The demise of Vocation

“I’m afraid we’ve been dropped in it by health this weekend as they have reneged on the promise to provide carers. They had said someone would come at 10 AM on Friday and that there was also cover on Saturday. What actually happened was (name) turned up with a carer at about 3:30 PM, stayed for a few minutes, went and got the prescriptions [which was helpful] and came back for about one hour. Our son was a little escalated because he wanted to show them something on the computer that he couldn’t. They appear to have been spooked by that and at 7:11 PM yesterday evening, we were told by email that a decision had been made not to provide any cover this weekend.”

Here’s a very concise backstory. LivesthroughFriends has been assisting this family (pro bono) for nearly 2 years. They contacted us concerned that when their autistic son came to leave a specialist college (where he was struggling) he would be forced into a ‘sausage machine’ of a placement system wherein successive placement failures would inevitably lead to life in a ‘secure’ setting. They wanted their local statutory commissioners to engage us to plan and independently commission a robust and life enhancing bespoke support package. It was late in the day but a compromise was reached. The family could choose from a list of approved providers and LivesthroughFriends would develop the existing plan and train and provide ongoing support to the provider. Just weeks before proposed transition, the provider pulled out. Because, in an approach guaranteed to elicit challenging incidents, the college had forwarded ‘PBS’ plans that indicated that 4 to 6 people were needed (for restraint!). The provider labelled the lad as ‘too challenging for us’.

As a consequence the college placement was extended, the young man became gradually more ‘challenging’; childhood ended and responsibility shifted to Health; the family continued to campaign for a bespoke solution; Health refused, prevaricated and eventually started to listen to their own advisors; and then the college served immediate notice and the young man found himself detained under section in an ATU. The RC soon agreed that this was untenable, his parents took him home (with no support), and the Section was lifted. We had indicated that we had already introduced a very principled and creatively competent support provider to the county in similar circumstances and that we were confident that they could recruit a robust support team quite quickly. They indeed volunteered to supervise domiciliary support while recruiting (and while a suitable property is being sourced). At last, with nowhere else to turn, we are commissioned to plan and implement bespoke arrangements – in a month to six weeks – with the system primarily concerned to have a back-covering risk assessment in days. The immediate and dire needs of his parents seem to have far less import. There was however scope for some NHS staff to be available…? As a consequence of Friday’s emailed decision and the consequent impact on a distraught family, our team, the provider’s leadership and our clinical advisors connected over the weekend to attempt to organise support. To the best of my knowledge that statutory world was absent.

So let’s compare and contrast…

It’s around 1980. I’m a Team Leader in a Midland’s city, organising fieldwork, residential, domiciliary and day services. It’s a Friday. Following serious incidents, it had been necessary to ‘rescue’ two teenage brothers from what turned out to be a very abusive out-of-county placement. Both brothers had severe learning disabilities and extremely challenging reputations nourished by, as it emerged, lifetimes of neglect and abuse. There’s no obvious immediate solution. We need time to assess and plan; and the weekend is upon us.

We have a presently unused ‘Warden’s Flat’ above what used to be a Children’s Home and is now a Respite Care Centre. It’s available and easy to equip and make serviceable. I make some calls to colleagues in the various services I lead and associates in Health and our voluntary partners; to folk who don’t usually work at weekends. It doesn’t take a couple of hours to assemble a healthy roster for the weekend and offers relating to activity/recreational opportunities seem to arise unbidden.

I think I worked the whole weekend until my deputy sent me home on the Monday. I remember it as an exhausting but exhilarating time, getting to know and understand the lads, with optimistic, skilled and resourceful colleagues who seemed to enjoy the team work and each other. There was a definite sense of achievement and mutuality. I don’t think pay was raised. Folk were granted time in lieu, but this wasn’t a time when professionals clock-watched and home visits frequently followed a full day’s work. We were professionals and we trusted each other to pull our weight!

It’s August 2020. We’ve had another heatwave. This time temperatures peaked 40 degrees Celsius for the first time since records have been kept. Concurrently, a combination of Brexit, Covid, and Russian imperialism – in addition to a more generalised mounting crisis in our adolescent economic system – has given rise to such levels of poverty and inequality that the defenders of the indefensible are overtly warring over how they can sustain their hegemonic mythology. You know; the one where the perpetrator sustains the uncritical sympathy of the victim – a bit like Stockholm Syndrome. It seems that the last thing that the political class has on its mind is the state of our society and, in particular, any interest in how we care for and ‘look out’ for each other – and the role that the State should play in enabling the relational and associational processes that have been, if anything, the key to the ‘success’ of homo sapiens.

The naivety and ignorance that surrounds the ‘social care’ debate is, from an engaged practitioners’ perspective, frankly astounding.

How can it be that how we care for each other at vulnerable points in our lives can be reduced to a matter of monetised transactions? And how can it similarly be that we allowed our ‘caring professionals’ to be converted into the sales executives and internal auditors to facilitate and police something so wrong-headed?

It’s now OK for our public servants – having undertaken to provide support to a struggling and heroic family at a weekend – to withdraw that offer by email at 7.11pm on a Friday evening. Professionalism and Vocation were once inseparable bedfellows, as were status and personal responsibility. They could and should be again.

Bob Rhodes