Tuesday, 9 December 2014

Vic Citarella and Debbie Sorkin Muse on Systems Leadership

Everyone has a system they favour, while it seems we all like to discuss a system. Plus, we all seem to know a better system then the one being used!

But joking aside, systems thinking is applicable in all walks of life and is the basic stuff of leadership. Here are our top ten systems thinking tips, we hope you find them useful:

1. Follow the money ‘Make the money do all the work’ is a timeless truism (and may explain why good betting ‘systems’ are probably the systems most written about!)

2. Pass and move quickly Short passes are often best; they really help build towards a goal – thus the Liverpool (FC) Groove and it works. Systems are made up of good habits that you repeat

3. Know when to get out of the way Heroic leadership may not be in vogue right now, but the hallmark of a top person is someone who stands aside at the right time, in the right way and because it helps the system work well

Stevie Gerrard’s Homework
4. Understand place and space There’s a time and place for everything; an observation that leads to real understanding of how systems work. In business they say never take your eye off the ball, but in systems it is what happens in the spaces ‘off the ball’ that matters as well…

5. Look good, but be effective Say no more – we all know what we are talking about here. Don’t be taken in by appearances and check the system does what it says on the tin

6. Always have a ‘Route One’ up your sleeve A system that gets the results in the most direct way is often a welcome option. Know the pitfalls

7. Put the time in to training and preparation Systems work best when they are looked after; true ‘fitness for purpose’ involves skills and leadership coaching

8. Always a marathon, never a sprint Except when it’s not – always worth challenging a clichĂ©. Horses for courses is your watchword here

9. Stick by your team-mates In the world of systems we are all leaders and our behaviour as team members is critical

10. If all else fails - sack the manager Sadly, even the most effective systems break down sometimes. Scapegoating rarely works, but systems which anticipate problems, learn from mistakes and plan leadership succession are a good bet to follow.

Why don’t you now help us by telling us what systems you participate in - and do you have any hot tips?

Thursday, 27 November 2014

Mike Wright asks what ‘adulthood’ is, how should we recognise it – and why is it so important?

Adult - from the Latin adultus, "grown up, mature, adult, ripe"

Above is the etymology of the word ‘adult’ that I found using an online etymology dictionary. And if it were not for the words ‘grown up, mature, and ripe,’ this blog may have taken the form of the old ‘which came first – chicken or egg/adultus or adult?’ paradox…

However, fortunately the test for recognising a fully grown up, mature human is apparently the same as selecting a good grapefruit or banana!

I guess that does raise an additional question, however, as to when you consider a banana to be ripe – a contentious issue to say the least (I personally prefer a banana with a few light speckles!).

Anyway, when can we say that somebody is ‘ripe’ without insinuating it’s time to crack open a nice bottle of Chianti and get some fava beans on the hob (a la Hannibal Lecter)? Wikipedia has seemingly distinguished between two ways of defining adulthood, it seems to me: – a biological and a legal or social sense. ‘Biologically, an adult is a human being or other organism that has reached sexual maturity. In human context, the term adult additionally has meanings associated with social and legal concepts. In contrast to a "minor," a legal adult is a person who has attained the age of majority and is therefore regarded as independent, self-sufficient, and responsible.’

This suggests that the transition from childhood to adulthood appears as almost a quantum leap from one to the other. To borrow the examples used on Wikipedia, one day on the calendar separates a person’s eligibility to either become an adult movie actor or run for Presidency – an example which, one might argue, represents a less obvious quantum leap! (I apologise – this shall be my first, and last attempt at political satire, I promise!)

There is clearly an assumption that by having ridden this planet around the sun for a certain number of orbits, or by having developed hair where there had not been hair before, one is somehow qualified and responsible enough to make independent decisions that the individual in question had not previously been deemed ready to make.

In each case, adulthood is seen as something that can be objectively measured and observed – but how far does this reflect the reality of our experience in making the transition?

The Romantic poet William Blake expressed the dichotomy between ‘Childhood’ and ‘Adulthood’ as ‘two contrary states of the soul’; Childhood being expressed as a state of innocence and Adulthood being marked through experience, leading arguably to a more cynical and perhaps inhibited outlook on life. This represents a less tangible interpretation of the transition but reflects a transition nonetheless, whereby our inner experience appears to be the determining factor as to whether we have reached a state of Adulthood.

Understanding Self

Perhaps a more positive view of adulthood comes from looking upon the change as a development towards a greater understanding of self. The Psychologist Carl Rogers (in his book ‘On Becoming a Person’) wrote, ‘… It shows itself in the tendency to reorganise his personality and his relationship to life in ways which are regarded as more mature.

‘It is the urge which is evident in all organic and human life – to expand, extend, become autonomous, develop, mature – the tendency to express and activate all the capacities of the organism, to the extent that such activation enhances the organism or the self.’

This interpretation of maturity is one that is expressed in terms of a positive enhancement of the individual, rather than as a loss of innocence or becoming more inhibited due to the assumption of responsibilities commonly associated with the transition into adulthood.

There are obvious practical and social reasons for being able to objectively recognise and distinguish a child from an adult. Such a distinction helps to ensure that those who are vulnerable through, perhaps, a lack of experience, are not exposed and subjected to conditions that could threaten positive development towards maturity.

However, it seems also to be important to me that the standards that society uses for such purposes are not adopted, without question, as representing our own level of experience, as they may limit the natural course of our development. My own personal experience has told me that the fact that I had reached the legal age, did not mean I was ready to become I porn star! (I’m 30 now and I’m still not ready.)

For me, adulthood is not an objective destination, which symbolises the end of our previous phase of life as a child. For me, it represents a continuing positive development towards maturity and a greater understanding of self, one hopefully leading to an enhancement and enrichment of our experience as a person.

This perhaps means that we can never truly say when someone is ‘ripe’ unless we are that person and can judge through the measure of our own experience.

