I want to break free

H is for HappinessOn the 13th March 2017, the law commission published their long overdue report on Mental Capacity and the Deprivation of Liberty Safeguards (DoLS).  The report finally arrived a week after news broke of the death of Rusi Stanev, aged 61.  The ruling on Stanev v Bulgaria by the European Court of Human Rights in 2012 was a catalyst for change in UK social care law.  Just two years later Lady Hale referenced his case when she set the acid test to determine what would constitute someone being deprived of their liberty in landmark Supreme Court Ruling on the Deprivation of Liberty Safeguards, which has come to be known as Cheshire West.

The Cheshire West ruling was a wake up a call to adult social work, reminding the profession of its roots as an academic discipline that promotes social change and development, social cohesion, and the empowerment and liberation of people based on principles of social justice and human rights.  The ruling reminded social workers that the most important letter in the DoLS is the letter S – it standards for Safeguards.  The first of these safeguards is the role of Best Interest Assessor, a professional qualification which social workers have embraced in huge numbers post Cheshire West.

A common confusion is that the Deprivation of Liberty Safeguards scheme is not there to deprive a person of their liberty.  The DoLS scheme provides a set of legal safeguards on behalf of the person to protect them by ensuring their right to speedy judicial review against the agency who is depriving them of their liberty.  The role of social work and social care commissioning is not to wrap the person in cotton wool in the name of adult protection, but is to enable people to experience life in the same way as anyone else would. This is a hugely important turning point in the role of social work and social care commissioning.

Take Paul (names have been changed). Paul has a learning disability.  He was 17 when people first became really worried about him being a risk to himself and others.  Professionals decided that it would be in his best interest for him to be moved 100 miles away from his family for his own protection. Anyone can talk up risk, professionalise the risk and then transfer it onto a support plan. There are plenty of social care providers who are willing for a price to offer to mitigate the professionally imagined risk.  In Paul’s case the risk related to him having been seen once, 10 years ago, in a kitchen holding a bread knife.  No one ever asked if he had picked the knife up because he wanted a slice of bread.  10 years later, despite no further incidents having been observed, he was living a life with hardly any independence and very little contact with his family.  As Paul says, if he’d been in trouble with the police and ended up in prison, he would have been released home years ago.  It took a talented social worker, using the Mental Capacity Act to challenge the assumptions being made about Paul and start the long, slow process of working with Paul and the provider to lessen the restrictions on his life and reconnect him to his friends and family.  Possibly, over time and with support, he may finally live an ordinary life, free from services.

And then there was Mary.  Mary’s Saturday treat has been a cream scone every week for as long as her daughter could remember.  At 86 Mary had advanced Alzheimer’s disease which had led to her moving to live in a care home.  The care home staff were very worried about Mary’s love of cream cakes.  They called in the community matron who agreed with them and called in the dietician.  The dietician agreed that these were bad for Mary and wrote a long and detailed explanation of the risks associated with cream cakes which made clear Mary must not be allowed ever again to have one.  Mary’s daughter asked for help from her social worker who took the very sensible decision that in keeping with Mary’s previously known wishes and feelings the home should uphold her right to continue to make the decision which health professionals deemed unwise to eat a cream cake every Saturday for as long as Mary wanted to do so.

The Law Commission have recommended that the Best Interest Assessor role should be made even stronger through introduction of Approved Mental Capacity Professionals to be the safeguard of people’s rights and wellbeing. What greater opportunity can there be for all those social workers who came into the profession saying at their interview to get on the course that they wanted to make a difference?  The challenge is there to social work professionals to raise the quality of capacity assessments.  The bar in law is rightly low.  It’s our job to make sure it stays there and maintain people’s control over how their care needs are met.  After all, the only person who really knows what goes on in a care home or hospital at 3am when the lights are off is the person who experiences the hands on personal, intimate care or otherwise that care worker provide. As Professor Harry Ferguson has found in Children’s services – it is too easy for the person to become “invisible”, their voice unheard, their rights ignored as the social worker becomes overwhelmed by the complexity of the circumstances surrounding them.

