The Ghost in the ATM

ATM

A few years ago, when I was a Team Manager, I chaired a meeting about a man who the Local Authority had recently placed in a care home. During the meeting I noticed that the man’s mother Sheila was becoming increasingly frustrated by the meeting, in particular she became fidgety as the Social Worker insisted that he go carefully and line by line through (what was then) Community Care Assessment. The Social Worker patiently explained to Sheila that he had to make sure he had captured all the information appropriately and accurately and so that everyone’s views were incorporated. Sheila stopped the meeting and said ‘Can I tell you something? I work for a bank and I’ve studied commerce. You know mini banks? Cash machines? When you put your card in and you want to withdraw cash, what happens? Take me through that process’ Uncomfortable silence ensued. No-one spoke, everyone looked down not wanting to make eye contact with either me or her. After a few moments of awkward silence, she continued ‘Ok. I’ll tell you. You type your PIN in and then you issue your instructions to the machine. It asks you if you want information about your balance, receipt and then finally you get cash options. You choose what amount of cash you want. But the crucial thing is that the machine doesn’t give you cash straight away. First it gives you back your card and then and only then it gives you your cash. That’s deliberate. Does anyone know why?‘ Again, nothing from the stunned MDT. ‘It’s because you’ll forget your bank card once you see the money because that’s what you came for. You will take the money from the machine and turn and walk away and you’ve forgotten about the process because it’s not important. The card will then come out of the machine and the machine will bleep loudly to remind you to take it. If it didn’t you would be down the road counting your money and planning on what you’re going to do with it. We have research in commerce that evidences that this happens on 90% of transactions we’ve tested it. The product is always the thing, not the process. You’re assessment is a process but it doesn’t mean a thing to my son or me. We want action‘.

Sheila went on to explain that the ‘action’ for her son was the care and support, that was the outcome. The process (the assessment), as she saw it, was for us not her and absolutely not something for her son. This observation had quite a profound effect on me. I reflected on earlier that week I had been to see my GP. Although I recalled answering the GPs questions and listening to the GPs observations about what I told her, it was her diagnosis and her intervention that really mattered to me. That’s what I was there for. That was the action. Whether I was there for the prescription, or the referral on or the sick note or the something else, I was there for outcome and not really that interested in the process about how she got there. The GPs assessment was just that – the GPs. I didn’t need her for an analysis of my life to date and the environment I lived in. I was the expert of my life and my circumstances, I’d lived it! I just needed her to make the next step happen to help me stay healthy.

By this point in my career I had been schooled in assessment and genuinely believed in their merit. Even in my first qualified social work post I had the job title Social Care Assessor. I had showed off to colleagues at the hospital team that as Social Care Assessor covering older people’s mental health wards. In a typical week, I brought 6 cases to funding panel for placements in care homes. I worked hard on producing the assessments. I learned to write lots. They were huge. They covered everything. I wanted to show just how person centred I was so in every assessment I included a pen picture of the person making clear how much research I had done on to understand their younger days, their likes, their culture. The assessments were approved at panel. The CCG had copies. Prospective care homes received copies. And eventually when the person went to the Care home the assessment accompanied the person. As a Social Care Assessor, I would then see the person again in six weeks to see if they had ‘settled in’, which is essentially Social Care code for ‘have they given in and accepted the Care home and all it entails’….

But faced with Sheila I found my faith in my assessment wobble. I went home that night and couldn’t sleep, my mind churning with questions:

  • Who cares about the consequences of the product when we’ve got the process to do?
  • Were the assessments I undertook as a Social Care Assessor ever read again?
  • Did anyone other than me read the carefully researched person centred pen picture?
  • In processing the person through a conveyor belt of assessments was I really being person centred?
  • Did any of my assessments lead to anyone being better off?

I didn’t sleep well for weeks after meeting Sheila.

My assessments were produced after a huge amount of input, but in reality they consistently resulted in a very simple to arrange outcome – the Care home says yes, they’ll take him, send them the Care plan we can settle him in ready for the evening meal round. Ultimately the success of the product was invariably what the care provider made of made of the person I had processed towards their final resting place. The long term happiness of the person entirely dependent on the quality of the individual provider, my assessment recording a point in time which faded into the past as it was superseded by a plethora of new documents to process – support plans, med charts, meal charts, visitor logs.

