is the case? Do we as social workers and professionals in the social care field possess the required skills to empathise with out most disadvantaged service users? Are we able to go to the complex personal spaces that these young people inhabit? Can we as professionals develop the skills to engage in the most intimate of dialogues with the most disadvantaged of young people?

In Scotland there has been a move to disaggregate Throughcare and Aftercare services from local authorities and move them to the voluntary sector. I believe this is morally wrong and an abdication of the local authorities responsibilities to our most vulnerable young people.

The second theme that was of interest to me was the disconnect between some foster carers and some of the young people they cared for. In the programme one foster family described how challenging their assessment period was, they stated that more than half of the families who started the process did not complete it, suggesting that the assessment process was more than rigorous. Why then do placements disrupt as a result of the “behaviour” of the children? Somewhere in here seemed to me to a blaming of the victim. The young people who I spent twenty years working with came from complex, abusive and frightening places, there experiences were beyond any reasonable understanding of “troubled”; abuse, of all forms was commonplace and the messages received from parents were more than confused. There was no consistency, the children I worked with had no parental role models and they were exposed to disruption violence and uncertainty. Why then were foster carers using the paradigm of behaviour to explain their actions? This seemed to me to be setting the children and the carers up to fail, perhaps the preparation groups need a greater emphasis on understanding the extent of the difficulties young people face and the need for there to be responses that are proportionate and supportive of all involved. The link between care and incarceration was considered and it seems to me that investment in developing better fostering services would negate the cost of incarceration, and the repeated costs of recidivism.

Finally and on an optimistic note it was heartening to see the influence that some residential staff had on the lives of young people, it was uplifting to hear that Ashely (the narrator) had obtained a degree, he himself cited the support from a residential worker as an important motivating factor in this. The power of the relationship was such a positive. I could write thousands of words about my admiration for residential workers, I have been privileged to work alongside some wonderful, committed, dedicated staff whose unshakeable belief in the young people they care for has been and continues to be an inspiration to me.

“Child Stealing” Conspiracy Theory Codswallop

Back in February I blogged about Brian Gerrish, a spectacularly deranged conspiracy theorist who peddles claims of “child-stealing” by a nefarious conspiracy of social services, CAFCAS, CAMHS, police and, for some reason, a management training company called Common Purpose. So that’s why children are occasionally taken into care? Not because of difficult and tragic cases where children have to be removed from their parents for their own safety, but because it’s a trafficking industry to make money?

Strangely enough, I had a conversation yesterday with a friend who spent this weekend at the Secret Garden Party festival. He told me, “That Brian Gerrish was on the lineup for Secret Garden Party, along with a guy who’s suing Leeds City Council for genocide.”

“What? Did you see this?”

“Nah. It was on some fringe stage called the R/Evolution Bunker. I was tempted to go see if for a laugh, but then I discovered his talk had been cancelled and replaced with an ex-Mafia bodyguard. So I went to a shamanic drumming workshop and watched some mud wrestling instead.”

From browsing the R/Evolution Bunker’s lineup, they have talks on hidden pyramids in Bosnia and on how the Arab Spring was caused by solar cycles. But Brian Gerrish was cancelled? Were his ideas too mad even for them?

But what’s this about a guy who’s suing Leeds Council for genocide? I did a Google search, and it turned out to be somebody called Chris Jarvis. Surprise, surprise, he’s had his children removed into care, and he’s come to the conclusion that this is genocide.

Leeds City Council to be prosecuted for ‘Genocide’ and ‘Crimes against humanity’

In modern language usage, brought about by use within the Courts, the word “care“, has become synonymous with the word “custody“.

A family is a group. The taking of children and moving them from one group to another is prohibited by UK and International Law, this is evidenced by the provision in UK Statute Law – “International Criminal Court Act 2001 – Schedule 8 – Article 6 – Genocide (e) forcible transferring children of the group to another group”

I wonder what the court made of his argument? Actually, I don’t need to wonder, because he posted on his blog that in May 2012 he turned up at Leeds Magistrates Court for a hearing.

It would appear that the information from the Draft summons was used to create a private hearing where Chris was not allowed his assistant, was not allowed his witnesses where he was placed in a locked Court room before a District Judge that appeared to have come to a predetermined decision based on previous correspondence to the Court and reportedly told Chris that he had presented no evidence to the Court and that his application had been refused.

This now allows the application to be taken to a higher level at the High Court in London, due to the multiple technical errors in Law that exist.

