What’s in a Word? Patients, Clients, Service Users…

Part of my job is to mentor student nurses. This week I had a look at the recently-revised competency portfolio that the students have to bring on placement. This is a hefty document about the size of the Yellow Pages, which lists all the skills students have to learn with me, and which I need to sign off to say they’ve learned. It’s very detailed and long, with a dizzying array of competencies in it. I’d challenge anyone who thinks a nursing degree is an easy option to read through it and then say so. However, there was one thing that struck me about the competencies.

They didn’t make a single use of the word “patient”.

Don’t get me wrong, it isn’t that the competencies weren’t aware that nurses work with people, but they were constantly referred to as “service users” and “clients”. The word “patient” was conspicuous by its absence. Apparently nurses don’t have patients.

There seems to be a view out there in mental health that “service user” and “client” are good and “patient” is bad. I don’t buy it. I’m not saying there aren’t people who don’t like being called patients, but I’ve also come across people with mental health problems who loathe being called service users or clients. Besides, anyone who’s ever been to the dentist is technically a patient.

The wording on the student competencies is particularly ironic because I work in Wales. Recently the Welsh Assembly Goverment passed the Mental Health Measure, a very progressive piece of legislation that enshrines certain rights for people receiving a mental health service into Welsh law. It gives, for example, the right to have a care and treatment plan that’s formed collaboratively between patients and staff, and a right for people who’ve been in secondary care to self-refer back to services. It’s a very good piece of law aimed at putting the person using the service at its centre. Even so, the term used in Mental Health Measure documentation is “relevant patient” not client or service user.

I suspect there isn’t a “right” or “wrong” answer when it comes to whether one should use patient, client or service user. It all depends not only on what those words mean, but also what people take them to mean. For example, when we talk about “health” some people would take that to mean a fairly narrow, medical model of diagnosis and treatment. However, if you go by the World Health Organisation’s definition of health…

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

….then that’s a much broader concept.

It’s also worth pointing out that the meanings of words can be changed, often due to a conscious effort by those to whom they apply. A good example of this comes from the recent #mentalpatient furore that erupted on Twitter and into the mainstream news. The Asda website was discovered to have a “mental patient” fancy dress costume (which Asda has since removed and apologised for) on its online store.

 

The response of various Twitter users was to post pictures of themselves in their own “mental patient costumes.”

As well as patient, client and service user, the term “expert by lived experience” has also been bandied about in mental health debates. I recently asked Twitter users what they thought of this particular wording, and got a high number of responses which I’ve Storified here. The answers varied wildly. Some loved it, some hated it, and quite a few people gave nuanced answers somewhere in between.

I’m not sure that I have an opinion as to which is the “right” wording to use (and as I’ve said, I’m convinced there even is a right answer). I’d hope that whatever wording is used, people are treated with dignity, respect and in a collaborative way that upholds their rights and wishes.

 

 

 

Prejudice or Privilege? Some Difficulties with Privilege-Checking

A couple of weeks ago there was a fairly spirited exchange between the former MP Louise Mensch and the feminist writer Laurie Penny over the phrase “check your privilege”, which started out as a feminist term on Livejournal, and has turned into something of a Twitter trope. It’s mostly (though not exclusively) used in online feminist debate. Louise Mensch isn’t a fan of it.

And that is what the modern feminist movement has become. Full of intersectionality, debates about middle-class privilege, hand-wringing over a good education (this is again “privilege” and not well-deserved success), and otherwise intelligent women backing out of debates and sitting around frenziedly checking their privilege.

It does nothing. It accomplishes nothing. It changes nothing.

Laurie Penny defended the term.

Telling someone to “check their privilege” isn’t the same as censoring or silencing, but to people who aren’t often introduced to the concept that they might be wrong, it can sometimes feel that way. When someone asks you to check your privilege, it doesn’t mean you should stop talking – it means you should start listening, and sometimes that involves giving the other person in the room a chance to speak. That’s what often upsets people most about the whole idea. It’s about who gets to speak, and who has to listen, and social media is changing those rules.

I’ve been pondering this for a while, and I’m going to give a list of what I think are some of the problems with privilege-checking. Some have suggested that the only people who have an issue with being asked to check their privilege are those who are privileged themselves. Given that I’m white, male, straight, cisgender, middle-class and able-bodied, quite possibly I may be guilty as charged here.

