Social Work andPersonalisation

talk by Simon Duffy for social work students at Huddersfield University, 10th November 2014

Know how to take things. Never against the grain, though they’re handed to you that way. There are two sides to everything. If you grab the blade, the best thing will do you harm; the most harmful will defend you if you seize it by the hilt.

Baltasar Gracian

Agenda9.15 Introduction - some personal background9.45 Exercise on individual service design10.30 The reality of social services11.00 Break11.15 Exploring key concepts for social work - a bit philosophical12.45 Lunch1.45 Exercise on creativity in individual service design2.00 What you need to know - a bit practical3.15 Discussion3.45 Break4.00 Social work and the welfare state today - a bit political5.15 Finish

Dr Simon Duffy

Photos from “Christmas in Purgatory”

Citizenship model

Personalised support

Keys to citizenship

Self-directed support

Personal budget

an exercise in individual service design

1. Who will help represent you?

2. What will you do with your life?

3. Who will support you?

4. Where will you live?

5. How much will your support cost?

You have had a serious car accident. It has left you with significant disabilities, including some brain damage. You will need help with many daily activities and help to make some decisions.

Work in pairsand discuss

You are still the same person, with all the same interests and preferences and you still have all the relationships you had before.

0

40

80

120

160

Network Professional

Who will represent you?

0

25

50

75

100

FT Work PT Work Vol. Work Education Love

What will you do with your life?

0

40

80

120

160

Natural PA Service Voluntary

Who will help you?

0

35

70

105

140

Family Friends Alone Service

Where will you live?

0

7.5

15

22.5

30

0 <10 10-20 20-30 30-40 40-50 50-60 60-100 >100

How much will your support cost per year?

figures are in £1,000 per year

0

30

60

90

120

More Less Unsure Same

How important will the people in your be life now?

0

12.5

25

37.5

50

Yes No Not Sure

Will you be happy?

Freedom Network 76 Prof. 10

Life FT 10 PT 60 Vol. 11 Educ. 53 Love 13

Help Natural 94 PA 71 Service 48 Vol. 10

Home Family 76 Friends 3 Alone 4 Service 1

People More 67 Less 2 Unsure 9 Same 6

Happy Yes 39 No 20 Unsure 30

Social work in practice

The relative risk by different environments

We spend people’s money for them on things they wouldn’t buy for themselves

English data 2003-2005, first In Control pilot

How do social workers in adult social care use their time?

Mostly on assessment and planning…

44 women with complex needs

Managing a serious health condition 64%Finding a safer place to live 27%Living with childhood abuse 51%Didn’t finish their education 76%Recent experience of domestic violence 85%Fractured family (for those with young families) 66%Children have experienced abuse (for those with children) 55%Living with a severe level of mental illness 55%Living with some mental illness 91%History of drug or alcohol misuse 52%Victim of crime 41%Perpetrator of crimes 39%Worried by debt or lack of money 65%

Of 44 women working with WomenCentre:

Service label N Urgent problem N Real need N

Victim of domestic violence 55 Debt 50 Better self-esteem 64

Mentally Ill 39 Housing 48 To overcome past trauma 54

Criminal 35 Benefits 46 To manage current trauma 51

Poor Mother 33 Health 37 To stop being bullied 50

Misuses Alcohol 24 Rent 32 Guidance 50

Uses Drugs 22 Criminal Justice Advocate 24 Relationship skills 45

Violent 19 Dentistry 8 Mothering skills 26

Chronic Health Condition 16 Others 3 Others 1

Exploring key concepts

• What’s wrong with the Professional Gift Model?

• What does personalisation really mean?

• What’s the difference between personal or individual budgets?

• Why invent self-directed support?

• What is citizenship and Independent Living?

• Why we need rights as well as needs?

• What are the keys to citizenship?

• What is social work?

Exploring the meaning of key words and concepts.

1. The Justice Problem

Ursula Le Guin

Honour can exist anywhere, love can exist anywhere, but justice can exist only among people who found their relationships upon it.

John Rawls

All social values - liberty and opportunity, income and wealth, and the bases of self-respect - are to be distributed equally unless an unequal distribution of any, or all, of these values is to everyone's advantage.