As to the vexed, perennial question of when a banana is ripe, I guess we can never truly know… but let the debate rage forever onwards!

Monday, 10 November 2014

Cameras in Care Homes – Mixed Views in the Profession

Cameras in Care Homes – Mixed Views in the Profession, according to Andy Merker, Vic Citarella and Janti Champaneri

Last week, The Times told us that research into use of cameras to protect people in care homes had found the following proportion of stakeholders are in favour of their adoption:

• 90% of families with relatives in care

• 66% of staff

• But less than 50% of residents

The research, conducted by care home provider HC-One, came in the wake of CQC’s announcement that it is to issue a public information sheet for families and companies who want to film inside care homes.

Then, later in the week, respected commentator Roy Lilley wrote this in his blog: The CQC's Andrea Sutcliffe, inspector of care homes, is savvy enough to know she can't deliver 24-7 safe care for your Granny. She's given up and given permission for StreetWise relatives to sort it out themselves. She's handed her job to the relatives.

There's guidance on the way that StreetWise relatives neither want nor will be bothered about. It is a bureaucrat’s answer to a burgeoning problem that StreetWise families will sort out for themselves.

Roy’s conclusion is well worth including here:

If the law required CCTV in every care home, with the memory device only accessible by the client or family, we could make Andrea redundant tomorrow – and knowing her as I do [I am sure] she wouldn't mind at all.

The terms of the CCTV debate

A couple of days after all this I met with Andy and Janti to discuss the promotion of the embryonic Social Care Support Network at the Lahore Fort restaurant in Sparkhill, Birmingham (a venue chosen as we are thinking of hosting a Social Care Curry Club meeting as a way of giving the network some impetus).

Over a great buffet (a bargain at £9.95) inevitably, bellies perhaps slightly bulging, our conversation turned to this whole ‘cameras in care homes’ debate. And I have to say that in some respects it doesn’t matter what we concluded as the important thing was we debated the issues with as much relish as we tackled the buffet. Still, this is what we agreed:

We recollected that the Social Care Association had written a Parliamentary Briefing on the subject of care home CCTV in the late 1980s. Nostalgia then kicked in about the heyday, from our perspective, of professional debate. The policy, in the written piece, had been shaped in the cauldron of meetings, in actual formal debate and with postal interchange of comments.

Moving on, we thought the position emerging was a damning indictment upon CQC – and perhaps the regulator needs to look at what it is they are really measuring in terms of quality services. For those on the front line, the difficulty about good quality care is that it is what occurs at the interface between the carer and the service user. Frequently, this interaction involves deeply personal activities and/or issues for which we would usually require the utmost privacy/confidentiality. So ironically with most cameras in care homes currently sited in public areas few actually abusive interactions are captured – as perpetrators present themselves as all sweetness and light in such areas of the home.


Another aspect we discussed: the strength of the request for this kind of surveillance does not seem to be reflected quite so much by service users, in comparison to their relatives. And perhaps this is the more worrying aspect – the way in which social care has failed spectacularly to provide a guarantee of safe care sufficiently strong to secure the confidence of relatives.

The reality is that for most service users, support workers need to become involved in these intimate moments, and the difficulty is that abusers can use this mask of privacy to hide what they are doing. So atrocities can (and do) occur. And, of course, there is always the issue of the blind spots that cameras cannot see – which determined abusers will quickly work out.

Furthermore, it is not just deliberate criminal abuse that must be eradicated but any and all offences against dignity and respect – the insidious neglect that characterises poor social care practice. Here cameras could be a conscience, a training aid, a form of communication, as well as a reassurance to relatives that their concerns are either unfounded or are being properly addressed.

CCTV becoming ubiquitous in care settings may ultimately be the way that things may need to go.

However, the challenge has to be in what circumstances the tapes/disks would be accessible and in what ways would these tapes/disks be safeguarded from unauthorised viewing? Over our excellent repast we agreed that the kind of double key security one finds in safe boxes in hotels — with one held by the hotel, the other held by the guest -- may be one way of ensuring controlled access. Perhaps CQC should be present when such tapes are viewed?

But there are definite thorny issues about the service user, and indeed the worker, giving informed consent. It is possible we will have a scenario where the camera comes to replace the call-bell, in itself a source of discontent in many care homes. Residents and workers will work out together why cameras are useful, what concerns they address and how they enhance personal and safe care. In dialogue with relatives they will then utilise them accordingly; we agreed that is a convincing scenario.

On our way out of the restaurant, we briefly turned to domiciliary care – surely we can have whatever cameras we want in our own houses, can’t we? Would the safeguards need to be different in these settings? Are there any guidelines that we could pinch from the experiences of Big Brother? (Perhaps more of the Channel 4 reality TV version rather than Orwell’s nightmare vision?)

In any case, we think this is a significant and professional topic for debate. We also believe that this issue does need to be actively considered by practitioners, as well as residents and their relatives, to develop a beneficial and safe way forward.

Saying farewell to the patron of the Lahore Fort we queried whether there might just be an upstairs room for a social care practitioners meeting prior to partaking of a buffet. A professional network facilitated discussion followed by all the curry you can eat, including pudding, seemed to us an offer practitioners simply couldn’t refuse.

Tuesday, 14 October 2014

Mike Wright contemplates: The Physical Impossibility of Combing a Hairy Ball Flat in the Mind of Someone Living Intolerably

I recently received this image (right) in an e-mail. And after affording myself the appropriate level of chuckling time over the quality of content and the craft of delivery, I was prepared to move mentally along with my day, perhaps diverting my attention to some other procrastination-worthy material… but an idea got stuck in my head. My attention was suddenly held hostage by the thought that, ‘You can’t comb a hairy ball flat.’

