Why the Jeremy Forrest case is NOT a love story

[Trigger warnings: sexual abuse, grooming, victim-blaming]

Clearly the Sun must have either a short memory or a lot of gumption. Today they’re trumpeting the headline that Jeremy Forrest wants to wed the teenage girl he abducted, and the girl’s father would be happy to walk her down the aisle. Yesterday they reported that other teenage girls, some as young as 13, had received advances from him. The story focuses particularly on one girl who describes what sounds like some fairly classic grooming behaviour, while another was touched inappropriately and a third was receiving texts and online messages from him.

Really, Sun? From sexual predator to star-crossed love story in the space of 24 hours? Don’t you read your own newspaper?

I’ve read a lot of comments on social media trying to depict the Forrest case as some sort of modern-day Romeo and Juliet, in which the authorities have simply over-reacted. The trouble is, such suggestions are immediately scotched simply by reading the judge’s remarks prior to sentencing. There are almost no mitigating factors and a whole slew of aggravating ones.

Just to prove what absolute rot is being spoken out there, I’ve juxtaposed some excerpts from the sentencing remarks with a selection of quotes that I found through a quick trawl on Twitter. The sentencing remarks are in bold. The tweets are in italics.

“I really don’t understand how Jeremy Forrest is guilty of abduction when she willingly went with him”

“the evidence showed clearly how concerned your fellow members of staff were for your reputation as a teacher. They responded to the reports from students of your behavior and their own observations. Time and time again between Feb and July 2012, they warned and advised you and offered you support. You lied to them as to the nature of your developing relationship and denied sending the messages and photos that pupils had seen.”

“This is so wrong, she consented”

“You even complained that the rumours that were circulating were lies by X. You lied to her mother and complained that X’s silence in relation to those ‘false’ rumours was ruining your career and that she was harassing you. She felt mortified that her daughter was behaving in that way.”

“Wife and him were distant well before this happened. She didn’t and still doesn’t get on with her Mum. Jeremy was her saviour.”

“I am satisfied that you deceived X, too, about the true nature of your relationship with your wife.”

“Prosecution used terms like ‘paedophile’ and ‘grooming’ and the jury bought it.”

“I have seen nothing in the evidence which shows that at any stage you tried to provide proper boundaries between yourself and her, to discourage her, or let other staff deal with the matter appropriately. Indeed all the evidence shows that you encouraged her infatuation and provided opportunities for her to communicate with you and be alone with you.”

“Maybe she exploited his sensitive and caring vulnerability :-)”

“Your research into what might happen to you, if caught, is proof of the deliberate nature of your behavior.”

“I don’t really get how Jeremy Forrest got 5 and a half years, he didn’t exactly abduct her or do anything she didn’t want :S”

“On 20th September you took her to France. I suspect you went for your own purposes. In taking her with you, you subjected her family to appalling distress and concerns for her safety. You made no attempt to think of their welfare or let someone know she was safe.”

“he may have done it the *wrong* way, but he potentially saved her from suicide or some other fate on her own in France”

“You have contested the abduction charge raising a spurious defense, so that she had to give evidence, evidence very different in content from her original account and designed to support it. She had clearly received assistance in relation to what she should say.”

“He said sorry for failing her, and putting her through all the proceedings – that’s what a genuinely caring guy would do :-)”

“Where is that genuine care for her welfare that is the hallmark of a truly loving relationship?”

Rich Pickings In Foster Care

In January the Financial Times carried a piece about the investment potential for private companies seeking to invest in foster care. Entitled Fostering Sector Ripe For Consolidation, it begins in seductive fashion not with high finance or balance sheets but with the personal experience of carers who are clearly dedicated to the disabled child they look after. They don’t do it for the money – you couldn’t, because as they say it works out per hour at a fraction of the minimum wage. And that’s the last time children are mentioned as anything other than a commodity.

The economy of care has always been mixed and many private companies do excellent work, often with some of the most damaged children and young people. Yet the language of the balance sheet rather than the review form sticks in the craw and masks the realities of caring for vulnerable children to the standard they deserve.

Companies, including private equity, are attracted to the sector because of the potential for “cost savings” and “economies of scale”. Fostering is a “growth market” – Peter Connolly’s death and the increase in care admissions that followed becomes an investment opportunity.

Large companies from the health sector as well as private equity are gazing enviously not only at potential profits but also at the relatively high number of small to medium size firms who are ripe for a buy-out or as they call it, “consolidation”. Small-scale one or two person businesses, often started by social workers or foster carers from their spare bedroom, propelled the exponential growth in the independent fostering sector that began in earnest in the mid to late nineties. Now, IFPs care for almost 40% of children and young people in foster care.

However, many of the originals are keen to sell. Smaller providers feel pressured because of competition, the administrative tasks around Ofsted and contract compliance and the tender/contract process leaves less room for niche providers. They may also be coming toward the end of their careers and need to provide for their retirement. I’m not blaming them – these small companies led the way in the development of excellence in foster care practice in the days before and after regulation. With the big boys moving in, it’s hard to keep going.

This isn’t the world where we talk of standards of care, of healing relationships between carers and vulnerable children, not even of outcomes or aspirations. This is “the fostering space” where consolidation provides opportunities for profit, where large concerns, often multi-nationals from the health and, latterly, service sectors could invest and please their shareholders. This world has its own language: “It’s a classic private equity play. Private equity have been consolidating and investing in the fragmented domiciliary care space for the last five years and have begun to exit those investments to facilities management businesses. You can see something similar occurring in the fostering space.” I genuinely do not know what that means.

