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ESA -Letter to Anne Milton

Dear Anne Milton

Although I am a Senior Social Worker with the Community Drug Service in Guildford, I write this letter in a personal capacity. I have twenty years of experience in the substance misuse field and am committed to supporting individuals with substance misuse issues towards recovery and meaningful re-engagement with their communities.

Some of the clients I work with are of the most vulnerable in society. In particular, I have one client from …….  who was raised in extremely difficult circumstances. Her mother was mentally ill and committed suicide while my client was a child. Her father was unable to cope and his two children, my client and her brother, were left to fend for themselves. Both of their lives unravelled and both ended up slipping into drug dependency. My client lost her brother three years ago when he died in police custody.

When incidents like this occur in the life of a drug user, things can go either way. They can either harden and develop a fatalistic attitude towards life and increase the risks associated with their drug use, or they can use it as motivation to improve their lives and ensure that such circumstances do not befall them. In this case, my client chose the latter. After a difficult period of grieving for the loss of her brother, with my support and the support of another worker employed by Surrey County Council, she began picking up the pieces and trying to improve her life and life prospects.

This was a tall order for her. Aside from the drug dependence, she was involved in a domestically violent relationship, where she was controlled by a bullying partner. She also has multiple physical issues. She is a Type 1 diabetic, asthmatic, under investigation for Coeliac’s disease, has a rare skin disorder which requires intensive daily treatment and she suffers from PTSD, anxiety and depression.

Despite all of this, she is engaging well with treatment and developing confidence in herself. She is illicit drug free and taking slow but steady steps to re-engage with her community on a meaningful and rewarding level. I see her regularly and a support worker helps her to get out of the house and works towards instilling her with positivity.

Three weeks ago, I attended a medical assessment with her at the DWP office in Guildford. She openly discussed the significant impact on her life of her physical and psychological illnesses. The medical records were stacked up on the desk next to the assessor. Towards the end of the assessment, the assessor effectively asked my client to wave her arms around, which she did. My client expressed her concern and anxiety around being placed in any work-related activity. I can confirm that she is NOT psychologically or physically ready to get involved in any group activity as I have been working towards this eventuality with her myself. I will know when she is ready because I have been supporting her intensively for the past three years.

On Friday, she received a letter from the DWP, placing her in the WRAG group. She must attend a meeting with a work coach on Friday June 30th, or lose her benefits. I went to see her at her home to discuss the contents of the letter and I was met with a despondent client, bordering on suicide. I spoke with the department on her behalf and was told in no uncertain terms that she must attend the appointment or ‘her benefits may be stopped’. The letter also told her she has already lost £50 a fortnight and has been taken off ESA. I left her house with her devastated but was reassured by her that she will not self-harm in any way. I have agreed to attend her appointment with her to offer her support.

My questions on this instance are manifold. Firstly, how is this helping? How can any medical assessment derive that a person is fit for work when there is a mountain of evidence at hand that suggests otherwise? Why as a professional, who has supported a service user intensively, taking into account every dynamic that affects her life, are my views not taken into account? Why are the DWP actively working against the work that another arm of the government is doing to support a vulnerable person to achieve normality in their lives while enabling them to re-engage and contribute to their communities?

The issues that I raise in this account are not unique. I find that they are happening routinely and are achieving the opposite of what I assume the intention to be. There are cases where people need strong encouragement to take responsibility for their life circumstances but it needs a restorative approach that listens to highly-trained and experienced professionals to find the best way to support people to move forwards. In the case of the client I refer to above, forcing her into activities that she is unprepared for risks the progress that she has already made. Relapse for her would mean continued physical and psychological deterioration, indefinite and costly drug treatment, increased medical costs due to hospitalisations and ultimately, inevitably, death

I would be interested to hear your views on the issues raised in this letter and urge you to advocate for vulnerable people while considering your party’s social welfare and benefits policies. As a key-worker, it is soul-destroying to see progress being sabotaged as a result of the impacts of a broad-brush social welfare approach that aside from setting up a false economy, places vulnerable people at risk of severe poverty, deterioration and even death.

 Yours Faithfully

 William McCarthy

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Bias? no. Ignorance? Perhaps.

