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 ‘Red Tape Challenge’ does Health and Social Care

We all knew it would come in time. This wonderful government idea to slash all that awful ‘red tape’ that stops people doing what the government otherwise would stop them doing finally arrives at Health and Social Care.

I had a brief look at some of the provisions detailed as ‘red tape’ for which the government is asking for comment and quite frankly, I am horrified.

What I might see as essential protections, they are presenting as ‘red tape’ and asking for feedback about potential abolition.

This is a consultation so it’s really important that as many people as possible to contribute and in the joyful spirit of openness, the website allows up to see the live commenting on others. I wonder how those with less technological access or knowledge are able to comment quite so openly about some of the provisions up in the air.

But openness and accessibility only seems to go so far and for the government departments responsible they seem to be after whipping up public distaste of ‘red tape’ although actually, we really do need to move from the idea that bureaucracy is necessarily bad.

There is a separate website entirely to focus on ‘ regulatory enforcement’ and where it might be unnecessary.I feel robust regulation (and thus, enforcement which has to follow as a result) is essential. The big problem with social care and health regulation since the CQC was established was the ‘light touch’ type approach which had been taken and the ‘back office’ regulation and not enough enforcement.  I really really hope that it is not cut back further. I want to see more regulation and stronger enforcement, not less of it.

But back to the ‘red tape challenge’. I want to share some of the provisions ‘up for discussion’ that the government has classed as ‘red tape’.  I’m solely concentrating on what is up under ‘Quality of Care and Mental Health Regulations’ as I felt that was the area I knew best. The numbers refer to the list of these ever so demanding provisions in the Excel list here.

39 is that oh so burdensome (!!!) regulation that requires the Care Quality Commission ‘to monitor and access for monitoring purposes, people who are deprived of their liberty’ and necessity to report this to the Department of Health.

40 is a nice one about requiring people ‘who assess Deprivation of Liberty’ to have an enhanced CRB.  – clearly unnecessary because.. er.. people who lack capacity and may potentially be subject to DoLs aren’t likely to be vulnerable, right? I think there’s an issue about effectiveness of CRBs in general but a bit worrying that that’s considered ‘red tape’.

43 is much more worrying as it is the obvious ‘red tape’ which introduced IMCAs as a safeguard for ‘those who have noone to speak on their behalf’ making them mandatory in abuse and review situations. RED TAPE??

55 is another ‘good one’ which ensures that IMHAs are ‘of an adequate standard’ because clearly, that is unnecessary (!?!)

Obviously there are many many more – I’ve just, for reasons of time, picked out a few that interest me personally but do have a look at them and COMMENT.

I’m frankly insulted that some of these provisions are even considered to be ‘red tape’  but as there’s an open consultation, it’s important that as many people as possible who know and understand the implications of removing them, to contribute.

If the government want to know what ‘red tape’ is in terms of adding unnecessary burdens, I’ll gladly explain about how useful (or not) it is to spend time recording how much time I spend on ‘smoking cessation’ work or time spent ‘clustering’ people according to diagnosis into tiny little tick boxes which are, clinically, unhelpful in order to get the ‘Payment by Results’ systems which will never work well, up and running. THAT’S red tape.

But it seems to be red tape that potentially infringes on the rights of those who might be least able to protect their own that they are classing as ‘red tape’ here.

Contribute to the consultation and let’s tell them how important some of these provisions are.

Oh, and someone should tell the Department of Health that the GSCC doesn’t exist anymore as they seem to have forgotten on their Professional Standards page (published this week!) but we know how much interest the Department of Health has in social work and social care so shouldn’t really be surprised.

Pic by Martin Deutsch@Flickr

Crisis in Mental Health Care

Crisis Care in Mental Health – both community and inpatient –  is inconsistent and increasingly unable to deliver quality services.  Mind published a report today following an independent inquiry which they have carried out called ‘Listening to Experience’. This inquiry looked at evidence from 400 patients, professionals and providers and was intended to provide a qualitative shapshot of care in England.

While the press release points out that some outstandingly good levels of care were reported, it is useful to note some of the main points of criticism that were raised.

When looking at some of the examples cited in the statement from Mind, it’s hard to separate these issues from the agenda of cuts that is currently underway in public services and despite the government’s vehement denial that this is not going to lead to reductions in clinical staff, all I can say is that on the ground, I see it happening with my own eyes.

We have, and this is personal experience, wards closing, staff with redundancy hanging over them, downgrading of professionals and replacing qualified staff with unqualified staff. These are not management posts. These are all clinical posts. Staff remaining are pushed further and yes, eligibility is rising and service delivery is reaching a smaller group of people.