For the common good…

I always said this blog would be sporadic!  Just to show I haven’t entirely gone to ground, here are two for the price of one.  The first can be found at http://conversationsinhsc.wordpress.com/2013/04/25/guest-post-collaboration-and-integration – my reflections on a recent seminar on collaboration and integration, one of the Conversations in Health and Social Care hosted by the University of Edinburgh.  Bob Hudson from Durham made us feel good to be living and working in Scotland, while Helge Ramsdal from Norway outlined a system where localism rules.  Read more if you are interested on their site.

Yesterday I went along to the launch of a partnership initiative between Glasgow Caledonian University and SCVO designed to involve service users (or as I prefer people who access support) and carers in all aspects of teaching, learning and research in the School of Health and Life Sciences.  A current example is the family placement educational experience through which third year students on the learning disability nursing programme spend two weeks with a family with a child with disabilities.  A parent and a student outlined what they had both gained from the programme.  Peter Scott from Enable talked more broadly about the ways in which his organisation seeks to ensure the involvement of people with learning disabilities across their operations.

The GCU Principal, Pamela Gillies, and the Dean of the School, Nicky James, also contributed.  The Principal outlined the University’s commitment to using their skills ‘for the common weal’, exemplified by the Caledonian Club which uses students as mentors in nursery, primary and secondary schools in areas with low participation rates in higher education.  The Dean argued that ‘users, carers and students are our moral compass’, and as part of the approach embracing all the different players outlined the commitment to interprofessional training being introduced across the School.

How refreshing to hear a vision that embraces the wider community in this way, positively encouraging involvement of everyone and engagement with the messy realities of everyday life.  I spent three decades working in Universities and, much as I enjoyed it, the environment was very inward facing.  The sense was often that the wider community was for observing and studying rather than for embracing and engaging.  As someone dubious about the policy of transforming every higher education institution into an identikit university, a strategy which seeks to take the university world out to the community rather than seek to draw everyone into it makes a lot of sense.  Even more encouraging is the real attempt to train people of different professions together.  As Scotland moves forward on integrated working, much time and energy is devoted to learning what other professions do and breaking down the tribal barriers that have gone up over time.  If only all this could be prevented in the first place; hopefully with these initiatives we can have some optimism.

A Sense of Belonging

Last night I was at a celebration of the Sight and Sound Project, a research project led by Stirling University and funded by the Economic and Social Research Council.  At the end of a long day (including a PhD viva in the morning) an invitation to hear about a(nother) research project might not sound the most attractive of suggestions.  I was proved wrong with a vengeance.  With the Lighthouse (Scotland’s Centre for Design and Architecture) as the venue, the walls were covered in the photographs, drawings and writings of young people; the room resounded to music; and a film was being projected in the background.  This didn’t feel like the traditional dutiful feedback…

The project has been using creative methods to explore how young people who are or have been looked after relate to the places where they are living.  In particular feelings of belonging (or not) have been explored through sight and sound and touch.  Sarah Wilson introduced us to the project, Tam Baillie, the Children’s Commissioner, spoke of his passion for hearing the voices of young people and presented certificates to some of the young people who had been involved, and EJ (Milne) introduced the great films and the songs which those involved in the project had created with the help of SWAMP creative media centre.  The project summary fleshes out some of the key elements that people said were important to them: creating spaces where they felt they belonged; cherishing objects which were important to them; maintaining a sense of identity through music; building relationships through animals.  Three images which drive home: tattoos as a permanent but portable visual representation of a life story; the potential of mobile phones to generate and store photos for young people who may have little photographic record of their lives; the desolation felt by a young man in a flat without a single lampshade.

Those involved in research activity can get immured in pointless debates about the merits of qualitative versus quantitative methods.  Each has their place, but the messages conveyed by these images speak volumes to those involved with policy and practice for looked after young people and, equally important, their transition beyond the care system.

And the wine and food were great – research sharing in style!

