M A L C O L M P A Y N E
I came into social work in the 1960s, starting as a probation and after-care officer and then moving into social services departments when they were set up in 1971 following the legislation that enacted the Seebohm Report. Originally I was attracted to social work at university by the chance to learn about people and society, in a broad social science course including economics and law as well as sociology and social policy. All that offered a completely new take on what had been a very restricted world of a conventionally educated north-London grammar school boy.
I was able to include a lot of variety in my career too. About half my career was spent in agencies and management jobs and half in academic posts. I worked for the Council for Voluntary Service in Liverpool, mainly on community projects for unemployed people, in the 1980s, then developing residential and housing projects for mentally ill people nationally, and for the last ten years of my career worked for a large hospice, St Christopher’s, in south London near my birthplace. So I had the chance to get involved in all sorts of social work. In between these, I worked for the University of Bristol in the 1970s and as head of a very broad applied social science department at Manchester Metropolitan University for 15 years until 2002. I’ve also had part-time posts at the University of Helsinki, Opole University in Poland and the Comenius University of Bratislava in Slovakia, so I’ve had the chance to see social work up close in several different countries.
I chose as my object this box of spanners. I took the photo in the hardware tent at a country fair in the Lake District a couple of years ago.
I chose Box of spanners because …
… it reminded me of a trend in social work that I have my doubts about: developing ‘tools’ for practice.
I first came across ‘tools’ when I worked in palliative care in the early years of the 21st century, the government was promoting three ‘tools’ for practice: the Liverpool Care Pathway, the Gold Standards Framework and I understand the wish for clear guidance and comparability in assessment or intervention. But I don’t like the image of tools, because it implies that instead of seeing the whole person you are working with, you are concentrating on making some mechanical change in some nut or bolt in their make-up.
Then I looked at some of these so-called ‘tools’. The Liverpool Care Pathway, it turns out, is basically a tick-list of things to do when someone’s dying, to make sure you make appropriate decisions and consult people who should be informed and involved. I would hope that, knowing that you are with a person who is dying, you are thinking about what they are experiencing and experiencing it with them. I met a coordinator in a local hospital whose job was to introduce the Pathway, and she went round training staff about the issues, and giving them tick-lists to use to make sure they had done what policy told them to do. I would rather they sat beside people, spent time with carers and relatives, thought about what they might need. It does not surprise me that the later Independent Review of the Liverpool Care Pathway found that people were ticking the boxes routinely when they made the decisions, but didn’t go into the human business of consulting and talking things through with people.
I also looked at the Preferred Priorities for Care document. It is basically a questionnaire. A good thing about it is that it’s short and it has lots of white space. It asked three questions: In relation to your health, what has been happening to you? What are your preferences and priorities for your future care? Where would you like to be cared for in the future? Duh! You mean, people were not asking this? And a questionnaire is not a tool, it’s a questionnaire.
The final straw for me was when I looked recently at the Skills for Care document that promotes dignity in care. It’s called a toolbox. It consists of some introductory conceptual material, and it sets out seven principles for dignity in care. For each one there is a separate document, which contains a brief explanation of the principle, some case examples, a brief case study for you to think what you might do in that situation, and some inspiring quotations from people about the issue. It’s an OK training package but in what way is that a ‘toolbox’?
For me, social work was always a human process. I know that’s difficult, and it’s sometimes hard to bring your humanity with you to sit alongside someone who is suffering or who’s pissed off with you and the world and the social services. But this is another human being here. You can be another human being. Throw away the toolbox, and don’t degrade your humanity by claiming that a social work spanner is the best way of sharing someone’s humanity.