Over the past 9 months I have entered the world of blogging, or probably rambling in my case, and have covered a few subjects. One area I have often thought about commenting on but avoided is, winterbourne, post winterbourne, WJIP, Concordats, hospital abuse, the answers and Bubb. My avoidance has been prompted by the many and I mean many out there (Bill Love, George Julian, Mark Neary, Sara Siobhan, Martin Routledge, Chris Hatton to name but just a few) who are taking up the cudgels and reminding the world, strategists and leaders that there is a simple solution. Treat people, as part of society, and allow them to be true citizens and long-term hospital incarceration would be eradicated. I am of course over simplifying, there are many more complex areas to tackle than just this but true inclusion is a start. However the movers for a lasting and inclusive answer to the post winterbourne hinterland continue the debate and fight far more proficiently than I ever will so I proposed not to Blog about Winterbourne, assessment and treatment units or my view on the debacle that is the plan to fix it, until now.
I have a colleague who like me is a social worker and someone I respect. She is trying very hard to develop a community response and new life options for those non-citizens in hospital with her team of social workers on the ground. We often and by often I mean every chance we get have a debate about the answer to Winterbourne and the mess that is being made of it. We often put the world to rights but have differing views on how to make change happen. However there is one statement that she has said to me on a number of occasions that I constantly return to and reflect on. In those original debates I disagreed with this statement, which hurt, but now I’m not so sure. Her proposal is simple “we let this happen”. Let what happen? We as in social workers nationally let this happen. We let people with learning disabilities live in assessment & treatment units and as social workers & managers we never thought to challenge this. In our minds people were safe, being looked after and only needed our attendance at the CPA and any MHRTs that took place. Hell, the doctors even told us they weren’t ready for discharge and needed treatment so we didn’t need to discharge plan. They were ok in hospital, being treated and safe. We would plan discharge when all were ready, I mean there would be no suitable placement in the community anyway and most providers said they could not meet their need.
This is what she meant and in reality she was correct. I am adding a sense of generalisation here and Social Workers may not be wholly and singularly be responsible. There will also be many fantastic stories where social workers have prevented admissions and or developed the most innovative support packages that are personalised and turn visits to the community into living there. However, 3500+ people detained in hospitals wouldn’t care for these stories, they want to know where all the social workers were for them? The basis of my colleagues argument was that in a world of ever increasing pressures, having someone in a hospital safe, secure and receiving treatment was never going to be a priority for pro-active social work management let alone retaining a named social worker. If your team is struggling to allocate work and deliver even the most basic of social work functions to those in need of support then her assertion was probably true and it is painful to hear. Again before the criticism comes flying I accept that this statement may be generalised and controversial and this blog also but that is my point. It cant be wholly generalised otherwise thousands of people would not have been in hospital for years, or our screens filled with the horrors of torture in a modern day health service or horrendous preventable deaths such as that of Connor Sparrowhawk.
Another reality that we must consider is that for the vast majority of those in assessment and treatment units the admission would have been by the signature of a Social Worker. Other than those admitted under Part III orders MHA 83 via the court most would have been on civil sections of the same act. All of which would have required the consent and order of an ASW or an AMHP. Given that, even after the amendments to the act, the vast majority of AMHPs are social workers these admissions would have been on our hands. Again having been an ASW and subsequently an AMHP I am aware of the pressurised but important work that is done. Should we however, think beyond the detention. If as assessors we knew that the person would be there 2,3,4 and many more years later would we have signed those pieces of pink paper, least restrictive?. Clearly the role of the ASW/AMHP was to asses the situation and legal responsibilities at that moment in time. Not necessarily to consider the persons life for the next five years. Should the criteria have been met, the opportunity that care and treatment could be provided at …………. and no viable alternatives then detention was the start of the journey. I do wonder if that ASW or AMHP had to go back 6 months later and review the order or even every year thereafter until discharge then maybe they would have thought differently on the day of the assessment.
There are great social workers doing great things but all social workers should be doing great things. Things that sometimes people, society and the media will comment on and critisice us for but none the less if they are done with the values of social work at their very heart then they will be great things. I once put the poster below up in our social work offices and it caused a bit of a furore. Some were upset at the poster, some angry that I had put it up but it started the debate, which was the point. We can never be so assured of our work or ourselves as social workers so as to let complacency in.