I genuinely cannot recall a single 40 odd page assessment that ever genuinely informed my view on things like eligibility, need and what the right support would be. The skill of the social worker is in recognising the value of a cuppa and a chat, a frown or a joke, the mention of a relationship, a loving glance between family members. Social Workers shine for me when they celebrate that they are experts in human interaction.

So, let’s embrace our humanity and the humanity of the people we serve such as Sheila and her son. Sheila and her son were the experts of their lives. We are there to understand environmental and sociological issues and place those in a context of their human rights. That’s our role. Let’s stop wasting time spending days in the office typing up pages and pages of assessment forms and case notes which no one will read. We are the PIN number, the bleep in the machine, the questions about balance on screen and whether receipts are wanted. We are the action, not the assessment.

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Clouds in my Coffee

latte-art-kak-delat-risunki-na-kofe-foto-7

My favourite mornings start with a coffee. I’m a member of the coffee club at work. Gossiping with others over that first cup is a ritual that grounds the day. There’s something about the feeling of belonging that being part of the coffee club brings. I can’t imagine how it would feel to have that removed from me.

The gossip which goes with the first cup of the day often drifts into speculation about big ideas. Social work naturally draws people in who are interested in big ideas about people, community, society. So, it’s no surprise that the speculation over a morning cuppa at the moment is about the content of two big papers on social care which are due this summer:

There are big headlines coming out of the CQC led reviews. The focus on the person is uncompromising. If care and support isn’t person-centred – it isn’t high quality. And being person-centred mean upholding the 5 statutory principles of the Mental Capacity Act through every decision.

  1. The person has the right for it be assumed that they should be in control of whether they want support at all, and if they do how their support is arranged.
  2. All practicable steps must be taken to enable them to make the decision including reasonable adjustment to enable them to communicate how they want their support arranging.
  3. If they want to arrange their support in a way that doesn’t fit the views of professionals – the social workers job is to advocate for them and use the law to enable them to take risks, challenging where professionals and others argue that the risk is unwise and therefore questions the original assumption that the person has the capacity to be in control of how their support is arranged.
  4. Any decision taken on behalf of a person who does lack the capacity to make the specific decision must be taken in their best interest. Section 5 of the Mental Capacity Act provides a defence against liability if the statutory principles are applied. The bar is much lower than most professionals realise when it comes to capacity. The latest analysis shows a 95% increase in the number of requests for the Deprivation of Liberty Safeguards not granted. This includes people who have died since the request was made, but it also includes people who the MDT deemed lacked capacity to be involved in the decision whether to go home or whether to move to a care home, who have subsequently been found to have had the capacity to understand, retain, weigh up and communicate their view once a social worker trained to a higher standard of legal literacy as a Best Interest Assessor has met the person.
  5. Any decision taken must be the least restrictive. Rarely will 24-hour settings, such as a care home, a supported living house, a hospital be the least restrictive.

When it’s understood well, the Mental Capacity Act is the most powerful tool in the social work tool box. It defines a unique role for social workers of knowing legislation, understanding advocacy and the ability to interpret and enact keeping power and control with people. Person-centred enshrined in law.

Lizzie’s social worker is also a coffee drinker. When she met Lizzie, they shared their love of coffee. Over coffee Lizzie shared a secret, she had a lover. Her sons didn’t know. She didn’t want to upset them. She used to meet him in a coffee house. But now she was in a care home she wasn’t allowed to go out, she didn’t have her own phone, she couldn’t speak to him or see him. Lizzie couldn’t go home, her sons had sold her house. Her heart was slowly breaking. She just wanted her life to end so she could meet him again in heaven.

Lizzie’s social worker spoke to the nurse who had arranged for Lizzie to be moved into the care home when she’d been in hospital. She was very worried about the suggestion that Lizzie leave the care home to walk to the local coffee house, she wouldn’t be safe, she might get confused and lost.