This is not new and I’ve written about it before on NSBS “Children In Care Are Big Business”, to the point where the FT article niggled away but I had not intended to go over old ground again. However, what made me write this was something I found out this week. Another private company (not the one mentioned in the piece) works at a profit margin of 30%.

That’s plain wrong. It may be irrational, it may be unusually high (although but I suspect it isn’t), for all I know I could be a wishy washy mung bean eating sandal wearing pinko liberal bleeding heart, but that’s an excessively high profit margin. As my piece from last year suggested, the best way to make money in fostering is to limit the services you provide for children and cut corners on matching, the process by which a child’s needs are matched with the capabilities of the carers. Take any placement, the money comes in and if it fails, blame the child or put it down to experience and move on to the next referral. Plain wrong.

The other way is to charge an inflated fee, which hurts cash-strapped local authorities struggling with constrained budgets precisely at the time when numbers in foster care are going up.

It chimes with other things that I have been told around and about. Carers from a private company who were told that allowances and services for children were to be cut back because local authorities were cutting their fees, when I know that company has increased the price it charges. A group of carers looking to change providers after the CEO arrived for a football match in his helicopter. Most tellingly, from my own experience on interview panels, the number of social workers seeking to move jobs because their professional standards have been compromised beyond redemption. Managers instruct them to take a placement when they know the match is not right.

I knew one of the candidates. She used to work for a small private company with a deserved reputation for long-term commitment and success with complex placements. The man who put this in place regretfully sold up after twenty years to a large national private company. Now, placement support services like therapy have been cut and she is forced to meet targets regardless of how appropriate the placement may be. That’s what is happening in the fostering space right now.

The Socialist Workers Party: Sex, Power and the Abuse of Trust

[Trigger warnings for rape and sexual exploitation]

I’ve blogged a couple of times about the scandal engulfing the Socialist Workers Party, an organisation I regard as closer to a cult than a political party. Just to recap, a senior figure in the SWP was accused of rape by a female party member. Rather than call the police, the SWP held an internal inquiry by a “Disputes Committee” made up of the accused’s friends, who completely exonerated him. Details have been published on the internet, prompting an internal revolt.

There’s been intense discussion of this on various left-wing blogs. This has resulted in details emerging that paint the whole affair in an even more disturbing light, bringing to bear issues over possible abuse of power dynamics.

To summarise these details, here’s a post by former SWP member Anna Chen. She replied to an exhortation by one of the SWP leadership not to listen to “filth” on the internet.

WHAT IS FILTH?

“Filth” is an alleged rape taking place when a woman is nineteen, 2 years after she and her party leader meet, at which time he is forty-six and she seventeen.

“Filth” is an appeal to the party’s internal disciplinary body being met with a kangaroo court run by several of the party leader’s friends, who then exonerate him.

“Filth” is the woman denied access to his evidence while he sees hers: the game is surely “I’ll show you mine IF you show me yours.”

“Filth” is a woman ostracised, cast out as unclean with a scarlet letter “A” carved into her forehead.

“Filth” is her friends put under heavy manners by the party’s attack dogs, fresh from their two-minute hate.

What particularly concerns me here – quite aside from what sounds like allegations of disgraceful treatment of the woman by her party – is the age difference between the two people involved. When they met he was 46, and a party leader, and she was only 17?

Given the widespread discussion of the case on various blogs, I don’t think it’s breaching any secrets to say that the accused is Martin Smith, former SWP secretary, and currently the national organiser of Unite Against Fascism. My understanding is that he denies rape – not that the truth can now be established either way. The SWP’s kangaroo court will have massively prejudiced any attempt at a criminal prosecution. However, he admits to having had a consensual sexual relationship with the girl in question.

There’s references to this in the transcript of the Disputes Committee report, which was leaked onto the Internet.

We also however thought it was important to be clear that the disputes committee doesn’t exist to police moral, er, bourgeois morality, so we agreed that issues that weren’t relevant to us were whether the comrade was monogamous, whether they were having an affair, whether the age differences in their relationahip, because as revolutionaries we didn’t consider that should be our remit to consider issues such as those.

Trouble is, this isn’t just about “bourgeois morality” but power relations. Let me draw an analogy. Normally, the age of consent for sex is 16. However, if the older person is classed as being in a “position of trust” over a younger person, then the age of consent runs up to the 18th birthday, for the simple reason that trust can be abused. Teachers are an example of this, and I previously made this point while discussing the Jeremy Forrest Case. As a nurse in Child and Adolescent Mental Health Services, I too would be classed as being in a position of trust. Hence if I slept with a 17 year old patient I wouldn’t only be committing gross professional misconduct. I’d also be committing a crime under the Sexual Offences Act.

Obviously, leaders of Trotskyist sects are not subject to the same legal obligations as teachers and nurses. Even so, the power relation still exists. When considering the power relation, remember that the SWP is absolutely notorious for authoritarianism, control-freakery and groupthink.

At its most extreme, the sycophancy appears cult-like.  A number of [Central Committee] members are big fans of jazz music. Under their leadership over the past few years, the party has organised a number of (mostly loss-making) jazz gigs as fundraising events.  Regardless of their own musical tastes, comrades were told they were disloyal if they didn’t purchase tickets.  This elevates the cultural tastes of the official leadership to a point of political principle; and clearly is not in any way a healthy state of affairs.

This is an organisation that claims to speak truth to power. Yet they seem incapable of understanding the potential for abuse of power when a middle-aged party leader is having sex with a teenage volunteer barely old enough to be out of school.

Then again, maybe their relationship had nothing to do with power relations, and Mr Smith cuts a dashing Robert Redford-style figure?

 

Moving On and Looking Back

Forgive me for the slightly self-absorbed post. Blogging by its nature can be the epitome of self-absorption but I attempted to write with a look to the wider world, particularly in the sector I know best, social care. I put this in the past tense as this will be the last post I write.

