Category Archives: Safeguarding

The ambiguity of ‘evidence based practice’

It has also become apparent how the contested nature of ‘subjectivity’ in EBP serves those in power well. By excluding the ‘subjective’ voice of those in society who are marginalised, their stories, their experiences and their knowledge is discarded, branded as unscientific, not rigorous, not valid …… whose interests does this serve?

Uncertainty is an inevitable aspect of social work practice, yet, the creation of certainty is a fundamental tendency of the human mind, and it is not just our perceptual system which automatically seeks to transform uncertainty into certainty. Government and wider society demand a high level of certainty from social workers, especially following high profile tragedies, and subsequent reports identifying ‘failings’ in practice. As a response to such ‘failings’ the concept of ‘evidence based practice’ (EBP) has proliferated in social work.

EBP is presented as a model of critical appraisal, designed to inform practice, where the practitioner has a relatively autonomous role in searching for, and critically analysing, research evidence to inform their decision making. The latest guidance on the refreshed PCF articulates this commitment once again, and adds an additional expectation that social workers also generate ‘evidence’ to inform practice.

‘More reference throughout to importance of evidence and evidence-informed practice and the inclusion of more reference to ‘evaluation’ alongside ‘research as key source of evidence and engagement of practitioners in evidence/knowledge generation.‘ (BASW,2018)

Whilst practitioners and educators strive to adhere to this principle it could be argued as a ‘professional capability’ this ignores the complexity associated with notions of EBP at both a practical and philosophical level.

Is EBP at odds with real work social work?

Practitioners across allied professional groups are constantly called upon to manage uncertainty, ambiguity and complexity where there often seems to be a plurality of ways to understand what is happening in practice contexts.

From a philosophical perspective EBP appears to operate on modernist foundations.  For example seeking to adhere to methodological and analytic standards of rigour, which demonstrate the reliability of a scientific approach, because this will provide clarity in establishing the ‘right’ evidence is combined to create systematic and cohesive frameworks of knowledge. The belief that by adopting this approach one can achieve a level of certainty is alluring, yet, arguably, unrealistic in social work practice, and indeed may lead practitioners into a false sense of security when making decisions based on EBP.

Postmodernist frameworks are of benefit here to thinking about the multiple discourses at play in social work practices, and understandings the dynamics between them – particularly concerning power. This includes shifting from singular forms of objective understanding, to consider the diversity of subjective knowledges at play in practice contexts. This requires practitioner and academics to appreciate how objective knowledge is a contested concept which can lead to a fruitless search in complex situations for certainties that may not exist.

Peshkin (1988) provides an interesting perspective which extends, and troubles, the notion of objectivity by suggesting the ‘taboo’ of subjectivity stems from a misunderstanding of its potential role in EBP. It is our own subjective involvement in practice—not the precise replication of the event—which can provide strong theoretical insight. However, we are somewhat conditioned as practitioners and academics to see subjectivity as a ‘contaminant’. Yet, that contaminant is always present, one can never get away from one self. As Alan Peshkin eloquently reminds us

“Whatever the substance of one’s persuasions at a given point, one’s subjectivity is like a garment that cannot be removed. It is insistently present in both the research and non-research aspects of our life. … our subjectivity lies inert, unexamined when it counts ….. ” (Peshkin 1988, p.17)

The key point here is that subjectivity cannot be removed. It shapes and mediates our thinking and action in a whole range of ways. Therefore, it needs to be valued understood and utilised . Instead of trying to remove the garment and declare ourselves clean of subjectivity, it is important to acknowledge it, and draw upon it in deep analysis to inform decision making.

(for an alternative critique of post modernism in social work click here)

The practical application of EBP

Research from Scandinavia suggests whilst practitioners support the notion of EBP it is rarely applied in a way that is conducive to improved decision making. Their findings highlighted a number of fundamental flaws, which may be relevant to practice in the UK. Firstly, the research found professional autonomy is not a given , suggesting the greatest barrier to practitioners engaging in EBP is the organisational context.

The research identified five significant organisational issues which impeded practitioners from adopting a more focused EBP approach to inform practice;

  1. No access to databases where they can search for, and evaluate research
  2. Time constraints
  3. ‘Organisational logic’ (predictability) prioritised over a ‘logic of care’ (unpredictability)
  4. A focus on following organisational guidelines which aligns EBP with organisational logic to guide decision making
  5. Financial considerations taking priority over research findings to inform practice

The research concludes whilst social workers were not content with the current conception of  EBP they felt incapable of challenging it. The issues highlighted in this research provide little that is new, previous research seems to support these recent findings and arguably leaves practitioners in an untenable position, from both a philosophical and a ‘professional capability’ perspective.