But nothing is too difficult if you want to make it happen. The social worker was upset for Lizzie. They wanted her to be happy. The social worker made contact with her lover. He was alive and missed her deeply. He wanted her to live with him. A meeting was arranged between Lizzie and her lover in the coffee house.

Lizzie’s sons were furious. They thought he would steal her money. They wanted her to stay in the care home where they thought she was safe. The social worker used the MCA to uphold Lizzie’s right to make the decision about where she lived. She arranged a family meeting where Lizzie told her sons that her decision was to move to live with her lover. The sons wanted other professionals there. Lizzie was quiet upset listening to the nurse and her sons tell her why she needed to stay in the care home. But the social worker was brave and stayed clear that Lizzie had retained and understood what they were worried about and had weighed up the risks of staying in the care home over the risks of moving in with her lover. Lizzie clearly communicated that she wanted to move. The social worker made it happen.

There’s a hashtag at the moment #socialcarefuture where bloggers are speculating big ideas. It’s worth a look. But it seems to me that being drawn to big ideas misses the point. High quality care is person-centred. Being person-centred means being drawn to the small places – the coffee houses where real social care is happening.

Speculating about big ideas is the realm of professionals who are looking to find their place in people’s lives who may not want them there at all. A mature health and social care system is one that recognises and critically reflects on its need to exist at all. Our systems are remain stubbornly determined by historic models of investing in ill health. Debates about how to work within the system will do little more than incremental gains. Perhaps this is enough, it certainly worls for athletes. But if we are to achieve a genuine shift to upholding people’s right to live healthy, happy lives as active citizens free from unwanted state intervention it will require braver shifts from the system controlling resources to people being in control. It requires professionals to be open to challenging their professionally taken for granted assumptions that their involvement in people’s lives is helpful. Being a member of the health and social care coffee club is a comfortable place to be, but being a bystander in a coffee house, walking away from Lizzie as she gets on with her life is a far more person-centred place.

For the Valentines I never knew

Valentine

There’s a song by a band called the Wedding Present which like so many other songs is about falling in love.  It’s called A Million Miles.  It’s about that moment when you meet someone for the first time. The moment when your stomach spins. You can’t eat, you can’t sleep and yet despite this, as the song goes, you ‘can’t even remember the colour of her eyes’. The song connects with that first fleeting moment when a returned smile and a burst of shared laughter on the walk home together means everything. When your world is filled with subsequent endless telephone calls to each other (it was written in the mid 80s before text). It’s about that mad bit. The bit where the massive risk has paid off, even if it’s only momentarily.

I know it’s different for everybody but that song has always resonated with me because that’s how it feels when it happens. It’s a kind of prolonged Christmas Eve of anticipation. It’s mystifying, scary and the most exhilarating experience that you can have. Its the 1000-1 off-chance of a new human relationship that may lead to love and will involve lust and desire alongside, hopefully, some happiness on the journey. The risk you’ve taken was huge. The smile that might be unrequited, the humiliation of a misread signal, the shocking discomfort of a blind date from hell, the deeply personal hurt that comes from rejection if, as may be likely, a rejection is just around the corner. Yet despite that, despite all of that, we felt it was risk worth taking.

Love and falling in love. Seeing people fall in and out of love. Beginning and endings to relationships plays a huge part of our lives. I’ve completed two three year courses on issues around humanity and social care and I’ve completed countless additional training courses but I genuinely cannot recall ever being asked to write about love in any assignment that I competed. I have definitely never written the word love in an exam. I can’t remember a single lecture on love or certainly not one that didn’t medicalise it, or quickly move towards framing love in terms of ‘attachment’ or ‘obsession’. But love and relationships appear to be one clear thing that drives us. We don’t get to choose who we love or we can not prevent unrequited love. It is part of who we are, and can at times lead to terrible sadness. It is the essence of humanity. And yet, it is something that health and social care isn’t comfortable with.

As social workers you would think that our profession would be there when people needed help and support with love – it’s sort of in our job title. But in my career, I have found the most significant block in terms of our thinking about supporting people to experience the love, with all the risk it brings.  I can recall on one hand the number of conversations I have had with people where there has been a positive approach to helping someone with any aspect of having that ‘Wedding Present song’ feeling.