When I started writing, I had the voice of a social worker and AMHP (Approved Mental Health Professional) in a Community Mental Health Team. I was trying find that voice amid the policy and processes that we found ourselves, as practitioners, caught up in and trying to extend outward some of the frustrations and observations garnered from the ‘frontline’. It felt and it feels like that policy happens from afar, away from the homes I visited, the wards we attended, this was my world and it felt like a completely different world from the one defined by officials in the Department of Health when they remember ‘social care’ is a part of their remit.

I believe wholeheartedly in social work as a profession and social workers as professionals but I became frustrated at the lack of professional leadership. There is no doubt that the last year of my professional life has been one of the most challenging. I’ve worked in social care for 20 years (gulp – I look younger, I promise!) as anyone can imagine, I’ve seen many changes in that time. ‘Reconfigurations’ were nothing new to me. Working with change and in organisations that change frequently is one of my fortes but the most recent one was the most painful by far. While parts of my job, I loved – particularly when I was able to work with and alongside individuals and families and walk with them through some of those moments of crisis – working in an organisation and delivering services which were being ripped to pieces was difficult. Defending organisational decisions became impossible. The fight was still there inside me to promote and present a better way of working and honest interactions with everyone who needed our service, I saw waiting lists grow and discharges of people who I felt would benefit from more support. I saw the effect of the programme of cuts in the NHS in a very visceral way. I was and am very lucky. I have been able to walk away. I find myself in a job that excites and interests me and presents many new challenges. The same ease with which one can move on cannot be said for those who are reliant on the support of social care services and I remain acutely aware of my privilege in being able to.

I found a different (but related) job and thought I’d be able to continue writing with the passion I never stopped having but I can’t. The situation has changed and the voices need to be heard from the frontline I’ve stepped back from. I have become the person I resented for so many years. As a social worker, I always had a hint of scorn for those who took the ‘desk jobs’ and moved away from the direct work with people who use the services we provide but I’ve become one of those people.

In defending myself to the old me, I’d say that changing the world can happen in different ways. I am no less committed to the same ethical standards of making the world of health and social care better for those who use services. I am seeing that social work and social care happens in many different places. Is it an attempt at justifying my decision to leave social work behind? Yes, probably but that’s something I’m reflecting on a great deal at the moment.

I have been disillusioned by the time I spent working in the statutory sector as a social worker. As a parting salvo as I head off into the sunset, I want to reflect on a couple of themes that revolve around social care at the moment.

Kneejerk funding decisions lead to more expense, both in terms of quality of life and finance in the longer term. I’ve seen panic cuts both at a national and local level. The problem with panic cuts is that the things that are easily destroyed cannot be built back up in the ‘good times’.

‘Choice and control’ the buzzwords of change ring very hollow to me now as I saw in both the NHS and the local authority, the way that data and information is manipulated to meet performance targets that are meaningless to people who use services. Choice is one of the most nefarious words in the sector in my opinion. ‘Choice’ is very much defined by what organisations allow to be chosen and the confidence, communication skills, advocacy support of the individual doing the ‘choosing’. I railed against processes that favoured ‘he who shouts the loudest’ but it was to no avail. Presented by the government as a panacea of positivity, I have seen the downside of ‘choice’. It has been the creation of a two-tier service in adult social care that provides those who are able to choose with fantastic opportunities but those who may not have the capacity/support to choose are left lagging behind, in poorer, oft forgotten services. With funding drying up and fewer third sector organisations able to pick up the slack, there is a massive void of support which often falls on family and friends – the ‘informal’ support networks that the government still feel able to criticise.

Dementia care is a particular interest of mine. Professionally I have worked in the area for a number of years. Dementia is moving further forward in terms of government policy making and the so-called ‘dementia challenge’ which is currently trying to increase diagnosis rates. That’s all well and good and I won’t enter that conversation but I will say this. In order for dementia to be better understood by the public it has to be better understood by the government agencies who are supposed to be providing the information. There is a horrendous lack of information about the role that supportive social care services play in improving the quality of life for people with dementia. As I worked alongside a ‘memory clinic’ which had been decimated by cuts, I laughed hollowly at the words of the government ministers about increasing diagnosis rates in primary care and for hospital inpatients. See my first point about panic cuts and lack of cohesion. Reading some of the Department of Health missives you’d be at a loss to think they ever discussed any of their plans with anyone with a current social care background. Perhaps the new Chief Social Worker (or one of them anyway) will provide a sticking plaster to this but it’s very apparent at the moment that there is no cohesive, current social care voice in the government department and it makes some of their policies woeful. The level of ignorance even of government ministers who clearly haven’t been briefed by people who understand social care would be embarrassing if it weren’t desperately sad.

Lastly about Social Work itself. I retain my social work registration and will now until 2014 at the very least. I suspect far beyond that as I don’t want to give up my registration. I am very proud to be and to have been a social worker. The ethics and values of the profession can really shine a light and guide many of our colleagues in allied professions and we shouldn’t be shy of realising our own worth. Often I hear social workers talk of status and comparing ourselves unfavourably to nurses, teachers, doctors, psychologists etc. We shouldn’t need to constantly compare. We have a fine profession with its own knowledge base, standards and codes. Having worked in a multi-disciplinary mental health team (and I think being an AMHP helped with this as we are known to be a stubborn and independently minded bunch) I never felt anything but an equal to the other professionals I worked alongside (and challenged – psychiatrists – I’m talking to you ;)). We do need to ‘sell ourselves’ more and we can’t rely on waiting for ‘good press coverage’. Do the job, however hard, with the ethics and values at the heart and remember why we are there – it isn’t to promote organisational will but to walk alongside and guide. Sometimes there are difficult, coercive decisions to be made but reference to values and ethics become all the more important there. The nature of a job that sometimes has a coercive function is that ‘hearts and minds’ will never be particularly straightforward. I didn’t become a social worker to make friends or to swan in adulation of my ‘goodness’. I went into it because I felt it gave me more opportunities to make a positive difference in someone’s life. More often than not, certainly over the last couple of years, it became more about saying what wasn’t possible than what was – but if I could deliver that with as much humanity and empathy and transparency as possible, it could be a start.