Creating an alternative approach in my practice

Just as practitioners may find themselves out of kilter with EBP, I too have experienced the oppressive effects of  the polarity that exists in understanding EBP when combined with organisational logic in a Higher Education setting.

As a lecturer I am more used to drawing on the objective research knowledge of ‘expert’ academic others to inform my practice, where objectivity and evidence based practice is privileged as an expression of professionalism. However, the eloquent exploration  by Staller (2007) of the interaction between a social worker and sexually abused child resonates with my experience of the polarity which exists in presenting objectivity as synominous with professionalism as she writes

He speaks about his responsibility to retrieve objective stories from sexually abused children, knowing He holds their heart in His hands‘ (p.766). Going onto to suggest ‘His need to get an “objective” story is because the alternative is subjective or fictitious’ (Staller,2007;p.776).

Staller’s experience of encountering this exchange provided a ‘trigger’ moment. Her experience has become the ‘data’ which she will explore from every angle possible to locate that moment within the social, cultural and political realms. This process then has the potential to extract new learning from her experience, to create and share knowledge which will enhance practice.

Reading Stallers work provided a ‘trigger’ moment for me, where I filtered its meaning using the theoretical lenses of modernism and post modernism,   to try and be aware of, and make sense of, how I decide what ‘counts’ as knowledge and how I create and transform data into knowledge, and then ‘evidence’ to support my professional self.  I also had to locate my thoughts in the wider context of the organisation I work in, and the current  structural frameworks which directly influence current practice within higher education (i.e. the use of metrics to ‘rate’ the quality me and my institution, and so inform prospective students how ‘good’ I am, we are – I will leave this for another blog!)

It has also become apparent how the contested nature of ‘subjectivity’ in EBP serves those in power well. By excluding the ‘subjective’ voice of those in society who are marginalised, their stories, their experiences and their knowledge is discarded, branded as unscientific, not rigorous, not valid …… whose interests does this serve? 

(WARNING – Shameless plug here: From this, and subsequent experiences,  my colleagues Annastasia Maksymluk  , who has used auto-ethnography in curriculum development & Andy Whiteford , who focuses on sustainability, and I have collaborated to create a ‘no smoke and mirrors’ research and writing partnership, from which we developed  an open access on-line peer reviewed journal the Journal of auto-ethnography for health and social care). We encourage submissions to the journal from anyone who wants to be part of producing evidence to inform practice;  students, professionals, service users, patients – all are welcome!

Conclusion

Regardless of whatever EBP might, or might not be, it appears practitioners are currently expected to work within a model of EBP which might be more accurately conceptualised as OBP, Operational Based Practice , where professional decision making is centred in processes designed to meeting organisational demands. This is problematic because

“ …it is argued that whatever group controls the way things are seen in some ways also has the power to control the ways things are. Whoever’s interpretation gets accepted will doubtless control how the idea is enacted.” Fook (2002:37).

From this perspective the production, and application, of ‘evidence’ is the product of deliberate, conscious human design, which is amenable to a whole host of organisational, ethical and political requirements. Evidence is not value-free and we need to ask what values and processes currently underpin the discourse that surrounds and shapes EBP in education, research and practice and whether these align to the professions values and ethics?

From a logic perspective EBP provides a neat linear model of deliberated decision making. However, real world social work is rarely a logical, or a linear activity, dealing as it does with often complex and chaotic human lives. Lives where meaning is constructed by a variety of individuals, and subjected to a plethora of structural and organisational filters that heavily influence the practice of decision makers and the lives of those they work with.

Whilst the notion of EBP has provided the profession, regulators, educators and government, with a seemingly straightforward response to improving decision making in complex cases, the structural realities of practice continue to be ignored, as do the structural inequalities that exist in many of the lives practitioners work with.

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Older people still dominate Safeguarding practice, will this ever change?

Has there ever been a ‘golden age’ where older people were consistently valued, respected cared for and protected by family and the institutions that make up wider society?

Latest figures in respect of Safeguarding referrals under s42 of the Care Act 2014 found for the 2016-17 reporting year there were 109,145 individuals that were the subject to a safeguarding enquiry, an increase of 6 per cent on 2015-16.  Of these individuals at risk, 63 per cent were aged 65 or over and two thirds of these were over 74 yrs of age.

This will come as no surprise to many within the health and social care professions, and indeed many feel the numbers could possibly be an underestimate given previous statistics. For example a House of Commons report on elder abuse published in 2004 stated

Other witnesses also commented on the estimate of “half a million” older people abused at any one time. Both Bill McClimont, Chair of the UK Home Care Association, and Sue Fiennes, National Lead for Older Peoples Services of ADSS, suggested that the figure was an under-estimate. Mr McClimont commented that it was likely that there was greater reporting in the part of the care sector that was currently regulated. As regulation spread to other parts of care, detection and reporting were likely to rise.