Equality of income is important, but it is even more important that we treat each other as equals: whatever our differences.

2. The Institution

At the age of 23 I visited an institution. The experience was life changing. I wondered:

• What a dreadful place!

• What amazing people!

• How come I’ve never met anyone with a disability before now?

The long history of institutionalisation, abuse and the Holocaust reveals that we are capable of great evil, especially when:

• We are frightened

• We find a scapegoat

• We dehumanise our intended victim.

3. The Phoney Community

Sometimes we just replaced the institution with another institution, but without the park.

Services come as a ‘professional gift’ which the person cannot shape or control.

Maimonides

There are eight levels in charity, each level surpassing the other. The highest level beyond which there is none is a person who supports a Jew who has fallen into poverty [by] giving him a present or a loan, entering into partnership with him, or finding him work so that his hand shall be fortified so that he will not have to ask others [for alms]. Concerning this [Leviticus 25:35] states “You shall support him, the stranger, the resident, and he shall live among you.” Implied is that you should support him before he falls and becomes needy.

The power and control given to those who help can become toxic. The challenge for our society is to find out how to support each other without degrading each other.

4. Innovations & Ideas

Personalisation

Does that word actually add anything?

I can’t see that it has a helpful meaning.

Real and valuable innovations emerge as people, inspired by values and visions, craft thoughtful solutions for real problems.

Self-directed support and individual (or personal) budgets was an effort to shift the whole system towards the citizenship model by converting services into entitlements.

In reality the shift towards ‘personalisation’ has been undermined by its ambiguity and by the lack of real power or effective legal rights for disabled people.

5. Equality, Diversity & Citizenship

We are different and we are equal. And our differences are good - in fact they are essential for a decent society. So why do we find it so hard to reconcile difference and equality?

“How could men be equal in the eyes of God and yet unequal in the eyes of the Psychologist?”

Michael Young in The Rise of the Meritocracy

Robert Nozick, Anarchy State and Utopia

The most promising ways for a society to avoid widespread differences in self-esteem would be to have no common weighting of dimensions; instead it would have a diversity of different lists of dimensions and weightings. This would enhance each person’s chance of finding dimensions that some others also think important, along which he does reasonably well, and so to make a non-idiosyncratic favourable estimate of himself.

We do not have to acquire humility. There is humility in us.

Only we humiliate ourselves before false gods.

Simone Weil

Citizenship is not about having some common property like a certain kind of brain or a passport. Citizenship is the way in which we come together to make sure that we all belong and know we belong.

Aristotle explains that a community is not made out of equals, but on the contrary of people who are different and unequal. The community comes into being through equalising, 'isathenai.' [Nich. Ethics 1133 a 14]

Hannah Arendt

We create equality between us by creating a universal framework of rights, duties and freedoms. But citizenship demands more than just ‘equal rights’.

We must create practical solutions to support and enhance citizenship for all:

1. Planning

2. Decision-making

3. Money

4. Housing

5. Help

6. Community

7. Relationships

The keys to citizenship are the practical social conditions of self-respect and dignity.

6. Needs, Wealth & Rights

Needs are important. But many needs cannot be met unless people are able to meet their needs for themselves.

And if we do focus on meeting other people’s needs for them we can undermine capacity.

Pippa Murray has developed a model of ‘real wealth’ or capabilities:

1. Resources

2. People

3. Community

4. Gifts

5. Spirit

You could no more make a city out of paupers than out of slaves.

Aristotle

7. Next steps

We are beginning a new phase of thinking and action, one which demands:

1. A focus on real and effective legal rights

2. Less jargon and more commonsense

3. Organised political power to challenge and direct.

Although we keep ‘taking the institution with us’ we can still make progress. The final stage means tackling the institutions of the mind - our prejudices.

Not only must we close down the community institutions we must also start to reduce the problems built into our welfare system.

We need to redesign the welfare system so that it supports and sustains citizenship, family and community for everyone.

Social workers are key agents of positive change. But they will need to develop their role in the coming phase of development.

Social work’s business is citizenship and justice.

Its field is large and exciting.