Many thanks to Zarathustra for this space and for the support he has offered to me.

And thanks to everyone for reading, commenting and responding over the last year or so. My reasons for stopping are work-related but not in a bad way. I just think my voice has changed now and it’s important that those ‘on the ground’ have the way left open to them to find it. I won’t say I’ll never write again, I may at some point in the future, but if I do it won’t be anonymously I will, though continue to knock around on Twitter I expect!

Goodbye

Exporting Care

Location, Location, Location

Yesterday I read this article in the Guardian. It reports that in Germany there is an increase in Germans being placed in residential, retirement and rehabilitation units in eastern Europe where the costs are lower.

As the article says

Germany’s chronic care crisis – the care industry suffers from lack of workers and soaring costs – has for years been mitigated by eastern Europeans migrating to Germany in growing numbers to care for the country’s elderly.

But the transfer of old people to eastern Europe is being seen as a new and desperate departure, indicating that even with imported, cheaper workers, the system is unworkable.

But before we are too quick to castigate Germany, I think it’s important that we look at what happens in this country.

Until one month ago, I was a local authority employed social worker, seconded into an NHS Trust (as I was a mental health social worker) working predominantly with older people. I made a lot of residential and nursing placements. I worked in an inner London borough.

The amount of local placements we had came nowhere near meeting the needs of the local community. Yes, there has been a push towards caring for people longer at home – perhaps it was a feature of central London, perhaps not,  but many of the people I worked with did not have family around them. The cost of housing had pretty much seen to that in terms of ripping communities apart.

Still, there are pockets of close communities even amid the high towers of the financial centres of London. Among the office blocks and fancy shopping streets, there are communities that have evolved over the decades, centuries even and those tourist spots visitors see, they are ‘home’ to many people who might not wear the smartest suits or have the fanciest accessories.

We ‘converted’ some of the residential provision locally into ‘extra care sheltered’ provision – see, that would be good, that would ‘keep people at home’ for longer.

So where are we now?

The chances of getting a placement in the local area are very slim to zero. We had waiting lists months long for some of the residential provisions in the area. The wonderful ‘extra care sheltered’ housing provision realised soon that they could not manage the needs of those who needed 24 hour residential support or maybe the criteria for residential care moved higher but they have not truly become an alternative for someone who needs a residential placement. They have become a safer environment with a constant ‘warden’ for those who may otherwise have had sheltered accommodation.

So there are fewer residential and nursing placements for people who are local to the area. If a family shouts and hollers enough they may get someone on the ‘waiting list’ for a place. Who knows when that place will come up. We don’t like saying it explicitly  but places in residential and nursing homes usually come up for one reason and that’s a death or a deterioration in physical health and noone wants to think about that.

What does a local authority do then?

It moves people out. It is more likely to move out people who have no family support and no ‘links’ to the area. You see, living somewhere for 70+ years isn’t seen as ‘link’ enough if your family and friends aren’t there. Anyway, even if they don’t want to move you out, if there are no beds, there are no beds.

So while we aren’t moving people to other countries, that’s only really by virtue of us being an island. We aren’t that much better than Germany in this respect. We are moving people to unfamiliar settings and localities on the basis of cost alone.

Commissioning Quality

How are these decisions made? Well, to absolve myself from responsibility, I’ll say it wasn’t my decision. I did and do rage against it. I raised it internally as the ways these decisions are made are purely on the basis of finances of local authorities to make placements.

Currently, in inner London we are placing frequently in outer London but soon it will be the Home Counties and further and further away from familiarity. I wonder how consistent this is with the Mental Capacity Act which demands previous preferences are taken into account. This can be ridden over roughshod if there aren’t any local placements at the right cost.

So we move to commissioning. There has been a race to the bottom in terms of providing services and placements at the lowest cost. Property is a massive cost in central London so cheaper land can push down general cost but at what price to autonomy and preference?

There has to be a way for commissioners to be accountable for the decisions they make. Families can push and make complaints on behalf of those who are not able to make decisions for themselves but there really needs to be, in my opinion, some external scrutiny of commissioning decisions made by people who really understand the social care sector. Yes, councillors can scrutinise but how many understand the needs of those who are not pounding on their doors making complaints about council services? Who understands that those who have the quietest voices or who have noone to advocate for them may be having their rights ripped away from them?

I’m not sure of the answers. All I know is that I wish the commissioners would have listened to their social workers. I wish there were a stronger, formal system of advocacy which would raise these issues with people who commission services and I wish there were an understanding in central government of the impact that geography makes on the cost of social care.

There may be cheaper and more available placements in South Yorkshire but that doesn’t mean the answer is placing Londoners there. I fear it may well be in the future.

We can’t become too complacent. Germany today may well be Britain tomorrow.

Beyond Winterbourne

Yesterday, the Department of Health published ‘Transforming Care : A national response to Winterbourne View Hospital’ (PDF)  the ‘final report’ about learning and developments following the case which highlighted, via a BBC Panorama documentary, the systematic abuse which was embedded in the running of a private hospital for people with learning disabilities ‘with a stated purpose of providing assessment, treatment and rehabilitation’.