Several things about life in the UK bother me a lot but none more so than the issue of immigration. Recent research carried out by the polling company Ipsos Mori concluded that the public are wrong on virtually every major issue but spectacularly so on immigration. We all have our opinions on immigration. In my experience, I am much more likely to encounter conversations about immigration than say the future of the NHS, or the reduction in funding of social care. So everybody has an opinion on immigration. But what is it based upon? What we see on the news? What we read in newspapers? What we hear from others? What we 'want' to hear? One thing it is rarely based on is personal experience. Take Rochester and Strood as an instance. At the bi-election two years ago, immigration was a central issue. It resulted in Ukip's Mark Reckless being elected on the back of a robustly anti-immigrant campaign. Yet Rochester and Strood have a lower than the national average number of 'foreigners' living within its boundaries (seehttp://www.bbc.co.uk/news/uk-england-kent-29803209). So it is easy to conclude that Ukip won this election on the basis of an issue that everybody talks about and has an opinion on but does not actually affect them. Take it forward to the #brexit vote, which in my view was largely won on the basis of anti-immigrant feeling, and we see on a national level what we saw at Rochester and Strood. Perception appears to have become the new reality. What people think or perceive to be true is more important than what the actual evidence suggests. Its more confirmation bias than open-minded weighing up of information. Politicians and media outlets of all persuasions sell this perception and the public largely lap it up, without any scrutiny. It ensures that rational debate is suppressed and replaced by what amounts to little more than gossip and rumour. It is useful for politicians because it diverts from the tragedy that is modern ‘post-truth’ politics. It is fake news and it is a free hit. Immigrants have nobody to defend them. Public services are decimated under the guise of austerity. Real, actual, demonstrable hardship caused by a political choice, austerity, yet the focus remains on immigration. Its an ingenious ploy; keep them preoccupied with non-issues and we can get away with murder. It is the oldest trick in the book, divide and conquer, the catastrophe of our time, where politicians have managed to turn poor people against other poor people. Along with the neutralising of unions, this is why the gap between the rich and poor has grown dramatically since the banking crisis in 07/08. Recently, while on Twitter, I read a post from a guy from Carmarthen, complaining about how immigrants were given preferential treatment over 'locals' for housing stock. I have no idea what his motives were, other than vague dislike of Labour, whom he blamed for mismanagement of his local council. I asked the guy to provide some stats to back up his argument. He informed me that there were 9000 or so immigrants, and that no new housing stock had been built since 1983 (a national trend, I expect). So I said I’d contact the council on his behalf, which he accepted. I received a reply yesterday from the 'housing needs lead'. He provided me with relevant stats for the last twelve months. Of 938 housing allocations, 26 properties were let to people who described themselves as 'other than white''. This also included people from eastern Europe. That is just over 2% of the years total. The actual number of ‘immigrants’ was just over 7000, and included students, irish people, travellers and eu citizens. So in terms of housing allocations, 26 properties were given to 'non-nationals', which I think you'd agree is negligible. The facts as presented by the council were completely at a variance with the figures presented by the twitter user i.e. post-trutherism. We used to call it lying. When challenged, he provided more anecdotal evidence around ‘what he sees’ and further vague accusations towards Labour, who had been supplanted by Plaid in recent elections, possibly as a result of widespread rumour-mongering around numbers of immigrants taking housing stock etc. The themes addressed in this vignette are replicated up and down the country. There's always an angry bigot willing to pass off evidence-free anecdotal, back-of-beermat hearsay and rumour as gods gospel truth. Politicians and media outlets inflame this and now #brexit has all but legitimised perception over truth. What I suggest as an antidote is to fact check. it is not difficult. When you hear immigration 'facts' around housing, or benefits, or even uptake of NHS services, fact check it. Send an email to the council, all of whom have websites and email addresses. Find research, not opinion. Pull the curtains back. Write to the local NHS governing bodies and ask them directly for information. It is only by doing this can we begin to identify what the real problems are - underfunding, privatisation, austerity and the abject failure of the country's media to hold the politicians to account.

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*Tester*

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A mental health service experience

I spent a recent afternoon as a guest of a colleague on the front line of community mental health services. She is a senior social worker/Amp (advanced mental health practitioner). It was a salutary experience. It enabled me to see at first hand the intricacies, challenges and frustrations in delivering quality services to often vulnerable individuals with mental health problems and their families.

My reason for being there was purely selfish. I am considering my career options and wanted to experience at first hand the Amp role in the community. If I am to follow my current career trajectory with adult social services, I would have three options available to me. Firstly, I can apply to train to become an ‘amp’. An amp is required to be in attendance when an individual becomes mentally unwell in the community. Without going into too much depth, they are responsible for carrying out the assessment, paperwork and liaison necessary to detain somebody for further assessment on a psychiatric ward. It is a role that carries great responsibility and requires a balanced and deeply ethical mind-set. With respect to myself and my sensibilities, it doesn’t rest particularly easily on me that I would have the power to compromise or remove somebody’s liberty. I’ve closed my eyes and imagined wearing the coat but in truth, I just can’t see it.