So what did we do wrong? Why were we not there seeking alternatives and supporting families and services to find the other way, the other route that would not lead to long-term incarceration? Did we resist the call of the consultant to admit, did we actively request it? Did we work with the family that thought this was the best route and explain possible alternatives? In a post Winterbourne publication the colleague of social work stated; “Social workers have an important role in helping to build community strengths and in fostering community support mechanisms for learning disabled people and their families. These will include knowledge of peer and third sector support groups and the confidence to put people in touch with them and to offer practical assistance. Social workers should be able to identify community assets and work with others to sustain them and should seek to involve the person being supported and their family and friends in such initiatives. Social work managers should support colleagues in this activity and seek to develop an area overview.” This simple but obvious paragraph for me is one of the elements that lay at the core of social work practice. The words can vary and the models differ but at the heart of any social worker must be the belief that we ensure social justice, inclusion and citizenship. Everyone counts and we must mean absolutely everyone. You can be nothing but a non-citizen in an A&T unit a world in which social justice will be something you watch from the window.
Of course as social workers we can call many a witness to our defence. Work pressures, short staffed, no decent community services would be the first we’d put in the dock to back us up, but these are at best excuses and at worst complete and utter denial of the social work role. These excuses may be valid but they are not able to and should not shape our practice and the fundamental reason that we trained as social workers. “Enable social change, problem solving in human relationships and the empowerment and liberation of people to enhance well-being” That for me is one of the better lines from the HCPC’s standards for a social worker. It goes some way to reminding us that whatever world we practice in we are still the guardians of our profession. What does this mean though? For me it means that when we can find no other alternative to someone being admitted to a hospital because they “challenge” we go back and look again. With the family, with the person, with every other professional in the room and even on our own if no one else will look with us. That we use the very essence of social work and explore the community and the wonders within it to find the alternative, not to use it as the excuse to hide people away. When all that fails and A&T becomes a reality, we carry on looking. We continue to seek the alternative and the imagination that will see a rapid reunion with community and freedom.
The challenge from my colleague that we turned up once a year was for some individuals very true. It is so easy to be persuaded by the incumbent multi-disciplinary team that all is well but they need another year before discharge could be considered and off we trot for another 12 months. One of the things that makes social workers different to other professions is that we should see the whole. So often when in a room full of professionals we hear the reports that relates to their view based on their needs and requirements. This in itself is wholly acceptable as long as we accept it is one part of the jigsaw. The social worker is the person that should be able to put the jigsaw together without losing any bits and making sure that the bits that don’t fit are challenged and re shaped. In essence working with the whole but with the person as the absolute focus. Just because an MHRT will take the word of a consultant over that of a social worker does not mean we should give up. It just means we should try harder and come back fighting in more assertive ways.
Social work has for want of a better word the power to work alongside the individual and family to make great things and wonderful things happen. The thinking and analysis of social work is far more important than any building that a commissioner may commission. The art of the success is finding the right people to walk through that door to support the person within. Support them in a way that finally brings about citizenship and freedom that we all experience in different ways. After all being placed in the community just means you live there not that you are part of it. People are what makes people included, not buildings and not medications just people and the care and ideas that they can show and share.
Ever since the post Winterbourne carnival started we have seen so many journeys taken by so many parts of the systems and groups that are put in place to solve the problem. Yet the same old patterns appear, numbers data and pressure to move by deadlines. Shouting and blame when a commissioner here has not managed to move one person there. CCGs get leant on by NHS England. LAs get leant on by politicians poachers turning game keepers and yet the numbers in A&T increase. Time to learn that this approach doesn’t appear to be working. In my opinion good people with good ideas have been lost as casualties of this never ending journey and power struggle.
As a social worker I forever get angry over the lack of focus on social work as one of the roles that could make a difference going forward. However we have to now earn that focus again. If as my colleague says “we let this happen” then we need to prove that we can be the ones to stop this happening going forward and to be a key player as part of the solution for those still living as non-citizens. So did we let this happen? This must in part be true and what is indisputable is that a social worker would have had a hand or role in every single A&T admission somewhere along the line. We need to make sure that that hand in the future is one that is used to design real concepts of care, support and citizenship. Packages of support in conjunction with the person and all those that are important so that the thought of long term self fulfilling admission don’t even become an option. We need to make sure that the social workers, the right social workers are there making a difference so that no one can say again where were all the social workers?