Social workers are uniquely privileged, carrying a title protected in law, to access the person, their history and insist that other professions listen when they speak.  This is especially true when it comes to the person objecting – not kicking off, we all recognise that – but quietly resisting the attempts to persuade them that they can never go home but now must accept the decisions that professionals are making about them. Recognising, understanding and acting on objection is the sign of an outstanding social worker.  Objection still isn’t understood well enough.  A person could be objecting quietly but not be regarded as doing so because unless a relationship is built with the person, you might never learn that they feel resigned to their fate, afraid to raise their deep desire to go home, not wanting to upset their family.  Slow social work practice, based on relational practice is the answer here.  The more we recognise objection, search out and encourage people to be open and honest with us about their feelings, the more we can engage in mediation, advocating on their behalf to secure better outcomes. The success or otherwise of the Law Commission recommendations will ultimately turn on this.  Every morning Stephen Neary greeted the manager of his care home with the song – I want to break free – spotting objection and acting on it, is at the heart of safeguarding liberty.


No Further Action

The purpose of this blog post is to encourage social workers to consider how their use of language when writing about or referring to people can impact on practice. It explores some challenging ideas which reference the disability studies literature.

A Guest Social Worker Blog 

When I first qualified as a social worker I had an agency job at a hospital. I got on well with the nurses, I supported the discharge of many older people into care homes and on at least one occasion, it was against the woman’s wishes. She begged me to get her home but it was ok because I referred to ‘common law’ to justify my actions.  Her physical needs justified it and everyone (apart from her) agreed, so into a care home she went, the placement processed in less than an hour.

I jotted down little medical hieroglyphs on my handwritten notes and used medical jargon on the electronic recording systems. People were ‘patients’ or sometimes ‘service users.’ This language protected me from the reality of what I was doing to people caught in the system, lacking power and influence because of their age and disability, unable to square up to professionals like me with our clipboards and our own language. 

Social work with adults can be difficult when people are in crisis and experiencing loss, and they pour their pain into you because there is nothing else they can do.  And so I learnt that dehumanising people through my use of the language of the professional made it easier for me to cope. 

I stopped doing it, very quickly. There was another woman on the ward for whom I was the allocated social worker.  I had never met her but I phoned daily for a progress report. “How is she?” I asked the nurse. “Oh, she’s very poorly today, not fit for discharge,” said the nurse. On my notes, I wrote, “TC ward, Pt med” that is, “Telephone call to the ward, patient medical” (i.e. unwell, not able to be discharged). 

Next day the same call, the same note on her records. 

The third day I phoned, the nurse told me the woman had died during the night. I wrote “Pt RIP NFA”; that is, “Patient dead, no further action”. 

I stared at what I had written and the scales fell from my eyes. If I write about people in this manner, and think of them in this manner, I thought, then what is my treatment of them going to be? 

From then on, all my references to people use titles of respect – Mr, Mrs, whatever the person wants. I am not comfortable with the use of initials or ‘P’ in legal proceedings but the need for confidentiality justifies that I suppose. 

The words in the image above are words many of us professionals use and have used. You will find some of them in guidance from respected health and social care bodies. For example, ‘service user’ is a very common term most people reading this will have used at some point. Is it bad? Not necessarily. But why use the term at all? Or any other term which separates ‘them’ from ‘us’? 

Whatever our opinion, dehumanising people is contrary to the European Convention on Human Rights which is grounded in the basic right of every person to be treated with dignity. The Convention rights, incorporated into UK law with the Human Rights Act, were written after WWII, to prevent the horrors of Nazism from happening again.

I am absolutely not comparing myself or colleagues to officials working for fascists. But we must remain vigilant. The echoes of the call to the special path can be heard when we use language to dehumanise and other people. Unchecked, language can take us towards social extremes. Us and them. We are always superior to them. This is one reason why human rights should be at the heart of social work practice and education.  

After watching the recent Charlottesville riots in the USA, I found myself reading a story I found about a German railway clerk in 1944 who did not consider himself complicit as he wrote in his ledger not of people, but of how many Stücke (literally; ‘pieces’) he had processed through his station for special treatment that day (i.e. how many people crammed into cattle trucks without water or sanitation he arranged to be transported to a concentration camp). In “A Holocaust Reader” (1976) Lucy S Dawidowicz refers to bureaucratic language as “a language that concealed more than it communicated, its very structure and vocabulary buffering speaker and listener from reality.”