But here’s something I’ve noticed about the often-virulent arguments between feminists on social media (anyone who says, “If feminism ruled the world, there’d be no war” doesn’t have a Twitter account). These are debates where I’m at best an ally and at worst merely an outside observer, but when I’ve criticised some of the discourse, I seem to get an easier ride than when those on the inside say the same thing. Why are those involved expending so much energy to hurl vitriol at other feminists like Louise Mensch, Caitlin Moran and Helen Lewis? Why aren’t they flaming me?

I suspect that might be one to file under, “Be careful what you wish for”.

Anyway, here’s what I think are some of the problems with saying, “check your privilege.”

1. Not all privileges and oppressions are immediately apparent.

When someone says “check your privilege”, it suggests that they know what privileges the other person has. Trouble is, there are plenty of hidden oppressions and privileges. A history of mental health problems and/or childhood abuse, for example. I recently spoke to a woman with an anxiety disorder who got Twitterstormed by various feminists who (wrongly) interpreted a comment by her as transphobic. Getting bombarded with abusive messages telling her to check her privilege for several hours prompted a mental health relapse.

Even apparently straightforward privileges/oppressions might not be especially visible, especially if all you know about someone is from their social media profile. I spoke to a woman who’d been accused of showing her “white privilege”. When she pointed out that she’s actually mixed-race, she got the retort that since she could pass for white, she still has white privilege.

2. It’s patronising and dismissive.

I’ve actually seen some suggestions that Stephen Fry, when talking about his mental health problems, is doing so from a “privileged” perspective. Admittedly that was said before he disclosed his recent suicide attempt, but even so, do we really want to tell people with a mental illness to check their privilege? Sounds a little too close to, “Chin up, you could be starving in Africa.”

3. Privileges and oppressions don’t necessarily affect prejudices in straightforward, linear ways.

This point leads me onto the question whether we should really be talking about prejudice rather than privilege. There seems to be an assumption in “check your privilege” that more privileged = more prejudiced and more oppressed = less prejudices. Okay, there’s plenty of examples where that’s true, but by no means always. George Orwell was educated at Eton, and went on to become one of the sharpest observers of injustice and the abuse of power in English literary history. Or there’s Joe Strummer, the son of a diplomat.

Sadly it can also be the case that some people subject to various oppressions can internalise the oppressor’s logic, and even applying it to their fellow oppressed. There isn’t a shortage of people on benefits who will tell you that there’s too many benefit scroungers in this country – though they’d frequently be mortified if someone suggested that they might be seen in the same way by others. Likewise, a while back I had a conversation with a Nigerian-born woman, and was surprised to discover that her views on immigration were well to the right of mine. She simply didn’t view herself as that sort of immigrant.

4. Privilege isn’t the only thing that affects prejudice.

Don’t get me wrong, I’m not saying privilege doesn’t affect prejudice. It can affect it a lot. But it’s not the only thing – what about your life experiences, the people you’ve met, your cultural background, the books (and blogs and Twitter feeds) that you’ve read? this is why I think it’s better to have a wider discussion about prejudice (of which privilege can be a part) rather than talking simply about privilege.

5. It talks at people rather than with people.

Laurie Penny insists that “check your privilege” is an invitation to listen rather than telling someone to shut up. That’s fine in principle, but having seen it used in various Twitter flame-wars, it’s clear that all too often it does get used as a shorthand for, “You are male/white/straight/cis/able-bodied therefore argument invalid.”

And even if it is used as an invitation to listen, is the other person also listening? I actually agree with Penny that social media is changing the way people communicate, but for slightly different reasons. Social media changes the old world of books and newspapers from one in which ideas are presented to the public, into one in which those ideas are co-created by people talking and listening with each other rather than at each other.

I’ve actually found blogs and Twitter to be powerful tools in challenging and reshaping my prejudices. I can hear about the lives of prisoners through @PrisonerBen or sex workers such as @itsjustahobby or @pastachips – two groups that tend to be talked about or to rather than with. Just recently I’ve been reading about the experience of having a gender identity that doesn’t fit into a binary male/female divide from @halfabear and @jaspergregory – a group that’s barely written about at all. But these people didn’t change my thinking through, “I’m going to tell you about your life and what you think”, which is what “check your privilege” does. They did so by saying, “I’d like to invite you to hear about my life and my thoughts.”