Reflection on Significant Case Reviews (SCRs)

This week saw the launch by the Minister for Children and Young People, Aileen Campbell, of the Report on the Audit and Analysis of Significant Case Reviews (SCRs). This has been carried out over the last few months by Sharon Vincent from the
University of Wolverhampton in collaboration with IRISS. Following the Minister’s
speech, Sharon highlighted the key findings from the work, with the level of interest
reflected in the barrage of question that followed.

Three further contributions added to the value of the morning. Sheila Fish from the
Social Care Institute for Excellence (SCIE) outlined Learning Together, the multi-agency
systems approach for case reviews (SCIE Report 19)
. Developed with six cohorts in
England, this is now to be piloted in Scotland with the three authorities comprising
the North East Scotland CPC. Two issues highlighted by Sheila struck a particular
chord: ‘how a review is conducted will affect what is learnt’ and (quoting Charles
Vincent) ‘even seemingly idiotic decisions will have seemed sensible at the time’.

Marion Brandon from the University of East Anglia, one of the gurus in this field, then
spoke of the findings from a project funded by BASPCAN which had sought to explore
the role of family involvement in SCRs. This both contrasted the different expectations
across the four nations and reported the perspectives of the small number of family
members that they had been able to engage. Interestingly the role of agencies which
sought to speak for parents as to whether they would wish to participate in the research
chimed with my own experience of gatekeeping many years ago when seeking parental
perspectives on the Children’s Hearings.

Finally Lawrie Davidson from the Care Inspectorate outlined the future plans in respect
of learning from SCRs. Child Protection Committees will submit completed ICRs and
SCRs to the Inspectorate for review, details from the reviews will be entered in an
ongoing database developed from the template used in the research, and summary
reports will be produced for Ministers.

The challenge in respect of SCRs is to acknowledge the importance of the individual
case, in particular what can be learnt, whilst at the same time recognising that SCRs (56
in five years) represent a tiny proportion of child protection activity. The complexity
of such activity was brought home to me during the weeks I spent collating the
information from the reports. Not an area in which I am expert (I was the labourer,
Sharon the gaffer), I really enjoyed getting back to the analytical coalface, reading
the reports in detail and distilling the key elements. At the same time it was a stark
reminder of the challenges faced by all those featuring in such reports. Parents
wrestling with a range of conflicts and challenges, children hovering on the thresholds
of neglect, professional groups where a missed appointment or symptom can have
catastrophic consequences. Of course, as detailed in the report (to be available via
the Scottish Government website), there are a number of areas in which both practice and recording can be improved. This has to be embraced however within the wider understanding of the system detailed by Munro and the type of process detailed by Fish and her colleagues. We will watch the experience in the North East with interest.

A Celebration of Dementia

I had the treat yesterday of attending the ceremony at Hampden for Scotland’s first Dementia Awards.  Organised by Alzheimer Scotland in partnership with SSSC, NHS Education Scotland and NHS Health Scotland, this had sought nominations across six categories, ranging from best acute care initiative to best educational initiative.  Over 120 entries were received, itself a significant indicator of the rising profile of dementia.

It was particularly heartening that virtually all the award winners for the six categories were initiatives that were very much at the heart of mainstream practice rather than ‘special projects’.  The most innovative partnership, for example, went to the Argyll and Bute Dementia Teams, a partnership between Alzheimer Scotland, Argyll and Bute Council and NHS Highland which offers tailored support for individuals across the challenges of a rural area.  The best dementia friendly community initiative was won by the Motherwell Dementia Information Café, a partnership between the Motherwell CMHT for Older Adults and NHS Lanarkshire, and a good omen for the launch today (World Alzheimer’s Day) of Motherwell as Scotland’s first dementia friendly community.  While individual projects can be invaluable for testing and refining ideas, the acid test is for initiatives to be embedded long-term.

