Contradictions and Difficult places

I have been neglecting my blog a little partly because I like to allow things to emerge rather than to write daily or weekly and partly because I am busy in other areas. So I made a promise to myself over the weekend that I would post today.

This entry is essentially about personalisation but I suppose it could be about any element of social work practice, particularly practice in these difficult times. Personalisation is a conflicted notion. For many social workers it offers as many threats as it does opportunities and it feels for some of us like we are welcoming a lovely wooden horse into the gates of our city only for a load of soldiers to spill out of it and take it from us.

My first contradiction in personalisation is how we as social workers feel about it. There are many good things. Increased choice for service users, greater involvement, allowing more of the decisions to rest with the expert, i.e. the person themselves are a few but there are equally worrying aspects of it; the shift to free choice means potentially thin times for service providers, for LA’s they are often providers and purchasers. Purchasing services allows local authorities to promote services they feel have a “fit” with them either in delivery or ideology or both. A greater menu does not guarantee that not all of the dishes available are too your taste. So there can be a conflict right at the heart of the process.

Equally service user choice is (copyright @jaxrafferty) at best an illusory choice, a little like Henry Ford you can only choose what is made available and the making available comes with a series of choices and decisions you are not part of, so how much of a choice is it really?

Further there is the issue of shopping in Waitrose as Jose Murinho once put it. If your driver for buying care is to buy a lot at a low price this could precipitate a disaster, take for example respite care. This is often seen as high value, for obvious reasons. However it is also high cost (for similarly obvious reasons) so purchasers may avoid it. Equally LA’s may avoid it as it requires greater application to contractual obligations and regulatory arrangements so there is limited desire to purchase. The risk of course is that things get advanced and people need respite but then can’t access it. What appears to be a win win becomes a lose lose.

There are other contradictions. Families are experts and can and should direct the process however there may be other motivating factors involved that families are not aware of or are kept from them. Professional relationships ebb and flow. Services once seen as useful and beneficial may go out of fashion, or be seen as “old” and in need of modernisation. LA’s often see no good in anything that is “old” this can be very confusing for service users who may have established relationships with services then find them withdrawn at short notice and with little or no explanation. In such cases families are likely to lose trust in LA’s and see them as having some form of “agenda” If this happens it is often difficult to recover from. Once the trust goes from any relationship the quality of the appreciation and understanding goes with it.

For social workers this can be frustrating. When decisions are taken on any basis other than need there is dilution in the quality of the relationship. The complexity of the relationship increases and the sense of creeping agenda’s come to dominate. Social workers find themselves caught in a cul de sac of competing priorities and ever changing agenda’s causing frustration and disappointment. Something that promised so much becomes tangled up in a series of issues that are beyond your control. In these circumstances people can begin to loose faith and feel that they are marginalised. Not a nice place to be.

So we find ourselves in a world like Willy Wonka’s chocolate factory all of the exciting prospects come with them a risk that is not always visible and we have to rely on integrity and the support of others to get us through it. We can leave feeling confused and used and we need to get back to those that matter most to us.

Like Charlie Bucket the way we feel safe and protected is in the environment we feel closest to, it may change over time but it is here that we find the protection that intimacy can afford, and we find that it’s not so bad after all. For social workers this may mean an increased reliance on colleagues and professional bodies but it can also be a virtual experience. For families it can be virtual as well but the comfort is derived from the understanding that despite the confusion and obfuscation you are need and relied on.

For Jane Gregory.