Ultimately, I don’t think people’s views are changed by simply tweeting “check your privilege” at each other, and in that sense it fails in its purpose. It doesn’t get the recipient to think differently. If anything, it’s the obsolete old media thinking of talking at people rather than with them. I think views are changed through civil constructive discourse where people tell each other about their own lives rather than presuming to tell someone else about theirs.

The Philpott Case – A Lesson from History

I’m idly flicking through a copy of The Burning of Bridget Cleary by Angela Bourke. It tells the tale of what’s sometimes referred to as “the last witch-burning in Ireland”.

In 1895 Bridget Cleary, a 25 year old woman from County Tipperary, Ireland, was burned alive by her husband. It was a bizarre and grotesque tragedy in which her assailant used an unusual defence. He claimed that his wife had been abducted by the fairies, and he had only killed her changeling rather than Cleary herself.

The case provoked huge media interest, and that interest turned into politicised comment. To give a flavour of how this was reported in some quarters, here’s a quote from the Clonmel Nationalist around the time of the trial.

We found yesterday that the dreadful occurrence has been utilized editorially by the Tory-Unionist Dublin Evening Mail for purposes of political capital and as a suitable occasion to pour forth slander, odium and abuse on Irish people generally; to stir up racial and religious passion and prejudice, and if possible to damage the cause of Home Rule.

As you might gather, right-wing newspaper barons used this unusual and shocking event to slander an entire people, dismiss them all as unreasoning savages, and to advance a political agenda against them.

Thank goodness we live in 2013, not 1895. This is a much more responsible media era.

Should health professionals be anonymous or non-anonymous online?

This is a topic I’ve been thinking about for quite some time. Today, the General Medical Council announced that doctors should identify themselves on social media. To the best of my knowledge my own regulator, the Nursing and Midwifery Council, has not yet issued a similar rule. However, I wonder if this is an indicator of what other professions are also likely to do.

Professionals blog and tweet under pseudonyms for all kinds of reasons, and by no means all of these reasons are ominous. Ermintrude2 and Dr Grumble not only use their platforms appropriately and ethically; they also write extremely well and passionately. Some people just feel more comfortable under a pseudonym, and feel more able to speak frankly.

I’ve been Zarathustra on various blogs, and more recently on Twitter, over the years. I’ve grown quite fond of and attached to my online alter ego. Look at Zarathustra’s awesome moustache! I can’t actually grow a moustache in real life. Despite being a grown man any attempts turn into something resembling teenage bumfluff. I ask you, who wouldn’t want a tache like Zarathustra’s?

Over the years I’ve noticed attitudes to social media and healthcare steadily evolving. At first it was something of a free-for-all. I remember the anarchic days of NHS Blog Doctor, Dr Rant and Militant Medical Nurse. A lot of those early blogs were expletive-fuelled swearathons, with people yelling all kinds of earthy insults at NHS managers, at politicians and frequently each other. The language was of a variety that would have a fishwife telling people to tone it down a bit.

A lot of those blogs simply aren’t there any more. In some cases, I suspect it’s because people got into trouble. Some people found out the hard way that internet anonymity can be seriously overrated, especially in the long run. As behaviour on social media started to find its way into disciplinary hearings and fitness-for-practice investigations, the professional guidance became more detailed and suddenly everyone became incredibly anxious about social media. It became a demonic creature, waving a P45 in one hand and a letter from the NMC in the other.

That anxiety is still around, but I’ve also noticed a more mature set of thinking around social media starting to emerge. The Royal College of GPs’ Social Media Highway Code, and Victoria Betton and Victoria Tomlinson’s Social Media in Mental Health Practice give good examples of this new maturity. What these publications say is, remember your responsibilities to behave ethically, but also maintain a sense of playfulness to explore this evolving medium, and work out how it can be used as a force for good.

And there’s no doubt that social media can be a force for good. Last night I joined in the #mhnursechat on Twitter, which was on the subject of borderline personality disorder. This is a difficult topic, often laden with mutual suspicion on both sides. Patients with this condition are often regarded as “difficult” or “attention-seeking”. Professionals are accused of dismissing the suffering of people with BPD, and using it as a label to stigmatise and exclude rather than provide support.

The chat was joined not only by mental health nurses but also by a number of people with BPD. For an hour everybody talked openly, equally and respectfully. We talked about what the diagnosis means to people, what helps and what doesn’t help. The feedback from participants at the end spoke for itself.

