Monday 16 June 2014

‘Who is helping who?’ - Co-production and professional boundaries within social care services.

A Blog entry by Nick Andrews: N.d.andrews@swansea.ac.uk


I have been working in education and social care for thirty years, and have seen various new initiatives and buzz words come and go, whilst the fundamental principles of humanity remain the same. ‘Co-production’ in its truest senses is grounded in these principles. However, as with the concepts of ‘personalisation’ and ‘reablement’, there is a real danger that the term  ‘co-production’ is misused for hegemonic purposes to cover up what is essentially a cost cutting exercise. Under this scenario, individuals and their communities are expected to take on more responsibility for their own well-being whilst the machine of impersonal and ‘professionalised’ public services carries on as it always has done, albeit it with a few less staff employed. In my opinion, this would be a travesty and missed opportunity to restore warm humanity as the driving force for public services, not compliance with increasingly centralised and de-personalised processes and systems.

One of my favourite quotes by the theologian Martin Buber is ‘all real living is meeting’. Please note that Buber’s understanding of the term ‘meeting’ is much richer than the idea of putting a group of people together in a room or placing nurses and social workers in the same office, which is commonly assumed to result in integrated practice. I am sure many people will share my experience of being in meetings where no one actually met, where each person had their own agenda and the purpose of the meeting was to get this across – to win the argument.  For Buber, ‘meeting’ is about genuinely connecting with other people and being changed in some way by the process. In order to explain this process, he talks about two ways of relating to people and the world, which he calls ‘I-It’ and ‘I-Thou’.
In ‘I-it’ relationships, the person is detached and unaffected. In ‘I-Thou’ relationships, the person is attached and vulnerable. Tom Kitwood, in his seminal book ‘Dementia Reconsidered – The Person Comes First’ talks about his experience of seeing how people living with dementia were dehumanised through receiving emotionally detached task based care:

‘A man or woman could be given the most accurate diagnosis, subjected to the most thorough assessment, provided with a highly detailed care plan and given a place in the most pleasant of surroundings – without any meeting of the I-Thou kind ever having taken place’ (Kitwood, 1997)

By contrast, I believe that genuine co-production facilitates and nurtures the development of ‘I-Thou’ relationships between all parties, which in so doing begins to challenge the prevailing understanding of professionalism and professional boundaries.  In relation to this, I am currently co-ordinating a NISCHR and Joseph Rowntree Foundation (JRF) funded project in Wales, which is focused on the use of evidence from their ‘A Better Life – for older people with high support needs’ programme, along with other forms of evidence in social care service and workforce development.

The ‘A Better Life’ programme has identified that relationships are key and ‘Often it is the simple things that bring the most pleasure (and the lack of them can bring a sense of sadness and loss) and services do not always seem to be very good at delivering ‘the ordinary’’. (Blood, 2013 p13)
The research challenges also call for a different way of working, which is often alien to the world of emotionally detached and compliance focussed task based care, which is summed up nicely in the following quote by Edgar Cahn:

‘The world of helping others in need is now built around one-way transactions…. and with the best of intentions, one-way transactions often send two messages unintentionally. They say: “We have something you need – but you have nothing we need or want or value.”’  (Cahn, 2004).

In a series of recent focus groups and learning events involving older people, carers and frontline staff, I have been struck how many people feel that current regulation and guidance is risk averse restrictive and at worst destructive of human relationships. For example, workforce regulation states ‘the inappropriate use of touch is not permissible’, rather than ‘the appropriate use of touch is fabulous and to be encouraged’.

 This is a particular issue for people living with dementia, who often have to express themselves and connect with others through feelings and emotions. Frontline staff talk have talked about feeling guilty when they do little kind things that are not written in the Care Plan or receiving small gifts of appreciation, older people have been ‘told off’ (in the name of health and safety) for pouring tea for others in day services, and carers have been made to feel that they no longer have a role when the person they love goes into a care home.
At the heart of co-production, is an understanding that everyone has something to contribute and that exchanging these contributions is enriching for everyone concerned.  I am reminded of the work of Jean Vanier, who established the L’Arche Communities in learning disability services. Vanier did not see his role as caring for people with learning difficulties, but rather sharing his life with them and being open to receive and learn from them as much as to offer them support.

I am reminded of one of my earliest experience of working in social care services. It was 1984 and I had started my first job as a residential support worker in a children’s home. I thought I was the ‘sorted one’ who was employed to help others. I worked hard to form good working relationships with staff and children in the home, but one boy, who had experienced a lot of hurt in his life, kept his emotional distance. As anyone who knows me well can tell you, I am not gifted in DIY or anything that involves fixing something mechanical. One day, I was trying to repair my bicycle (I did not drive at the time) and was getting nowhere fast. The boy walked past me and said ‘I’ve got a book about repairing bikes, do you want to borrow it?’. I am pleased to say that I took up his offer and our friendship took off from that day. He is now a happily married 43 years old who lives on the other side of the country, but we still keep in contact via Facebook and phone and offer each other support and encouragement whenever we can.

