Winter – Part 3

Each year the headlines going into the NHS winter seem to forecast a bleaker outlook.  

Whilst the 1st October still feels very autumnal, the build up to this years NHS winter is underway.

Which is worrying if you are responsible for arranging services for people who will need some extra support from adult social care to help them home from hospital.  In adult social care we rely on so called winter monies to fund out of hours, home care, intermediate care and transitional beds, all of which get people out of hospital and back to their communities so they can complete their convalescence and recovery.  This winter however the signs are that these funds won’t reach social care.  The NHS winter is biting and hospitals are needing every penny health commissioners can find.

This is further destabilising fragile social care providers, many of which are small local businesses who are really struggling to make things stack up.  As reported by the Kings Fund & Nuffield Trust social care providers face huges pressures in terms of retaining staff, maintaining quality and staying in business.

social-care-for-older-people        Social Care for Older People (home truths)

Our experience is that small, local providers are full of caring, passionate people who are trying to make social care work despite the challenges.  People like Mark, whose story from 5.05 minutes into this video about what happened on Boxing Day 2015 when the River Calder broke its banks left me speachless when I first heard it.

Mark and his team faced the worst that winter could throw at them.   But driven by deeply held convictions that it was their job to care, they are made social care work in the most challenging of circumstances.

Going into this winter we are anxious, but we haven’t lost hope.  People have an incredible capacity for caring and to find humour and happiness in the bleakest of circumstances.

winter-okie-aged-80

So going into the social care winter 2016 here are our suggestions:

1.  Remember why you work in the social care sector.  You care.  If you didn’t you could earn more somewhere else.

2. Nevet forget you are a guest in people’s lives and this is a huge privilege.  The minute it stops feeling that way it is time to move on.

3. Create space with your friends and coworkers to talk about the people you are here to serve and support.  Every person is a bright spark of colour in your life.  Sharing those sparks might catch a fire to keep you and your colleagues warm during the darkest of days when the pressure is on.

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Are we Human or are we Care Manager?

Law Commission consultation

OK, so I am a bit of a social work addict. I love my job and my profession in a way that I never felt possible. I get hurt by criticism of social work to the point where I have to genuinely challenge myself to properly listen to criticism of it just in case it’s true. A lot of times it is true and the truth rings out through the voices of parents such as Sara Ryan and Mark Neary. Their criticism of the social work they experienced is wholly true and we as social workers know it’s true because we recognise, we’ve seen it and we may have even been it. The criticism of social work that really hurts me is when I recognise it. To be social works biggest fan you must be its fiercest critic.

I was told during my first week as a social worker that I wasn’t here to practice social work.  I was told I was in fact a care manager. As a care manager I was told I had a range of solutions for people. These solutions became my care management box of tricks. They included home care, day care, respite care (which I learnt was code tricking people into permanent care), residential care and nursing care. All roads led to care and all care led to a charging assessment. My job wasn’t to challenge it was to assess social care needs, it was to ensure eligibility and it was to safeguard resources and maybe people.

I am optimistic about adult social work and as such I do think those days have gone or are at least on the way out. Adult Social Workers at least seem to recognise the shackles (or abhorrence) of care management and I feel there has been an effort to engage with what the role is about. I felt the sea change in adult social work in 2005 with the Mental Capacity Act. For the first time since the murky day of the implementation of the NHS & Community Care Act it was possible to see a role emerge for adult social workers that required us to properly advocate for people and to work to promote the inherent principles than span not only the MCA but also our profession.  For social workers like me, who swam around for years looking for something to cling on to, the Act was vital in rediscovering ourselves. The creation of Best Interest Assessor roles, the unique role that social workers now take in MDTs around MCA and human rights gives me lots of confidence for the future. I would gladly take the pressure of a thousand Cheshire West judgement (sorry Cheshire West, no-one hardly ever mentions Surrey instead do they?!) because the Supreme Court ruling is human rights. Not brokering care or completing a CHC Checklist.  Human Rights, that’s our thing.

Care management had its trappings and for social work employers across Local Authorities and mental health trusts it was comfortable to administer. It didn’t require much thinking and despite the fact that it was often highly damaging for people it literally ticked a box. It wasn’t that stressful for the workers and for the role we did it wasn’t that badly paid. Care management came with statistics, performance measures and KPIs! Why worry about measuring the quality of the social work and upholding rights for people like Connor and Steven when you measure where in the 28 days a Community Care Assessment and Care Plan is churned out? If the social workers wanted a care management role then the employers weren’t going to resist any call for change.