Following the awards it was heartening to hear the reassurance from Geoff Huggins, Head of Mental Health at Scottish Government, that Alex Neill, the new Health Minister, would continue the commitment to dementia shown by his predecessor Nicola Sturgeon.  The pesky business of a budget in the Scottish Parliament had precluded his attendance at the ceremony.  Geoff also highlighted the consultation that would be held during the development of what is being called Dementia Two – apparently few countries make it to a second dementia strategy..

A final award was announced at the end of the ceremony, a lifetime achievement award for Mary Marshall.  In her inimitable way she scolded Henry for his eulogy and then demonstrated over the next 15 minutes exactly why the award was so appropriate.  In a few brief strokes she profiled both the huge advances in understanding and support for dementia over the last thirty years and the challenges which remain.  A cause both for celebration of the enormous strides that have been made and a sober reminder of how much remains to be done – hopefully to be celebrated as further achievements at future awards.

Adding a Bit of Theatre

Over the last week there have been a number of blogs and commentaries reflecting on lessons the world of social services might take from the Olympics.  These have included vision, leadership, inspiration, sheer doggedness.

As an alternative, for this contribution I will look to another major institution, and offer some reflections triggered by sporadic dipping into events at the Edinburgh Fringe.  A couple of evenings ago I found myself at Thread, a production from Nutshell Theatre.  I had been led to this from seeing their earlier production Allotment, true to form produced in plen air on the fertile allotments at Inverleith.   A fringe first winner, I have to confess I had chickened out last year when the day of my ticket produced a monsoon; this year I had been luckier.  As I waited at Thread for the opening game of beetle (great fun!) I read the programme note.  This told me that the production was sponsored by ON at Fife through the Reshaping Care for Older People Change Fund…  So much for an evening off… (turns out Allotment was similarly sponsored).  More specifically the note informed us that ‘Thread has been created in collaboration with people over 65 in Fife who have provided memories and reminiscences of the era.  They are taking part in a unique cross–generational project we are running with the support of Creative Scotland and the Scottish Government Reshaping Care for the Elderly [sic] – Change fund through ON at Fife.’

Once I had adjusted to the semi-work mode, I thought how refreshing it was to find a project that seemed much closer to the transformational aims of the Change Fund than many of the initiatives that have emerged.  The Change Fund is supposed to be addressing the need to support people in different ways, to include the isolated, to foster community engagement.  Yet much of the fund to date appears to have been dispersed to services little different from those that have dominated over the last decade; we need to remember that the aim is to shift the balance of care and support – as it says on the tin, to change.  And the arts, whatever medium, are a prime agent for change on two fronts, both for engaging older people (or other groups) themselves and for informing and changing the understanding of the wider public.  Indeed scratch the surface of the fringe and the common concerns of social services (or perhaps it is just life) are widespread – exit for the terminally ill (Bill Paterson in And No More Shall We Part), dementia (Hand Over Fist), anorexia (Mess).

If the involvement of arts and other innovative approaches are heartening, can we also dare to believe that the intimations today of a U-turn on Dilnot and the funding of care and support for older people may actually come to fruition.  This debate in its current form has endured for more than a decade.  I am heartily sick of the continuing evasions and body swerves; could there really be some resolution (however sub-optimal) in sight?

Getting it Right All the Time

Apologies for the silence over the last few weeks;  I have been deep in Serious Case Reviews as part of the Audit and Evaluation being undertaken with Sharon Vincent for Scottish Government.  My colleagues however have asked me to post this blog in response to comments made at a session at this year’s JSWEC (Joint Social Work Education Conference).  The comments focused on the extent to which IRISS works with users and carers and with universities, suggesting that this is not a priority.

It is inevitable that different people will have differing perceptions but we were somewhat surprised by these comments.  Currently for example we have projects in partnership with Edinburgh, Stirling, Strathclyde and Glasgow Universities and are just this week advertising an ESRC internship focusing on enhancing outcomes for BME social work students in partnership with the eight HEIs in Scotland that offer social work education.

