Coordinating Care: Art or Science?

Being a care coordinator and managing the care programme approach has become a challenging function of our care and support services, attracting more than its fair share of negative connotations. A genuine tension exists between the passion and artfulness of human relationships on the one hand, and the pursuit of a scientific basis for interventions on the other. The science of research seeks to impose a sense of reassurance by means of consistent results when defined sets of circumstances are observed or applied. By contrast, the quality of an artful endeavour may be measured more by its emotional characteristics and the feelings it engenders in those involved or observing. In reality, the experience and practice of mental health and learning disability services is primarily a study of people’s emotional experiences, feelings and behaviour patterns. So we should be wary of any attempts to understate the elements of artfulness and passion; and we should recognise the potential impact this may have on our enjoyment of the work, as well as our motivation for doing it.
 
Arguably, one of the most crucial effects of the evidence-based practice focus of research is that it undermines the art of relationship-building. The pursuit of a rigorous scientific rationale places a clear priority on the cult of numbers. ‘How many?’ and ‘How frequently?’ and ‘How quickly?’ become the valued quantitative outcomes of an efficient service. But what is the cost of this, in terms of an effective, good quality experience for the individual service user within this wider research picture? Or, indeed, what is the cost of its impact on the qualitative experience of the work that, for many practitioners, is their motivation? Ideally, we need to strike a careful balance between art and science in the delivery of good quality care and support.

Find out more on these views from the published manual The Art of Coordinating Care

Inadequate risk assessment

A Foundation Trust (along with a care home provider) has recently received a heavy fine for inadequate risk assessment when placing a man at the care home; he subsequently killed one and seriously injured another care home worker. The degree of tragedy should not be underestimated, but you can instantly feel the bureaucratic knees jerking across the managerial universe. Larger tick-box forms will be required in greater frequencies so we can all rest assured 'this will never happen again', or so the political rhetoric goes!

I don't know the full details of the case, but I do know these are extremely rare incidents that should not be allowed to cloud over the vast majority of good decisions and good practice that does happen across our stretched public bodies. However, there is a wider case to be answered in the quality of information being communicated when a person with complex issues is required to be placed out of the health care system into the social care system. There is a 'tip of an iceberg' effect happening here, but it is not one that is going to trigger a rash of homicides. What I observe in my travels around the care and support landscape is a wholly inadequate approach to referrals, mostly driven by fear of the commissioning and managerial stick that drives the pursuit of numbers and throughput.

The result is often one of referral being a process of withholding relevant information (particularly risk information) for fear that it will be used to refuse the placement. Practitioners are under pressure to get people moved on, not to find the most suitable place for their continuing progress and support. Even when risk information is passed on, it is more frequently in the format of the dreaded tick-box exercise that communicates little of any use or relevance for planning appropriate support.

For me this case does raise the issue of poor examples of practice, but I would like the starting point for addressing the issue to be one that investigates the crazy 'system' we have evolved, whereby staff are under constant pressures from the bureaucracy that completely undermine any chance of delivering good and safe practice. If you want to develop a system that thrives on good practice it has to be a bottom-up approach; if you want a system that demonstrates what schizophrenia actually is then use the top-down managerial approach of 'talking the talk while actively disabling the walk'.

Reflective Practice

The following article is published with the kind permission of Jayasree Kalathil (Editor of Open Mind). It is with mixed feelings that I post the following article. It hopefully helps to raise the profile of the vitally important role of 'reflective practice', but it is also a sad reflection on the passing of Open Mind, as the final edition sees the end of what has been a terrific source of reflection, knowledge and a welcome haven for independent thinkers... it will be greatly missed and cannot be replaced.

Link to article

Do what you say on your tin

Are you taking the risk? It is something we all do, but why do we confuse and complicate it by our lackadaisical use of language? We take risks in order to gain something for ourselves, and occasionally others. We weigh up the options available to us, and make a decision based on what we compute to be the most beneficial course of action. It is called positive risk-taking not because we are trying to find a ‘positive risk’ (whatever that is), but because we are taking the risk in order to achieve a positive outcome...

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Reflective Practice - Re-connecting with a lost art might ignite a revolution in training

Excerpt: Service users and carers are likely to benefit most when they are served by a workforce that is motivated and enthusiastic about its work, that recognizes and works to its strengths, that feels supported, and is able to reflect on practice as an on-going function of its own development. Within this picture training as a function has an important role to play, but can easily become a wasted resource if it is poorly focused and lacks clarity of purpose. Furthermore, service users and carers possess invaluable experiences and skills that can contribute to the development of the workforce. So, why does it so often feel like reflective practice and genuine involvement are lofty ideals belonging to a parallel universe?

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