It is particularly stark when it comes to people with a learning disability. Instead of love, I hear about sex a lot. And sexually transmitted infections. And grooming. The words sex and relationships in social care are invariably linked to risk and danger and professional worry, rarely love. I worked with a young man some years ago who according to his allocated learning disabilities nurse had had sex with his boyfriend who also had a learning disability after an evening party at the day centre. Within the course of that day over 20 professionals were made aware of what had happened. We knew what had happened in forensic detail and more or less where it happened. The police were mentioned. No crime had taken place but someone thought something needed to be done. What about the risks? What about consent? What about protection? Everyone focused on the sex. No one of course said anything about love. Whilst I find the term ‘making love’ a bit toe-curling, it was safe to say that none of the people who got to hear the intimate details of whatever happened between that loving couple stopped for one moment to consider it to be anything other than a physical act. The couple are still together. They are still upsetting people by having sex. No-one is mentioning that they love each other and may get married. No one is talking about how their lives have been enhanced through love. They often skip their allocated day centre to spend the day together travelling on buses. The fact that as a couple they want to stay in each other’s company all day every day, seemed to worry and upset professionals rather than be celebrated. But surely that’s what love does, it puts everything else outside of that relationship into context. For them, love is the answer, not social care.

Social care, day centres, endless games of ten pin bowling, coffee and cake in Merry England for ten people and two carers – all makes sense when there’s nothing in your life other than people who are paid to care for you. Especially  so if you also do not have the comfort of love from your family. Add love into the mix and suddenly ‘outcomes’ and ‘achievable goals’ and ‘support plans’ find their context – in the bin. Love between two people makes sense of everything.  Leaving the question – why don’t we embrace the possibility of love for the people we support rather than reframing relationships in terms of worry, risk and danger; The pain from love is a risk that we are willing to take ourselves, and not infrequently do so. Yet by worrying about others feeling pain from those very risks we embrace for ourselves, we inadvertently ensure love remains always just outside of reach and relevance of those we support.

Perhaps, as professionals we find this so difficult as it calls into question our professionally taken for granted assumption that our interventions are wanted and helpful. If we properly understood love and humanity we would have to understand our place in a person’s life is somewhere much father down in the pecking order. Our rules, our say so, our plans for you suddenly lose gravitas when competing with forces like love. What always strikes me about Mark & Steven Neary’s powerful account about ‘Getting Steven Home’ is that via the Court of Protection the Local Authority seem to very late in the day to be forced into having to grudgingly accept the fact that there is a relationship between Mark and Steven which must be respected and upheld in law (Article 8) but never really seem to get close to understanding that it is the love between them that drives everything about their words, actions and motives. It’s as if love is quite literally an emotion beyond us. We’ve typed ‘love’ into our health and social care computers and it’s come back with an error message and then crashes.

So we tend to stick with what we know and what keeps us safe as professionals. We’ve sort of come up with a fudged thing in assessments which is about relationships. This means that we don’t really have to talk about love but we can talk about other people – significant others, next of kin, nearest relatives and relevant persons. And we’ve got a form and a process for every relationship. Some relationships (nearest relative and relevant person) even come with special powers. Whether nearest or relevant relationship is loving never really crosses our minds. Love becomes relationships. Relationships become processes. Processes get processed. Health and social care box ticked. Love don’t live here anymore. Not that it ever did.

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.

https://twitter.com/CommunityCare/status/899307540470804482

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

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.

 

 

All life is an experiment – I am not vulnerable!

friendship

I once worked with a young woman called Emma (not her real name) who had a mental impairment and would sometimes go into town alone, whereupon two young women would sometimes meet up with her. Emma would withdraw £200 from the ATM which she would share with these people. After an hour or so, the two women would desert her. The care home staff where Emma lived wanted to prevent Emma from going out on her own, they said it was ‘mate crime’ and that Emma was being financially abused.

I met with Emma and put this to her. She said, “I know they are not my real friends, they only want my money. I’m not daft.” I asked what would she do if it happened again? She said, “The same probably. It’s worth £200 to me because it feels like I have friends, I can pretend to have friends even if it’s just for an hour.”