I can’t say I’m exactly surprised. The judge probably viewed him as just some pain in the bumhole pursuing a vexatious case in order to conduct a feud over the fact that his kids had to be removed. Good luck to him at the London High Court. My non-lawyer brain suspects that he’ll find it gets struck out on the spot there too, and then he’d be likely to be handed a massive bill for costs.

Perhaps I’m being too cynical. Maybe he’s genuinely the victim of a miscarriage of justice, rather than just some grubby child abuser? To show how badly he’s been wronged, he has various YouTube videos of him interacting with various social workers, council staff and police officers.

Well, that didn’t come across as paranoid, evasive or creepy in the slightest, did it?

He’s got another YouTube video, which I don’t intend to link to, in which he films the police and social services removing his child into care. It makes for distressing viewing. The police officers and social worker spend several minutes remonstrating with Mr Jarvis and his child. The child doesn’t want to go (this does not mean he isn’t being abused; removal into care is invariably distressing in the extreme), and is being exhorted by Mr Jarvis not to cooperate. Eventually, and inevitably, the police have to remove the child by force, leading to further distress for all concerned.

Interestingly enough, Brian Gerrish refers to Chris Jarvis on this podcast as being some sort of legal expert, like he’s some sort of amateur Perry Mason.

Good grief, where do these people come from?

Olympics, Hope and the Dampening of Cynicism

I can be cynical grump when I so choose but ! can’t help feeling a bit of excitement about the Olympics though as they roll into town this week. I almost don’t want to. I know they are expensive and it’s a distraction from the government agenda which is forcing cuts on those who are least able to afford them.

I know that logically, but as a child and as an adult, I’ve always enjoyed ‘remote participation’ in the over-commercialised ‘greatest show on earth’ because despite the organisers, despite the sponsors, there are moments of humanity and hope that dig deeply.

I remember the day in 2005 when it was announced that the Olympics would be held in London. As a native Londoner, I was excited and pleasantly surprised. I wasn’t as cynical as I became because I wasn’t sure what it involved. I will though, forever link that day with the day that follows, the 7th July 2005 when the terrorist bombs exploded in the transport infrastructure in London, killing 52 people as well as the four perpetrators and injuring over 700 people and that doesn’t account for the mental scars the day left on many many more.

The happiness and excitement turned instantly to pain, fear and distress and the two events become almost linked in my mind.

So it took a long time for me to feel comfortable and feel happy about the circus coming to town again. I enjoy spectacles, I enjoy distractions, even commerce-laden ones and I can’t apologise for that. If I’m excited that the world is coming to my city, I only want for her to be able to show herself to her best. To enjoy it and enjoy myself.

It’s not ‘cool’ to be excited and I’m not blind to the poverty, distress and suffering that is happening in the city while she paints herself up and while we aren’t watching because I’m still working and will be every (work) day the games are on (with a one exception as I did grab some tickets).

I went out to see the Olympic Torch as it passes through London. I saw joy. I saw happiness and I saw kids getting really excited.

Is it worth the cost? Is it worth allowing this government to be painted in anything other than the true colours of pain and distress that they are explicitly handing to the nation? Probably not. On balance, I’d rather have a fairer society with income distributed to provide more to all. Is it worth giving Boris his moment in the sun? That hurts too, because I never for a moment think that Boris is a mayor for London – he is a mayor for the parts of London that will be likely to vote for him.

But these aren’t the choices I was given.  Am I going to pretend I don’t want the excitement, celebrations and joy which exists around me? No. I’m going to enjoy these few weeks that London is at the heart of the sporting world. I’m going to use the events to build conversations with the people I visit, draw on memories of previous events and celebrations and use the excitement and celebration that is finally beginning to settle in the city. I’m going to use the time to enjoy the other associated celebrations, events and displays taking place. I’m going to enjoy the summer and the city.

I love London and I love the people who share this city with me. I want everyone else to come to know what a great place we are and can be. I tried to be more cynical, I tried to balance the head and the heart, but eventually the excitement came.

Yes, it’s going to be harder to get to work and it’s going to be harder to get home. We don’t have the luxury of ‘working at home’ but we don’t really know what the effect will be on the day to day work life as a social worker in the heart of an Olympic city but I’m sure it’s a theme I’ll come back to before the party is over.

For now, I’m going to try and enjoy it.

Incorporating a New Model into Healthcare Using Community Resources

This is a guest post by My Little Social Worker. 