This may well be accurate when we consider the abuse of older people is a global issue.

The World Health Organisation suggests the abuse of older people occurs in many parts of the world with little recognition or response. This serious social problem is often downplayed or hidden from the public view, and considered mostly a private matter. Even today, the abuse of older people continues to be a taboo, mostly underestimated and ignored by societies across the world. However, evidence has accumulated to indicate that the abuse of older people in the UK is an important public health and societal problem.

The full extent of abuse is unknown, however, its social and moral significance is obvious. As such, it demands an active response, one which focuses on protecting the rights of older persons, and a change in our perspective on whom, and what, we value in society.

Although representations of old age and societal responses to older people have differed over time it could be argued old age has always been viewed as negative.

In ancient Greece old age was portrayed as sad, with the Greeks love of beauty marginalising the old. Although some commentators suggest the reality was more complex with the portrayal of older people in the classics as ‘both pejorative and complimentary’ (Thane, p.32). For Plato reverence toward old people was a guarantee of social and political stability, whereas Aristotle disagreed with such positive images. Cicero’s work De Senectute, written in 44 BC, points to the variety in individual experiences of ageing, acknowledging that for those who are poor and without mental capacity ageing is miserable, however, suggesting older people need to strive throughout their life to remain intellectually and physically able.

Arguably this belief still underpins social care legislation and policy today in respect of older people.

It has been suggested older people’s status in society is linked to their ability to participate in society from an economic perspective, especially in terms of activity in paid employment. Historically where older people have been unable to participate in paid employment, help and support has been provided through a mixture of family and state support, with an emphasis by government on the former rather than the latter. However, commentators suggest, post industrial revolution, another victim of change were older people. The old did not merely lose power, they also lost respect. The rise of the alms-houses, and institutionalised poor-relief, may indicate their children were increasingly shedding responsibility for their support and transferring it to the community.

Although Thane  argues, this may have been due to families own depths of poverty, rather than lack of care or a shedding of responsibility.

The abuse of older people was not something government identified as a problem throughout this period, although, self-neglect was identified as an issue which government sought to address in the 1948 National Assistance Act.

This is not to say it did not occur, for example, the 1942 Exceptional Needs Enquiry found most older people living with families were there under sufferance. They were often less well off than those who lived with strangers, and lacked essential items of clothing, bedding or household equipment as families used any provision, such as clothing coupons, for personal use. Whether this constituted abuse is not clear as many families who cared for older relatives were often living in poverty themselves and older people often willingly gave their families any support they could, even if this meant going without themselves. Of course, records do not exist to either confirm or deny whether such relationships were abusive or mutually supportive, however, it might suggest in terms of individual worth and personal identity, a cultural norm existed where the welfare of the younger generation was prioritised over that of the old by both young and old.

However, Peter Townsend’s landmark study  of long-stay institutional care for older people in 1950’s Britain, provides a little more insight into the experiences of older people receiving care. One of the interviews he recorded was with a matron of a small private residential home in Greater London, which Townsend suggested was by far the worst home he had visited, was clearly describing abuse, as defined in legislation today.

This suggests the abuse of older people has been going on for a long time, both nationally and internationally.

How will we ever change this I wonder?

To deliver good, safe, sustainable care, leaders need to think beyond traditional boundaries ……

Our care system is at breaking point. People are struggling to find a good care home when they desperately need it. With demand for beds set to rise, the time for action is now. Help us convince the regulator to confront the care crisis before it’s too late.’ (Which?)

CQC have confirmed in their State of Social Care report the problems many requiring social care already know, the system needs reform.

As Which?  and CQC yet again bring to government and wider societies attention to the problems and poor levels of care some older people experience, one wonders will we ever get to grips with this issue? The transformation of ‘care’ into a commodity that can be bought by families and those who use services, like any other product, dominates current health and social care reform, however, discussion on what ethical principles underpin the delivery of such care has not emerged. This raises the question for me, is it wise to continue to build a system of care provision with no clear ethical foundation outside of that of the free market? Arguably, we need greater ambition in developing great care for older people and a more strategic approach to make real improvements. But how?

Developing ethically sustainable care for older people

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 relevant issues; the need to support those older people currently requiring care, without compromising the future of the care system.

Need, capabilities and the ‘good life’

A first step in developing ethically sustainable care involves reframing our understanding of ‘need’. 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 are viewed as a necessary condition for survival. However, we should also view older peoples’ needs in terms of security, respect, love and justice.