This may feel, and hopefully is, a thousand times removed from our use of language in health and social care. However, if a person is described in terms of being a thing (a Downs, a service user, a bed number) rather than a person, is it easier for us to cope with the emotional and physical pain the person is going through and possibly our failure to be able to do anything about it? Does it enable us to sleep at night like the railway clerk. I failed to listen to the woman begging me to let her go home who I processed into a care home; I saw her as a collection of things that had gone wrong and needing to be put right, and discharge to a care home was my solution. 

How we think about people and refer to them can become manifest in our practice.  I once saw someone working in a care home use a cloth to wipe down a table after lunch and then – without a word or any eye contact with this person – she used the same cloth to wipe the face of a woman still sat at the table who had just finished her lunch and had some food on her chin! That worker could only do that if she did not consider the woman to be equal to her, to be a fellow human being. And how many steps is it from treating a person like that, to neglecting her personal care needs, to hitting her, to stealing from her? Because she is no longer a human, she is a thing. But the care worker would probably never have thought of herself as doing anything mean or bad or hurtful.

As a social worker, I am privileged that the state trusts me to do the job I do. Anti-oppressive practice is central to good social work practice but just because we have a professional qualification, it doesn’t mean that we are immune. Far from it, the need to continually critically reflect on our practice and be open to the observations of others, in particular those “others” who we purport to serve, is an essential part of the job. 

The language we use is important because it can very easily be used as a tool to dehumanise people and yet it is also easy to fix. Looking at what we write about people and asking: “would I be happy to read this if written by another social worker about me or one of my relatives?” is a good place to start. 

Suggested reading:

Becoming dishuman: thinking about the human through dis/ability


Total Eclipse

In the main, people working in care choose to do because they want to be caring. But sometimes they don’t support people to live the lives they want to lead. Perhaps it’s the surprisingly ordinary, possibly even dull nature of an ordinary life which leads to workers talking up worries.  Leading to a reframing of the ordinary act of asking another person for advice or help can be turned around and become a problem to worry about, evidence of a dependency, a vulnerability the person needs protecting from.

A recent Community Care article highlighted the case of a Local Authority which breached a man’s human rights by forcing him to stop his sexual relationship with his wife when they asked for help.  Like any other ordinary couple they wanted to start a family.  But when they asked for help professionals began to worry.  Despite the couple having been married for years, a decision was suddenly taken that the learning disabled husband lacked the capacity to consent to sexual relations with his wife.  In attempting to turn around the implications from this hugely intrusive decision, the Local Authority was to arrange access to sexual health education  but then somehow failed to provide him with the education he needed.


The couple were kept separated for a truly shocking amount of time because the workers involved failed to understand their role in upholding their rights.  They had been married and lived in a mogonomous relationship for years. Just pause for a minute and really let that sink in.  Years.

Lucy Series has written a brilliant analysis of the issues – https://thesmallplaces.wordpress.com/2017/08/23/the-price-of-protection/amp/

However, equally brilliant (as always) was Mark Neary’s take on the case –

Mark’s timely reminder that married life is in the main outstandingly ordinary in nature, challenges the values behind the professional decision taken in this case to singularly focus on one aspect of the couples relationship when deciding not to support their request for help with fertility treatment but to instead force them to sleep apart for over a year.

The facts of this case aside, for spcial workers it is another prompt to be careful to avoid the “protection imperative”, that moment when professional worries eclipse clear and objective reasoning.  See Justice Baker in the case of CC v KK & STCC

Professionals and the court must not be unduly influenced by the “protection imperative”; that is, the perceived need to protect the vulnerable adult…. There is a risk that all professionals involved with treating and helping that person – including, of course, a judge in the Court of Protection – may feel drawn towards an outcome that is more protective of the adult and thus, in certain circumstances, fail to carry out an assessment of capacity that is detached and objective.”

If you think the community care report is of an “unusual case” you may be disappointed.  A self advocate recently described how he and his partner were subjected to 360 questions by professionals when they decided they wanted to become parents “because we have learning disabilities”.

There are many aspects to being a parent.  The right to experience all that goes with being dad or mum is a hugely important part of being human. Perhaps there is more we can do to make accessible information to those who want it beyond that which covers to act of potential conception.