Emma’s story made us feel sad and angry that people would take advantage of her and we wanted to protect her. But she did not want us to do that. She had the mental capacity to make the decision and, putting it bluntly, she did not care how we felt.

I also worked with a man who was nursed in bed at home but his son – frustrated with his dad’s deteriorating health – would shout at him. We wanted to stop the son from shouting at the older man, possibly apply to the court to prevent him from visiting altogether, but the man told us and the police to do nothing. He acknowledged it upset him when his son lost his temper but he loved him and wanted him to be around. In time, he died at home with his son visiting him to the end. As social workers with both children and adults know well, from the perspective of the person a not-very-good family is usually better than no family.

Had the legislation been available, we could have over-ridden their decisions to protect them. They would have been protected from abuse, so we would feel better, but would Emma or the older man feel better? If a capacitous person wants our support then we give it; if they don’t, we must walk away, no matter how upset or concerned we are.

I am reminded of that much quoted speech by Sir James Munby (‘When is Safeguarding Abuse?”) in which he says that if local authorities are to justify intervention then what follows must be better than what went before. I have no doubt the intention of the Vulnerable Adults Bill is not to wrap all people in cotton wool, but to take what Sir James calls a proper balance in supporting those “less well equipped” to deal with risk than others.  If you want to find out more try the brilliant Lucy Series @thesmallplaces – https://thesmallplaces.wordpress.com/2014/11/14/what-good-is-it-making-someone-safer-if-it-merely-makes-them-miserable/

However the proposals for a Vulnerable Adults Bill concern me because, although I have little doubt that while the courts would continue to respect the right of an individual to make an unwise decision, where such is to be over-ridden that must be by a higher authority than a council employee. Indeed, I don’t see why the inherent jurisdiction of a judge sitting in the High Court does not already meet this need. And as I see it, treating people who are vulnerable because of their disabilities differently from all other people is discriminatory.

In practice then I fear such an Act would be used against people, not to support people, and there would be little consistency in its application by health and social care workers. The culture of paternalism and protection is still deeply embedded in some quarters. For example, I have been challenged many times about the outcome of a capacity assessment I have completed, but not once when I said the person lacked capacity to make the decision, only when I said the person had capacity. That is absurd; the assumption of capacity unless proven otherwise should be well established but it is not, even ten years on.

I doubt those drafting the Bill would want this to happen but in practice many people with dementia (or not!) in hospital making the natural decision to return to their home would be deemed ‘vulnerable’ by ‘concerned others’ and needing protection. The ward staff would want this because they would not want to be held responsible in the event something bad happens to the person. This paternalism exists now in spite of the law preventing it. In my experience some professionals are not afraid so much of something bad happening to the person, they are afraid of something bad happening to them as a consequence of something bad happening to the person!

I tell social workers all the time that if they do what the MCA says then Section 5 of the Act will protect them from liability. But how could a social worker trying to defend the right of a person to make an unwise decision deal with such ward staff or police officers or concerned neighbours telling them that they must do something and citing the new law? Who among us wouldn’t be more worried about their job than the rights of the relevant person? The MCA is already intentionally used against people so what then would be the chances of a person unfortunate enough to be objectively considered ‘vulnerable’ appearing on the radar of health and social care retaining their autonomy?  See the case of Fluffy the Cat if you don’t believe this to be the case – https://ukhumanrightsblog.com/2015/01/29/what-price-liberty-damages-dols-and-a-cat-named-fluffy/

By the way, in time Emma found a real friend and moved out of the care home and into a shared flat and those two women lost their free money. What she had needed was support from her social workers, not for her social workers to decide what was best for her.

Ian Burgess, BIA and MCA Professional Practice Lead, on behalf of the Adult Principal Social Worker Network in England

 

Lymbery, M (1998). Care Management and Professional Autonomy: The Impact of Community Care Legislation on Social Work with Older People. The British Journal of Social Work 28, 836-878.

Munby, Lord Justice (2011). Safeguarding and Dignity: When is Safeguarding Abuse: Keynote address by Lord Justice Munby to the Rotherham, Doncaster and South Humber Mental Health NSH Foundation Trust’s AMPH and Social Care Conference.