Don’t worry, the image had not created some sort of irony-fuelled vortex, sucking all sense and meaning out of my mind. If you bear with me for a moment, I will try to explain…

I had once heard it said that you can do anything if you set your mind to it. It seems that whoever made this grandiose statement had evidently never tried to comb a hairy ball flat! My skepticism towards the claim derives from my awareness of the ‘Hairy Ball Theorem’ of algebraic topology (where else, I hear you cry), which Wikipedia informs me ‘states that there is no nonvanishing continuous tangent vector field on even-dimensional n-spheres’… or in English, ‘whenever one attempts to comb a hairy ball flat, there will always be at least one tuft of hair at one point of the ball’. (See image, left (Wikipedia).)

But how is this (or anything) relevant to the first image, you ask? Well, it seems to me that whenever we are compelled, whether through intolerance towards the existing paradigm, circumstance or opinion, to effect some external form of change we are (figuratively) attempting to comb a hairy ball flat.

We are attempting to achieve the unachievable, that is to say, in willing outer/external circumstances to universally correspond to a harmonic ideal, itself motivated by inner disharmony and dissatisfaction.

It appears that there will always remain a resistant ‘tuft’ (hairy ball-like) if action itself is compelled through resistance and force.
This is not to suggest that we should never seek to effect any form of change. It is to suggest that we must first start with ourselves. This insight is far from being original: the mystic poet Rumi observed in the 13th century that, ‘Yesterday I was clever, so I wanted to change the world. Today I am wise, so I am changing myself.’ It’s a thought echoed much later by Mahatma Gandhi, who famously advised, ‘You must be the change you wish to see in the world.’

If we act from a standpoint of intolerance, then we project that intolerant attitude, perpetuating a climate of intolerance completely non-conducive to creating or sustaining any harmony, be that internally or externally. The ‘vandalism, irony, and lists’ image above helps to convey (humorously) the inherent irony and hypocrisy that ensues from adopting such a position. To act in this manner actually supports and maintains an attitude that, in itself, is directly opposed to peace, as Pierre Bayle expressed when he stated, ‘It is thus tolerance that is the source of peace and intolerance that is the source of disorder and squabbling.’

So what are we to do if the comb of intolerance is laid down? How are we to accept what we find to be unendurable? Eckhart Tolle counsels that, ‘If you find your life situation unsatisfactory or even intolerable, it is only by surrendering first that you can break the unconscious resistance pattern that perpetuates the situation… It does not mean to passively put up with whatever situation you find yourself in and to do nothing about it. Nor does it mean to cease making plans or initiating positive action. Surrender is the simple but profound wisdom of yielding to rather than opposing the flow of life.’

It seems that firstly we must accept that our external circumstances are continually changing; that by their very nature are impermanent. To effect lasting positive change, it also therefore seems that we must adopt within ourselves a positive standpoint of tolerance and kindness.

Too simple? It makes sense, surely, that if intolerance begets more intolerance, then by becoming more tolerant ourselves we effect positive change as an active agent of that virtue.

We may occasionally choose to surrender to, or in other words accept, what ‘is’ in our present situation to avoid resisting or opposing the natural flow of life and to free ourselves from inner conflict. And if resistance is indicative of conflict, then freedom and flow must surely be the expressive movement of harmony and peace.

Therefore, to prevent ourselves becoming stuck up in a hairy ball ‘tuft’ of our own, we must accept that the hairs may move this way or that - and rather than forcefully comb them in a fixed direction, we should perhaps embrace and join in with this merry dance of change.

Above all, let’s not forget the important fact that ‘you can’t comb a hairy ball flat’… except, of course, in the case whereby a laboured metaphor which serves to justify its own tenuous use as an angle for a blog theme, can be deemed to be an acceptable application of force towards the reader!

I am grateful for the tolerance and compassion displayed by any reader who has borne with me until this point.

Friday, 26 September 2014

Toothpaste, Vinyl versus Latex and ‘DNACPR’

Helping out at a home owners and registered managers’ event recently I noticed three interesting topics were animating discussions.

One: toothpaste as a hazardous substance. This started off as a tale told to emphasise another ludicrous CQC inspector going over the top— until somebody posed a personal care scenario where toothpaste could really be potentially harmful. It is worth weighing the benefit of toothpaste to basic dental hygiene against the possible dangers to eyes from misuse, we learned.

Next: the relative merits of latex and vinyl gloves was in terms of practicality versus cost discussion. It centred on a contractual requirement to use only latex. Apparently both makes of gloves meet the same standards for infection control purposes. So, if this is the case, why the insistence on latex given vinyl is half the price? We speculated on the added sensitivity to touch of the latex and contractor ignorance of how and when gloves are used. However according to one home owner there were potential savings of £1,000 per year – and it’s a matter of personalised practice for another?

Three of three: DNACPR stands for ‘do not attempt cardio-pulmonary resuscitation’, which came up discussing the 5 key questions CQC will ask of registered social care services. In true workshop fashion, the questions were allocated around tables for discussion, and the table that had: Are they responsive? came up with a really helpful description of how the practitioners in their care home respond to situations when possible resuscitation may be a matter of choice – and may be potentially more harmful than beneficial. Clearly, caring and common-sense make it not only responsive to the resident and their relatives but importantly professional. On a personal level it gave me useful information that I could have done with several months ago, when my father was terminally ill.

So what did these three vignettes teach us at this event – besides, that is, the subject matter of the day (the Care Act and CQC Fresh Start)? We learned that it is often the little things, the details, which make the biggest differences in people’s life — indeed, they are often the crucial difference between harm and benefit.

Thursday, 11 September 2014

Connecting Memory and Imagination

Mike Wright shares his thoughts

One thing that could be said of both memory and imagination is that each only exist in the mind. Now that could be said of many things (in fact, some would suggest that everything exists as an expression of Universal Mind, but forgive me if I side-step that one for now!), after scratching my head and pondering over what connects the two, I looked into my own mind – and there they both were!