In case you find yourself facing a similar scenario the link below will take you to accessible information and resources on sexual health and other things – http://www.btm.org.uk/resource-category/health/

And here is the RiPfA case law summaries on working with parents with learning disabilities – https://www.ripfa.org.uk/resources/case-law-summaries/?platform=hootsuite

Article 8 ECHR right to a private and family life

Human Rights Act 1998 right to marry and have children; right to respect for a family life

UNCRPD right not to be discriminated against in marriage, family and parenthood

Care Act 2014 the general principle of wellbeing takes into account relationships

The Saturday Boy

I am three months into a new job. Its really been hard. All the things you take for granted when you’ve known people for a long time are gone. Its hard having a bad day and no-one knowing you well enough to know that that is what your experiencing without explaining it. Its hard not swearing. Its hard remembering that no-one really knows my sense of humour or my cultural references. It reminds me of all the jobs I’ve ever had from Saturday boy to social worker. It gets easier the less new you are of course but the desire to feel settled, accepted and wanted is strong.

Last week I read a blog from Mark Neary that has preyed on my mind ever since. It was about an incident at home that had triggered a memory for Steven from where he was held (illegally) in a unit away from his dad and where a staff member had casually referred to Steven has  ‘a nasty piece of work’.  That the comments still  upsets  Steven all these years on and made his dad upset too are testimony not only to the powerful spiteful words used but moreover perhaps the intent behind the words. Whether or not the carer believed the words they used to describe Steven is one thing but the intent behind the words, the casual hateful remark towards someone they are caring for, is really quite sickening. For me the words are a reflection of culture in social care that thrives on not allowing people to feel settled, accepted or wanted. We are comfortable with belligerence in social care. We can even deal with hate. But if someone feels settled, accepted and wanted there is a risk that they may be loved and that is considered a real risk in social care. Its easier to consider people has a nasty pieces of work than it is to consider them as people, with the same desires as the rest of us. If we consider people who require social care as people like us we have to consider the totality of that. This leads to a risk that people might be possibly be loved. Love and social care anyone? Words you very rarely see in the same sentence.  

For the last few years of her life my sister had a Direct Payment. It took her a while to find the right person for the role of her PA but eventually she found Christine (not her real name). What amazed me at the time was how much my sister had to hide her relationship with Christine from social care. My sister was an extremely generous person with a  huge personality. Her relationships with people were intense and beautiful. Within weeks of employing Christine my sisters personality and humanity had completely dwarfed the Direct Payment arrangement that was supposed to govern it – it was always going to. Over the years a deep friendship grew but it was always hidden in the shadows of social care. When Christine was diagnosed with cancer it was my sister, the person Christine was paid to care for, who was at the hospital with her holding Christine’s hand as she received the diagnosis and prognosis. As Christine died it was my sister who stayed with her, gently singing to her and reassuring her that her daughter would be cared for. After Christine died my sister became the guardian of her daughter until she was 18. All this, the complexity of the relationship was extremely normal if you knew my sister and Christine. Humanity had completely overtaken the narrow definition we have of people in social care. That the relationship  was completely  hidden to health and social care was not really spoken about at the time because we knew social care could not ever understand it. It didn’t have a form to explain love or relationships or humanity but it did have a form on boundaries, inappropriate behaviours  and people abusing Direct Payments – all things that appear to be quite expected of people who need social care. How could that relationship ever be explained to social care with an expectation that the state would understand it? How do you tell an Audit Officer or a CHC Nurse or a social worker that a human relationship and love were meeting the ‘assessed need’ for both the cared for person and the carer? 

Dealing with love and relationships is really too difficult for social care to contend with so we constantly work in an environment where people are left feeling  unsettled, unaccepted and ultimately unwanted – its just easier that way. It’s a system where calling people we care for hurtful names, such as Steven and Mark experienced, is actually far more comfortable for us to deal with than love. A system where Marks love for his son or my sisters deep friendship with her carer is something that is seen to be so remarkable that it has to be fought for through courts or hidden in shadows. A system where love and human relationships, with all the complexities that they include, are viewed with suspicion and an industrial response to protect people from the very thing that we all strive for in feeling settled, accepted, wanted and yes, lets say the word, loved. 

<And la, la, la, la, la, la, la, la, la means I love you>

Walls Come Tumbling Down


When you look at these pictures – what do you see?  What do you think goes on inside of them? Would it surprise you to know that these buildings host social work – or would that be no surprise at all?