“brilliant to be able to collaborate with mutual respect for each other, a wonderful experience”

“It was such a nice change to be included instead of being ignored and spoken over so to speak”

“brilliant to see and I am glad that patients welcomed in #mhnursechat not just professionals”

“What a brilliant & informative chat. Thank you all so much for joining in”

It reminded me of some comments by One in Four editor Mark Brown.

Social media, by its nature, puts together people who would never have met.  It creates strong public voices which didn’t get there through traditional routes.  It creates stories that appear from odd angles and at unexpected times.  It makes public issues of things that might once have remained behind closed doors.  It doesn’t let things stay where policy makers have traditionally put them.

It also creates a situation for mental health where it is less ‘them and us’ and more ‘just us’.    There is something hugely satisfying in seeing someone who offline would be seen as a ‘patient’ discussing online with someone who would be seen as an ‘expert’ and both learning from that experience.

Returning to the question of whether to blog and tweet anonymously or non-anonymously, there is the matter of accountability in all this. Ironically my recent Twitter run-in with Dr Christian Jessen has galvanised my thinking on this matter. I’ve been criticised for “calling out” Dr Jessen on his online statements. Personally I don’t think I’ve done anything wrong in that regard. I think he behaved disgracefully in an extremely public manner, and that I’m entitled to criticise that behaviour. But should I be hiding behind an anonymous ID to do so? If I’m confident in what I’m saying, shouldn’t I be willing to put my name to it, and if necessary defend it?

As well as being accountable, there’s also the matter of taking credit for what you’ve done well. There are pitfalls in social media, and if I’m honest with myself I think it’s fair to say I’ve made some mistakes along the way. But there’s also things I’m proud of, such as exposing the shocking lack of regulation in the psychotherapy industry. I’m also proud of helping create and maintain the regular This Week in Mentalists round-ups, in which bloggers take it in turns to tell us about their favourite online mental health writing. I’m proud of the #TwentalHealthAwards that I started this year.

So, I guess what I’m trying to say is this.

Hello. My name’s Philip Doré . Pleased to meet you.

The trouble with Dr Jessen

In the last couple of weeks the Royal College of General Practitioners published their Social Media Highway Code. As a professional with a longstanding interest in how social media can be used constructively in mental health, I’ve often been disappointed that most guidance being issued tends to focus only on the negatives and risks of this new form of communication. The Highway Code is a welcome antidote to that: it acknowledges the risks and and the need to behave online in a professional way. However, it also recognises that social media has rewards and opportunities. I highly recommend it not only to doctors but to all health professionals.

Which makes it unfortunate that today I got caught up in the absolutely atrocious online behaviour of a doctor. A TV doctor, no less.

I don’t actually watch the TV show Supersize vs Superskinny, hosted by Dr Christian Jessen. I work with children and adolescents with eating disorders, and watching a show about it feels a little like taking my work home with me. I know that some people with eating disorders have complained of experiencing triggers from the show.

Ilona Burton is a journalist who writes for the Independent about eating disorders. She writes passionaately and well about the subject, not least because she’s in recovery from an eating disorder herself. In 2012 she was nominated for the Mark Hanson Award for Digital Media in the Mind Media Awards. She also holds strong views about the content of Supersize vs Superskinny, which she regards as socially irresponsible.

Early today, an increasingly heated debate was building between Dr Jessen and Ilona.

Dr Jessen then started retweeting Ilona to his 222,000 followers. The result was that Ilona started receiving tweets from Dr Jessen’s fans, some of them abusive. Ilona was clearly distressed by this, which really didn’t seem to concern Dr Jessen. For that reason I threw my own tuppence into the ring.

I also tweeted him a link to the RCGP Social Media Highway Code, and suggested he pay attention to Section 7, “Treat Others with Consideration, Politeness and Respect.” He didn’t reply directly, but responded by retweeting me.

The result was that I too started getting a large volume of tweets, which quickly turned into a Twitterstorm. As with the content being aimed at Ilona, some of the tweets I received were also hostile or downright abusive. It went on and on, lasting for several hours. This wasn’t helped by Dr Jessen retweeting more of my responses.

Okay, maybe that last tweet by me was a little tetchy, but getting several hours of online abuse does that to me.

I’m a fairly opinionated tweeter, so I’m no stranger to getting hostile messages. I’ve had some nasty stuff thrown my way by supporters of UKIP, and also by people who object to the work of child protections services. I can honestly say that today was the worst and most intense level of trolling I’ve ever been subjected to.