The consideration that I may have to go outside of that mind to find another connecting factor convinced me it was wise to stay put, and further explore this initial discovery.

Essentially, memory and imagination are both processes of thought, the activation of which places a slight veil over our immediate experience, and therefore, reality. This is not to undermine the usefulness of both as tools helping us to live practical and high-functioning lives, but we do not ‘exist’ in our thoughts: rather, the fact that we have consciousness means we are able to think.

Therefore we should not mistake either memory or imagination as conditions of who we essentially are, as the following quotes convey:

“…if you made a mistake in the past and learn from it now, you are using clock time. On the other hand, if you dwell on it mentally, and self-criticism, remorse, or guilt come up, then you are making the mistake into ‘me’ and ‘mine’: you make it part of your sense of self, and it has become psychological time, which is always linked to a false sense of identity.” Eckhart Tolle

“Thus I know that none of those things that I can understand with the help of my imagination is relevant to what I know of myself, and that the mind must be turned away carefully from those things so that it can perceive its own nature as distinctly as possible.” Descartes

Of course, I’m not suggesting that we refrain from the free use of imagination – say, reminiscing about the momentous impact that sliced bread had when it made its debut in the shops, or attempt to inhibit the creative impulse by forbidding Jeremy Paxman to rewrite Harry Potter as a polemic against fascist dictatorship.

What I am suggesting is that when our memory and imagination come together to construct some sort of narrative thread as to what type of person we are, or what other people think of us, this only exists in the realm of thought and does not constitute an immutable truth.

False senses of Identity

The implications of this are that we are not bound, as Eckhart Tolle says, ‘to a false sense of identity’. Rather, if we allow thought to dissolve back into its source, which is our ever present consciousness, we are eternally born back into the present moment - free of the suffering we may have experienced in the past and with our essential nature undiminished and without the limitations so often imposed through our imagination.

By the same token, if we merely view memory and imagination as tools of thought, to be taken up and dropped as and when they are needed, not as inseparable extensions of our identity, then we are surely free to once again to enjoy our present experience and dwell in our true nature.

This has implications for the way we view and behave towards those people who experience dementia, or other diseases which inhibit a person’s mental function. If a person’s overt ability to think or reason appears to diminish, this does not imply that the essential nature of that person is also diminished.

The disease does not therefore render someone less of a person - and it should not allow for a person to be stigmatized or treated as though they are. Again, if we are able to free ourselves from negative judgements and opinions which belong entirely to our imagination, then we may allow ourselves to act more in accordance with our nature, and instantly reduce the likelihood of someone feeling judged and undervalued.

If we seek to connect with a person on the level of our mutual fundamental nature, rather than our ability to think, reason, and remember, then perhaps we would be closer to sharing in the experience of the only reality that truly exists and not find ourselves so caught up in the ones that we construct in our minds.

Just a thought.

Friday, 8 August 2014

A Quiet Place: What Is Done In Love, Is Done Well

Mike Wright reports on his recent day of training with A Quiet Place

I recently had the privilege of being invited to attend the National Staff Training Day for ‘A Quiet Place’,‘a "within schools" programme of therapeutic support for pupils experiencing social, behavioural and/or emotional difficulties’.

I had initially been introduced to ‘A Quiet Place’ after being rather serendipitously handed a book (the best kind of ‘being handed a book’, I feel) written by Penny Moon titled ‘The Practical Well-Being Programme’ (for my review of the book, see here). So, acquainted with the ethos behind Penny’s holistic approach, I was grateful to be given the opportunity to gain a fuller picture of how this ‘artfully vague’ structure comes together in practice.

The structure of the Training Day quite aptly reflected that of Penny Moon’s general approach in not adhering too strictly to formality - and therefore allowing more space for creativity and spontaneity. This was personified in Penny herself, who artfully meandered through topics with an often hypnotic style; the deviation between precision and vagueness forming the ebb and flow of her stream-like speech (and I say this in the most positive sense, of course!). Bullet points were acknowledged, providing often very useful anchors of structure in the stream of experiential anecdotes, relevant informative updates, inspirational videos and breathing and meditation exercises.

The first thing that struck me, however, on entering the conference room situated on the 4th floor of 54 St James Street, Liverpool, was that ‘A Quiet Place’ comprised of actual, real people. Now, of course it seems plainly obvious that any Training Day, for it be effective and useful, must have people there to train. However for me, as a relative newcomer to ‘A Quiet Place’ and a relative outsider to the structure of how schools are run, it was not until this moment that I realised ‘A Quiet Place’ was not simply one person’s philosophy, existing as a detached ideal, separate from a system of statistical and results-focused teaching. It soon became apparent that this was in fact a practical and organised holistic model, designed to enable individuals to realise their true potential and value. Each person in the room had a role to play in making this aim a reality within the school system - and judging from the various experiences being shared, each person appeared to be galvanised by the challenge.

Being in a room with people who appeared committed to making a difference in terms of increasing the general well-being of their students gave me a more refreshing and hopeful impression of what was being achieved in schools today, as opposed to the demoralising and slightly cynical attitude that I often sense in the current educational climate as a result of, for example, the government’s proposal of introducing performance-related pay to the profession.

Instead, the climate within the room seemed to be one of positivity and optimism, as a result, perhaps, of the ability in being able to share in the more valuable reward: helping a student achieve their potential in terms of both well-being and education, not simply by pushing them towards a high A-grade at all costs.

