The referral was pretty bog standard these days. The neighbours didn’t get Elsie’s permission for any of her details to be referred to Social Services. In truth it had never crossed their minds they’d be asked for this. When pushed by the call centre about the issue of consent they said that they didn’t think they needed her consent and that this was a matter that ‘the Council must take seriously for everyone’s sake’. And then behind the thinly veiled threat to act the neighbour stumbled upon four little words. Magic words. Words that suddenly change the meaning of everything and words that seemingly come with their own legislation, procedures, judges and juries. ‘It’s a safeguarding issue’. And boom, there it is. Elsie, aged 87, never known to the Council, never having failed to pay for council services or any other tax that propped up with welfare state that she didn’t really partake in, was known. Consent overridden. Case opened. Within moments Elsie had an electronic file. Elsie had a Reference Number. And Elsie would receive an automated letter thanking her for contacting the Council and she would receive a call within the next seven days. All done within five short minutes from the start of the phone conversation. Within ten minutes Elsie was on waiting list of other Reference numbers waiting to be allocated to a Social Worker and sat on the computer screen of the Manager. Whether Elsie used services or not, from that moment on to the day of her death, nothing was clearer – Elsie was a Service User and there was a record to prove it. There was, as far as everyone was concerned, someone to safeguard.
The social workers went in twos to the address. No-one was quite sure why. The referral mentioned that Elsie had got cats but there wasn’t any belief that the cats were dangerous. Perhaps the second social worker was there because social workers love cats. The referral said the house was ‘dirty’, ‘things everywhere’, ‘cluttered’, ‘soiled pads in the garden’ and Elsie, although not seen for some weeks, was wholeheartedly felt by the neighbours to be dirty herself. ‘She’s self neglecting’.
Having knocked at the door and getting no response the social workers pushed slightly at it and the door opened. A cat ran out and then back in again. No sign of Elsie in the hallway. The social workers called her name, walking gingerly through the hallway, past a sideboard with some framed pictures of a moustachioed man with the ‘Geraldo, King of Swing’ emblazoned on them. Calling out her name and holding out their ID badges the social workers continued inward.
Elsie was in the kitchen. She smiled when she saw the social workers and beckoned them in still further. The social workers introduced themselves and whilst doing so Elsie kept on smiling before raising her hand as if to stop the second social worker saying their name. Elsie bent forward and placed her right ear up against what looked like a radiogram from footage used to show listening to the broadcasts of Prime Minster Churchill telling them they wouldn’t surrender. Almost trance like Elsie’s smile remained fixed as she listened to the radio. Elsie probably listened to the radio for a full three minutes, to the social workers, observing the cats, the newspapers (one from May 1991 with a picture of Paul Gascoigne on) and moving their feet on the sticky floor tiles, the three minutes felt like a lifetime.
When Elsie moved away from the radio she asked the social workers ‘who are you again, love?’. The social workers explained who they were and said that they were there to see if ‘she was alright, you know, see how things are’. Elsie said she was fine and asked if the neighbour had asked for them to visit. ‘She’s lovely, like that. Looks out for me’. Elsie explained that she had lived in the house all her life. Her parents, who she said ‘died recently, in 1971 and 1975’ had left the house to her. The social workers listened. They wanted to be respectful, they had questions of course (and they had lots of boxes to tick) and had already decided that things ‘weren’t right’ but they listened nevertheless. Half way through talking Elsie’s eyes suddenly lit up. ‘John!’ she said. Within moments Elsie was back to the other side of the kitchen, head propped up against the radio, same expression on her face, which now to the social workers seemed almost rapturous. This time a longer a wait. Five minutes. Elsie broke her concentration just once, to beckon the social workers to sit down. Neither did. Elsie didn’t notice or care.
Elsie said that John worked for the radio. He was in his late forties and his job was a ‘broadcaster’ and that each day John ‘either announced the news or introduced big bands… sometimes both’. Elsie said that John was based in London and he still lived there. She said John sometimes slept in the radio station and sometimes broadcast during the night, but not usually. The social workers continued to listen but really wanted to talk about the cats and Elsie’s ‘daily routine and keeping clean’. More in an effort to wrap the conversation up about John and move on to the matters at hand, the self neglect, one of the social workers asked a question. ‘John sounds lovely. Is he someone you have actually met and know’? And with that the tone of the conversation changed. Elsie explained that John had spoken to her on the radio for over 60 years. He was her man friend and he was engaged to marry her. Her betrothed. John had promised Elsie that one day he would drive up from London in a white Bentley car and marry her. Their plan was to live in London and take Elsie away from all this, including the cats. Elsie said the social workers could have the cats if they wanted them.
On walking to the door with the social workers Elsie thanked them for coming but they had to go now as John liked to ‘talk to her alone’. Elsie smiled as she shut the door behind them. The last thing the social workers heard Elsie say as the door closed was that John was her man and ‘was not for sharing, goodbye’.
