Protecting the vulnerable or creating a climate of mistrust?

My contribution to Who's risk is it anyway? 
An Institute of Ideas and Wiltshire Council Safeguarding conference. 
March 2010

Cast your mind back to December 2008 and the Old Bailey trial of Baby P’s abusers.
Sharon Shoesmith, the then Director of Children’s services in Haringey, brazened it out, refused to apologise and said she had no intention of resigning from her post. She confidently asserted that because Haringey had followed all of the Laming recommendations following Victoria Climbie‘s death, Social Services couldn’t possibly be at fault or be held responsible. During a media briefing on the case, Mrs Shoesmith boasted Haringey had been given a 'three-star' performance rating by Ofsted.

She said: 'The child was killed by members of his own family and not by social services. The very sad fact is that we can't stop people who are determined to kill children.' And: “If any resignations or sackings were needed there would have been. I certainly will not be resigning.”

Brave words, but in saying this, then, she struck a wrong note, and the public and the media’s fury were unleashed.

We’re all familiar with what happened next; her dismissal, without compensation, by the Children’s Secretary, Ed Balls, her ongoing appeal, Ofsted admitting making a “serious and deeply regrettable error” in failing to disclose potential evidence etc. etc.

I think it’s fair to say that this is something everybody here dreads and wants to do everything possible to avoid happening. Nobody wants that type of witch hunt. It’s helped make already tough work harder and recruitment and retention of Social Care Workers (SCW) has been badly affected as a consequence.

Inevitably, since then, protecting the vulnerable and being seen to do so, has become an even greater priority for Local Authorities and I include among the vulnerable category not only service users, but managers and front line staff also! But is what’s happening in practice currently the best way of doing this? I’d suggest not.

What effect has this had in practice?

Work trends that were already under way prior to the Haringey case -the bureaucratisation of work and extension of control by managers over the workforce, have become worse.  Defensive practice has become the norm. This is fuelled by a lack of trust by staff in management, by management in their staff, by staff in service users and vice versa. This is not peculiar to Social Care, I hasten to add. Similar is happening in the NHS. Box ticking, rules, and a risk-averse culture are deployed to protect us from ourselves and each other.

Vulnerability and abuse are assumed to be commonplace, to the extent that we’re all deemed vulnerable and abuse is rampant. According to the Safeguarding Vulnerable Groups Act (2006), vulnerable people are everywhere. The ‘No Secrets’ definition is a person aged 18 or over, who is or may be in need of community care services by reason of mental or other disability, age or illness; and who is or may be unable to take care of him/herself, or unable to protect him/herself against significant harm or exploitation. This also includes any adult receiving any form of healthcare.

It’s been acknowledged that adult safeguarding systems are underdeveloped within the NHS. A recently advertised ‘Safeguarding Vulnerable Adults in Hospital’ conference aims to address this and will discuss whether pressure ulcers and falls should be seen as safeguarding issues.

The supposed prevalence of abuse indicates that a very low opinion of humanity has developed. It’s all encompassing - verbal, physical, financial, sexual, psychological, domestic, elder, professional, of individual rights and institutional. Neglect and poor professional practice are also included. I counted 67+ sub divisions of these headers on one Council’s website. And much of it is supposed to occur in the private realm; people’s homes/residential settings, perpetrated by carers, and needs to be exposed. As Ken McLoughlin, who is speaking here today has commented, ‘Society is fast becoming an asylum -a place without privacy, because private space away from scrutiny is where abuse occurs’. This is the territory in which SCW’s operate.

But the term abuse is so disparate as to be meaningless e.g. pulling faces, calling names are examples. And because it’s deemed to be everywhere, it’s nowhere. How can anybody focus on finding and supporting cases of serious abuse when they are contending with this vile view of humanity?

But the Association of Directors of Adult Social Care (ADASS) says they’d like adult protection to be on par with child protection and to have the high profile that the NSPCC’s ‘Full Stop’ campaign has helped child protection to achieve.

So, just as with children, we’re all now supposed to be on the lookout for adult abuse -Social Care, NHS, Police, Housing, Probation, Libraries, Community Services, Culture/Arts centres, the public etc. But because we‘re not, more public awareness of it and community engagement around it is needed.  Prevention after all is (supposedly) everybody’s business. We must prioritise the safety of vulnerable people. Risk is increasingly assumed to be probable as opposed to possible.

What’s it like at work?