Each ‘A Quiet Place’ Champion or Facilitator appeared to have a story to share in which the way of learning had been a positive catalyst for change in an individual within their own school setting. Interestingly, one Champion had brought along a living, breathing example, in the form of a student who had agreed to attend the Training Day to share their experience of ‘A Quiet Place’. The young man keenly expressed that for him, ‘A Quiet Place’ had offered him valuable space in which to calm down when he felt agitated; a place in which he was not shouted at, but rather listened to and treated with empathy. He explained that this had encouraged a better sense of self-awareness and enabled him to better regulate his behaviour by remaining calm when facing certain aggravating stimulus. He admitted that his behaviour had been bad in the past, but now he was able to help some of his peers due to the understanding he had gained from his experience.

The Day culminated with some meditation and breathing exercises which quite a number of attendees had been eager to practice. This represented to me the level of commitment within the room towards the ‘A Quiet Place’ ethos, in that each participant was enthusiastic in increasing their own level of self-awareness, and therefore in increasing the experiential grounding from which they could understand and better help other individuals.

I recall watching ‘Question Time’ once and hearing one teacher’s view on performance-related pay, expressing the fact that people don’t generally join the profession because of its lucrative nature. This really brought home to me what ‘A Quiet Place’ is all about and crystallised for me the real reason that most teachers join the teaching profession in the first instance. I would suggest that the main motivational factor that I sensed during the Training Day was actually that of bringing about positive change through unlocking the full potential of an individual. And this does not mean reducing potential to equate to a grade or something easily quantifiable, but rather viewing it holistically to include a sense of well-being that could remain after leaving the classroom.

Having compassion as motivation for work, rather than being concerned towards receiving the fruits of the labour, reminded me of a quote from Van Gogh, who once memorably observed that, ‘What is done in love, is done well.’

I wonder how many people could argue with that.

Thursday, 31 July 2014

Only Connect – How to Bridge the Gap?

Edwardian novelist EM Forster
Mike Wright gazes at a connected future

My last blog expressed concern that undue reliance on technology could threaten to dilute our experience of the ever-present moment – threatening the only connection with reality we have.

I suggested that dystopian visions of future societies ruled by computers may not be too far from the present state of things, in so far as we allow social media to dictate our actions and opinions.

But of course, technology is also an inseparable feature of our everyday lives – while in reality the dystopian vision can never be realised, as the future can never be experienced. But equally we might want to start recognising that a Utopian alternative, of living harmoniously with technology, is something that is not awaiting round the corner but is possible now… perhaps only ever now.

The words of Edwardian novelist EM Forster seem apt – that we ‘only connect’. And it is completely possible to envisage a society in which technology aids us without disengaging us from experience and reality.

After all, technology has been responsible for connecting and reconnecting people in all manner of ways, all over the world. The Internet is probably the most obvious example of this, while Alexander Graham Bell decided to invent a rudimentary Skype system all those years ago! Just as importantly, technology is – and can be – routinely used to help people become connected in a manner that improves the quality of everyday experience. For example, a small, but sophisticated, device worn on the ear can pick up, process, amplify and transmit sound. Hearing aids make a world of difference in terms of the experience of hard of hearing people keen to have a share in the knowledge of the ever-humming gossip of the world.

Technology likewise offers people with disabilities the means of accessing lifestyle choices and opportunities to make the most of their abilities, thereby serving to lessen any sense of alienation or isolation that could arise through impairment. Prosthetics have helped to restore mobility to individuals who have lost, or simply never had certain limbs – and I have even heard of technology which hopes to be capable of restoring vision to those who have inherited blindness, or age-related macular degeneration, through the development of ‘bionic’ eyes.

It would seem that our sense of independence and personal freedom to be able to do things for ourselves – something which is perhaps often taken for granted in the normal human experience – can often provide us with a feeling of worth and value, making it easier to feel ourselves as part of a whole, not merely an isolated fragment.

Based on the examples I have mentioned, I would suggest that the aim has not necessarily been to reshape the world through technological means but to reassert the status quo and pay particular attention to the importance of our natural human experience.

In my Utopian view of a society – that’s to say, one that makes use of technology as a means of ensuring collective happiness  – I would suggest that perhaps an answer lies in viewing technology not in its darker aspect but positively… as a means of providing us with the personal freedom and self-awareness to realise that essentially, we are all connected, Forster-style, so that we may ‘live in fragments no longer’ and hopefully find ourselves exalted through such a relationship with one another.

Monday, 21 July 2014

Serious Case Review (SCR)

Ruth Eley tells of her experience of preparing an overview report for an SCR

Surrey Safeguarding Adults Board report on Mr ‘D’ was the first time I had dipped my toe into the murky waters of Serious Case Reviews and it turned out to be a fascinating experience. Initially, there’s a period of waiting for other people to do their bit, then the information starts coming in and you have a dawning realisation that this is going to be just as complicated as you feared it might be when you agreed to the undertaking all those weeks ago. Although all Individual Management Review authors from each partner agency are expected to use the same template and work to the same terms of reference, the reports vary in depth, style and quality, so making sense of them can be daunting. In this case, the safeguarding team produced a master chronology from all the individual ones, which ran to over 90 pages, and it was fascinating to see the same incidents recorded by different agencies, e.g. a visit to A and E could be recorded by the ambulance service, various professionals in the patient record, social services emergency duty team and the police.

It was as I was putting together the ‘Key Events’ section of the report that I realised that I was the only person who had the whole story. Writing the report therefore became even more of a responsibility to make sure that I got the detail right, as well as drawing out the important themes from the analysis, coming to conclusions that were fair and based on the evidence before me and shaping recommendations that would be useful to the various agencies and to the safeguarding board itself.

Importantly I needed the confidence to seek further information or clarification to answer questions that arose as I was doing the work or to fill a gap in the story. There was broad agreement at the Safeguarding Panel about my conclusions and the discussions and negotiations about the final recommendations were considered, honest and constructive. All in all I was pleased with the final product and am hopeful that all agencies really will use it to improve practice and the ways in which they endeavour to work together on behalf of vulnerable people.

Tuesday, 1 July 2014

Mind the Gap – Is our use of Technology an aid to living or clever distraction?

