What a week! I am so angry, so deeply angry, that I don't know how to express it fully. The craziness of the system, and not even just in social work, makes me furious! This week there has been an outburst of moral outrage in the press about the treatment of the elderly in care homes. One in five hospitals aren't meeting the required standards of care of the elderly and too many are left without proper attention and unnoticed even when they need to go to the toilet or have a drink of water. If there was a possibility of that being my mother or father, how angry I would feel.
But the debate is taking the tone of "we must employ the right sort of people, with the right sort of values." Not these monsters who apparently have slipped through into our precious NHS and are busy neglecting our nearest and dearest. How dare they!
There are comments about the paperwork taking up too much time....but still, one of the responses I heard was..."Let's have new procedures."
Great! Wonderful! Let's have a bureaucratic response which will probably add to the burden of paperwork and ramp up the "control and command" within the system.
I wish I had a voice that could be heard. I would say: Look, you have created a system based on logic and the left brain. To function in that system, people have to make efficiency their number one priority. Caring is fundamentally not an activity driven by logic. It's a heart centred attitude. You can't measure and quantify it. Yes you can make rules about actions and behaviour. Do this every so often, take the pulse, take the temperature, give so many drinks etc. And if people are busy beyond belief, and know that their performance will be measured based on those actions, they may do their best to reach the targets. But the targets are not designed for human beings and the system itself robs its staff of their humanity.
Caring is about having time to see. It means having time to get to know a patient or a client, not to see them just as a number with a chart of boxes to tick. It means time to have little chats about how they are feeling, what they are looking forward to. Time to have human encounters that establish a connection. Then it comes naturally to look out for Mrs A who didn't have a visit for 3 days and feels a bit down. Or to take the time to listen to Mr B who is worried he isn't going to get better in time to go to his son's wedding.....and you wouldn't dream of leaving Ms C, a former teacher, lying in soiled bedding for hours because you've got paperwork to complete....."
Impossible? Well, no, actually. That is what is so annoying about all of this. I remember very well growing up in a small community where that is exactly how it was, when I was in hospital. I had my tonsils removed and I was a frightened 10 year old. But I was being "cared for" by nurses who knew my mother, where there were connections and links between people and even if a particular nurse was a bit lazy or not in the right mood, she would not want to let my family down. It didn't even have to be thought about.
I also remember as a young person hearing about how computers were going to change our lives. Away with drudgery! Everyone would have a 4 day week and we would become the leisure society! But of course, computers have provided a system of control and measurement which has generated vast amounts of unproductive work with no relevance to CARING.
I remember as a young (ish) social worker in a "patch based" team. We were....maybe 20 people dealing with the needs of an area the size of ...let's say the Isle of Dogs in Tower Hamlets. Every week there would be about 6 new cases, sometimes more. We had a team meeting at which the cases were allocated. Often someone would say...oh that's the Bloggs family! What is it this time? Was that not the family where...such and such happened or there is so and so who is a bit risky?
We often knew our cases as people, they turned up for s. 1 payments, and we offered support and at times we intervened on a statutory basis. As a social worker, I was not all that aware of working for the Council, I was primarily a professional doing the best job I could. After a visit I would write a short note on the file and do anything that needed to be done....
Nowadays, how does it go?
There are about 20 of us dealing with all the new cases for a whole Borough. That's called intake. We have 10 days to complete an initial assessment. That includes seeing the child alone. There is no actual limit to the number of new cases you could get in a week. Could be 3, could be 8. And the "paperwork" ie computer work for each case is ridiculous.
Examples...this week I was asked to go and check who was caring for a child whose mother has mental health problems. In the old days, I'd have gone and done a short visit, established where she was living and as it was mostly in another Borough, I'd have contacted that Borough, advised them to follow it up and referred mother to mental health services. I would have kept the case for a few weeks or months to make sure that mother was getting services and to liaise with the other Borough. I would have been able to meet the older brother, who is 16 and attending College. I would have done write ups as needed.
Nowadays, I have to go, do the visit and complete an initial assessment, covering 8 "dimensions" including social presentation and identity. I have to write this up. Instead of taking half an hour, it takes at least 3 hours to put on the computer. It has to go straight to a team manager for approval and that must happen within 10 days. I have to contact other professionals for information about health and education.
I can't keep the case open, and I am not at all sure it will get passed on to the locality team as there is not actually work to do other than checking that referrals are made and services provided.
I should have "opened" an assessment on the 16 year old as well and will probably get my knuckles rapped that I did not. But I was trying to complete the assessment within time scales and that would have caused a bit of delay.
The pressure is phenomenal, when these timescales are made the be all and end all of the job. They just take over. This week I got a new case where the family was feeling quite anxious and I wanted to visit briefly before a visit I had already planned. I left the office to go and collect my car.We can't park at the office any more of course....I was running late...(dealing with paperwork) and the car would not start! I had to think whether I could till do the visit, and be late for my appointment, or postpone it to the next day. It was raining...I chose to postpone, made the appointment for the next day and went to my original visit.
This worked out OK, I suppose, but I know that the nerds who designed the system that controls my life, made no account of car breakdowns, the longer time travel by public transport takes, the fact that the weather influences moods and choices. It did not matter on that occasion, but I wondered if the situation had been different would I have been able to make the choice to do two visits on that afternoon? I am not sure.
A robot though, would never be put off by rain, tiredness, too much work, wanting to have a life of its own. Maybe it could be programmed to care for people too, little robotic chats that make people feel good. A robot would function efficiently, not need breaks, not need water or to go to the toilet or to have a little human contact...it would not want to enjoy its leisure time, question authority or see the absurdity in this brave new world. A robot would never make mistakes.
This week I spoke to my manager about feeling slightly down and not sure I would stay in this job. He is quite a reasonable human being who has some sympathy with my frustration. But he did say..."Don't you think you might become more efficient as you get used to the job?" And he sent me information on a training about dealing with stress. I fully appreciate the desire to help which he is expressing. But it also conveys the message....this is about you, it's your responsibility, it's not the system. You have to be more efficient. You have to cope with stress......
Someone should suggest replacing social workers and nurses with robots.....if we want efficiency at all costs, it is the ultimate solution. In the meantime, I just stifle the human bit of myself and become as robotic as I can....let's get the job done. Caring...mmmh, isn't that a luxury that only real human beings can experience, not half robots like me?
And that's what my anger is about, feeling that the system I work within is depriving me and many colleagues of my sense of joy in life, my wellbeing. Why, really, should I care about anyone else's wellbeing when the system itself leave me and my colleagues feeling like victims and slaves.... and how will I care, when I have to numb my emotional life in order to do the job at all?
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