The failure to distinguish between different types of need has led to limiting our understanding of how to care for older people, and has subsequently influenced how service provision has developed. Amartya Sens’ concept of ‘capabilities’ provides an alternative approach Sen is concerned in this model with identifying what individuals require to flourish and live a ‘good life’. In this model it is recognised older 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 in the wider community. Successive governments’ appear to believe an expansion in a consumer culture within health and social care provision is the only route to a ‘good life’ for older people, as it enables individuals to increase choice and control by becoming consumers of care, rather than receivers of care.

Yet many older people are clearly not flourishing in a culture that defines the good life in terms of their ability to engage as a ‘customer of care’. A more useful way of thinking about this, from an ethical perspective, links Sen’s idea of capabilities and Aristotle’s vision of the ‘good life’. From this perspective achieving quality of life is central, rather than just meeting physical needs. 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 to develop their full potential, whatever that might mean for that individual.

This approach moves beyond ensuring older people have the ability to flourish to consider whether they are actually flourishing. Commentators suggest there are five areas in which older people need to flourish to live a good life, regardless of where they live. These 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 the commissioning and delivery of service provision based on achieving these five areas might enable older people to receive care that is both compassionate and dignified.

The 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 to older people.

Within the public sector the organisation and delivery of care is structured to focus on the meeting of targets rather than enabling an individual to flourish. The health and social care sector is arguably over managed and under led. In the private sector it could be argued a free market economy contains structural incentives for business to pursue a notion of the good life that supports the sale of a narrow range of care ‘products’, whilst there are not mechanisms in place to ensure the market operates within a clear ethical framework outside of the profit ethos.

By not actively endorsing care provision from an ethical stand point the government and regulatory bodies may actually be unwittingly aiding the abuse of the most vulnerable within the care system. A shift in focus from human need to human flourishing has already begun with the development of the personalisation agenda and emphasis on voice, choice and control however, this agenda has been overshadowed by a managerial approach to consumerism and consumption in a low paid, low status care system and this is undermining the ability of the care system to develop ethically.

Markets versus Values

Michael Sandel argues markets are not a mere mechanism designed to deliver goods, they also embody certain values, and the problem is these values ‘crowd’ out non market values like compassion and dignified care. Where values and ethics are weak we need a strong and active state to intervene, where both are weak those most vulnerable in society will continue to be exploited and abused. This begs the question can we afford not to have an ethical care system?

 

‘Old age,more feared than death’…… have we ever cared about older people?

Has there ever been a ‘golden age’ where older people were consistently valued, respected cared for and protected by family and the institutions that make up wider society?

The World Health Organisation suggests the abuse of older people occurs in many parts of the world with little recognition or response. This serious social problem is often downplayed or hidden from the public view, and considered mostly a private matter. Even today, the abuse of older people continues to be a taboo, mostly underestimated and ignored by societies across the world. However, evidence is accumulating to indicate that the abuse of older people in the UK is an important public health and societal problem.

The full extent of abuse is unknown, however, its social and moral significance is obvious. As such, it demands an active response, one which focuses on protecting the rights of older persons, and a change in our perspective on whom, and what, we value in society.

Although representations of old age and societal responses to older people have differed over time it could be argued old age has always been viewed as negative.

In ancient Greece old age was portrayed as sad, with the Greeks love of beauty marginalising the old. Although some commentators suggest the reality was more complex with the portrayal of older people in the classics as ‘both pejorative and complimentary’ (Thane, p.32). For Plato reverence toward old people was a guarantee of social and political stability, whereas Aristotle disagreed with such positive images. Cicero’s work De Senectute, written in 44 BC, points to the variety in individual experiences of ageing, acknowledging that for those who are poor and without mental capacity ageing is miserable, however, suggesting older people need to strive throughout their life to remain intellectually and physically able.

Arguably this belief still underpins social care legislation and policy today in respect of older people.

It has been suggested older people’s status in society is linked to their ability to participate in society from an economic perspective, especially in terms of activity in paid employment. Historically where older people have been unable to participate in paid employment, help and support has been provided through a mixture of family and state support, with an emphasis by government on the former rather than the latter. However, commentators suggest, post industrial revolution, another victim of change were older people. The old did not merely lose power, they also lost respect. The rise of the alms-houses, and institutionalised poor-relief, may indicate their children were increasingly shedding responsibility for their support and transferring it to the community.

Although Thane  argued, this may have been due to families own depths of poverty, rather than lack of care or a shedding of responsibility.

The abuse of older people was not something government identified as a problem throughout this period, although, self-neglect was identified as an issue which government sought to address in the 1948 National Assistance Act.