Mike Wright looks toward our possible future: will it be a happy one or a ‘dystopian’ one?

I have my concerns about Technology. However, my concerns are not the kind that all centre around a dystopian vision in which computers have become sentient and made us all slaves, where memory foam remembers things we wish to forget or where self-service checkouts learn to expect the unexpected items in the baggage area.

Instead, my concerns are about how far today’s Technology, in the form of Social Media, may remove us to a realm of thought and away from a world of experience. Actually, it’s not really Technology itself I have concerns about but rather how we use it. A wise man once remarked that ‘one of the first conditions of happiness is that the link between man and nature shall not be broken’. My question is then whether, a gap (between man and nature) is being formed - and if so, what can we do to restore the bond?

My concern stems from the multiple situations where I have found myself playing ‘gooseberry’ to a friend and their Facebook page. Or where I find that a smile - as evidence that I like what they have said - is insufficient validation of a statement, when measured against a ‘thumbs up’ icon being clicked. Or again, when a memory of being present at an event (such as, perhaps, meeting for coffee) is deemed untrustworthy, unless supported with an evidential group ‘selfie’.

In response, I find myself asking whether we can ever truly live in the moment if we are constantly trying to capture and relive it. And as the present moment is the only thing we can ever truly experience, it seems infinitely important to me that we don’t lose our only connection with reality through interaction with a virtual representation of it.

So, the dystopian future in which we have become slaves to computers does not seem all that distant when I reflect on how much time we spend relying on them for the purpose of work, interaction and entertainment. Is our complicity in playing Candy Crush Saga for seven hours a day in fact a symptom of Stockholm Syndrome in the digital age? Is our nature as a Human Being, evolving into that of a Human Thinking?

Perhaps this has all been a bit too one-sided. After all, I am writing these very words using the fruits of Technology and they are to be published and read exclusively through the medium of the Internet. On a practical level, we can’t function without Technology. I suppose the key consideration is whether our use of Technology is an aid to living or acts as a distraction that keeps us from living.

And in this regard, happiness is always the method of measure. I can’t help feeling that less time spent interacting in cyber space would mean a restoration of the bond between ‘(wo)man and nature’ and a rediscovery of our own nature as truly living beings.

An increase in the amount of time we spend having real, shared experiences may also go some way in restoring the sense of community and the common bond that has apparently been lost as an exclusive quality that only ‘the good old days’ possessed. Who knows?

If at this point of reading you feel the desire to break the connection of thought, and instead wish to wander into the world of experience, I encourage you to log off and rekindle your relationship with reality for a while!

And remember - mind the gap!

Saturday, 21 June 2014

Carers are Individuals in the Act

Vic Citarella considers carers in the evaluation of Fulfilling Lives: supporting people with multiple needs projects

It is, perhaps, self-evident that people with complex needs frequently require correspondingly multiple and complex responses... wrote Henwood and Hudson in their 2009 CSCI study Keeping it personal. Now as Carers’ Week passes we have, in the Care Act, the strongest rights yet for carers. When put together with the duty of assessment for young carers, in the Children and Families Act, the legislative framework is suitably reflective of the very complexity identified for policy makers five years ago. It is a challenge for the Fulfilling Lives: supporting people with multiple needs evaluation to explore, understand and share how project investment resolves the problematic issues of real life complexity. Those involved in caring relationships shaped by homelessness, criminal behaviours, substance misuse and fragile mental health are potential benefiting contributors to making the most of that significant investment. The evaluation process has to identify both the benefits and contributions of carers to the success of Fulfilling Lives.

The Care Act refers to ‘individuals’ and so clearly covers both those with care needs and carers. It has a principle of well-being and includes duties to:

• Reduce carers’ needs for support (prevention)
• Provide information and advice (including financial advice)
• Assess carers on the appearance of need and that they may benefit from prevention, information or other support
• Apply eligibility criteria to carers’ services (yet to be defined in regulation)
• Provide services to meet carers’ assessed needs based on an entitlement
• Charge for carers’ support as applicable
• Prepare a support plan with the carer and help them choose how it is met
• Make sure there is no gap in services when people move home
• Promote diversity and quality in provision of carers’ services

There are also important new legal provisions regarding transition, delegated duties and safeguarding. The children’s legislation ensures that young carers have the same rights as adult carers based on the appearance of need.

The complexity kicks in when seeking to pinpoint who exactly is the person in need and who the carer is. Where the needs assessment applies and where the carers assessment? People, families, relationships, households and, indeed, communities characterised by multiple and complex need do not neatly fit into binary boxes. Such is the stuff of ‘gift’ relationships on which much of the system is founded. In fact relationships ebb and flow between cared for and carer, dependent and independent, care-giver and recipient, child and young carer – at one moment symbiotic and then parasitic, sometimes mutually beneficial and at others potentially harmful. That fluidity is equally a necessary feature of the evaluation process.

Whole System

Each Big Lottery, Fulfilling Lives project is measuring how well it is achieving its objectives. In so doing there is the overarching objective of providing tailored or bespoke support services that are personalised and unique to the needs of each individual. Those people will meet the given definition of complex need. The individual support will address all the issues faced from within the funded partnership. Because the legislation is about ‘individuals’ those people may or may not be in a caring relationship – the important thing is supporting them to tackle the complex need. Clearly a whole system approach to support is needed and equally to evaluation. That whether support is provided as a person in need or carer in need diminishes in the face of ensuring that the support system is built, maintained and becomes self sustaining – making change real.

The legislation allows for this in its founding principle of wellbeing, in its emphasis on prevention and its recognition of the individual with ‘an appearance’ of need whoever they are. Similarly the evaluation allows for this in giving even weight to input, activity, output and outcome. It uses case studies and formative approaches to learning as well as the more quantitative techniques – both are important. The research logic chain refers to individuals with multiple and complex needs rather than service users; just like with people being cared for and carers, it is not an either/or when it comes to the Fulfilling Lives evaluation. It is about capturing what works, identifying why and how so that others may learn and replicate success.