The social workers weren’t inexperienced. One had just become an Approved Mental Health Professional and the other had worked with older people for years. But as they walked to their cars and drove back to the office the silence between them spoke more than any words of completed boxes on the safeguarding form. ‘What was all that about?’
Safeguarding referrals can be complex. The social workers knew that. They also knew that to ‘help’ Elsie they had to get to know her, build up trust etc. So the visits continued throughout the next week. On each occasion Elsie spoke to the social workers but continued to ignore any questions about her health, her wellbeing, her cats and the state of her house. Most questions were met with ‘I know love. John’ll see to it’. All conversations were interspersed with long periods of Elsie listening to the radio and smiling with occasional, knowing nods and some ‘ah’s’ aimed at the social workers as if ‘John’ was further confirming plans that would need to be relayed to the social workers. For the most part the social workers just heard the hiss of the untuned radio. For them there was no voice, no programme and without doubt there was no John. However what bothered the social workers more than this was that there was no progress. No getting Elsie to see what state she was in. No getting Elsie to consent to sorting the house. No getting Elsie to realise the safeguarding issue. The self neglect. The abuse.
Safeguarding doesn’t allow for stalemate or for someone to continue to be abused. It identifies the abuse and through a list of ‘outcomes’ it makes the social workers do something. For the social workers things needed fixing for Elsie. She had a choice. Either Elsie worked with them to ‘improve the situation’ or they would ‘Refer to other agencies’. The case notes were clear. Elsie wouldn’t engage. She lacked capacity to make the decision. It was all in her best interests. The risks were unmanageable. The hoarding was a fire risk. The cats were underfed and the RSPCA would be cross. She needed safeguarding. If only she could see it! She was a problem. The problem needed fixing.
The social workers didn’t seek Elsie’s consent to refer to other agencies. In Elsie’s case the ‘other agencies’ was the Mental Health Team. Elsie was visited by a Community Psychiatric Nurse, who within hours visited again but this time with the Psychiatrist. The social workers received a call ‘How has this gone on so long? and ‘she’s in a terrible way, totally delusional, paranoid ideation’ and is ‘refusing all treatment because of this bloody John thing’. The next call was to the AMHP. Pink papers in the bag, the Mental Health Act Assessment was to take place that evening.
The Ambulance couldn’t stay and eventually the police were called. 87 year old Elsie was escorted out of her property by two young police officers. One of the police officers had to switch the radio off during ‘the incident’ in the house. He at least had the foresight to give the radio to Elsie and reassured her that she ‘could hold it’ in the back of the car. It was the only bit of humanity Elsie ever witnessed either that evening or throughout her entire dealings with the ‘support’ agencies. Section 2 completed. Safeguarding outcome achieved. No more self neglect. Someone had been safeguarded.
The first thing Elsie did on the ward was to find a plug for the radio. John was there. Reassuring her and helping her to stop crying. And that’s how things stayed for a number of weeks. The medication was taken, Elsie complied. The nurses moved on to the next person, Elsie listened to John. There was no more worry about Elsie from the neighbours, the problem had been fixed. No more self neglect, no more self to neglect. Elsie’s care plan said ‘needs all cares’. And that’s what she had. All cares attended to and a continued love affair with John.
The discharge planning never once considered home. Home was where the ‘multi-disciplinary team’ had felt that the bad thing happened. Home was where the cats had had to be removed and where the social workers had found Elsie’s love letters to John, which had ensured merriment on the ward due to the details that she went into about her feelings for him. The self-neglect would re-start at home and why risk things? Elsie was happy enough. Everything was fixed, apart from the John thing.
The Care Home never fully read the care plan about Elsie and the new social worker had not really written much up about John and what had happened at home. The radio didn’t go with Elsie to the Care Home. Elsie noticed this on her first day at the home. However instead of asking for the radio Elsie screamed for 8 hours. In the end she was given medication. The Care Home didn’t call the hospital or speak to the psychiatrist about how distressed Elsie was. They made one phone call that day, which was to the social worker requesting more funding ‘due to the screaming’ and the impact this was having on other patients and staff.
Over the next 3 months Elsie moved into two different care homes and was returned to hospital following a fall. The radio was never switched back on.
Elsie died in a care home. It was four months, five days and 6 hours after the phone call from the neighbour.
Lord Justice Munby stated ‘what is the point in making someone safe if it merely makes them miserable’. In ensuring Elsie was miserable, we were unfit to even ensure her safety. John did exist for Elsie and we never saw that. John was the risk management plan. John stopped Elsie self neglecting, not the other way around. Elsie was the expert in her own situation and had an 87 year start on the rest of us who tried to study her and fix her within weeks. John was her flickering light of hope which we extinguished in the name of safeguarding people from themselves. I hope she saw John again somehow.
12 replies on “Someone to Safeguard”
Very good post, a poignant and accurate description of what can and does happen. Thank you. It’s all about consent and privacy.
A person’s Article 8 HRA right to privacy (and family life) can be described as their right not to have someone like me sat on their settee asking them how they manage getting to the toilet.