This is not to say it did not occur, for example, the 1942 Exceptional Needs Enquiry found most older people living with families were there under sufferance. They were often less well off than those who lived with strangers, and lacked essential items of clothing, bedding or household equipment as families used any provision, such as clothing coupons, for personal use. Whether this constituted abuse is not clear as many families who cared for older relatives were often living in poverty themselves and older people often willingly gave their families any support they could, even if this meant going without themselves. Of course, records do not exist to either confirm or deny whether such relationships were abusive or mutually supportive, however, it might suggest in terms of individual worth and personal identity, a cultural norm existed where the welfare of the younger generation was prioritised over that of the old by both young and old.

However, Peter Townsend’s landmark study  of long-stay institutional care for older people in 1950’s Britain, provides a little more insight into the experiences of older people receiving care. One of the interviews he recorded was with a matron of a small private residential home in Greater London, which Townsend suggested was by far the worst home he had visited, was clearly describing abuse, as defined in legislation today.

This suggests the abuse of older people has been going on for a long time. It is increasingly clear the abuse of older people exists, and as a society we cannot ignore it any longer.

CQC, older people & funding cuts:It’s not just about the money….

As CQC yet again bring to government and wider societies attention the poor levels of care some older people experience, one wonders will we ever get to grips with this issue?

The latest report suggests cuts to social care,  mental health and public health mean “the NHS is being stretched to the limit,” said Stephen Dalton, chief executive of the NHS Confederation, which represents hospitals. “Relying on political rhetoric that promises to protect the NHS but fails to acknowledge that a cut in social care results in a cost to the NHS, is an economic deception.”

Arguably, the discussion  needs to go beyond financial issues  to consider the greater deception of successive governments who have consistently ignored their failure to develop an ethically sustainable approach to the care and support of older people.

Let’s be honest, growing old in the UK is not for the faint hearted when we consider research and inquiries over the last decade.

In 2007 The Joint Committee on Human Rights suggested older people in hospital and residential care routinely receive inhumane and degrading treatment, whilst an analysis of outcomes for patients commissioned by the Royal Medical Colleges in 2010 concluded inadequate hospital care for older people condemned many to death.  The Health Service Ombudsman review of complaints, in 2011, suggested the National Health Service (NHS) is inflicting pain and suffering on patients, citing examples of older patients leaving hospital with numerous physical injuries, mentally confused, soaked in urine wearing other people’s clothes held together with paper clips.  Sadly the report suggested the individuals discussed are ‘not exceptional or isolated cases’ and clearly indicates the attitude of staff was indifferent to those older people for whom they were supposed to care.    Then in 2012 the Royal College of Surgeons found older people were discriminated against when being assessed for surgical treatment, with decisions being based on chronological age rather than clinical need, whilst Bingham   suggested the treatment of older people in care was so bad that in many cases it met the legal definition of torture. The  scandalous mistreatment of older people in Mid Staffordshire was exposed in the Francis Report in 2013, whilst in 2015 CQC reported on the continuing poor care older people received in care homes …. and so it goes on.

When we move away from  hospital and residential settings things are often not much better with Action on Elder Abuse consistently highlighting the prevalence of abuse older people experience in the community,  leading in 2016 to the publishing of  a ‘dossier of shame’ which outlines how crimes against older people frequently go unpunished.

From a European perspective research findings suggest older people’s experience of ageing in the UK falls behind that of many of its European counterparts, with the UK performing most poorly on indicators such as income, poverty and age discrimination (WRVS,2012).  The report states “the UK faces multiple challenges in providing older people with a positive experience of ageing, scoring poorly (although not always the worst) across every theme of the matrix” (WRVS, 2012, p.8).

This all provides a troubling vision of older people’s experience of ageing in the UK.

Older people’s experience of ageing in the UK can be improved, and it is all of our responsibility to try and achieve this.  However, we first need a coherent strategy to bring about the change desired by many who work with older people.  Government in the UK tend to address issues associated with an ageing population in individual ‘silos’.  Research from Europe suggests those countries taking a joined up approach, where government consider how factors such as income, health, age discrimination and inclusion interact, the more successful policy approaches are likely to be to improve the experience of ageing.

However, any action needs first to take a long term approach and have a strong ethical, rather than financial, foundation founded on a clear understanding of, and agreement to, promote older peoples equality and human rights across the political divide.

Why it matters who controls the curriculum in social work education ….

Change is the life blood of social work. Supporting people to adopt changes which might improve lives is fundamental to social work. Change is also fundamental in government, although , in my experience over the the last 5 years it does not always deliver improvement in a way which is helpful to social work, or those who require services.

Far too often, it feels to me, governments drive for change is ideological and rooted in making changes which ignore issues related to failure in government, especially in respect of their unshakable belief in neo-liberal ideology as the foundation of everything.