The failings were found not only in operation of the hospital  but in a complicated and confused health and social care system which on the one hand seems to have been moving away from ‘institutionalisation’ over the past few decades while on the other hand commissioning services which embed institutionalisation and powerlessness into failing and very expensive systems’. The case of Winterbourne View also highlighted the failure of the regulator, the CQC, to respond to information provided by a whistle-blower and of local authorities and commissioning NHS Trusts to actually quality assure the services which are being provided.

Another related report which was also published yesterday (PDF)  came from Family Mosaic – a housing association which provides supported living services which highlights its own failings in terms of poor care and proactively looks at new policies and ways to turn this around. In a way, the Family Mosaic document – is a testament to an organisation which wants to learn pre-emptively and the organisation should be applauded for producing it.

I want to look at some of the issues in both these reports as I think they are  linked,.

Lessons from Winterbourne View

The introduction to the report sets the context of Winterbourne View Hospital – a placement for 24 adults with learning disabilities. The report explains that 48 patients had been referred there since its opening in 2006. The average cost of a placement was £3500 per week and

‘13 were referred by commissioners within 20 miles

12 were referred by commissioners within 20-40miles

14 were referred by commissioners between 40-120 miles

9 were referred by commissioners over 120 miles’

14 separate English NHS commissioning bodies had acquired places there plus some unspecified (presumably a problem with exact data) from Wales..

You’d think that maybe there’d be quite a lot of quality assurance going on with all that money streaming in.

Both the Serious Case Review and this report pick up on the amount of lost opportunities in terms of communication between agencies – between commissioners and between primary and secondary health care services. There has been a lot of confusion – not least from the Secretary of State about the position of Winterbourne View but that fact that it was a hospital and received detained patients (rather than a care home which it has been incorrectly yet frequently referred to) means some of the responsibilities and monitoring processes would be different.

The police, hospitals, commissioning bodies, local authority (who was responsible for safeguarding alerts), CQC Inspectors and Mental Health Act Commissioners seemed to have failed to ‘join the dots’.

While the Serious Case Review goes into detail about what went wrong, this report is more interesting in terms of what is going to happen next.

What is happening as a result

Immediately the CQC changed some of the systems for pulling in whistleblowing information and started an inspection programme for learning disabilities settings.

There was to be (and is to be) a focus on more local settings where possible as distance from family and familiar settings is crucial. Where it is not possible the placing authority should remain in close contact and plan moves back to local areas as soon as possible. A long term distant placement is not an option.

Hospital the report states, which should be obvious I guess, is not a long term placement and should only be used for the minimum time necessary.

If it is necessary at all.

The report talks about the need to listen to people with learning disabilities and their advocates as ‘not listening’ was a big failure. It’s important that listening is beyond hearing what someone might say as well – particularly if there are communication difficulties. It’s important that those who don’t have families to advocate for them are heard as well. Fortunately the report touches on the need for strong advocacy services to be developed.

What will happen

The Department of Health has set a timetable for June 2014 for a ‘rapid reduction in the number of people with challenging behaviour in hospitals or large scale residential care’.  These numbers will be monitored by the DoH.

I am interested when the report talks about ‘people with challenging behaviour’ if they are just referring to people with learning disabilities. My hope is that they aren’t and this will apply equality to those people who have more advanced dementias and may display behaviours which could be interpreted as challenging due to communication difficulties

There is an emphasis on ‘personal care plans’ being developed which partly shows the failing of the personalisation agenda to date as it has completely passed by swathes of people with the highest needs. Maybe there’ll be some attempt to ‘catch up’ now. Let’s hope.

Interesting to that the report nudges the CQC to consider the ‘model of care’ delivered in terms of regulation and compliance. .Personally I’d see that meaning that these larger institutions inherently carry a ‘higher risk’ but it will be interesting to see how that develops.

Interesting that the report focuses (rightly) on the involvement of ‘families and self advocates’ in driving quality and change. My only comment would be a plea for the Department of Health not to forget those people who have very high support needs and who are, due to their cognitive impairments, not able to ‘self-advocate’ and who do not have family advocates. There is a gap here and often these people are at high risk of abuse due to the lack of ‘supporting voices’. There must be a way for formal advocacy to speak on their behalf.

Strengthening Corporate Responsibility

The report also looks at the organisational failings of Castlebeck and the lack of responsibility taken by the organisation itself.  The report urges the CQC to take more enforcement action organisationally if necessary and there has been a move to appoint ‘Corporate Compliance Managers’ – presumably to hold large organisations to account.  The Department of Health will also be looking at the way the CQC are able to ensure the ‘fit and proper person; test which is applied to registration can apply to organisations – whether a board member is nominated to be responsible. However the powers do not exist in legislation for the CQC to check more than one appointed person. This is something that strays into the ‘to be decided’ part of the action plan but no doubt will be an interesting space to watch.

Improving Practice

The report highlights good practice in the hope it will be modelled  more broadly. A voluntary register for people working in adult social care is being mooted. Personally I favoured full regulation of the social care workforce but that’s likely to be too costly to organisations who are working on minimum wage payments to many staff whom they don’t necessarily want to professionalise even though the work is crucial. The low status of social care work is inherent in the attitudes of employing organisations. Training is important though and so is modelling of good care. While compassion doesn’t cost, environments in which it can flourish are better sustained when staff aren’t under constant pressure and are treated, themselves, with respect.

Whistleblowing mechanisms are mentioned and tightened where they haven’t been already.