I don’t feel I need any sympathy for that. I’m big enough and ugly enough to handle it. However, I’m saddened that it happened at the instigation of a fellow healthcare professional. I’m even more saddened that the brunt of it was also caught by someone who has lived experience of one of the very conditions that Dr Jessen talks about in his show.

Dr Jessen seems rather unrepentant about all this.

What does the Social Media Highway Code say?

You have a right to express your views openly–but not to do so in a way that causes offence to others or infringes on their own rights….

When part of an online group, don’t be tempted into joining others in making derogatory comments or ‘ganging up’ on another individual – this behaviour could be regarded as ‘cyber-bullying’. Be wary of the power of the mob…

HEALTH WARNING: making derogatory,threatening or defamatory comments about others could have a harmful effect on your career. ‘I was just blowing off steam’ may be an honest explanation, but is not likely to be accepted as a valid justification by professional bodies or employers.

I hope Dr Jessen takes up my suggestion of reading the Highway Code.

Meanwhile, Ilona has posted her own thoughts on the matter in a vlog.

In praise of Sally Bercow

The wife of the Commons speaker is not normally someone who I’d go out of my way to admire. When she appeared on Celebrity Big Brother she struck me as somewhat vain and publicity-seeking. She’s also a former member of the Oxford University Conservative Association, a group that I’ve been gleefully sarcastic about in the past.

Even so, the news that she’s refused to settle in the matter of Lord McAlpine vs The Internet suggest the actions of someone with a lot of gumption. Libel cases can run into costs of £100,000 without even reaching court. Simply fighting the case (never mind losing it) can financially ruin all but the considerably wealthy.

Over the past month a lot of rubbish has been talked about the supposed evils of Twitter and other new media. This conveniently forgets that the original allegation was made in old media, and on usually-trustworthy Newsnight. The tweeters simply discovered that Newsnight was referring to accusations that had previously circulated, and correctly identified who they were talking about. Unfortunately, the Newsnight report then turned out to be inaccurate.

I can appreciate that Lord McAlpine must have experienced an extremely distressing week, but it’s also important to remember that he was not only generously financially compensated by the BBC and ITV. He was also quickly vindicated. The entire world now knows that Lord McAlpine is not a paedophile.

But more importantly, McAlpine’s subsequent legal action is one that could set a hugely dangerous precedent. That large numbers of people could be pursued and financially ruined for briefly and non-maliciously discussing the TV news. Those who’ve cheered on his pursuit of 10,000 people simply haven’t thought about the consequences.

News about his mass action against tweeters seems to have gone a bit quiet lately, but a few weeks ago these claims were circulated, suggesting that Twitter was simply refusing to hand over personal information to Lord McAlpine’s lawyers without 10,000 court orders, and that overtures to the police were being met with a bland “not a police matter”. I have to add some words of caution here in that these claims are unsourced, and if we should have learned anything recently, it’s not to believe everything that’s tweeted. Even so, it seems hard to imagine that any demand to Twitter that 10,000 sets of personal details be disclosed en masse would be met with anything other than a referral to the reply given in Arkell v Pressdram.

According to news reports, Lord McAlpine is demanding £50,000 and an apology from Sally Bercow. Given that Mrs Bercow has already publicly apologised, it seems likely that the sticking point on settlement may well be the matter of fifty thousand quid. And since, Mrs Bercow has indicated that she’ll meet him in court, what is her defence likely to be?

A quick disclaimer here. I’m not a lawyer, and I’m therefore not qualified to parse the following suggestions. For that reason the next few paragraphs should be treated as speculation and not as legal advice.

This blogger claims to have already obtained some legal opinions on any possible defence.

“The McAlpine case is weak on three grounds. First, the evidence that his reputation was maligned by contemporary tweeting is flakey, given the pre-existence of internet rumours going back a long way; second, suing individual tweeters for £500 could easily be construed by a Judge as a ridiculous not to say greedy valuation to put on one quite possibly neutral enquiry of others; and third, singling out Twitter alone is preposterous in the context of a multivariate world of online social networking. You have Facebook, Linkedin, blog threads and a dozen other equally effective ways of innocently transmitting speculation – up to and including word of mouth gossip in the office. To set a precedent in favour of civil prosecutions against mass opinion and gossip would be ridiculous. Further, we suspect that any higher Court (especially one within the EU’s legal framework) if faced with an appeal against any judgement favouring such a view would overturn the verdict without exception.”