First published on the Fulfilling Lives blogging site

Monday, 16 June 2014

Mike Wright Guest Blog: ‘Happiness Runs’! Or, How I Keep Mentally Fit

Mike Wright shares some thoughts on maintaining personal well-being

Mike Wright

One way that I try to keep myself mentally fit is to keep physically fit. I don’t say that to suggest that you have to be physically fit to be happy: in fact, some of the most jovial personages are often represented as rich-living, portly, ruddy faced, bon vivant-type characters (I’m thinking Santa Claus, Buddha… and, of course, Brian Blessed!).
But - for me at least - a bit of physical exercise helps to get the endorphins flowing (whatever they are), plus gets me out the house and away from distractions for a little while. For me, running is a form of meditation. It helps me to shift the focus from my senses and thoughts and settle into a rhythm that allows me to direct my attention inwards. The result is I find myself aware and present, without forming any analytical judgements about my environment, the past, or the future. What is left: a sense of stillness and peace? I suspect this is what encouraged Forrest Gump in the famous 1990s movie to take up jogging and stop himself from dwelling over when he and his lady love would be ‘like peas and carrots again’.
Actually, if the words ‘I’m drunk’ are substituted for ‘I run’ (perhaps both a literal and figurative suggestion?), the following lyrics of Bob Dylan are quite fitting: Well, ask me why I’m drunk alla time/It levels my head and eases my mind. It seems that in fact most of us use some method of adjustment to reach a happy state.
However, I find it’s not really practical or possible to always be running - nor do I feel it to be positive to become addicted to practices that keep me from functioning and living in every day terms. So I have found other means of recalibrating myself towards happiness. I personally find that reading a poem, reciting certain song lyrics, or even just stopping and observing life happening, without interpreting it, can help. Like Tolstoy says, ‘In the name of God, stop a moment, cease your work, look around you’ – the old procrastinator!
Perrhaps try this: S.T.O.P....
There is an attitude expressed in Zen Buddhism I often remind myself of, as I feel it conveys a wholesome approach towards well-being. It upholds the practical wisdom that when we are hungry, we eat, when we are sleepy, we lay ourselves down - that our minds live harmoniously with necessary actions.
Obvious, right? Probably, but it isn’t always easy. I have experienced mornings when the alarm clock has seemingly beckoned an overwhelming task, as though I am Sisyphus, having to face rolling the proverbial boulder up a hill all Eternity, without knowing why.
But if instead of despairing, I perhaps invoke the gentle and simple spirit of Donovan’s lyrics and sing, Happiness runs in a circular motion. Thought is like a little boat upon the sea. Everybody is a part of everything anyway. You can have everything if you let yourself be’, well, then I find the day starts to unfold a little more easily.
Worth a try in your case? I think it may well be.

Monday, 2 June 2014

It’s Complicated – the Care Act and Multiple Needs

First published on Fulfilling Lives on May 28, 2014

The parliamentary ‘ping-pong’ is over, amendments agreed between the Lords and the Commons and the Care Act has Royal Assent. Everyone – local authorities, NHS bodies, public, voluntary and private organisations – are busy assessing the potential impact of the new law on what they do. How will it help/hinder; what are the gaps; what are the costs; what will we do now and what can wait; which clauses take priority; who is going to do what and how will we cope? The questions go on and the project and risk management training is put to the test. Projects will be making similar judgements themselves and the national evaluation team too will be considering how it might impact on our work on Fulfilling Lives; Supporting people with multiple needs.

Thinking positively, it is thus timely for a blog on the subject of the Care Act. If you are reading this then you are probably on the news and events section of our website dedicated to the national evaluation of Big Lottery Fund’s Fulfilling Lives; Supporting people with multiple needs. When you are done reading this, please do take a moment to look around the rest of the site and glean some more information about the anticipations of those involved.

It is certainly true that the Act, is a massive piece of legislation – both consolidating and creating law. For those of you seeking an understanding of the fledgling legislation see the government‘s explanatory notes. If you want to explore the extensive impact on those with multiple needs and their families then this and subsequent blogs will provide some thoughts and signposts that are intended to creatively provoke.

This is not simple stuff and the government has already published 19 factsheets and a glossary on the Act. It is not something that can be dealt with in a single blog. Even honing in on the Fulfilling Lives; Supporting people with multiple needs initiative doesn’t make things more straightforward. There are not many parts of the Act without significance to the initiative. To get an idea of the scale of effort involved have a look at the recent Adfam policy briefing. This, one of many that comes from an internet search, has the particular value of recognising that it is not just the Care Act but the Children and Families Act as well that requires attention.

So it’s complicated. But this blogger has a plan to trigger thinking about the Care Act. That plan has two elements which will feature in each blog:

• First, to share and comment on the approach of local authorities and other public bodies
•Second, to support learning and evaluation around the Big Lottery Fund’s Fulfilling Lives; Supporting people with multiple needs initiative

The blog plan will prioritise what is new in law and practice, alongside those aspects of the Act that are new in law but not in policy. Here we will focus particularly on considering how the Act might affect the national evaluation. The top half-dozen items of interest are:

1. Carer’s Assessments – clause 10
2. Eligibility – clause 13
3. Cap on care costs – clauses 15 and 16
4. Independent Personal Budget – clause 28
5. Care Account – clause 29
6. Advocacy – clauses 68 and 69

As an illustration, for one local authority, these are all in a project plan that contains 45 such high level items of which the risk RAG rating has 13 in the red – or lots of work to do and not yet ready – category. Their agenda seems like a worthy blogging schedule with the next being about Carers and Multiple Needs – what does the Care Act offer?

