Adoption Is Not Meant To Be Simple

Following National Adoption Week, the movement for change is gathering momentum. Yet following last week’s debate in parliament, I retain my doubts about the direction of travel.

Members from all sides praised the efforts of adopters and for that matter foster carers too. There was cross-party agreement that there were no straightforward answers because the system unavoidably meshes different organisations and professions, such as the court and social services, and to be fair there was little direct criticism of social workers themselves and acknowledgement that they themselves are frustrated with delays in the system.

Speakers from all parties took their cue from the Prime Minister’s comments during questions at the beginning of NAW:

“the Government pledge that we will make the process of adoption and fostering simpler. It has become too bureaucratic and difficult, and the result is that it is putting people off.”
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Little Hope In The Big Society

Although I’ve been to the centre once before, I’m lost in the maze of this industrial estate. Every unit looks the same, sharp angles and harsh functionality, and my satnav has given up. I think it’s shrugging in helplessness so I turn it off, park up and walk.

 

After a couple of aimless minutes, a low building down an alley catches my eye and I head towards it, the 60s brick, rusting metal rectangular windows and a couple of portacabins the clues I need. This must be an ex-council building. Inside, the faded paint, slightly stained carpet and chaotic noticeboards are welcoming and familiar. I’ve spent the majority of my working life in places like this and amongst the shabbiness I feel right at home.

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Retreat into the Medical Model

Like just about everywhere else in the public sector, Child and Adolscent Mental Health Services (CAMHS) are feeling the effects of the cuts. As in so many other areas right now, jobs are having a nasty habit of not getting re-advertised when people leave. We haven’t yet had actual redundancies in our neck of the woods, but the whispers are in the wind.

Particularly vulnerable to the cuts are the psychotherapists – psychodynamic therapists, family therapists, art therapists, play therapists. There aren’t many of them employed in CAMHS, but their influence extends beyond their numbers. I’ve had some fascinating conversations with our psychodynamic therapist who keeps “accidentally” leaving papers on attachment theory on my desk. The opportunity to co-work with systemic and family therapists has genuinely transformed the way I conduct my clinical practice. They don’t just change kids and families. They change their colleagues too.

We get a complex mix of cases coming through our doors. Kids with neurological disorders such as ADHD and autism. Kids who have been abused, neglected or traumatised. Young carers to physically or mentally ill parents. Families under enormous strain, or with tortuous family dynamics. Educational issues. Child in need/child protection issues. It can be a bewildering variety of problems. To navigate it requires an eclectic mix of clinical models in your toolbox – medical, psychosocial, cognitive-behavioural, systemic, psychodynamic.

In hard times, it seems to be the psychotherapists – with their specialist outlooks and long, arduous training – who are most likely to be for the chop. My worry is that as we retreat to a core of doctors, nurses, psychologists and social workers, we’ll also retreat into a more narrow view of what CAMHS is for and what it does. Possibly diminishing into simply a medication and CBT service.

Don’t get me wrong, I’m not anti-medical model. I’ve worked with plenty of kids who’ve genuinely benefited from a bit of methylphenidate or fluoxetine. I’m not anti-CBT either, though I don’t think it’s the panacea cure-all it’s sometimes touted as. But one of the reasons I chose to work in CAMHS is because of its wide mix of models to suit the equally wide mix of problems that we deal with. Seeing our toolbox get smaller before my eyes is something that worries me.

Social Care in a Time of Cuts

When I went into social work, and still from time to time, I come across more experienced colleagues who have been working in the field for far longer than I and they tell me about the ‘golden era’ of social work.

They tell me about the joys of real generic social work where they might start the day liaising with foster carers and end the day supporting an adult with a mental health need. Where they might have been involved in ‘real community work’ rather than the staid and procedural role that seems to have forced its way into the profession in recent decades.

It seemed to me, as an extension of the human propensity to reminiscence about times and experiences ‘in the past’ with a certain sugar coating. Just as ‘schooldays are your happiest days’ type memories.