Particularly interesting to me as a (now) ex-AMHP and BIA was mention of the Mental Health Act and Mental Capacity Act. The report confirms that 73% of the people are Winterbourne View were detained under the Mental Health Act. They should have had statutory protections of appeals and access to IMHAs. It also makes one wonder under what grounds the other 27% were being detained. Was it –really- ‘informal’? Were DoLs ever used? If not, were there any questions asked by those visiting about why or why not?

One of the most interesting ‘key actions’ to me is that

‘The Department of Health will work with CQC to agree how best to raise awareness of and ensure compliance with Deprivation of Liberty Safeguards (DoLs) provisions to protect individuals and their human rights and to report by Spring 2014.

I have a particular interest in DoLs – their use and their lack of use so will certainly be keeping a VERY close eye on this. I’ll try not to be cynical. I’ll really try.

Family Mosaic’s proactive report

Family Mosaic’s ‘No Going Back’ report (PDF) unfortunately has faded into second place in this post but it almost deserves more than one post to itself however the themes link in so tightly with the Winterbourne View Review.

I’d recommend that both reports are read together and it is commendable that Family Mosaic as a provider organisation have looked proactively at how they can do better in terms of challenging institutionalisation and poor practice among their own staff.

The report looks at the history of ‘deinstitutionalisation’ and the move to Community Care principles but also where the failings have crept back and cultures where care may be delivered in different settings but where the quality has been in question and abuse has resulted.

The organisation provides examples of poor and indeed, abusive care in its own settings to look at how to improve and what to offer in terms of building a better culture of delivery of care.

One of the interesting aspects they consider is the lack of ‘whistleblowing’ so that staff who might witness poor care and who have been on the requisite training may not feel they are in a position to report it or may not recognise it when they are involved in the delivery.

The report focuses on aims and action points for the organisation as a whole including a more open policy towards whistleblowers and those who raise concerns internally.

It explains clearly basic expectations for delivery of services to service users by staff and all in all, it is a fantastic piece of work by Family Mosaic who should be commended.

Conclusion

These two documents offer a way forward for delivery of care and attitudes towards those who need care. I wish we had a Winterbourne View type document and review of care for older people, particularly older people with dementia and hopefully when the document refers to ‘people with challenging behaviour (a term I don’t really like to be honest’ it isn’t only referring to those in learning disabilities settings – however I fear it is.  We need to have a wholesale reappraisal of large institutional settings for care delivery – be they hospitals for people with learning disabilities or 90 bedded nursing homes for people with dementia. Age/cognitive ability/family involvement/means to self-advocacy cannot determine ones right to dignified and high quality care.

Family Mosaic have presented a good model that moves beyond care for those with learning disabilities – I hope more providers take notice and take a proactive response.

However, there will be costs and if the government is truly intent on building better services across the board and for all sectors, there has to be an understanding that the money will have to come from somewhere.

I hope it will happen. The right noises are being made. I just hope the results are equally satisfying.

On Change

So I’ve ‘come out the other end’ so to speak and made the leap from a frontline social work post into another job. While I don’t want to cover the specifics of what I’m doing – that may come with time – except to say it’s related – I wanted to pause and consider how the move has gone.

On the positive, having come from being a social worker seconded into an NHS team employed by a local authority that barely seemed to remember that it had Mental Health Social Workers and couldn’t quite grasp the fact that not all of their employees could access their LA intranet/email system, it’s actually really pleasant to be a part of an organisation that remembers I exist!  While it can be easy to joke about, it could get both frustrating and lonely being out on the periphery between NHS and LA – owned by neither – and ‘belonging’ to an organisation can be important psychologically and certainly helped develop a loyalty to an organisation.

Organisational loyalty can be positive in the sense of belonging but there’s also a need to see beyond ‘blind loyalty’ and to be aware of accepting criticism where necessary.

I’ve done a lot of ‘meeting’ of people. One of the most refreshing developments over the last week is that I’ve met many people from different occupational backgrounds in a ‘work setting’ and that’s actually something very new for me. I’ve worked in social care since 1993. Gulp. While I dabbled briefly in another field for a couple of years since then, that was in a very different context but basically it’s been a LONG time since I’ve had constant contact with people who haven’t worked in the health and social care sector.

It has allowed me to see the world and particularly the sector through ‘different eyes’. So much of our ‘system’ makes no sense whatsoever that I’ve almost become used to it.

Putting more money into dementia screening but not providing any services for those who have dementia diagnoses to garner more personalised support makes no sense yet it will ‘tick another box’.

‘Personalisation’ in name only while Local Authorities deliver exactly the same ‘managed personal budgets’ that they did before the individual had an ‘personal budget’ with no more choice’.

The existence of residential care provided at high cost which delivers poor quality via staff on minimum wages while profits siphoned upwards.

None of this makes sense in the sector and yet the challenges to some of these from within the sector need to be listened to.

I’m in the middle of solid induction programme. The last proper induction I had was when I did my last social work placement which was.. um.. quite a few years – and a few jobs – ago. It’s something I’m trying to make the most of.  There’s a lot of learning which is exciting to me. I enjoy learning and while the skills I have are those which got me to the point of ‘getting the job’, I will need to develop a lot more to move on.

I’m excited about going to work – I know it’s still early days but while there were parts of my last job that I always loved – there were fewer of them.

On the other side, I miss people. I miss the people I worked with and the families I came to know. I miss my colleagues who were to an individual, a fine group of people who wanted to make a difference despite the organisational obstacles placed in their way and I miss the confidence I had in knowing what I was doing/who to talk to about things/how a particular organisation works.

It will take a long time for me to feel as comfortable in the new organisation as I did in the last one but that took years of experience and relationship building to grow. I had (I think!) a good reputation within the last organisation of working hard and I need to start building another reputation from scratch.