Recently I have noticed some negative views of social workers on the Law Commission proposals for the new Approved Mental Capacity Professionals. I wonder if the legacy of care management is one of the reasons for this?  Far from embracing the opportunity to embed our profession and unique role in the promotion and protection of human rights the criticisms I have heard are that as social workers we are too busy to undertake the new AMCP role. Social Workers are busy. We are busy doing a myriad of things that we probably shouldn’t be doing like CHC Checklists and more of the box of tricks.

In truth I probably do need to get over the CHC thing!  I recently suggested on Twitter that I was going to do the Haka before my next meeting with health colleagues over CHC eligibility.  I was only a half joking.

But the AMPC role is important. Too important to let the legacy of care management and any fear we might have about our role going forward to stop up. This is social work.  It is human rights.  It is something every adult social worker should be aspiring to be.  The care management thing hasn’t gone away, but the assessment, the support plan, the ‘management’ of peoples care through helping others to manage their care, is not how we can be defined any more.  We are not there to broker on behalf of the other ‘real’ decision makers in the MDT, we are there to uphold human rights and ensure that everyone else understands that human rights are for all, there is no threshold for entry.

If the proposals by the Law Commission are accepted and implemented, then the new role of Approved Mental Capacity Professionals would be “in the same position legally as Approved Mental Health Professionals”. Indeed, the AMCP will probably have more authority than AMHPs. Given social work with adults has in recent years, lost its way and questions are asked about the role or even the need for social workers with adults, the role of AMCP is a lifeline being thrown to the profession and it should be grabbed with both hands. It is a role most naturally suited to social workers with adults because of that profession’s knowledge of and passion for human rights and the Mental Capacity Act (2005). AMCPs will be the decision makers for the local authority, the ones safeguarding people’s rights and well being. 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!? And we did all say that. The ones who came into social work saying they wanted to broker care and complete reviews within specified timeframes weren’t offered the posts. How many social workers can say they trained for three years to become experts of surviving panel and restarting home care?

The AMCP will ensure the 5 principles of the Mental Capacity Act underpin every assessment.  That capacity is assessed to a certain standard, which means from the outset there would be no grumbling about poor quality assessments completed by other professionals. They will also decide who assesses capacity, and they will monitor the degree to which a person has been enabled and involved.  They will decide if a mental health assessment is needed. That will mean, among other things, that intrusive and expensive mental health assessments are not needed on every occasion, for example, where a person has lived with dementia for years and the illness is well documented. This is a development that the BIAs I have worked with have wanted for a while. AMCPs will also be the ones to consult in the event a proposed (and extremely scary) 28 day hospital authorisation needs to be extended and will further ensure all parties involved are compliant with other legislation such as the Care Act (2014). This opportunity should be fully welcomed by social workers who are frustrated when colleagues in health are slow to appreciate human rights for all, regardless of age, disability or appearance. This gives us our chance to get a real foothold into the future and to embed our unique role.

The AMCP will work closely with CQC and Safeguarding teams as well as with providers and the families and advocates of those protected by the new scheme, networking which will be second nature to social workers with adults. They will be a source of knowledge and information about the Mental Capacity Act and will guide practitioners in its application, ensuring that people’s rights are central to all state intervention.  There will be no need of expensive applications to the Court of Protection for the authorisation of the deprivation of liberty of a person living in their home or supported living, the AMCP will do that and will also appoint people to support the person and displace them if they don’t do the job properly. The degree of power is daunting and social workers will need to be at the top of their game for this role. There will be no making recommendations to signatories in supervisory bodies about conditions and so on; the AMCP will apply the conditions, authorise the deprivation of liberty and ensure everything done for a person who cannot consent because of their mental impairment will be in that person’s best interests and not those of the provider or the commissioner or the family. The AMCP may also delegate certain tasks to other social workers. If it is not social workers taking on the role of AMCP, then that could well mean other professionals who become AMCPs are delegating tasks to social workers. Do we really want that? These functions and responsibilities take our role to another level so let’s rise to it! Crucially these functions, undertaken by social workers, tells employers, partners and the people we are here to serve that we do have a specified role. We aren’t over paid administrators and we aren’t care managers here to solely broker care and ensure compliance. We are here to do what we said we were going to do when we were being trained. We are here for human rights!

The role will have a dramatic change in the way social work teams are managed. There will be cost and recruitment difficulties not to mention the difficulties local authorities will have in ensuring quality is assured. But what will change – if social workers embrace the proposals and the role of the AMCP – is there will be fewer abuses of people human rights, less public money spent on lawyers and courts and mental health doctors, and less time spent waiting for things to be done. In addition to this social workers will cement their role within health and social care. The shackles of care management properly removed, the embodiment of genuine person centred, human rights enhancing social work would be at the heart of all of what we do.

These new roles merely reflect our growing professional identity and enshrine our values. We are here to enable people to experience the full embodiment of equal human rights as citizens. What’s not to love about that?