Alternately, I can either do an award to develop as a practice teacher or get back into management. For me, the latter is the least likely option. In an earlier manifestation, I was both a mental health and substance misuse manager and it is not a role I want to return to. In my 17 years of practice, I have never had a problem with a user of any service that I have worked with. I have however, had several serious issues with senior managers and fellow staff members over the years. Frankly, the stress associated with the role and the wage is simply not worth the hassle.

As I arrived, my colleague was in the process of calling a CMHRS (Community Mental Health Resource Team) to discuss a referral to her. A call had come in to the CMHRS at 09.30am from a concerned mother. Her son, a young adult, was becoming mentally unwell. For the previous few days, he had attempted to cut himself with a variety of household objects and spent much of his time cowering in the corner of his room. At the behest of his parents, he had been evaluated by a psychiatrist (from the private sector) over the weekend who advised that should he deteriorate any further, he should be admitted to a psychiatric ward for treatment. The CMHRS are the statutory agency who have a lead responsibility to intervene with severe mental illness in the first instance.

Along with carrying a caseload of service users, each CMHRS worker, whether social work or nurse, must ensure that demand for immediate assessment is met through a duty system. Every referral into a CMHRS goes through this duty system and is dealt with in order of priority. In this case, as the referral was likely to lead to an in-patient admission, they passed the referral on to the Approved Mental Health Social Workers to facilitate the admission. However, if they had read the referral through, they would have seen that the service user was prepared to be voluntarily admitted to the psychiatric ward, thereby rendering the need for an Amp assessment unnecessary. It would not be in the service users’ interest, at such a young age, to have a mental health detention on his medical records. An Amp’s decision-making on any assessment starts from the ideal of ‘the least restrictive option’. If hospitalisation is necessary, it is almost always in the service users’ best interest to be admitted voluntarily. A responsible AMP will exhaust all options to enable a service user to remain at home before going through with a detention under the mental health act.

In this instance, what should have happened (in accordance with inter-agency protocol) was the service user should have been seen by a worker from the CMHRS AND a worker from the (Mental Health) Home Treatment Team. The Home Treatment Team are ultimately the gate-keepers for in-patient admissions. If they cannot provide an adequate service to enable an unwell individual to remain at home, they will sanction an in-patient bed.

My colleague contacted ‘mum’ and quickly established that the service user was willing to enter psyche ward voluntarily. She then contacted the duty worker at CMHRS and asked why they hadn’t attended with the Home Treatment Team to arrange the admission. The duty worker, in this case an experienced senior nurse, stated that she could not possibly see the service user as she has seven referrals to deal with immediately, with several of the referred individuals feeling suicidal. She felt that the expedient thing to do was pass the referral on to the Amp service. The nurse herself sounded extremely stressed (I could hear her raised and agitated voice from across the desk). She said her service simply could not meet the demand. Her new manager had just walked out of the job, two months after she had started. There was a general crisis in morale as a result of these factors.

To give the Amp her fair dues, she resisted the temptation to jump in to ‘rescue’ her colleague. She felt strongly that the service user should not be admitted on a section, given his willingness to be voluntarily admitted. She decided to call the Home Treatment Team to see could they attend on their own, on a one-off basis to assess and arrange a bed. Again, they refused as such an action fell outside the service protocol. My colleague asked to speak to a senior manager to outline her position – this manager was off ill, due to stress. Further unsuccessful attempts were made to discuss the case with various service leads but all were unattainable. Finally, a senior Home Treatment worker on a different site was prepared to say that her colleagues may be behaving over-zealously but added that at this moment, there was no leadership in the service, resulting in a ‘crisis of morale’.

After a further 2 hours of seeking advice and trying to contact senior managers, my colleague got back in contact with the original duty CMHRS worker. She had finally found the time to go and see the service user (approx. 8 hours after the initial referral), only to establish at this point that the service user had changed his mind and was no longer happy to be voluntarily admitted. She was now in the process of negotiating with an Amp from the out-of-hours service to attend for assessment. Hardly the desired outcome, I think you will agree.