As an ideology, neoliberalism perpetuates the belief that the market cannot only solve all problems but also serves as a model for structuring all social relations. It is steeped in the language of self-help and individual responsibility,   purposely ignoring the effects of  inequalities in power, wealth and income and how these shape individuals and families lives. As such, it supports a society which cruelly ‘others’ those who require support, and is scornful of a critical and politicised social work profession founded on compassion and notions of equality and respect.

It appears to me our current government would prefer potential social workers to be ignorant of the political and structural forces which impact on individuals lives. Back in 2013 Michael Gove, then education secretary, claimed too many social workers had been filled with “idealistic” dogma that viewed people as victims of social injustice. Gove vowed to “strip this sort of thinking out of the profession”.

For example Gove and Co would seemingly prefer the consequences of government policy on those who require social work services in areas such as  housing, benefits sanctions and  zero hours contracts were ignored , ensuring the increasing levels of  poverty and insecurity individuals experience is accompanied by a culture of blame,   leading social workers to deliver individualised solutions to what are structural issues.

The Children and Social Work Bill is the latest ‘change’ causing many in the profession concern. Whilst some, such as Andy Elvin from Frontline, see the Bill as a positive step forward, many others within the profession highlight real issues, yet government appears set on ignoring these  concerns.  As a social work educator I have serious concerns, yes, around the potential privatisation of  children’s services, but also around who will provide social work education and what a future curriculum might look like.

It appears to me Government would like to ‘strip’ ‘idealistic dogma’  out of higher education as well. Instead preferring a depoliticised social work curriculum, a painting by numbers programme of training, rather than an education that prepares potential social workers to support, and challenge, change at an individual and structural level.

I believe a depoliticised education and social work profession, along with an ideologically driven clauses within the Bill would be a disaster for the children it seeks to protect.

A strong social work profession needs an educational system underpinned by critique and analysis, challenge rather than acceptance of the political status quo.  As Henry Giroux eloquently states

“At a time of increased repression, it is all the more crucial for educators to reject the notion that public and higher education are simply sites for training students for the workforce, and that the culture of education is synonymous with the culture of business. At issue here is the need for educators to recognize the power of education in creating the formative cultures necessary to challenge the various threats being mobilized against the ideas of justice and democracy, while also fighting for those public spheres, ideals, values, and policies that offer alternative modes of identity, thinking, social relations, and politics.

Pedagogy is always about power, because it cannot be separated from how subjectivities are formed or desires mobilized, how some experiences are legitimated and others are not, or how some knowledge is considered acceptable while other forms are excluded from the curriculum.”

Will the proposed changes improve life outcomes for children?  No one knows. I just hope the next reading of the Bill on the 18th October  is not reduced to ideological dogma because none of us who  debate the Bill will have to live with the direct consequences of the decisions made, nor any potentially negative consequences that might flow from this Bill if passed in its current form. ….

And these children that you spit on

As they try to change their worlds
Are immune to your consultations
They’re quite aware of what they’re going through

Ch-ch-ch-ch-changes
(Turn and face the strange)
Ch-ch-changes
Don’t tell them to grow up and out of it
Ch-ch-ch-ch-changes
(Turn and face the strange)
Ch-ch-changes
Where’s your shame
You’ve left us up to our necks in it

(Changes, David Bowie)

Social workers to learn how to earn ‘public trust’ from Politicians … Really!

Politicians to lead task force that will guide social workers in earning back public trust …… Really!

Forgive me, I almost choked on my coffee whilst reading a piece entitled ‘Social work needs to earn back public trust‘ on the Guardians Social Care Network.

The government has set up a task force to guide the social work profession on how to earn public trust. A stellar line up of politicians which include Michael Gove, Theresa May and Iain Duncan Smith, those well-known advocates of social work and those they work with. When did Politicians earn the right to pontificate on how a profession might earn public trust I wonder? I must have missed this whilst reading about the numerous promises this government has reneged on since the general election, and which clearly must have enhanced the publics trust in them …..

I am a tad perturbed the government seems to have ditched the comprehensive Munro Review, which provided a very balanced approach to reform that focused not just on social workers and their education but also the political and organisational contexts which also shape social work practice, and arguably go some way to explaining the current problems that bedevil the profession.

The piece suggests the new task force will focus on robust assessment of qualifying social workers involving employers, academics and those who use services …. ummm sorry to mention this, but I do not know of a qualifying social work programme that does not already do this. Social work programmes across the land expect students to pass a number of academic theory assignments and law based exams alongside practice based assessments which involve numerous observations of practice and a plethora of meetings and reports provided by employers, those who use services and academics commenting on the student’s performance and fitness for practice over a 2 or 3 year period.