‘The issue of intent is much murkier with regard to mentioning someone’s name on Twitter – especially if Mr X’s guilt or innocence in relation to the media expose was inconclusive at the time. Twitter users were simply commenting in real-time on what they were seeing, without any premeditated malicious intent,’ remarks another online source.

Meanwhile the political journalist Michael Crick has said that there’s another objection which will be raised by Bercow’s lawyers. Even in the worst libel cases, the maximum damages are usually around £220,000. Lord McAlpine has already received £310,000 from the BBC and ITV. Adding another £50,000 to the pile starts to look, well, a bit greedy.

The false accusations against Lord McAlpine were unfortunate, and they do show some of the potential pitfalls of social media. However, they also show the way in which our draconian libel laws can be used as a weapon by the rich and powerful against everyone else. This is why libel reform needs to happen as a matter of urgency. In the meantime, hats off to Sally Bercow for deciding to stand and fight.

 

 

Rotherham: Truth and Politics

The only time I read my local paper is at the Indian takeaway. Whilst waiting for my korahi chicken yesterday evening, I disinterestedly flicked through the familiar mix of parking problems, noisy neighbours and oversubscribed schools. I nearly skipped the article buried on page 11 about a man who died after an error from his GP, because I was pondering whether to order a popadom. Then I stopped and read it: it was my GP.

Our doctor is kind, caring and hard-working. He treats people as individuals and always makes time for them. On this occasion, the surgery computer system did not indicate that the prescriptions for the drugs his elderly patient required for a heart condition had stopped after the man was released from hospital. Several months on, he relapsed and sadly died. The coroner praised the doctor for his honesty. I can’t recall the actual verdict but the death could have been prevented.

Today’s Daily Telegraph didn’t lead with an avoidable death or for that matter any death. The case of foster carers who allegedly had children in their care removed from them because they were UKIP members has run on all media. It’s been top of 5Live news all day, for example. You would expect Nigel Farage to have an opinion but Michael Gove has swiftly weighed in too. As I write, Milliband is being quoted. Cue outrage at social work.

If UKIP membership is the only reason why these children were moved, I don’t agree with it. They should have stayed where they were. The council said on the news this morning that the children were going to move on anyway. This may be the case. However, the original Telegraph report says the boy was moved the following day and his two sisters soon after. If this is accurate, it does not sound like a planned move to me.

I qualify my remarks with ‘if accurate’ for a couple of reasons. Firstly, the report does not appear to have any corroboration from other sources. They may exist but it’s based heavily on the carers’ account. I thought journalists cross-checked, especially on a headline story, but this is different.

Secondly, it doesn’t chime with my experiences over the years. Judgments about the capabilities of  carers are never made on the basis of a single piece of information, unless of course it relates to a child protection matter or allegation, in which case prompt action must be taken to safeguard the child.

In this case, you would like to think that other evidence would have been considered, such as the history of the carers over their fostering career, the progress of the children in placement, any evidence that the actual behaviour of the carers had negatively impacted on the children (as  distinct from their membership of a political party) and the wishes and feelings of the children. Bear in mind that the Fostering Standards prohibit changes in children’s careplans without consultation unless there is a real and immediate need. If the local authority has other information, they could not possibly break confidentiality and share it publicly, which offers no protection to the storm of media outrage.

Some of the criticism is misinformed. Farage was calling for the immediate reinstatement of the carers but they are still approved carers, it’s just this placement that has ended. Also, he might think about considering the children’s needs first, which is the law after all.

However, what is most significant is why this is a story at all. My doctor will carry on practising, as he should. The competence of the medical profession has not been called into question because a man died. Yet in the case of the Rotherham foster carers, the ability of the entire social work profession has immediately become the issue. This is all the corroboration the Telegraph needed. We know social workers do this sort of thing, don’t we. Leaving aside the fact that as I have already suggested, any judgement is based on incomplete evidence, this is not about the actions of individual social workers or even the authority itself, it’s about how lousy our profession supposedly is in making these judgement.

The implication clearly is that social workers make snap judgments based on dogma and preconceived ideas. More than this, we are driven by political ideology. In much of the coverage, this deeply flawed and prejudiced perspective has not been significantly questioned. This must be the case – what other reason could there be? It shows how little the public still understand about what we do.

This may have been a carefully considered decision or something that was rushed. It could have been a wrong decision. If so, hold up our hands, but it does not prove one single thing about how social work as a whole assesses the needs of children.