I spent the rest of the evening at home trying to process my feelings on what I felt was a fiasco. I couldn’t escape the sense that despite all the bluster about ‘service user involvement’, ‘patient choice’ and ‘client-centred work’, the fact remained that the well-being of the service user was the last factor to be considered in the inter-agency to-ing and fro-ing. Would I want to be continually wrestling with red-tape and protocols that are service and not service-user centred? Could I work in a service that was sinking under the demands placed on it? Could I function in a team that was rudderless and engulfed in an ongoing crisis of morale and leadership? Most importantly, could I survive in an environment where service user and carers needs are routinely sacrificed for the needs of the service?

I found the affair totally discomfiting. I know that the people working in the services are mostly committed to providing a professional service. There are just not enough staff. I know that trusts are committed to providing quality services. There are simply not enough services. I know that commissioners are under pressure ultimately to get more for less. There is simply not enough money. I also know that there is a drive to streamline services through government sanctioned ‘payment by results’ schemes. The bottom line is that the government want more for less. It is about savings, and quite possibly, cynically even, it is about creating a situation where the NHS and local authorities ‘fail’, giving the conservatives further impetus in their drive to privatise health services. In a nutshell – cut funding, demand more, then blame the service for not succeeding. Hence, poor leadership, stress, low morale and consequent retreating behind protocol and procedure to defend one’s practice and remain safe. The service user becomes incidental.

I will not be training to be an Amp. As much as I want to see service users given a good service, I don’t want to be a powerless participant in an ideologically driven decimation of services, staffing and morale. The whole affair greatly conflicted me. I am a great believer in the NHS and its ideals. Free healthcare for all at point of entry in a dignified and respectful way. This ideal is dying, or rather, being choked on the vine.

My final thought centred on this service user’s family. They had obviously made a decision in the first place to hire a private consultant to address their son’s mental health issues. One can only assume why they made this decision – previous negative experience, patient choice, attempting to ensure privacy or avoiding the lifelong ‘label’ that comes with a mental health detention. In my mind’s eye, I could see them sitting together, frustrated, waiting for an NHS/Adult Services team to arrive, a full 8 hours after the referral was made, with the unsaid sentiment being ‘this is why we went private’.

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Conviction

Not many people know Peter O Connor. Peter was a man from a bygone era who was prepared to put his neck on the line for his convictions. He grew up in Waterford City in the early years of the twentieth century. It was a time of great upheaval, with the First World War raging in Europe and republicanism simmering at home in Ireland. Many Waterfordians had gone to fight for the empire in support of local political leader and Westminster Member of Parliament John Redmond, who believed that if the Irish fought on behalf of the British, the goal of Irish ‘Home Rule’ could be realised. Waterford boasts, if indeed ‘boasts’ is the right word, the youngest allied soldier to die in the Great War. John Condon was 14 when he was killed at Ypres. Of course Home Rule was never realised due to the revolution set in motion by Sinn Fein in Dublin at Easter 1916. Still, many Waterford ‘Redmondites’ laid down their lives for empire, believing they were doing the right thing for the right reasons.

Peter and his family were heavily influenced by the early trade union movements and events further afield in Russia, where the Bolsheviks had ceased power in 1917. Young Peter was a dyed in the wool Labour man. Real Labour, the representative of the working man, as opposed to the current feeble incarnation. The party that vigorously pursued the ideal of socialism, with equality, liberty and opportunity for all. In the face of narrow nationalism, religious hegemony and naked poverty, Peter and a minority just like him kept the red flag flying high in post-revolutionary Ireland. The conviction that separated Peter from many of his cohort however, manifested when Franco’s fascists emerged to overthrow the rainbow left government in Spain in 1936, precipitating the Spanish Civil War.

Peter, along with some tens of other Waterford men signed up to fight for the socialist cause in Spain as part of the International Brigades. Peter’s commitment to his cause was indefatigable. He fought at Jarama and Ebro. While Spanish fighters were suffering with heatstroke and swollen feet due to burning sand in the murderous mid-day Spanish sun, Peter could not be summoned from the front line. His charismatic force was identified by the high command, who wanted him away from the front line to return to Ireland to assist in recruitment. Peter was eventually removed but only as a result of a serious shrapnel injury.