In addition to the surveillance represented by Criminal Record Bureaux (CRB) checks that Dolan Cummins (speaker) alluded to, we’re seeing the iron fist of conformity being thumped repeatedly at work in response to the Government’s target-obsessed and politicised meddling. Mistrust of staff is commonplace.

And workplace leaders have become process driven, more into performance indicators than inspirational management. Managing risk and feeding beasts like Ofsted and the Care Quality Commission seems the primary preoccupations. Ratings have become the overarching priority and collecting evidence that can demonstrate compliance against standards and targets seems more important than ensuring that good, quality care is provided. Privately however, I’ve yet to hear a manager think these beasts are worth feeding. They seem to be pretty much considered a waste of a lot of people’s time and energy.

So, we’ve got controls, systems, standards, policies, protocols, procedures, processes and guidance coming out our ears. Databases are developed to help to share information. Risk and quality assessments are carried out, as are audits, incident reporting and inspections. And it goes on, and on.

This is compounded by the reality that like so many in the public sector, SCW’s now have less and less of a sense of  vocation and are quite demoralised. Once considered radical with a desire to change society, they now seem to feel as vulnerable and impotent in affecting change as they consider their service users to be.

The public sector ethos too has pretty much disappeared. It seems now that it’s every man and woman for themselves. That leaves the state as the only agent affecting change in society and caring professionals have become the conduits for whatever crackpot ideas they dream up e.g. public health campaigns that want changes enforced through the management of individual behaviour.

We’re regularly told that SW’s spend as much as 80 per cent of their time at their computers. They therefore must have more of a relationship with them than with their clients. When are they making the quality assessments that are needed to do the job well? When do they have the time to develop their skills as practitioners? Newly qualified SW’s, once welcomed for bringing new and fresh ideas to teams, are often now considered poorly trained and a burden. The consequence is a decrease in the amount of human client contact so vital to SC work, delays in developing professional expertise and a deskilling of more experienced SCWs as they kowtow to these regimes. And cynicism prevails.

Mistrust of colleagues is therefore not uncommon. The solidarity and camaraderie, so necessary to help cope with difficult work situations, can no longer be assumed or relied upon. An expectation of trust has all but disappeared. Bullying is instead reported to be rife. What was traditionally considered an unpleasant thing is now relabelled a pathology that scars its victims. And as with abuse and vulnerability, bullying definitions vary, but an industry has developed in response to it.

Stress too has become another occupational hazard. Workplace survey after survey confirms this. Rates of sickness due to stress have increased. But stress is whatever you define it to be and it’s acceptance as a label is problematic. Individuals carry the rap for what are in reality social problems caused often by overwork or feeling unsupported at work.

Snitching has become legalised through whistle-blowing and mystery shoppers are employed to spy on the workforce.  Results can be used to whip staff into shape as targets are implemented and monitored.

Codes of conduct are increasingly commonplace and are supposedly designed to help prevent misconduct. The General Social Care Council (GSCC) has one. In health and social care, workers who are investigated for misconduct by their own regulatory bodies may also face scrutiny from the new Independent Safeguarding Authority, which will make the final decision as to whether they are deemed safe to work with children and vulnerable adults.

On top of this, many public sector workers are expected to be role models outside of work! One wonders what a person’s private life has to do with their work.

And Social Care staff in turn ‘police’ service users behaviour in the interest of their health. Aspects of people’s private lives that are mostly none of their business are focused on to promote healthy lifestyles; smoking, diet, alcohol intake etc. (In the NHS community nurses are encouraged to develop what I consider to be coercive contracts that outline the responsibilities of service users and workers. In return for e.g. pre booked home visits, smoke free rooms are to be made available. Patients considered to be selfishly putting nurses’ lives at risk if they don’t. As we know, mental health patients are big smokers. It perpetuates their health inequalities if they’re not supported to stop, supposedly.

This constant monitoring reflects managers’ lack of trust in staff, and their abdication of responsibility for doing what they are employed to do: directing and motivating their staff, addressing shortfalls in performance and communicating with workers to resolve the problems. Instead, outside evidence is acquired in an underhand manner so that workers can be confronted with their shortcomings. While there has always been friction between management and staff, the public sector could once point to an overriding common purpose of achieving some public good; but that purpose is undermined by covert monitoring and the targets culture that it springs from.

We’ve consequently all become weaker. We crumble in the face of adversity. We suffer sickness due to stress and bullying. The horror of it all!

And despite the Tory’s pre-election promises, I suspect they’ll offer more of the same - just different. It’s time to take stock. SCW is about people, not systems, processes or expensive databases.