You would think the minister, our minister, might at the very least inject a sense of perspective. Not so. “The wrong decision in the wrong way for the wrong reasons,” he said. I humbly suggest he cannot know that for certain. But there are bigger issues at play here and it suits him to use the profession for which he is responsible for other reasons.

Rotherham is holding a by-election. It’s Labour-held, therefore this decision is the responsibility of the Labour authority even though it would have been made by social workers, i.e. officials not politicians. The assumption that this is a political issue has not been called into question. No coincidence.

Also, the consultation period for government proposals to diminish the significance of culture and origin in decisions about adoption placements is coming to an end. This has been well-trailed over the past year – see some of my previous articles – as a way of removing what the government characterise as impediments to swifter adoption. It’s an important proposal that has considerable opposition as well as its proponents. Whichever position you take, it’s disturbing that a matter about the health and well-being of three little children and public confidence in social work becomes a chance for political points-scoring.  We might look back at this episode in future and ask if anyone truly cares.

Why the #Rotherham #UKIP scandal is almost certainly a load of codswallop

This morning we awoke to a story that sounded like something from the worst nightmares of Paul Dacre’s feverish imagination. Rotherham Council had reportedly removed three children from their foster carers, based on the carers’ membership of UKIP. Nigel Farage, Michael Gove and Ed Miliband have all piled in to condemn the decision. An absolutely shambolic performance in a BBC interview by Rotherham Council’s Joyce Thacker didn’t do anything to dispel the outrage gathering across the media.

But does this story have proper substance? When I read it this morning, there was a distinct whiff of bovine ordure to it. Although I regularly come into contact with looked-after children, I’m not an expert on the fostering process. However, my co-bloggers Ermintrude2 and Abe Laurens are both experienced social workers, and the latter is particularly experienced at working with looked-after children. I promptly sought out their opinions, and their advice has informed this blog post.

There’s a couple of things we already know about the case from the media reports. First, we know that these children were always meant to be staying with the couple temporarily, and there was never any suggestion that this would be a long-term placement. I’d say that’s a big clue from the word go.

We also know that in a previous court case the judge had criticised the council for not adequately attending to the childrens’ cultural needs.

But as well as what we know, we also have to remember what we don’t know. The local authority will have a duty of confidentiality to these children. They won’t be in a position to go into the ins and outs of why they couldn’t continue to be housed by this particular foster family. When I asked Abe Laurens, he commented that, “In my experience such decisions are NEVER made on any single factor alone.” We don’t know what the other factors were.

But there’s something else we do know, and it almost certainly acts as a great big klaxon telling us exactly what this is really about. There’s a by-election in Rotherham on Thursday. A Labour seat is up for grabs, and UKIP are campaigning hard. Funnily enough, Nigel Farage is doing his damnedest to link the decision with the Labour Party.

The UKIP leader said his primary concern was for the welfare of the children and their foster parents, but hit out strongly at the Labour party, despite Today host Evan Davis commenting that the decision was made by “officials” at the council rather than elected representatives.

“This is typical of the kind of bigotry I’m afraid that we get from the Labour party and from Labour-controlled councils….their attempt to close down the debate [over immigration] is just to write off anybody that wants to discuss it as being racist,” said Mr Farage.

And strangely enough, this has come out at the weekend, when the council would be in the least position to come out with a prompt response. What a coincidence!

It’s almost as if this is a media stunt intended to give UKIP a PR coup on the eve of the by-election.

[EDIT: I’m now more of the view that the proximity to the election date is coincidental rather than any deliberate timing, albeit one that’s had the effect of massively throwing petrol on a flame. What does seem clear is that the various political parties are engaged in a lot of electoral jockeying on the issue.]

And with Michael Gove and Ed Miliband lining up to give Rotherham Council a verbal kicking, it’s almost as if they’re desperately trying to avoid losing crucial votes to UKIP on Thursday.

Once again, social workers and vulnerable children are being used as a political football by opportunist politicians. What a surprise.

Professionals, Patients and Social Media

Earlier this week I met up for a pint with Victoria Betton, author of the Digital Mental Health blog. This turned into quite an in-depth conversation about social media, and the way it’s used by people who work in or use mental health services. After we met I decided to jot down some of the thoughts and ideas we were bouncing about, and put them up in a blog post.

Where are the subversive professional blogs?