Wednesday, 28 May 2014

Review: The Practical Well-being Programme: Activities and Exercises by Penny Moon

Mike Wright reviews this important book for CPEA Ltd – social care, children’s services and management associates

For Penny Moon, ‘The Practical Well-being Programme’ is a book that ‘introduces readers to the underlying principles and approaches associated with a holistic approach to well-being in educational and other social contexts’. To do so, Moon draws on the principles of ‘A Quiet Place’ – a ‘within schools’ programme of therapeutic support for pupils experiencing social, behavioural and/or emotional difficulties,’ applying them with the wider scope of tackling the issue of stress management, plus making them serve as a roadmap of approaches that encourage a greater sense of self-awareness and well-being.

The ‘A Quiet Place’ ethos was originally put into practice through the provision of an actual physical room where the environment was not only aesthetically designed to engender feelings of calm and well-being, but was also a place in which the environment was one of creative self-exploration for the individual as a means of accessing the ‘personal resources necessary for increased self-awareness and self-healing’.

The aim of this book, then, is to distil the essence of ‘A Quiet Place’ so that it may be applied broadly for those seeking to understand how to manage stress more effectively – whether as a means of support for ourselves or for others. In this sense, Moon’s work remains true to its aim through the use of clear language –and an insistence on experiential learning through the use of a variety of tools and resources (e.g. diagrams, activities, guided visualisations, YouTube links, etc.) made accessible to all ages, rather than resorting to a complex and esoteric theoretical approach to stress management that, could threaten to isolate her work’s applicability to a more limited field. Her move also ensures that the book remains versatile both in terms of how it may be used and also in terms of who may wish to use it, ranging from teachers, parents, employers, social workers, but also to individuals dealing with their own specific circumstances and issues regarding the management of stress.

The holistic approach adopted by the book also means that there is no direct a priori position taken on what constitutes the self: instead Moon deploys a model which encourages an exploration of how we interact with our environment in terms of emotion, mind, body and spirit. This approach allows for a free and unconditioned interpretation of the information in the book, and plus it provides for the creative space necessary for the development of self-awareness and self-healing. However despite each chapter being divided into two parts – that of information and background, followed by activities and exercises – it could be said that the book is lacking, or at least is vague, in structure. That’s a point acknowledged and intended by the writer, however; although this could at first be considered a weakness, when the aim and ethos of the work is brought back into perspective, it becomes apparent that this is actually the book’s main strength. That’s because a vague, ambiguous structure puts the emphasis on making the reader the source of their own development and understanding – and in providing them the freedom to creatively explore the material, rather than have it explained in a manner that may not reflect their experience. ‘The whole world says that my way is vast and resembles nothing. It is because it is vast that it resembles nothing. If it resembled anything, it would long before now, have become small.’ – Lao Tzu.

The book recognises that stress is something which is experienced as a result of the individual’s perception of their environment and situation, rather than being effected by a specific external cause. If the opposite were the case, stress management would be a far less complex issue, of course, as we would be able to locate the common cause and merely remove it from our environment. Therefore the book’s approach, which appears to be shapeless on its surface, reveals itself to be both a practical and considered approach in addressing a complex issue affecting so many in terms of their ability to function in society, and more fundamentally in terms of the effect on their general health and well-being.

This is an especially refreshing approach when considered in relation to today’s modern, fast-paced society, which seems to breed an attitude of intolerance towards delay and dysfunction. The approach adopted by Moon thus addresses the issue of stress without stigmatising those that experience it through imposing labels, or making stress a medical matter. The book also avoids placing any undue emphasis on stress being a social problem, rather than an issue deserving attention due to the mere fact of it impacting on the individual’s well-being. This attitude towards stress management, in terms of a reluctance to attach any judgement or stigma to the issue, therefore facilitates a climate of empathy and acceptance that promotes and supports the understanding necessary for both individual and social awareness and change.

In summary, ‘The Practical Well-being Programme: Activities and Exercises’ serves not only to ‘introduce readers to the underlying principles and approaches associated with a holistic approach to well-being in educational and other social contexts,’ but also provides an accessible and pragmatic source of therapeutic support for personal development towards an increased level of self-awareness and self-healing. The book’s experiential and holistic approach, contained within a ‘light and breathing’ structure, also ensures that it is widely applicable to all ages and circumstances – making it an extremely versatile and useful tool for teachers, parents, social workers and individuals wishing to better understand and manage stress in order to achieve a greater sense of wellbeing.

Sunday, 4 May 2014

The Social Care Graph of Boon

Vic Citarella plots the longevity dividend

Two new words entered my lexicon today. Firstly the word "methuselarity" which was coined by Aubrey de Grey to mean a future point in time when all of the medical conditions that cause human death would be eliminated and death would occur only by accident or homicide. Secondly “singularity”, as a hypothetical moment in time when artificial intelligence will have progressed to the point of a greater-than-human intelligence, radically changing civilization, and perhaps human nature.

Aubrey de Grey
As Wikipedia kindly advises me the concepts behind these words are difficult to grasp, unfathomable and take us into unpredictable territory. What I have gleaned is that these moments in time, these future points and watersheds are not far away. According to experts as soon as 10 years away and certainly before I reach 100.

It seems therefore important that we elders turn our remaining energies and limited brain power to two things: preserving our bodies for the glorious day when computers take over and ensuring their processing power is caring power. Rather than the Barnet Graph of Doom – a three minute video – that shows how all spending in that council will be consumed by adult social care and children’s services in the same timeframe as the aforementioned phenomena, rather we should devise A Graph of Boon.

I am exhausted just thinking about all this but will return to it. There is a bonanza coming up and I want to be there. Now if I can just map the exponential growth of healthy older people on one axis and the processing power of computers on the other. With some good fortune I might be able to share in the bonus of a new and vibrant gerontocracy.