I would like to focus in this blog however on engagement in our work with people who access support and unpaid carers.  Again we could quote a number of projects which we have sought to develop on a collaborative basis, for example the community research project undertaken by young people, the choreography of care and support project with older people in Glasgow South, and the current work on social assets in East Dunbartonshire.  However we acknowledge there is a more fundamental challenge to seeking to ensure that our work is progressed in partnership with those who access support.  Too often there is a token ‘service user’ on an advisory group or board, a tick-box solution that we have been keen to avoid.  At my last organisation (RiPfA) we thought long and hard about this, consulted with gurus such as Peter Beresford, and opted for a Reference Panel.  The group did not seek to be representative; individuals were there by dint of their own experience and interest.  They did however work in partnership with us both on our overall business plan each year and on individual pieces of work.  SCIE (the Social Care Institute for Excellence) has recently decided to replace its Partners’ Council with a ‘co-production approach’ following an independent evaluation (SCIE Workforce Development Report 53).

Here at IRISS our thinking has led to us proposing Citizen Champions to work with us alongside the other IRISS Champions from local authorities and the third and independent sectors.  Champions have a critical role in identifying priorities for our work, in advising on the design of individual projects, and in linking us to others.  Each of our Champions is linked to a staff member within IRISS to ensure effective two-way communication.  We hope as the Citizen Champion network develops that it will have a strong influence on our activities and that co-production will become a reality.

I am sure we could do better.  But to imply that this is an area of little concern to us seems somewhat harsh.  We would be very interested to hear the models others have used to achieve effective and enduring partnerships.

Time Out

Together with three colleagues from IRISS I spent part of last week at the Third International Workshop on Evidence-informed Practice.  The first was held in 2008 at Dartington, the initiative of RiP and RiPfA, while the second was organised by PART (Practice and Research Together) in Toronto in 2010 – although unfortunately the Icelandic ash prevented the European groups from attending.  This year it was the turn of Ireland (NUI Galway and Queen’s University Belfast) who hosted sixty of us from ten different countries on a magnificent rural estate by Cavan.

I should make it clear that I have little truck with large international events where delegates have little in common, the chance of encountering the same person twice is unlikely, and the opportunity to forge relationships of lasting value even less so.  This set up however is different.  The original idea was to bring together those from social services involved in that relatively untrod territory between research and practice – ‘research utilisation’, ‘knowledge brokerage’, call it what you will.  Although I have to admit I was taken aback by the term ‘purveyor’ which was applied to us at one stage.  Sounds a bit like a pipeline, and, in the same way as ‘knowledge transfer’, doesn’t have much of a sense of partnership or co-production.  Whatever the label, it was good to be at an event where there was a commonality of purpose, you didn’t have to engage in all the preliminaries of trying to explain your endeavor in a cocktail sentence, and you could (just about) remember the names of everyone there.

Each group was charged with introducing themselves with a performance relating to their country.  Through the inspiration of Claire we chose to read Edward Morgan’s wonderful poem composed for the opening of the Scottish Parliament and recited on that occasion by Liz Lochhead.  We took the precaution of circulating pictures of the Parliament to give meaning to the description and left copies for those whose command of English might not have extended to a ‘nest of fearties’ or ‘the droopy mantra of ‘it wizny me’’.  Most particularly we hoped that the invitation to open and robust debate would serve as a metaphor for the three days.

Much of this debate took place outwith the formal sessions.  Perhaps we should all have a bit more courage in demanding that people read papers in advance and free the time at such events – where the format is ideal – for open space and unconference type activities (people – and indeed Wikipedia – tell me unconference is the current lingo!).  Indeed perhaps there is an opportunity to echo (with apologies) Morgan: ‘do you want classic papers and predictable responses?  A growl of old academic grandeur?  Not here, no thanks!  But bring together the unexpected and the innovative, the challenge and the riposte; the mix is almost alive – it breathes and beckons.’  Let us see where it leads.