Victoria commented that apart from the Not So Big Society and The World of Mentalists, she hadn’t come across many subversive blogs run by professionals (or in the case of The World of Mentalists half-run by a professional, since I co-edit it with Pandora). I must confess that I was pleasantly surprised that either of those blogs would be considered subversive. Once I’d recovered from the unexpected compliment, I did find myself agreeing that a certain chill has set over the health blogging world – from the professional side anyway; the patient side is flourishing. I’m not saying there aren’t good-quality, subversive bloggers out there – look at Stuart Sorensen and the 20 Commandments for Mental Health Workers. Even so, when you look back to the spleen-venting polemics of NHS Blog Doctor, Dr Rant and Militant Medical Nurse, it’s hard not to feel that professionals are increasingly cautious about what they stick on a blog or a tweet. I’ve felt this myself, and I’ve noticed that there’s things I might have said online three or four years ago that nowadays I just wouldn’t say.

Don’t get wrong, I’m not suggesting we all go out and start swearblogging. There are, after all, good reasons why professionals are more cautious. When I first started blogging on the now-defunct Mental Nurse, there were no guidelines from regulators about social media. Then one day an article appeared in the NMC News, basically saying it’s okay to blog, so long as you don’t breach confidentiality or bring the nursing profession into disrepute (gratifyingly, they recommended Mental Nurse as a good example of how to blog). Then a paragraph or so of guidance was issued. That paragraph has become increasingly detailed, mainly in the wake of people getting into trouble at work through social media.

As a result, professionals are now nervous about blogging or tweeting. In many cases they’ve interpreted “be careful about how you engage with social media” as “don’t use it at all”, which in fact regulators like the NMC have made clear is not their suggestion.

Which professionals are using social media well?

Something I commented on, which Victoria seemed to agree on, is that of the various professional groups using social media, one that seems to do it particularly well are the police. This especially seems to be the case on Twitter, for reasons I’ve yet to fathom. Possibly it may be partly due to the institutional sense of humour of police officers, which seems to translate well into tweeting.

It also strikes me that Chief Constables seem to trust their officers with social media in a way that perhaps directors of NHS trusts and social services departments might not. Nightjack is an obvious exception to that, though in his case he allegedly had the misfortune to be utterly shafted by the Times, to make it look like he’d breached confidentiality when he hadn’t.

If anyone has any additional thoughts on why the police seem so good at tweeting, I’d be interested to hear them.

The Ascent of Twitter

I’ve noticed a change in my approach to social media. Previously I thought of myself as a blogger who has a Twitter feed to promote the blog. Increasingly I think of myself more as a tweeter who also runs a couple of blogs. Interestingly, when I mentioned this to Victoria she felt she’d undergone the same change. Conversations that might have taken place on the comments thread to a blog post will now be tweeted after reading the post.

This goes to show that social media is still evolving. Different platforms come and go (Goodbye Livejournal! Hello Tumblr!) The way we engage with it is also involving, and becoming more multi-platform in nature.

Anonymous versus Non-Anonymous

I’ve generally felt more comfortable expressing myself anonymously as a nurse. This isn’t just because of worries about something I might say causing trouble with my employer. There’s been times when stuff I’ve blogged about has led to individuals trying to make problems for me in meatspace.

I do also have a non-anonymous Twitter and blog. Victoria seemed surprised when I said that I’m actually more careful about what I say under my anonymous Zarathustra alter ego than my non-anonymous one. I think the difference is that as Zarathustra I self-identity as a nurse, whereas the other identity is just me being me. So, if I want to say, retweet a rude joke, I’d do it non-anonymously, but also non-professionally.

Might professional cautiousness swing the other way?

As I said that at the beginning of this posts, some professionals are starting to avoid social media. I’m wondering if the trend might reverse. Just recently in the wake of the Twitter Joke Trial fiasco, the Crown Prosecution Service has issued statements suggesting they’re rethinking the extent to which they prosecute people for what they say online. In the case of the Twitter joke, they caused a man to lose his job, and squandered large sums of public money for something that was monumentally trivial. Their recent statements suggest they now recognise a need for balance to protect free speech.

If the CPS are starting to backpedal, and realise that they don’t need to run around prosecuting left, right and centre every time someone says something stupid on Twitter, perhaps that might lead to a climate in which people might become more comfortable in communicating online. I don’t dispute the need for social networking guidelines from bodies like the NMC, but I think it’s also important to recognise that professionals can use social media to communicate in a responsible, ethical and at times slightly subversive way. When they do, good things can come out of that.

Protected: How not to debate with health professionals on Twitter

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