It is hard to envisage community social work, working cooperatively in partnership with people, when social work is often detached from people based in corporate settings such as those above.  So much of how we understand ourselves and our roles is defined by the people we spend time with.  Who do people in these buildings spend their time with?  Who do they chat to in the lift?  Who do they have a coffee with or chat to over lunch?  Who do they share their hopes and worries and dreams for a different future with?  How does that shape what they imagine their future could be?

Is there another way?   Bob Holman and his wife Annette believed so – http://www.communitycare.co.uk/2015/12/01/social-workers-praised-40-years-outstanding-support-in-poorest-communities/

Social enterprises such as the one that they set up cooperatively, in genuine partnership with people are able to provide creative solutions to local social problems.  As the New Local Government Network has argued – rising demand for adult social care can be tackled 1 of 3 ways:

1 – a wasteland approach – where services cut back to the bone

2 – the wild meadow – where Councils withdraw core services by binding into tighter and tighter partnerships with health, using thresholds to deny access to services – hoping that voluntary sector prevention, self help and navigation services bloom around them to fill the gap

3 – the common – where the Council moves from primary responsibility for maintaining the public offer and estate to one of cooperative approaches shared with communities

The report is here if you want to read more about these options – http://www.nlgn.org.uk/public/2014/the-council-and-the-common-local-government-in-2020/

Although it may not be possible for all social workers and OTs to form their own social enterprise, the very act of influencing the policy and practice of the agencies we work for to ensure that social justice is on the agenda should speak to our core values and training.

And this is happening.  There are social workers across the Country who are working differently.  Developing cooperative approaches with people who have experience of accessing support from social work and occupational therapy services where they stop being “users” of services and become the people who lead it, who practice becomes accountable to.   One such example being People to People in Shropshire who inspired the National Development Team for Inclusion Community Led Social Work programme – https://www.ndti.org.uk/blog/community-led-social-work-devolving-choice-control-and-power

This isn’t about trying to convince you that you want your practice to be accountable to people, or that signing up to a mutual or cooperative approach is the right thing to do.  To really work in partnership with people, you first have to really believe that you want to change the way you think about your practice, be genuinely person-centred and be ready to talk openly and honestly about the fact that everyone makes unwise decisions.  The celebration of not being perfect all the time (and not needing to be so) is the start of a new way of thinking and feeling about the future.

walls 2

Should I stay or should I go?



  • We visited 63 supported living settings and residential care homes to find out what people with a learning disability were doing between 8 – 9pm at night.
  • We asked about whether people had gone out for the evening, were up, were getting ready for bed or were in bed.
  • We also asked about what time people had eaten their evening meal.
  • We found that most people who lived in settings managed by a care provider were getting ready for bed or were in bed when we visited.
  • People who were getting ready for bed or were in bed had eaten an early evening meal.
  • People who were living independent lives with support for their tenancy agreement were not ready for bed when we visited. Some people had gone out for the evening.


Here’s the link to the Big Bed Time Audit Paper – http://www.tandfonline.com/eprint/nZmMyCEzNDjqGunKPwcJ/full 

Adult Principal Social Worker Network

This week saw the publication of a piece of research by Elaine James and the Adult PSW Network Co-Chairs Rob Mitchell and Mark Harvey. The research paper titled ‘An inquiry by Social Workers into evening routines in community living settings for adults with Learning Disabilities’ looks at the life when living your life in care settings. This researched involved the collective efforts of overs 70 social workers wanting to understand the reality of the of choice and real lives.

We were extremely pleased to when Paul Richards  ( @Heavy_Load ) of Stay up Late and Gig Buddies fame agreed to write a blog challenging some of the concepts that lead to such arrangements and suggesting what we need to do. What’s clear is that as Social Workers we need to take responsibility for such restricted lives and be part of the solution alongside citizens. Over to you Paul……

Should I stay or should…

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Ten thousand whispering and nobody listening

cat 1

I received my social work qualification in the post just two days before I started my first ever social work post. New social workers, in the days before we defined Newly Qualified Social Workers, were just called a new social worker. The fact that you were newly qualified was never  discussed. I was a social worker. I bought a new shirt for the occasion of my first ever day in the profession. It would have been ironed had one of the children not delayed me by being sick in one of my wedding (now work) shoes.