Jean Vanier once said, ‘I am struck by how sharing our weakness and difficulties is more nourishing to others than sharing our qualities and successes’. This is an important message for social care practitioners and agencies. We need to open our ears, our eyes and our hearts to the people we work with, which might involve sharing our vulnerabilities and concerns and allowing ourselves to be changed by genuinely ‘meeting’ with them in truly co-productive relationships.

References
Blood, I. A Better Life – Valuing Our Later Years, York, Joseph Rowntree Foundation, available at: http://www.jrf.org.uk/publications/better-life-valuing-our-later-years

Cahn, E. (2004), No more throw away people – the co-production imperative, Washington, Essential Books

Wednesday 25 September 2013

Let’s use what’s already out there

Guest post from: Professor Jonathan Scourfield, Cardiff School of Social Sciences



My general pitch in writing this blog is to argue that social care researchers could make much more use out of existing data sources. Typically when our MA Social Work students are thinking about possible small-scale empirical projects they can carry out, they assume they need to collect their own data. Now the problem with collecting your own data is that it is very time-consuming and a busy Masters student (or indeed a busy practitioner researcher or academic researcher) might just find their data coverage ends up being disappointing. What a lot of people don't realise is that there are some large-scale data out there already collected that can be used for further research. 

The UK Data Archive has lots of fabulous data sets which are cruelly under-used. In this paper  we looked at the major UK panel and cohort studies conducted over many years to see which included data on social work services. The questions about social work contact were typically very limited, but there were seven studies with some potential for social work research. In a new project  funded by the Nuffield Foundation, which you can find here , we'll be seeing what we can do with four of these studies. 


A recently completed example, using a cross-sectional survey, is that Tom Slater used a psychiatric morbidity study for his PhD on social workers' role in preventing suicide , available here 
  . This data set is freely available to anyone registered with a UK university. No special permissions are needed and all data are already anonymised. Although many of the data set in the UK Data Archive require statistical analysis, there are also qualitative data sets available for secondary analysis. These include such classic social work studies as Dingwall et al's well known ethnographic research from the late 1970s-early 1980s 'The Protection of Children' and Townsend's research on the family lives of older people.

Routine social care data are the other major source for secondary research. Social care providers of course keep data on service users and these data can be used for research purposes, up to a point. I say up to a point because of course it is not appropriate for just anyone to have access to someone's personal records. But it is possible to produce anonymised versions of quantitative data with all identifying details removed. Even routine data which are more qualitative, and therefore more difficult to anonymise, can be used for research purposes in some circumstances. Nowadays there are also potential opportunities to link routine social care data with anonymised health records, for example via the SAIL databank at Swansea here . A couple of new research projects in Welsh universities are about to do just that, with the support of NISCHR, and I look forward to seeing the results.

Watch Professor Scourfield talk about his research:








Friday 6 September 2013

The Inaugural Wales Social Care Curry or Clwb Cyri Gofal Cymdeithasol


19.00 Thursday  5th September 2013 was a historic day in the field of social care within Wales as it saw the inaugural meeting of the Wales Social Care Curry Club.  You can find the history background and reasoning of the social care curry club here:  http://bit.ly/17DH7Hg but suffice to say the inaugural Wales event was hosted by Peter and Anne Marie who had contacted the organisers of the Social Care Curry initiative and offered to help organise one in the Welsh capital. The rest is now history and I am sure will prove to be historical to boot. Wales joined  a mix of such eat-ups that took place throughout the UK in nine different locations on the same date in: Birmingham, Bristol, Canterbury, Glasgow, Leeds, London, Manchester and Southampton. You can learn more about curry club here.

The involvement of @ASCCCymru came from a random tweet received from Professor Jonathon Scourfield , which was a little ironic as eventually he could not attend but @ASCCCymru is more than thankful to him for making us aware of this great initiative. Like many an innovative idea this one is just SO simple.  Just get anybody who is interested in social care to get together in a room and share a curry #DOH.  Those who might want to come along to make a pitch or try to sell something were discouraged as that is not what the night was all about.  It was just about getting to know each other and the sharing of knowledge and experiences between people who are genuinely interested in social care and who also enjoy a curry. The turn out to the first event was, shall we say, select with only eight attendees, but the quality of those attendees was top class and as the night progressed it very much turned in to a highly enjoyable and informative evening.

