Monthly Archives: September 2013

Daniel Pelka: Is more training and CPD the answer to improving professional practice?

One of the recommendations from the serious case review on the tragic death of Daniel Pelka calls for more training and professional development opportunities for staff. I’m not convinced professionals need more training, I think professionals need better quality training and the environment in which to put new learning into practice.

Having worked in higher education in developing and providing post qualifying courses and CPD activity for 9 years I know a lot of money is spent by the NHS and local authorities on training and education for their staff, and I wonder if it is time to review the quality of that provision and to get serious about changing the culture and structures which frame practice.

I know from experience how employers can respond to such recommendations. On many occasions I have been asked to develop a training package for a failing organisation for their staff on Safeguarding Adults and Children which would require no face to face input from anyone, something involving a tick box that staff can do on their own in front of a computer screen. I have declined such requests as it has felt to me the request was related to meeting a target, rather than addressing issues in practice surrounding adult or child abuse. The term I have heard used for this type of training in the health service is ‘sheep dipping’. I have heard this term used many times by senior managers and some senior academics. I find it insulting in the extreme that professionals and something as important as improving practice in safeguarding can be spoken about in such a demeaning manner. The value to staff of face to face contact with educators and peers in learning environments, and of having to provide work post course that is assessed, can not be under estimated.

We must hope those involved in learning from Daniels death in Coventry seek to develop education and training that is about quality, rather than quantity and meeting a target. However, of greater concern is that the changes required in the wider context of practice are not forgotten and that these are addressed at the same time, as recommended by Prof Eileen Munro.

I do my best to ensure I provide education and CPD activity that is worthwhile and supportive to developing practice, however, I also know that unless the structural issues practitioners face on a day-to-day basis are addressed those practitioners will find it difficult to put into practise their new learning and the opportunity to make real improvements will be lost….

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Energy prices: Fairness is the key to better business …….

As the energy companies raise prices just as the temperature is falling, is it time to ensure fairness is at the heart of business if we want to avoid another financial crisis?

It is unclear whether Ed Milibands proposal to cap energy prices will work or whether this is just a political move to attract voters (see FullFact for the stats) . However, the response from the energy providers comes across as bullying (the energy companies have threatened to raise prices ahead of Ed Milibands proposed price freeze).

Maybe it is time for government to promote a different ethos in industry, one characterised by fairness.

The Nobel prize winner for economics, Jospeh E.Stiglitz, suggests the current neo-liberal approach favoured by government is undermining a fundamental value many support, a sense of fair play. Stiglitz argues if financiers that lay at the heart of the current financial crisis felt such a basic value their actions should have led to feelings of guilt as they engaged in predatory actions that damaged individuals lives. He suggests few felt any sense of shame or guilt and that where making money is concerned there is ‘moral deprivation’, meaning something is wrong with the moral compass of so many working in the financial sector, and that this has changed the norms of society, allowing what might once have been deemed as unacceptable as acceptable when justified by financial gain. It appears moral deprivation is clearly not confined to the financial sector if the energy companies and governments response is anything to go by.

However, faith in under regulated free markets is unshakeable across government, and is seen by many as the only way forward. However, the re-branding of a basic need for life, such as warmth, as nothing more than a commodity to be bought and sold ignores some simple ‘free market’ truths, pointed out by the economist Adam Smith several hundred years ago;  the purpose of the free market is to generate wealth for those who own the means of production, or the ‘masters of mankind’ as Smith christened them, it is not a charitable endeavour but a single-minded system driven by cash not compassion, who Smith suggested had a ‘vile maxim‘  of  “all for ourselves”.  The ‘masters of mankind’  in Smiths time were the merchants and manufacturers who supported policy that enabled them to make more profit, they were not concerned with how such policy and their actions might impact on others.  

Today the needs of the ‘masters of mankind’, such as the energy providers, appear to be the governments primary concern, not the ordinary citizen on the street who works hard yet is struggling to afford even the most basic need in life. The rebranding of ‘energy’, and almost every basic resource required to sustain life in the UK, as a commodity, has reduced business to a series of faceless transactions. The truth is as winter approaches many in Britain are already wondering how they will afford to keep warm this winter, where their ‘choice’ will between eating and heating.

Have we learnt nothing from the financial crisis? Moral deprivation in business harms us all, the very fabric of society, as business and government continue to focus on ever-increasing profits year on year.

How much more could have been gained for us all had the response been more positive, kinder and willing to at least try to engage in a different way of being.

It’s time to stop meeting needs and start focusing on developing a ‘good life’ for those who use health and social care services…..

The funding of the health and social care system is currently at the forefront of policy and is overshadowing any understanding of the values and ethics that should underpin care provision, to the extent a consumerist based system is viewed as superior simply because patients and service users become purchasers. However, evidence would seem to suggest this is not always the case. This raises the question for me is it possible to build a system of health and social care provision that is both affordable and based on values such as dignity and respect?

Developing a sustainable care system

Drawing on the ecology movement sustainable development is defined as “development that meets the needs of current generations without compromising the ability of future generations to meet their needs”. This captures two important elements, the need to support those currently requiring care without compromising the future of the care system which is able to accommodate a growing number of users within budget constraints.