I met my first line manager in the first hour of the first day. She talked a lot and I was to listen. In fact she even passed me a notepad and pen as she commented that she was surprised I was not noting some of the things she was telling me. In truth I wont have been listening. I can’t listen when people give me instructions. If I get lost and ask people for directions I never listen to a word they helpfully try and give me. As much as I need their assistance I instead find myself concentrating on the kindly direction givers accent or slight whistle when they pronounce anything with an ‘s’ in it or I notice the expression of their passengers face. Whilst nodding and saying ‘yes, turn right’ after they’ve said it to give the impression I am listening I am wondering where they going themselves or where they have been. Now that I would listen to. But directions and instructions far less so. I expect my new superior was telling me about fire alarms that probably wouldn’t go off and the ritual of car parking or maybe even how to pay the tea club. I smiled and nodded and I remember noting something down in the pad she had given me. It will have likely to have been the last one I heard her say in order that it looked like I was listening. My guess is that it said something like ‘ok’. It may as well as said ‘turn right, yes’.

I remember my first ever social work client from that day. She was called Jean. She talked and I listened because she was talking about herself, her life, her ambitions, her present situation and her desires. Jean spent a lot of time talking about her cat. There were no instructions attached to Jean talking, and so I just listened. I asked questions from time to  time, but crucially I listened and Jean just spoke. On my lap I had a Community Care Assessment. This, my boss explained, was where we wrote down relevant points about peoples lives to do ‘The Assessment’. I had heard a lot about assessments in my first morning as a social worker. They were described as the cornerstone, the purpose and the focus of our role. In truth I hadn’t had much in the way of training on assessments at university. There was some mention of Care Assessments and Care Plans but in three years of training, 24 separate 3000 word assignments, two 8000 word portfolios based on two practice placements I rarely mentioned assessments. My training was about our approach, our understanding of people, relationships, the dynamics of relationships, empowerment, advocacy and rights. Maybe I was on the sick on the day they did ‘assessments’? Either way, assessments were a form and forms came with instructions. I wouldn’t have listened.

Half way through week one the boss was clear that my work with Jean needed reviewing. I was invited in to the meeting room and asked to explain where the discharge planning was up to. With my paperwork in hand I began talking about Jean. I had completed the assessment through recording what I had heard Jean say. So half reading from the assessment document and half through memory I talked about my conversations with Jean. I talked about her background and her family, I talked about her husband Bob and his job and how when he retired he died shortly after robbing Jean of the retirement that they planned. I talked about how Bob had helped choose the new carpet that she had tripped on, causing the fracture that led to her fall and how she laughed at the thought that he was getting his own back. I talked about the grandchildren in Australia and how the letters and photographs kept Jean going as well as the 3am phone calls from her granddaughter Laura due to the time difference and how excited Jean felt when she was due a 3am call. I talked about Jeans cat and how when Bob had died and her daughter had gone to Australia it was the main focus on Jeans life. I listened to Jean talking about the life that Jean once had, the life she was planning to have and the life she had now. After I had talked about Jean I waited for the boss to speak. There was a long pause and then she spoke. ‘You may have well as assessed the bloody cat’. She went on to explain that what I needed to assess was the support Jean needed, not Jean herself and certainly not her long lost husband, far flung daughter and bloody cat. I needed to listen to how many times she needed the toilet during the night. I needed to hear if she now thought she needed to be in a residential home. I needed to hear how the care package was going to get her back home. I needed to listen out for who manages her finances and how much money she has. I was genuinely perplexed. I wasn’t trained to do that sort of listening. I didn’t like that sort of listening. That wasn’t the social work I was educated in and in truth I didn’t even recognise that it was social work. But this was my job.

I didn’t speak to Jean again or get the chance to listen to her. Our conversation was converted into an assessment by an experienced social worker. Apparently with a half decent nursing report and a functional assessment from the OT we could just about throw together an assessment that would help Jean be discharged as quickly as possible. The assessment documented that  Jean needed four calls of home care a day. The calls would start anytime between 7am and 11am. Lunch was between 12 and 3. Tea from 3.30 to 7 and bed every night by 10pm. No mention of Bob or little Laura in Sydney or even Audrey next door. On the box that documented whether or not Jean had got any pets it said in bold capital letters NONE.