Graduating to social work

This week I had the privilege of hearing presentations from a group of the final year social work undergraduates at Dundee University.  I use the word privilege deliberately for I left the event with a big smile on my face – and it was not just the unseasonable sun and warmth or the fact I was heading for some leave.  I can only comment on the group of presentations which I listened to, those focusing on children, but by all accounts those in other groups were equally impressive.

I was impressed for two different reasons.  The first was the quality of the content.  By way of explanation, each student was presenting on an issue on which they were writing a literature review.  The choice of subject had often been shaped by interests developed during one or more placements.  The topics I heard ranged from parents with learning disabilities and children of parents with mental ill-health to the effectiveness of support for homelessness, effective alternatives to exclusion from school, interventions to reduce foster placement breakdowns, and strategies more generally for early intervention with children.  A further presentation asked the enduring question of the impact of poverty on children.  The sophistication and depth of the explorations bodes well for next generation practice.  Students were critically navigating a range of specialist literature and relating it to their practice experience with aplomb.  If this group retain this perspective in the workplace, evidence-informed practice has a healthy future.

The second impression was the panache of the presentations.  There was an assurance and engagement as many spoke;  powerpoint was used with care and with ease.  A range of other resources were also employed, including the production of a powerful DVD on self harm, an individual’s story.

Thank you for the invitation; it left me with a real feeling of optimism for the continuing profession.

Housing and support choices for older people

I had a letter from an old friend last week.  Old as in long-standing; chronologically she is the same age as myself as we were at college together, and as we all should know ‘old’ in terms of years is a fairly meaningless term.  But I digress.  She had written to me because she knew I was interested in the ways we provide housing and support for older people and wanted to share her experience of looking for a care home for her mother-in-law.

Her mother-in-law had been supported in her own home with three visits a day from paid carers, regular visits from doctors and nurses, and friends and family staying with her three weeks out of four.  It was becoming evident that this was not sufficient so they started looking for residential care (geographically we are in the East Midlands). In her own words, ‘We researched homes on the internet using CQC reports, we managed to dismiss ones without having to see them, even so there were more homes that were dirty or depressing, which we dismissed immediately or were where people were left to die.  Eventually, we came up with two, one seemed far better than the other and we managed to get her into it.’

The chosen destination is a relatively new development, purpose built to include both a 62 bed care home providing residential, nursing and dementia care and 22 apartments for purchase or rent by older individuals or couples.  For the latter, access to personal care and support is available as required.  ‘What impressed us immediately was a beautiful airy space, with a coffee shop, which anybody could come to and sit with their relative and friend and how much people could personalise their rooms.’  She reported that her mother-in-law has become much more perky from eating three meals a day and has begun to walk a lot more as the activities which take place three or four times a week are held in the coffee area – ‘but it still has space for others to read the paper or just chat’.

She also described another resident who could probably live independently but had been persuaded to move in by her children.  ‘She goes out on the mini-bus to town and to meet her friends, but loves being in the home as everyone knows she is cared for and not a burden.’  She concludes, ‘they don’t have a bar, but you can have drinks in your room’, perhaps a reference to an earlier conversation I half remember when I was no doubt advocating (to some surprise) such practice.

As I finished that sentence a new email popped up – the Housing LIN Viewpoint 23 on Building Mutual Support and Social Capital in Retirement Communities.  Some will know I have been heavily influenced by my experience while at Dartington where they plan to create a community for older people on the site of the former radical school. In the course of planning for this initiative we were privileged to visit a number of inspiring developments across England including those of the Extracare Charitable Housing Trust, St Monicas in Bristol and the JRF schemes.  The aspiration was (and is) for a community that builds on the best evidence, for example on design, on support of those with dementia, on community integration, and on equity.