He returned to Ireland to face excommunication from the church. He became a social outcast, a heathen to be avoided at all costs. Ireland was still deeply devout and the Catholic Church was the primary cultural and moral force. They came down firmly on the side of the fascists and implored the population to reject these returning ‘communists’ from the pulpit. People would literally cross the road when they saw Peter, including people he had considered friends prior to his participation in the Spanish Civil War. Despite this outpouring of ignorance and disapproval, Peter continued to pursue his socialist principles and remained a Trade Union and Labour activist throughout his life. In later years, in his autobiography, Peter outlined his belief that ‘a man must have something bigger than himself to believe in, otherwise it is a wasted life’. He inspired many locals to take up the leftist cause in Waterford and remained involved in politics until his death in 1999.

Tonight, I am lying in bed, deeply saddened by the news from France that Marine Le Pens ‘Front National’ have topped the polls in France’s European elections on an anti-immigration ticket. Ukip, a rag bag of disaffected establishment types, bigots and poorly informed pub drones have affected the same result in the UK. There is a truism that in times of recession, politics often turns right as the competition for diminishing resources increases. Immigration in particular, is a tried and tested rallying point for the disaffected. On the face of it, this belief is being borne out. But it doesn’t have to be like this. There is enough money, food, resources in the world for everybody. Suffice to say that plentiful evidence of this viewpoint it is a mere internet search away. I suggest you start with the recent reports of the massive recession busting increase in wealth for the top strata of British (and Irish) society since the crisis began in 2007. An increase in billionaires while millions more teeter on the brink of outright poverty due to the Conservative’s vicious layered attack on the welfare state.

For me the bigger issue is the willingness of politicians of all persuasions to use immigration to divert from the true causes of the recession i.e. the same strata that are increasing their wealth while the rest of us are forced to tighten our belts. Immigrants are a soft target, with no political representation to defend themselves with. They are simultaneously viewed as welfare dependents and occupiers of jobs that should be available to British people. They clog up the NHS and increase our children’s classroom sizes. Immigrants are low hanging fruit for politicians and media only interested in pleasing their corporate patrons. I expect the Tories to do it, Ukip are merely the extreme right-wing of the Tories (anti-establishment is just short of laughable) and the Lib-Dems are dead in the water. Labour however, are a different story.

Labour have yet to recover from the New Labour ‘Torylite-comfortable-with-obscene-wealth’ years. They appear lost between recognising the need to forge new ground and adhering to a broad neoliberal consensus. They are essentially pitching themselves into a position where they can’t win. They will never out-tory the Tories so they may as well tell the likes of Rachel Reeves and Tristram Hunt to cut out the pseudo tory sound-bites about education and welfare. Every single one of their public utterances are losing ever more traditional voters. Similarly with Ed Balls irregular interjections on the economy and future spending plans. Their biggest crisis however, is around immigration. Far from standing up to those most visceral and unpleasant in their blind prejudice, Labour are at best, maintaining a low profile and at worst tacitly compliant with the anti-immigrant complex. They appear to be running with the right wing narrative that the public are greatly concerned with immigration, with the consequent cry that ‘something needs to be done’. They even produced mugs to this effect, while Gordon Brown spoke of ‘British jobs for British people’.

Well I can assure them of two things. Firstly, the public are concerned with immigration, primarily because of the lies that have been propagated by those who wish to obscure the real causes of recession. Secondly, even though the previous statement is true, I strongly suspect that far more people are less bothered about immigration than is accepted, especially within the Labour movement.

What has this got to do with Peter O Connor, somebody I believed to be a true Labour man, in the traditional sense of the word? The man battered, bruised, burned, excommunicated and shunned for his political beliefs? Conviction is the answer. Truly believing in an ideal greater than yourself. The willingness to take your beliefs to the front-line and be counted, despite the probability of animosity and hatred towards you. Can labour under Ed Miliband produce this level of belief? He could certainly make a start by getting off the fence on immigration. Make the argument that the UK actually receives a net benefit from immigration but do it with real energy, not some watered down, think-tank inspired fudgery. Ultimately, lots of people may not agree with him but in an age where antipathy towards politicians remains widespread for all sorts of reasons (alienation, expenses, illegal wars etc), people will respect the fact that he is giving a strong voice to his beliefs. Were he to risk showing some moral courage, he will actually benefit more than he believes possible. He will rise above the detritus, the Enoch Powell inspired doom-mongers, the bigots and those who gleefully divert the glare of the public from their corporate paymasters. Miliband has a choice to make. He either continues with the bland safety of being the arch ‘career politician’, or he lets the Reeves, Balls and Hunts be carried away from the front line while he re-forges Labour by bravely and single-mindedly standing up to be counted.