Need, capabilities and the ‘good life’

A first step might be to reframe our understanding of ‘need’. The concept of human need is a relatively new one, and is used in different ways. Need in a health and social care context is often used to refer to a function to be fulfilled, i.e. nutrition, physical care. Such needs might be viewed as a necessary condition for survival. However, we can also view need in terms of security, respect, love and justice.

The failure to expand our understanding of need has arguably led to limiting our vision of human needs, and subsequently influenced how service provision has developed across a number of patient/service user groups i.e. older people, learning disability. A more useful way of thinking about need, from a values perspective, is provided by Amartya Sen with his concept of ‘capabilities’. Sen is concerned with identifying what individuals require to flourish and live a ‘good life’. For Sen whilst some capabilities depend on the fundamental provision of the basic elements of life i.e. nutrition, warmth and shelter, others require particular kinds of freedoms and social relationships. In this model it is recognised different people require different capabilities to flourish, depending on their personal circumstances and the community they live in, whether that community is within an in-patient/residential setting or lived in the wider community.

While the ‘good life’ is to some extent subjective it is also socially defined. In modern western societies it is largely defined in material terms as our ability to be consumers. A consumer culture within health and social care provision appears to be the route to a ‘good life’ as it enables individuals to increase choice and control by becoming consumers of care, rather than receivers of care. In this context care is viewed as a commodity, to be bought and sold. Thus enabling the individual to pursue their own version of the ‘good life’. Yet many people who use health and social care services are unable to flourish in a culture that defines the good life in terms of their ability to engage in a consumerist model of care.

A more useful way of thinking about this from an ethical perspective links Sen’s idea of capabilities back to Aristotle’s idea of the ‘good life’, where the good life was a life of happiness based on the exercise of rational capacity and moral virtue, but also requiring material means and relationships with family and friends. These were the essentials of a good life. Martha Nussbaum has expanded the specific capabilities drawing attention to the need for individuals to be free from state interference and free to form meaningful relationships with others to flourish. Nussbaum locates a capabilities approach around an individuals quality of life suggesting ‘it holds that the key question to ask is “what is each person able to do and to be?”. In other words it is not just about achieving an ‘average’ notion of well-being but about the opportunities available to the individual which will enable them develop their full potential, whatever that might mean for that individual.

This involves going beyond ensuring people have the ability to flourish to ensuring they are actually flourishing. This is pertinent to all service provision whether within the community or in-patient/residential setting.

Five areas important to flourishing and living a good life, regardless of the society/community you live in are: belonging to a family; belonging to a community; having access to material goods for sustenance, adornment and play; living in a healthy environment; and having a spiritual dimension to life. Arguably commissioning and delivery of service provision based on supporting the development of these five areas might enable individuals in receipt of health and social care services to flourish and have if not a good life, a better life.

A way forward

Conceptions of what constitutes a good life are varied, however, within health and social care provision it is prudent to assume a good life involves at a minimum care provision that is not abusive of those who are vulnerable. A first step might be to be more explicit in embedding the principles of capabilities and the good life to provide a solid foundation on which to build for the future.

Why is @FrontlineSW upsetting so many people?

I am changing jobs soon and will be teaching on an undergraduate social work programme in a University in the South West. As part of my interview I had to give a presentation on the challenges facing Higher Education Institutions, top of the list was Frontline.

It has been difficult to keep up with Josh, I followed him on Twitter but strangely have not received any tweets since I asked him how Frontline was being funded. My understanding is Frontline is now a reality. The brightest of the bright, from ‘good’ universities in Britain are possibly, as I type, engaging in bright intelligent conversation and debates guided by their Frontline mentors on the ‘Frontline’ way of doing social work. I’ve read some information about Teach First, the foundation for Frontlines approach, which suggests the first 5 weeks of the programme was spent in some form of student brain washing activity, but this is only hearsay. If it is true I wonder what such an activity might consist of in Frontline? I imagine images of Micheal Gove and his words of wisdom subliminally flashing across a screen as students learn about ‘problem families’ and what to do about ‘them’. Still I’m sure the candidates will be made to feel ‘great’ because they could have done anything with their top university degree, but instead they are choosing social work training with Frontline, which helpfully will not involve them having to fork out course fees whilst they undertake placements with no pay like the vast majority of social work students. Such altruism is a beacon to us all. I still wonder how it’s all being payed for? Frontline will also tackle the issue of retention in social work apparently. If findings from Teach First are replicated not many will stay in frontline practice for long, instead choosing other careers in policy or politics, or being fast tracked into senior management positions.

The full implementation and evaluation of Professor Eileen Munro’s recommendations would have been my first choice for positive action, not the introduction of another educational route. Also, before introducing Frontline I would like to have seen a robust review of the current strengths and weaknesses, including findings from Step-Up, of the system to establish first if current provision really is failing as suggested.

I do think social work eduction requires change, but I also believe the problems Frontline are seeking to address are not solely related to social work education. For me structural change in the way services are delivered and resourced is far more important. As is tackling issues such as inequality,poverty,poor housing, unemployment and low wages which would make the biggest difference to the lives of the families many social workers are in contact with, rather than having a social worker with a good degree from a top university.

I may be wrong, but then again……..