I was disappointed to see relatively little detail on different models of housing for older people in the Strategy for Housing for Scotland’s Older People 2012-2021 released by the Scottish Government just before Christmas.  There is reference in the section on Innovation to co-housing and retirement villages and to the Quarries (re)development by Dunedin Canmore HA in Edinburgh but very much a sense that such options are the exception rather than mainstream.

It is of course all about choice – many would regard living in a community with others as anathema.  For some however there will come a point when the choice is more constrained and, as for my friend’s mother-in-law, we want options that generate such enthusiasm as to write an unsolicited testimonial such as I received last week.

A new landscape for public services

Courtesy of a free place (thank you Anna…), I spent two days last week at the Guardian Public Services Summit in St Albans.  This is designed to challenge thinking on the future landscape for public services and encourages identification of issues generic to all public services.  I often struggle with broad strategy talk as it can spiral off into meaningless generalities; the discussion over the two days however was sufficiently grounded to give a satisfying mix of breadth and depth.

As an irregular tweeter, I find one of the most useful features of the 140 character message is that during events of this type it focuses the mind on distilling one or two key messages from each presentation.  So the following is in turn a distillation from those (very) brief responses on the day.

It was reassuring to hear familiar messages from the very start: the Chief Executive of the Local Government Association declaring that integration is the key to the resolution of public services challenges, and that tackling the funding of adult social care must be the starting point.  Within a very short time themes central to the interests of IRISS were tumbling out: assets based approaches, community capacity, partnership with independent providers.  Resonance continued with discussion of ‘what is innovation anyway’ (according to one great soundbite, ‘innovation lies in the shift from victim to architect’), and a suggestion that public services leaders are despondent at the lack of evidence-based policy making and the rise of an overt ideological base (not of course in Scotland; this was a primarily English perspective with only six of us venturing south from north of the border).

David Walker (erstwhile Social Affairs Editor at the Guardian) gave a refreshing input to a session titled ‘are we overly influenced by fashions in public service design’.  He called for evidence-inflected (at least) public management, a term that competes well with our ‘evidence-informed’ and introduced many of use to a new word, neophilia.  He expanded on this condition in a column on 7 February – ‘During the past two decades the public sector has succumbed to neophilia. It’s a condition defined as fixation with the new, the fashionable, the trendy … and soundbites from imported gurus.’  Social impact bonds, discussed as a potential option for families with complex needs, may for some have fallen into this category.

An interesting discussion developed around the appropriate measurement of impact, stimulated by a call from the co-founder of Southwark Circle for an intelligent approach that gets beyond crude metrics.  With the measurement of social value an element of the Public Services Bill in England, this will be an issue to watch.  A final reflection from day one, from the Director of the Clore Social Leadership Programme, was that the days of heroic leadership are over;  the requirement is for values based leadership at all levels.

Day two woke us up with a string of impressive speakers.  The leader of Suffolk county council presented their cautionary tale of the failure of a  ‘bull in the china shop’ approach and stressed the importance of understanding locality and effective partnership.  The chair of RNIB gave an inspirational and wide ranging address on how to approach reform (and likened the treatment of the voluntary sector to the shaking of a baby’s rattle) which should be widely circulated.  The Chief Constable of Greater Manchester revealed that the greatest challenge for their force is no longer crime but mental health; he also argued that getting people to break out of their job descriptions is the key to the cultural change needed for innovation.  The Director of Children and Family Services for Knowsley suggested that more than iterative improvements are required to achieve transformational change and outlined their use of the radical efficiency model to transform support for children and families through co-production.

And to end on a lighter note, two good jokes from the summit.  The new Chief Inspector of Ofsted and ex head of Mossbourne Academy described how one of his pupils had asked why he was joining Offhead, while the Bishop of London in a rousing final keynote told the story of a child in a cathedral who asked who he was and when being encouraged to guess from his vestments and staff responded ‘I know who you are, you’re the grim reaper’.