Simone Weil

Christ does not call his benefactors loving or charitable. He calls them just. The Gospel makes no distinction between the love of our neighbour and justice. In the eyes of the Greeks also a respect for Zeus the suppliant was the first duty of justice. We have invented the distinction between justice and charity. It is easy to understand why. Our notion of justice dispenses him who possesses from the obligation of giving. If he gives, all the same, he thinks he has a right to be pleased with himself. He thinks he has done good work. As for him who receives, it depends on the way he interprets this notion whether he is dispensed from all gratitude, or whether it obliges him to offer servile thanks. Only the absolute identification of justice and love makes the co-existence possible of compassion and gratitude on the one hand, and on the other, of respect for the dignity of affliction in the afflicted - a respect felt by the sufferer himself and the others.

What questions should we ask?

do you know about

advocacywhat do you

want to do with your life

what do you know of your

rights

What is important to

you

what do you expect of me

can you manage…

What are priorities

What do you need to live

independently

how are you…

what would you like to be doing

in the future

Who is important to

you

what about your money?

this in confidence

what support do you already

have

fruitful questions flow from an understanding of your purpose

there is no tool for creativity other than your whole humanity

Making citizenship real

What is the point of our work?

If we are not helping each other to be citizens what

are we doing?

What is citizenship?

Citizenship can sound very grand, but it’s a simple idea:

We’re all equal

We’re all different

& the best society is one where we all work together to respect and value everyone

Citizenship is also very practical

Everyone can be a citizen

Everyone can contribute

& the best support strengthens citizenship for all

1. Purpose• Citizen’s have a sense of

purpose - a meaningful life

• People’s sense of meaning has many sources

• We must listen and look for meaning in the right places

• We each have purpose - we just don’t always know it

Nan & Direction

This is not person centred planning

Help & Connect in Newcastle

2. Freedom• People have a right to be free

• But we need relationships with others to be free

• We need to provide help with information, communication and good representation

• A man in a desert is not free - he’s just alone

3. Money• People need the resources

necessary to be citizens

• The chance to earn and save

• Money for services is really the person’s entitlement

• People only do things for us for love or money - why not have both?

John-Paul & Money

4. Home• People need a home of their

own

• That means living with the people we want to

• Safe, secure and private

• Going into a home - means losing your home

Then the old Vainamoinen put this into words:“Strange food goes down the wrong wayeven in good lodging;in his land a man's better at home loftier.If only sweet God would grantthe kind creator allowme to come to my own landsthe lands where I used to live!Better in your own countryeven water off your solethan in a foreign countryhoney from a golden bowl.”

From the Finnish epic poem: The Kalevala

5. Help• Citizens need help - its not

independence that build community but dependence

• But help must be good help

• Supporters need to understand what good help demands

• If you need nobody you're no use to anybody

Individualise Everything

Choice Support & Southwark Council achieved over a 5 year

period a saving of 30% in the cost cutting up the block contract into

personal budgets and treating each person as an individual, using

technology and cutting central and salary costs.

6. Life• Life is made by living

• Work, play, volunteering and having fun

• Life happens in community

• But it really matters that you are in the right community for you

The lame rides a horsethe maimed drives the herdthe deaf is brave in battle.A man is betterblind than buried.A dead man is deft at nothing.

A Viking Poem from the Havamal

7. Love• We all need love - life without

love is hell

• Love comes in many forms

• We need to understand how to nurture and encourage love

• Love is what creates citizenship and new citizens

Margaret & Love

In order to create there must be a dynamic force, and what force is more potent than love?

Igor Stravinsky

1.Get good at listening for direction

2.Build relationships that liberate

3.Get clear about entitlements

4.Respect and deepen roots

5.Be flexible - in the extreme

6.Get stuck into community

7.Look out for love

Social and political realities

[The ill-fated Pruitt-Igoe

housing project]

Government doesn’t always

know best

Justice lives in poverty. She survives. She measures What is necessary. She honours what ought to be honoured. She seeks out clean hearts, clean hands. She knows what wealth and power Grind to dust between them. She knows Goodness and the laws of heaven.

Aeschylus