In 1965 a man named Dr. Geiger began prescribing his patients with resources, stating simply, “the last time I checked my textbooks, the specific therapy for malnutrition was food.” Intuitively it makes sense. There are a myriad of ailments that cannot be fixed within the walls of a medical facility. A little girl cannot be relieved of her asthma if she lives in a home with poor air quality. Elevations in BMI cannot be addressed if a family is too poor to buy healthier food or is uneducated about healthy living habits.

While there are a limitless number of ideas about how to change our healthcare system for the better, they often do not consider the challenges we face before and after entering the hospital – challenges Dr. Geiger sought to address. There is little doubt that the current U.S. healthcare system aims at managing disease instead of preventing it, minimizing damage, and moving on. It minimizes damage to patients that often could be prevented if our healthcare system tried more to maintain good health instead of just managing the unhealthy.

So, naturally, I was excited when I discovered an organization called Health Leads, which completely turns the page on our existing paradigm. Their agenda is straightforward — to maintain health while simultaneously training the next generation of health leaders.

It is a simple model by which doctors can prescribe their patients with basic resources in addition to traditional medications. Instead of a “don’t ask, don’t tell” policy, physicians are adopting an ecological view that forces them to confront difficult and previously unaddressed issues. Rather than simply writing a prescription, they are asking themselves, “Can the family read the prescription? Do they have transportation? Do they have food to take? Do they have insurance to fill the prescription?”

After a doctor writes a non-clinical prescription, patients fill it by going to trained medical students in the hospital who introduce them to existing community resources for assistance things like food, housing, and heating assistance. The medical students act much like social workers, bridging the communication gap between physicians, patients, and communities. Instead of wasting time in waiting rooms, people are reclaiming this time to begin a path towards maintaining health with non-clinical improvements. After participants are referred to resources, they receive follow up calls from Health Leads to ensure that their needs are being met.

Health Leads was founded by Rebecca Onie in 1996 under the conviction that things don’t have to be “just the way they are” for U.S. healthcare. Onie recognized that there are a multitude of environmental conditions that cause illness and prevent people from being healthy; she noticed that physicians with short appointment times and high levels of stress easily overlook possible barriers their patients face in becoming healthy. She came to believe that people remain in poor health not because of the lack of sophisticated specialists or substandard technologies, but because our approach to health is so narrowly focused on immediate treatment that it discourages providers from addressing important non-clinical issues that have an impact equal to that of medical technology.

It is uncommon to find a healthcare solution that does not involve some kind of economic trade off. However, all across the country, Health Leads continues to benefit others with a non-profit model. The New York Times 2011 referred to it as “one of the most impressive organizations in the country at addressing the conditions that make people sick.” The program is not only proven to increase overall wellness of participants, but it is also providing a unique educational internship opportunity for medical students, leaving them well-equipped to participate in the clinical world with a broader perspective. The program is highly rigorous and competitive and plans to create a new generation of health leaders who will improve the way patient care is delivered in the United States. Health Leads provides valuable experience, better care, and investment in the future of health — all without increasing tax spending or placing a greater burden on our providers.

Today, there are 1000 advocates with 9000 participants all over the country connecting people with their communities to improve and maintain their health.

Onie’s basic idea is not new, but Health Leads is showing wonderful impact. Instead of using diagnostic information to treat people, providers are acknowledging the big picture while utilizing an eager team of students who are unencumbered by clinical responsibilities. This is a model of social innovation we should continue to encourage and replicate across the country.

This article is a guest post by My Little Social Worker, a collection of journals offering insight into the field of social work, advice for students, and inspiration. Follow My Little Social worker on Twitter at @MyLittleSWer.

Reporting on Deprivation of Liberty Safeguards

If there’s one part of my work which is bound to cause confusion and misunderstanding, I’d say it’s the ‘Deprivation of Liberty Safeguards’ or DoLs as they are shortened to.

DoLs is a complicated corner of legislation that covers particularly those people who lack capacity to make decisions in relation to their care, accommodation and/or treatment (depending on the particular case) who are being ‘deprived of their liberty’ in a care or hospital setting. According to Article 5 of the European Convention of Human Rights, there is a residual ‘right to liberty’ so when someone is ‘deprived of their liberty’ (whether by being detained under the Mental Health Act or in prison) there has to be a legally prescribed process to appeal this and to ground the decision made. The ‘Bournewood Gap’ whereby there was no procedure to deprive people who lacked capacity to make decisions about residence/treatmetn/care was thus ‘closed’ by the introduction of these ‘Deprivation of Liberty Safeguards’ which provide a legal framework to authorise (and appeal, in legal terms at least) these orders.