I may need a bit more time to adjust than I thought I would. After a week, fortunately, I still think it was the right thing to do. I’m thinking of the ways I can ‘transfer’ my skills and knowledge. I’m absolutely sure that I will be able to.

I never thought I’d leave ‘frontline social work’. I’ve been reflecting a lot on that. It  was absolutely the job I felt I was ‘made’ for and what I wanted to do. I also thought that those who moved away were ‘running away’ from the real social work. And I’ve done that myself. It was one reconfiguration of services too many as far as I was concerned.  I’m hoping my old team gets some fresher eyes to challenge with and some different perspectives to put some more fight into the sector. One thing the sector needs is more fight. Is staying put and fighting more ethically coherent than moving on when you feel ‘ready’ and challenging from the outside? I don’t know but I will continue to ponder and reflect.

Of course, I remain a registered social worker – having just renewed my registration although I would have registered regardless and can’t see myself giving up that registration ever really – and will continue to relish the values of advocacy and endeavour for better services but will be coming from a different angle.

Maybe it’s just now I’m seeing social work more broadly than I did last week and perhaps that’s no bad thing.

The #Rotherham #UKIP fostering row: Further details emerge

Another day, another set of details emerge about the UKIP fostering row. This time courtesy of the Daily Mail. I’ve said before that I’m not comfortable with the way a sensitive case about vulnerable children is being played out and discussed in the media, but since other people are clearly going to comment on the case, I suspect throwing a tuppence forth from this little blog isn’t going to make much difference in the grand scheme of things.

Last week the Guardian alluded to tensions between Rotherham Council and elements of the local East European community, and yesterday’s Daily Mail fills in some of the blanks regarding this. Apparently the council has been the subject of protests from Slovakian families following a number of removals of children into foster care. These families are accusing the council of “child-stealing” for racist reasons and of trying to impose British values on them. This has led to protests from the Slovakian government who appear to be taking the side of the families.

Though the “British values” in question appear to be things like children going to school, not wandering the streets at 2am, and not living in a mice infestation.

The Mail being the Mail, they don’t appear to see any irony at all in, a couple of weeks after accusing the council of ideologically-driven fixations with multiculturalism, then granting a fairly uncritical interview with an alleged abuser, strongly suggesting that the council are racist towards East Europeans.

The words “shot at from both sides” spring to mind.

And naturally, there’s a rentaquote from John Hemming, an MP who seems to live in a strange parallel world where child protection proceedings are nearly always due to scheming, malicious social workers and hardly ever about averting another Victoria Climbie or Baby Peter.

These arguments appear to have been made in the courts as well as in the media and council meetings, apparently with some success. As the Guardian said,

But a family court judge ruled three of the children should be returned to the parents after the birth parents successfully argued that the council had failed in their duty to ensure the children enjoyed the linguistic right to learn and speak the language of their birth.

In the light of the Guardian and Daily Mail reports, I’m going to make a rough educated guess at the backstory here, which may or may not have to amended as further details emerge into the public domain.

It seems likely that the council would have been anxious to avoid a repeat of this judicial ruling. It also seems likely that they may have been vigilant for anything that would be immediately be pounced upon by the birth family’s lawyers, by the Slovak protesters, possibly even by the Slovakian government and media.

Something like the foster carers being members of UKIP. They may well have been doing a perfectly good job as carers, but that wouldn’t be what the family’s lawyers would say in court.

One could argue that the local authority should have challenged the judicial rulings, ignored the Slovak government and media, and served up the local Slovak community a hefty slice of if-you-don’t-like-our-rules-you-don’t-have-to-come-here. I’ll leave others to argue that one out.

But either way, the application of Occam’s Razor doesn’t require the council to be acting out of an ideological crusade about multiculturalism, or a Labour-inspired grudge against UKIP, in order to have acted in this way.

It certainly doesn’t require any David Icke-style conspiracy theories about Common Purpose.

Such a scenario is entirely consistent with the local authority trying to tiptoe around one set of legal, social and political grenades, and in doing so accidentally setting off a completely different grenade. And that’s my guess as to what’s happened. Eventually time will tell whether I’m right or wrong.

One thing this case does show is how complex and difficult fostering cases can be. When such cases are seized upon for political reasons, whether by UKIP or the Slovakian government, such complexities and difficulties are rarely grasped.

The #Rotherham #UKIP Case – Will Nigel Farage and Michael Gove now apologise?

When the story broke that three children had been moved from a foster family in Rotherham, reportedly for being members of UKIP, I went out and talked to social workers, solicitors and care leavers. Consistently I got a response that the reported account was implausible, and there was almost certainly a more complex story to it. I put up a blog post saying so, and got a barrage of responses, much of them abusive.

Now a more complete picture is coming out about the affair. And – surprise, surprise – it was more complex than that. The details emerging are not of politically-crusading social workers with a grudge against UKIP, but of a difficult court case, dealing with distressing circumstances, with social services trying to comply with court rulings and fend off legal counter-arguments from the birth family.

This was not a case that should have been played out in the public domain like this. These are incredibly vulnerable children and their privacy has been invaded in an atrocious manner. I’m not going to repeat the details here (though people can just go to the Guardian for that)  but the distressing nature of their abuse gives a clear reason why such matters should be kept confidential. Not because social services have anything to hide, but to safeguard the wellbeing of the children.

A badly-handled interview with Joyce Thacker, Rotherham’s director of children’s services, didn’t help. Though with hindsight this is likely to be partly due to being caught on the hop on a Saturday morning, and also partly due to trying to be careful about what she said about a complex case. It may have been better for the council to have simply put out a “no comment” rather than trying to rush out an interview at the weekend.