As I move through the stages of my career, such as it is, I feel some mild thoughts of ‘how it used to be type nostalgia’ creeping into my own narratives.

I never thought we had particularly ‘good’ times but when I compare the types of care planning and support that was available and look at the bare bones of support provision now, I can’t help but thinking that perhaps we are moving backwards as opposed to forwards.

Social Work in a time of cuts presents a whole new world of ethical dilemmas that previously we might not have faced.

There are some improvements. The roll out of  ‘Direct Payments’ whereby people who  need services were ‘given’ the pot of funding available and were and are able to choose ways to spend it on different and more creative services has been a big step forward.

However this has led to the ‘personalisation’ agenda or the ‘transformation’ agenda or ‘any-kind-of-large-mostly-meaningless-word-you-want-to-add’ agenda which wants to use this model and extrapolate it out. While this certainly provides better systems for some groups of people, the agenda has left others behind, but I’ll come back to that another day.

Regardless of the detail the fact that choice is extended (however poorly in practice it is done – and it is done poorly) and that users are put at the heart of service provision is generally a good thing.

It’s a shame that the push towards ‘choice’ has come in an era of cuts or perhaps it is and always was wholly inevitable. We are seeing an attempt to push the responsibilities present in the NHS and Community Care Act (1990) and the National Assistance Act (1948) away from local authorities and towards individuals. For some individuals this is wholly appropriate and welcome but as we march towards another type of ‘one size fits all’ provision I do worry where it might lead.

We have fewer provisions to ‘hand out’ and eligibility criteria are rising so that fewer people fall into the ‘service user’ category. As a result, fewer carers will be entitled to what sparse support is available for them and the local authority responsibilities shrink accordingly.

My hope as a part of this blog and as a social worker who has and does work with adults is to monitor and process the ‘dying of the light’ or perhaps, on a very negative day what might be perceived as the ‘dying of the support’.

While less state involvement is exactly the right thing for a lot of people, we have to remember those for whom it remains necessary. The old tired ‘throwing the baby out with the bathwater’ phrase can be overused but I’m going to take the liberty of referring to it here because it explains to me what I see as happening to our social care and health services at the moment.

We, who see it from the ‘inside’ have a duty to report and share with those who might not be aware as it’s happening.

We need to fight.

Big Society vs Actual Society

In the week that the Conservatives are holding their annual conference, an opinion poll of voluntary sector workers was published. The poll asked whether they thought Cameron’s Big Society initiative had resulted in an increase in volunteering.

95% of those polled said no.  If they’d seen any increase in volunteers, it had been as a result of people needing something to do with their time because they’d been thrown out of work.

Well, yeah, it’s an absolute shocker, isn’t it? Who would have thought the Big Society would turn out to be empty window-dressing? A meaningless lecture from a bunch of career politicians, lawyers and PR types, intended to make the decimation of our public services slightly more palatable.

Meanwhile, there are those of us who have invested our time and careers in society – doctors, teachers, social workers, nurses, voluntary sector workers. Some of us were doing it while Cameron was busy trashing restaurants with the Bullingdon Club. We’re starting to see the headlines about public sector cuts translating into services shrinking and in some cases disappearing.

I’m a worker bee in an NHS trust. Whether I speak to colleagues in my own trust or neighbouring ones, I hear the same words being uttered. Talk of recruitment freezes, of posts being deleted when people quit, constant memos offering voluntary early retirement schemes, offers to “buy” extra annual leave in exchange for a pay cut. No talk of actual redundancies…yet.

Part of my job involves liaising with other agencies – social services, schools, voluntary agencies. I hear the same talk with them, except in their case it’s even worse. We heard a lot of comforting assurings in the run-up to the general election of how the NHS would be “protected” from the cuts. In practice, “protected” has turned out to mean “a bit less awful”.

This blog will be about the actual society. Not the “Big Society” dreamed up by a political PR machine. It will be by and for those who work in or use health and social care services. Other authors will be joining and introducing themselves in the next few days.

The social consequences of the economic crisis have been severe, and there’s likely to be more to come. We intend to provide the dispatches from the front line. Watch this space.