A risk assessment can be described as; What is the bad thing that might happen?
How likely is that bad thing to happen? If that bad thing does happen, how bad is it likely to be?
And the risk management plan needs even more consideration. If the person cannot consent because of mental impairment, then it is possible that the local authority can infringe upon their Article 8 right – but that still must be proportionate to the degree of harm that would otherwise be caused.
It continues beyond the initial bit of intervention, it doesn’t end with a placement agreement and a review. We have a positive obligation to continue to do more, to assess the risk of harm that has come to the person as a result of our intervention and work to reducing that. Just because the person is not complaining doesn’t mean they are happy.
Sometimes a person is removed from their own home, where the person has a lifetime of memories; for example, the memories a woman has of her late husband and all the time they had together, the newspaper from the day their first child was born… that Christmas in 1963 when it snowed and that pine cone on the mantelpiece that was the snowman’s nose… that old clock which was a wedding present – it doesn’t work now, the spring is busted from over-winding but it is a treasured possession still…. Many of those memories and mementos are what some people who know little about the person might call clutter and evidence of hoarding.
And so people are moved into a care homes where, without any sense of irony, somebody once a week tries to help their dementia by having them join a reminiscence group!
Any meaningful person-centred care plan must involve the person and the people who know the person best, advising of what the person did before, what their hobbies and interests and likes were, and not a one size fits all activity; catching a ball or listening to a Glenn Miller CD.
This is not an argument against care homes, some people have needs which on balance, really can only be met in such an environment even if it means they are unhappy. It is an argument for truly person centred social work. Risks must be balanced and that includes the risk of making the person unhappy. And if we are making the person unhappy then we must strive to minimise that. And in all probability, will need to seek authorisation from the Court of Protection anyway; if the social worker has not considered less restrictive alternatives, the Official Solicitor most certainly will.
One way social workers can do this before the person is moved and before the matter ends up before the court, is through supervision, reflecting on their intervention and asking “What is the impact on that person as a result of my work? Are they better off now than they were before? What else can we do? What can we do to make this person happy?”
LikeLiked by 3 people
[…] https://lastquangoinhalifax.wordpress.com/2016/09/24/someone-to-safeguard/ […]
Not excusing this at all, but I can’t help but feel that if social workers had more time to reflect, more time for helpful conversations, less external pressure from targets, things like this would happen less often. But that would require more money, wouldn’t it.
Reblogged this on Declaration Of Opinion .
LikeLiked by 1 person
Reblogged this on disabledsingleparent.
Hi Rob -brilliant and heartbreaking. I’ve reblogged at alexfoxblog.wordpress.com
LikeLiked by 1 person
[…] I’ve never read the wonderfully titled Last Quango in Halifax blog before by Rob Mitchell (@RobMitch92) but I will be from now on. The story of ‘Elsie’ is the most telling (and saddest) illustration I’ve read of what we get so wrong in our highly selective view of which risks matter and what we should do about them. Thanks Rob. https://lastquangoinhalifax.wordpress.com/2016/09/24/someone-to-safeguard/ […]
LikeLiked by 1 person
Very helpful, looking ahead to coming back. http://bit.ly/2f0xJ92
Reblogged this on Adult Principal Social Worker Network and commented:
Thanks for posting this story. Gives me an appreciation of the challenges facing adult social care workers. Similar to child protection social workers- making these judgements is far from easy- can be a damned if you do damned if you don’t. However I agree with other posters that workers need time to reflect and to feel safe and supported in making judgements.
When I worked for a homecare agency as a care co-ordinator I used to get a daily call from this incredibly friendly and happy lady. She would tell me how she’d put her slippers on, was drinking a cuppa and looking at the flowers on the magnolia tree outside her window. How she fed the hedgehogs. It was a welcome respite from the endless stream of angry calls about missed visits, or too few visits, too rushed visits, too early or too late.
One day the carers were talking about a woman who was ‘a hoarder. They wouldn’t let her take the bin bags filled with rubbish out. The house was covered in cat faeces and they had to wear plastic liners over their feet and would gag at the smell. She was leaving food out for the rats in the kitchen. I remember this was the first time anyone talked about a mysterious ‘Court of Protection’.
It was only much later I realised the two women were the same person, because when she called me it was just for a chat, she didn’t want anything, and the nickname she used was different to the name everyone else used which the social workers had given us.
I don’t know where she ended up, but I hope they let her feed hedgehogs and call her by her preferred name. And I hope the trauma of the move didn’t shatter the mental world she’d created for herself.
She always made me think of that Milton quote – “The mind is its own place, and in itself can make a heaven of hell, a hell of heaven”
Someone to Safeguard has been really significant to my PhD which explored how people are safeguarded when they lack capacity as a result to dementia. I’m writing up now, and would like to incorporate it into the thesis in a particularly way. I won’t do this without your consent, so I wondered if I we could chat over email so could explain and see if its ok? My email is in the box.
Thanks very much