The article goes onto suggest the social work profession needs to ask itself ‘why the college failed’ and ‘why the public mood’ supports changes in the law where social workers can be prosecuted for wilful neglect. In response to the first question, from my perspective, the reason I did not join the college is that I felt it represented the voice of the government not social workers. To the second comment I would hazard a guess that 30 years of inaccurate reporting in the media, oft-repeated by politicians, and flawed serious case reviews have played a part in the general publics perception of the profession.

Just read the book by Prof Ray Jones which looks at why politicians and the media were so keen to blame and vilify social workers and Sharon Shoesmith, Haringey’s then children’s services in the case of Baby P, to gain some insight into why the profession is held in such low esteem by the public, aided and abetted by the media and government I would suggest.

I was surprised the piece did not mention the problems with inadequate IT systems, how social work now operates in a call centre environment where workers hot desk and have limited contact with their peers, or how workers work in their cars, making phone calls in lay-bys on their mobiles because they cannot access secure office space. Nor does it mention the failing court system, or the outmoded model of fostering and adoption which is no longer fit for purpose and in many cases just adds to the trauma of already traumatised children’s lives, it fails to mention the knock on effect of welfare reform, the lack of affordable good quality housing or the deterioration in mental health support services to both adults and children, it does not dig deep into the effect on frontline service provision of high levels of stress related sickness and social work vacancies, or the impact of temporary agency workers in providing important continuity when working with children and families.

I have worked with hundreds of hard-working social work students, many of whom are accruing debts of up to £40,000 to become a social worker in children and family services. Despite public and government distrust, and potential imprisonment, they are committed to being the best social workers they can possibly be …. because of this I believe in social work. Time for another coffee I think …..

The ‘McDonaldlisation’ approach to reform in health and social care is as unhealthy as a triple whatever with cheese and fries….

A couple of years ago a social work student suggested government policy wanted to make us all ‘beige’. I know what she means.

Of course commentators might suggest we are seeing a radical shift in emphasis across health and social care under the coalition resulting in an ideologically driven reshaping in our understanding of legitimate nature, and limits, of the state in individuals lives. However, how radical is an agenda premised on ‘consumerism’ and ‘consumer choice’? Policy designed to create a society of depoliticised consumers is hardly going to address the very real issues around equality and social justice that exist in Britain today.

In ‘Cameron & Co dream world’ delegating care provision to corporate providers is really about delegating power to places where there is limited protection for consumers, ‘choice’ takes precedence over ‘voice’. The McDonaldlisation of care is really a watered down version of consumer choice, and some believe by engaging with it you are living the neoliberal dream.

I have nothing against beige, or McDonalds, really, but a bit of colour and a change of diet would not go amiss in the current debates around the future of health and social care, and social work is well placed to provide the colour needed to create greater vibrancy in how we meet future challenges.

As government concerns itself with winning the next election we need to keep the debate going, we need tasty morsels to stimulate a much better quality of debate and deeper thinking about how to address current, and future, issues.

‘Over 50’s more scared of dementia than cancer’: I’m more terrified of the ‘harrowing neglect’ in our care system ……

As The Telegraph report people over 50 are more scared of dementia than cancer, I have to say I am terrified of any condition which might mean I need to rely on our care system when I get older.

As someone over 50, and who is currently spending every weekend at the hospital bedside and my mother in law because I’m so scared that without family around she will be seen as nothing more than ‘care home fodder’, the thought of requiring care, either in hospital or outside of hospital, once you hit the post 80 mark is a terrifying prospect to me.

There has been too many high profile inquiries to suggest these are anomalies in the care system, for example, following the inquest into care at Orchard View the Serous Case Review into the deaths of 5 older people has been published. The coroner has heavily criticised the quality of care at the Southern Cross home, and expressed incredulity that many staff were still working in the care industry, stating that “there could be another Orchid View operating somewhere else”.

The Daily Mail reports

‘Britain’s worst care home’: Damning report into ‘harrowing neglect’ at £3,000-a-month home aims to stop ‘institutionalised abuse’ of the elderly: Serious Case Review has made 34 recommendations after examining failings at Orchid View care home in Copthorne, West SussexRead more: http://www.dailymail.co.uk/health/article-2652709/Orchid-View-care-home-receive-damning-report-published-today.html#ixzz34ELlbfW6
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I’m afraid the type of ‘care’ received by those at Orchard View is not confined to Orchard View.

In 2010 the Royal Medical Colleges concluded inadequate hospital care for older people condemned many to death. In 2011 The Health Service Ombudsman suggested the NHS was inflicting pain and suffering on older people, and was indifferent to older people. In 2012 Bingham suggested the treatment of older people in care is now so bad in many cases it meets the definition of ‘torture’.