Quite possibly the foster carers may well now have some difficult questions to answer about the way they went to the media and ignited a political firestorm. But politicians also have some questions to answer about the way they conducted themselves in this case. Nigel Farage practically turned  the whole thing into a party political broadcast for UKIP. Then there’s Michael Gove, the minister responsible for children’s services. He called it “indefensible” though in fact it turned out to be totally defensible. He also called it “the wrong decision in the wrong way for the wrong reasons”. Did he even know the way or the reasons when he said that? Was he even interested, or was he simply putting the Rotherham by-election before his ministerial responsibilities?

Ed Miliband emerges only marginally better in that, unlike Gove and Farage, he admitted he didn’t know the facts of the case and limited himself to calling for an investigation.

If politicians were cynical and opportunistic, some in the media were even worse. For example, the inexplicably-respected blogger Guido Fawkes ran an absolutely barking mad article. “Rotherham’s UKIP Child-Catcher Joyce Thacker Follows Common Purpose Progressive Agenda.” He leapt on a set of conspiracy theories, straight from David Icke territory, that accuse a rather dull training company called Common Purpose of trying to rewire our society along a “Marxist and Fabian” agenda. He concluded.

Thacker is yet another graduate of the Common Purpose organisation which pursues a“we know best” Fabian-style progressive agenda in the public sector. She was a project advisor for a pilot programme, run by Common Purpose, that was concerned with diversity issues in the West Yorkshire area. Something tells Guido she has an axe to grind in this and is not a neutral public servant…

Something tells me that Guido had better hope Ms Thacker doesn’t find herself a decent no-win-no-fee libel lawyer.

Nothing good has come out of this affair. Vulnerable children have had their privacy invaded. Hardworking and honest public servants have been grossly slandered. And why? For short-term political gain in a by-election. The likes of Nigel Farage, Michael Gove and Guido Fawkes need to apologise for their shameful behaviour in this ridiculous and unpleasant case.

Patient Stories – Will we learn?

Today the Patients Association published a report ‘Patient Stories’ (PDF). It focuses on thirteen different stories. These are stories directly about the experiences of patients through hospital systems and discharges. Some are told by family members when the person involved and some are told directly.  Some are anonymised and one is from a doctor who received treatment herself.

The format of ‘telling stories’ is a good one because it makes for interesting reporting. It personalises tales that we know about poorly managed hospital discharges which take place before they should because we hear the voices of those directly affected and it is easy to see the lack of humanity in some of the systems that exist in acute health care.

Sometimes what is remembered is a single comment which may have been made by a busy member of staff in an offhand manner, for example, in relation to Margaret Allen, her sister writes

‘my (other) sister called the hospital to enquire after Margaret’s health before her death. The answering nurse replied that Margaret was ‘screaming away nicely’ and held the phone out for my sister to hear her cries’.

There are some shocking details in some of the stories of miscommunication, arrogance and rudeness of staff, basic care not being given but sometimes it is these snippets of language which are telling in terms of respect and attitudes of professionals towards staff.

While it may be possible to write these off as ‘individual stories’, I think that would be an massive error because there is an enormous amount of learning and themes which can be traced – not just through these stories but through the similar ones that have emerged over many years.

There is a consistent lack of flexibility and a lack of listening in these processes.

An example would be in the story of George Robertshaw who was admitted to hospital and was discharged in a way that his GP felt was ‘unsafe’ due to it being so rapid and was discharged in thin pyjamas in the winter – so that when carers did arrive to him he was cold, hungry, very thirsty and still not well.

His daughter writes

‘Following my father’s death, I again spoke to someone to inform them of my father’s demise and that I would be making a formal complaint re procedures. She told me directly that she would ask a nursing director to phone me back in a day or two, This never happened. No call, no communication, no nothing. I again rang and I was told that they had informed whoever it would be and that they would remind them. I got the impression that the relevant person was present but did not wish to speak to me and was telling the person on the phone what to say

Again, this could be claimed to be an isolated incident but as a rule of thumb and as someone who takes quite a lot of verbal complaints about the services that I provide, I tend to assume for everyone one person who complains or whose family complains, there are far more who will not have the confidence, strength or understanding to do so. It is important that systematic errors are challenged and improved but it is also important that clarity of information and respect are given to those who use services.

I wonder if that same Nursing Director would have been so slow to respond to her own manager? No? Then treat the people who use the services, particularly if they have a complaint with at least enough respect to contact them in the same time frames – even if it’s a matter of updating them with no additional information.

An organisation which is not willing to take or deal with complaints, cannot be a ‘learning organisation’ which is willing to improve.

I don’t have time to identify the issues in all the stories but it is worth reading as a snapshot of some of the care which is being given in hospitals in this country.

Of course there are good stories, and there are fantastic staff. The very first section of the report is based on positive feedback but we cannot ever become defensive about the systems as they exist and must treat each of these experiences as areas of learning. Sometimes it isn’t always about resources, it’s about respect and it’s about listening and responding.

Yes the NHS is wonderful and many of us have personal stories of gratitude, I have many myself, but if there is anything that can be done by any one of us to make things better, we absolutely must.

The main lesson I will take from these stories is to make sure that every interaction is bounded in dignity and respect. Mistakes happen but they can be resolved by listening and learning from those who experience them.

Defensive organisations that won’t encourage criticism are dangerous organisations. These lessons are just as important in all social care organisations as it is in health care.

The saddest thing about these stories is that we have heard similar before. There have been commitments between increasing ‘compassion’ in nursing and care staff but the systems need to become more compassionate too and far more responsive and flexible.

This is a series of awful stories and experiences but they must be learning experiences so that some positive may come amid the extreme pain and grief caused.