To my knowledge, the majority of these orders particularly would be made in respect to people with learning disabilities or moderate to advanced dementia.

So yesterday the Department of Health reported produced it’s Third Annual Report (pdf) on data provided in respect to the amount of DoLs across England and the Independent published an article about the ‘huge spike’ in applications made – a jump by 27%.

There was some discussion last night on Twitter about whether this was ‘a good thing’ or not. The article rightly identifies the mess inherent in the current rather confusing and potentially inaccessible system, saying

DoLs are notorious among lawyers, care and health professionals for being overcomplicated and deeply misunderstood. Both the Care Quality Commission and the Mental Health Alliance have criticised the legislation with the latter describing the entire DoLS system as “not fit for purpose”

I’d join in with the criticism to an extent. The current system is overcomplex and the lack of a clear path through the system for service users and for family members is notorious and verging on oppressive. The routes of appeal particularly are unhelpful and challenging DoLs authorisations is a complex process. The other difficulty is that there is a lot of variance in definitions of what ‘deprivation of liberty’ means. This is something that courts reinterpret frequently however thinking back to the safeguards as exactly that – safeguards – mean that by the context of them narrowing we are at risk of providing these safeguards to fewer people.

However regardless of the complexity of the system, these ‘safeguards’ are not bad in themselves. They provide an extra layer of scrutiny into some of the care and treatment of those who lack capacity and can be a potentially very strong safeguard.

The problem is, well, one of them anyway, is that the care home or hospital where the deprivation of liberty is or may be taking place have to make the referral themselves.

Back to the Independent article, it explains that one of the problems is the massive discrepancies nationally and I would concur with this. This is what happens when ‘deprivation of liberty’ is poorly defined.

So

A breakdown of the figures show that whilst a local authority like Leicester made more than 400 applications last year, Reading only made one for the whole year whilst Hull made just three.

This seemed staggering to me. I am astonished/sceptical. Is it really possible that there has only been one person who is in Reading (or for whom Reading is responsible in terms of financing their placement) who was deprived of their liberty in a case or hospital setting over the course of an entire year?

Reading’s response is interesting in itself

A spokesman for Reading Borough Council gave no reason for why they had only authorised one DoLS last year but added: “We advise and support care homes to support vulnerable people, and only use DoLs as a last resort measure.

Well yes, but this more shows a lack of training and advise regarding legislation rather than something that Reading should be proud of. Because to me, it screams that there are potentially a lot of ‘unauthorised detentions’ knocking around.

The problem is that noone is likely to pick up on this.

The Deprivation of Liberty Safeguards are not ‘bad’ per se. They are safeguards and when they kick in, they require two independent assessors to provide a report explaining the terms of the deprivation as it exists, a limit to it and the reasons why it is in that persons’ best interest.

How could they be made better? (and do bear in mind, I’m venturing a little into ‘fantasy land’ here).

• Streamlining the appeals process so that it is on a par with rights to appeal to tribunals under the Mental Health Act

• Provide a mechanism to trigger referral that does not depend on the care home/hospital

• Better define what Deprivation of Liberty is

• Provide a regulation framework whereby regulators and inspectors are actually aware of ‘deprivation of liberty safeguards’ and the relevant legislation

Will that happen? Unlikely because there is little resourcing available but however much the phrase might make one shudder with confusion, the Deprivation of Liberty Safeguards are important.

They protect the rights of those who have little recourse and for whom some of the most important decisions are made by staff in hospitals and care homes and by local authorities. These need to be scrutinised and considered but the complexity of the system has been its undoing.

The presence of a DoLs authorisation in a care home is not a ‘bad’ sign. The absence of any (or few) DoLs authorisations in an entire local authority is not a ‘good’ sign.

Poorly administered or misunderstood DoLs’ authorisations are very bad though however used properly, it is very important to remember they are safeguards.

Reading’s pride at the existence of one authorisation over a year is not really something for them to be enormously proud of because I worry about the existence of unauthorised deprivations of liberty – not just in Reading (where obviously they advise and support care homes so well) but in all the care homes and hospitals in the country where those for whom Reading may be responsible are living.

Sometimes it isn’t as simple as saying ‘rising authorisations’ are bad or that they are ‘good. It’s about the subtlety of implementation and review.

Most worrying is the variation. If anything points to complex law and poor information sharing – it is that.

Something to learn for local authorities around the country, I hope.

And hopefully a lot more work for those who train people to understand and use the deprivation of liberty safeguards properly!

pic by garryknight Flickr