Just for clarity Amnesty International has outlined the techniques used in ‘torture’, these include isolation, enforced trivial demands, degradation, threats, displays of power (i.e. controlling food and hydration, physical assault).

For some older people in care today, whether in the public or private sector, that is their care, torture.

No wonder from a European perspective research suggests older people’s experience of ageing in the UK falls behind that of many of it’s European counterparts (WRVS,2012).

Older people’s experience of ageing in the UK can be improved, and it is all of our responsibility to try to achieve this. However, we first need a coherent strategy to bring about the change desired by many who work with older people. Government in the UK tend to address issues associated with an ageing population in individual ‘silos’. Research from Europe suggests those countries taking a joined up approach where government consider how factors such as income, health, age discrimination and inclusion interact , the more successful policy approaches are likely to be to improve the experience of ageing. However, any policy needs first to have a strong ethical foundation founded on a clear understanding of, and agreement to, promoting older people’s equality and human rights.

There is clear evidence in the UK that poor levels of care, in both the private and public sector, is far to prevalent in our care system. Whilst the focus currently is on the leaders and professionals charged with developing and delivering care, wider society too has a role in ensuring compassion in care is the ‘norm’ and not the exception, as The Independent suggests

‘For a while we may pause to express outrage. But we then move on to the urgent business of our daily lives. Spot checks and hit squads may arrest the worst practice…but they will not do much about a society that has hardened its heart against the elderly’

Whilst many older people receive good quality care, the majority provided by friends and family, far too big a proportion of those requiring higher levels of care are failed by care providers in our system. It is not good enough to keep using the same old rhetoric, better training (what type and where from?), minimum standards (we have these), ‘big society’ need to take more responsibility. We have heard all of this before, and still the abuse continues.

Both my mother (82yrs) and mother-in-law (86yrs) have made clear to me this weekend they do not want to end up in residential care, the very thought fills them with horror. They remind me of the older people I worked with two decades ago who used to equate a stay in hospital with the workhouse and its associated horrors.

It struck me, it must feel terrifying being an older person requiring care today.

Re-think on outsourcing: Mr Gove, privatisation and the ‘missing shade of blue’ …..

Academics and experts have expressed their concerns in a letter to the Guardian following the Department of Educations announcement that it is considering outsourcing children’s services to private firms.

Professor Eileen Munro rightly highlights the ‘fickleness and failings’ of the market, suggesting caution in establishing a market in child protection which could create perverse incentives for private companies. A recent headline highlights the less savoury side of outsourcing – ‘Now troubled children are an investment opportunity: 18% return on the most disturbed and needy children in care homes is the extreme end of Britain’s outsourcing culture’ (Polly Toynbee)

A poll in the Guardian found 95% of respondents felt private firms should not be allowed to run children’s services.

However, the outsourcing/privatisation of children’s services is already here, and it’s extension into child protection is the next target for this government.

The letter has achieved its’ purpose in highlighting the issue and stimulating debate, the question is where do we go from here? I agree with my learned peers, we have to move beyond the ‘outsourcing’ of child protection and focus on our primary concern that vulnerable children will be exploited for profit, not unlike the vulnerable patients of Winterbourne View Hospital. A hospital set up by a Swiss equity company who primarily saw it as an investment opportunity and when the abuse of its’ patients was exposed promptly closed it down, probably moving onto the next investment opportunity provided by this government in the outsourcing of services.

Sadly government chooses to ignore this aspect of outsourcing. However, they do not ignore the opportunity to expose the failure of ‘social workers’ whenever possible. Although, they are less than explicit about the serious structural issues that prevent social workers delivering good services. The Munro Review provided a blue print for change which was universally accepted, however, it has been quietly watered down by the present government, a massive mistake in my opinion, but not unexpected as it really does not fit their ideological agenda and the dichotomous thinking of Mr Gove and co i.e. public sector bad, private sector good.

The issue is not about ‘outsourcing’, it is about the principles, values and ethics of those we outsource to. It is really about profit being made from the lives of those most vulnerable in society which feels abhorrent. Personally I feel the time is right to abandon the notion there is only one way of constructing the world of safeguarding, whether child or adult, if we are to move forward in this debate.

In a famous passage in his Treatise of Human Nature the political philosopher Hume writes about ‘the missing shade of blue’. According to Hume, if we are shown samples of two different shades of blue we can conjure up in our minds a third shade that fits between the two: the missing shade of blue.

The point of interest in Hume’s writing is not that we can invent a new shade of blue but that we can invent new ideas which connect to existing ideas.

Those working daily on the frontline of child protection I feel sure are more than able to achieve this, however, I have little faith, or trust, in those in government to move beyond their preferred shade of Tory blue.