I’m sure readers can appreciate that the prospect of walking in to a restaurant to meet and spend the evening with potentially a crowd of strangers can be a somewhat daunting experience. This was a little alleviated for me as I had at least met the indefatigable Anne Marie Cunningham on one previous occasion and had communicated with her on Twitter a number of times, so at least I already knew one of the participants.  Anne Marie did a fantastic job of welcoming people on arrival and putting people at their ease. What was a very pleasant surprise however was that on arrival, with one exception, I had either met briefly or had knowledge as to who they were  with everyone at the table.  Wales has a tendency towards this and South Wales in particular.  We are only a small country of three million and not everyone is interested in social care. Even if you want to remain anonymous in Wales, unless you never come out of the house or never engage in social media, it is difficult.  Having at least some knowledge or contact with most of the people at the table this is where the Social Care curry really came into its own, as it provided an opportunity to build on those previous professional meetings and take them up to a new level where we could actively consider closer collaboration and contact.  

The social care curry provided the opportunity for people from different areas of social care such as policy, practitioner, service user and indeed academic to come together in an environment where no specific outcome is expected, other than to eat a curry and have a chat.  What could be more simple, what could be more basic, but I think as the evening showed, what could be more enlightening and what could be more enjoyable?   
I am already looking forward to me next social care curry #NomNomNom :-)  

Thursday 20 June 2013

The All Wales Academic and Social Care Research Colaboration Seminar Series

As part of the ongoing development of ASCC we have organised a series of seminars based around topics that we feel, based on the research that we have conducted to date, will be of interest to social care practitioners.  A schedule of the progamme is below together with joing instructions.  Please feel free to circulate to anyone that you feel may be interested in any of these topics.

The ASCC Team







Friday 3 May 2013

Citizen Directed Support Summit llandrindod Wells



The Social Services Improvement Agency’s  Citizen Directed Support Summit.

On Friday 26th. April 2013 The @ASCCCymru team attended the Citizen Directed Support Summit at the media resource centre in beautiful  Llandrindod Wells. http://bit.ly/YhGdhG   


The summit was organised by @SSIACymru. http://bit.ly/15Vi4jG

Citizen Directed Support (CDS) is an approach/model by which people who require assistance can live as independently as possible.
Access to mainstream opportunities most people enjoy, are enabled through the support of others who recognise that the person her/himself is best placed to know what they need and how these needs can be met.  CDS adheres to the fundamental social work tenets of respect for the person, valuing and empowering her/him as an individual with the capacity to change and supporting  self determination.
The Welsh Government, within Sustainable Social Services, identified as a key principle that the people in Wales should have a 'strong voice and real control'. They identified Self Directed Care as an approach by which this could be achieved and stated that "The model will offer a range of methods for securing services".
To support the development of CDS across Wales there is a Citizen Directed Support Learning and Improvement Network (CDS LIN) which consists of local government representatives.  This network is supported and facilitated by the SSIA, to learn more about the CDS LIN please click here: http://bit.ly/13FFBRf

Structure of the Summit.
One of the morning sessions was provided by Steve Dowson a social care consultant and trainer who explored the international and other UK experiences of developing CDS outside Wales. This was a very interesting session where Steve explored the very different ways that CDS support has been interpreted in various environments and social care settings.  You can find a link to a selection of Steve’s papers here: http://bit.ly/10o4igU
Later in the morning there were three different perspectives delivered of experience of implementing service delivery change in three different local authority areas within Wales:
Gareth Jones – Wrexham  http://bit.ly/12dw1T5
Julie Boothroyd – Monmouthshire  http://bit.ly/ZY6i0w
Deborah Driffield – Swansea.  http://bit.ly/12VhH5I
This presentation again explored the various challenges that face those that seek to change more traditional ways of working and the challenges and promises this can present.

Following lunch there was a series of parallel workshops that explored:

Effective information for citizens
Definition of Citizen Directed Support.
Managing cultural change and expectations.
A New Focus on families

These workshops provided a focus for lively and constructive discussion of the day to day issues practitioners are facing.

The day was rounded off by a feedback session  to the whole group from the individual parallel sessions.  The whole day provided a useful focus to help improve knowledge and understanding  of best practice and current models  of CDS and how it can be best developed and implemented.

Friday 19 April 2013

Dr Martin Webber Presents the First ASCC Research / Practice Seminar 12 April 2013



On Friday the 12th April at the beautiful venue of Castell Amare Bracelet Bay, The Mumbles near Swansea ASCC held its first research/ practice seminar.  The seminar was very well attended by more than twenty practitioners and academics working in the field of social care from throughout South Wales.

The first invited speaker was Dr Martin Webber from the University of York.  Dr Webber spoke on social capital and its relationship to social care.  

 Dr Martin Webber

His talk can be viewed below:

Social Inclusion, Social Capital and Social Care Practice - Martin Webber from SOCSI TV on Vimeo.


You can also visit his blog at: www.martinwebber.net

Dr Webber’s talk provided the focus of the morning session of the all day seminar and the topics that were explored through his talk provided the focus for some very useful discussions during the afternoon sessions where approaches to evaluation were explored.

This seminar represents the first of a series that ASCCC intend to develop over the coming years in order to develop networks between academics and practitioners to increase research and practice capacity within Wales.  Details of forthcoming seminars will be posted soon.