In response to Dr Ruth Allen's recent guest blog on the merits of strengths based practice, Colin Slasberg, an independent consultant in social care, says she is absolutely right to consider how we might sweep away old thinking, practices and bureaucracies that hinder self-determination.
In this detailed response, Colin makes the case for a strong and compelling understanding of why these old ways persist, in order to know what action is required to leave them behind.
It has long been the assumption of policy makers that such practices are the fault of wrong thinking practitioners or finance conscious councils. All that needs to happen is a change in behaviour. But is this a sound assumption? It's time to review the evidence.
I qualified as a social worker in the 70’s. I saw the principles I learned then as the basis of a healthy society, based not on care or charity, but respect and mutuality.
I am still fired up by that vision even if the language has changed. But I have been painfully aware throughout a career in both operational and strategic roles that the system I have worked in has not shared that vision.
Good work was out there, but often isolated and happening despite the system, not because of it. This pointed to something being very wrong. I wrote a paper with Peter Beresford setting out evidence and arguments that identify the eligibility process as the culprit.
It’s a process that relies on categorising needs and locating people accordingly. This fundamentally contradicts the first social work principle of ‘starting where the client is’. If a service user’s view of their needs is beyond what the council deems ‘eligible’, the practitioner must reduce them to mere ‘wishes’, thus demeaning their view. What does this do to ‘self-determination’, to the practitioner/service user relationship and notions of respectfulness?
The bureaucracy Ruth identifies is built to deliver the eligibility process, but that process needs to be swept away, along with supporting practice, budgetary, finance and IT systems.
It is simply beyond the gift of practitioners to sweep away this change. If it wasn’t, it would have happened years ago. The article above outlines alternative strategies to manage spend against budget. I elaborate on this a little more in relation to the recent Oxfordshire case.
Crucially, a person centred process of resource allocation will allow authentic person centred practice. Being strengths based is a natural component, but not the entirety, of person centred practice.
Singling out being ‘strengths based’ and delivering it in the context of eligibility based working leads to a person’s assets being seen by the system as some kind of casket of treasures hidden away by artful service users just waiting to be legitimately raided. But in the main this is far from the reality of what it takes to access people’s strengths. They are indeed hidden, not by artfulness but by the person’s fears, lack of confidence and a host of other intimate issues.
This calls for best, person centred practice to identity them. And such practice can only happen when the person and practitioner work in partnership with high levels of trust.
I have been collaborating with a council for a couple of years to design such a whole system change. This was on the premise that it would be possible to buck national policy as set out in the Statutory Guidance to the Care Act and so replace assessments for eligibility with assessments for well-being.
The council opted not to proceed given the risks. However, this was not before work with practitioners, service users, carers, managers, budget holders, finance, IT and legal colleagues enabled the basis for development of a ‘blue print’ for person centred systems to deliver well-being. I used a recent seminar at Kings College to set it out.
Real change needs to be on a national scale. This will require a change to the Statutory Guidance. How does that come about?
For all we know, if best person centred practice became the norm – not an exception - the current £14 billion spend would be enough to absorb all the unmet need the independent sector is so painfully aware of.
About Colin Slasberg
Colin qualified as a social worker in the 1970's and after a career in practice, operational and strategic management, in recent years has worked independently to focus on what it will take to create a system that is authentically person centred.
1 comment
Comment by Peter Mitter posted on
At the time you qualified I was a member of CCETSW (RIP) and involved is providing a disability element in 3 social work professional training courses at Manchester University and also had an annual session with what seemed to hundred training at LSE.
I now work as a self-advocate for and with people living with dementia -characterised by OECD as receiving the worst care in the developed world.
Strength-based practice is badly needed in dementia by health and social care professionals where your personhood can be ignored or discounted at the point of diagnosis and stripped day by day by your experience of stigma and isolation