The Ghost in the ATM

A few years ago, when I was a Team Manager, I chaired a meeting about a man who the Local Authority had recently placed in a care home. During the meeting I noticed that the man’s mother Sheila was becoming increasingly frustrated by the meeting, in particular she became fidgety as the Social Worker insisted that he go carefully and line by line through (what was then) Community Care Assessment. The Social Worker patiently explained to Sheila that he had to make sure he had captured all the information appropriately and accurately and so that everyone’s views were incorporated. Sheila stopped the meeting and said ‘Can I tell you something? I work for a bank and I’ve studied commerce. You know mini banks? Cash machines? When you put your card in and you want to withdraw cash, what happens? Take me through that process’ Uncomfortable silence ensued. No-one spoke, everyone looked down not wanting to make eye contact with either me or her. After a few moments of awkward silence, she continued ‘Ok. I’ll tell you. You type your PIN in and then you issue your instructions to the machine. It asks you if you want information about your balance, receipt and then finally you get cash options. You choose what amount of cash you want. But the crucial thing is that the machine doesn’t give you cash straight away. First it gives you back your card and then and only then it gives you your cash. That’s deliberate. Does anyone know why?‘ Again, nothing from the stunned MDT. ‘It’s because you’ll forget your bank card once you see the money because that’s what you came for. You will take the money from the machine and turn and walk away and you’ve forgotten about the process because it’s not important. The card will then come out of the machine and the machine will bleep loudly to remind you to take it. If it didn’t you would be down the road counting your money and planning on what you’re going to do with it. We have research in commerce that evidences that this happens on 90% of transactions we’ve tested it. The product is always the thing, not the process. You’re assessment is a process but it doesn’t mean a thing to my son or me. We want action‘.

Sheila went on to explain that the ‘action’ for her son was the care and support, that was the outcome. The process (the assessment), as she saw it, was for us not her and absolutely not something for her son. This observation had quite a profound effect on me. I reflected on earlier that week I had been to see my GP. Although I recalled answering the GPs questions and listening to the GPs observations about what I told her, it was her diagnosis and her intervention that really mattered to me. That’s what I was there for. That was the action. Whether I was there for the prescription, or the referral on or the sick note or the something else, I was there for outcome and not really that interested in the process about how she got there. The GPs assessment was just that – the GPs. I didn’t need her for an analysis of my life to date and the environment I lived in. I was the expert of my life and my circumstances, I’d lived it! I just needed her to make the next step happen to help me stay healthy.

By this point in my career I had been schooled in assessment and genuinely believed in their merit. Even in my first qualified social work post I had the job title Social Care Assessor. I had showed off to colleagues at the hospital team that as Social Care Assessor covering older people’s mental health wards. In a typical week, I brought 6 cases to funding panel for placements in care homes. I worked hard on producing the assessments. I learned to write lots. They were huge. They covered everything. I wanted to show just how person centred I was so in every assessment I included a pen picture of the person making clear how much research I had done on to understand their younger days, their likes, their culture. The assessments were approved at panel. The CCG had copies. Prospective care homes received copies. And eventually when the person went to the Care home the assessment accompanied the person. As a Social Care Assessor, I would then see the person again in six weeks to see if they had ‘settled in’, which is essentially Social Care code for ‘have they given in and accepted the Care home and all it entails’….

But faced with Sheila I found my faith in my assessment wobble. I went home that night and couldn’t sleep, my mind churning with questions:

• Who cares about the consequences of the product when we’ve got the process to do?
• Were the assessments I undertook as a Social Care Assessor ever read again?
• Did anyone other than me read the carefully researched person centred pen picture?
• In processing the person through a conveyor belt of assessments was I really being person centred?
• Did any of my assessments lead to anyone being better off?

I didn’t sleep well for weeks after meeting Sheila.

My assessments were produced after a huge amount of input, but in reality they consistently resulted in a very simple to arrange outcome – the Care home says yes, they’ll take him, send them the Care plan we can settle him in ready for the evening meal round. Ultimately the success of the product was invariably what the care provider made of made of the person I had processed towards their final resting place. The long term happiness of the person entirely dependent on the quality of the individual provider, my assessment recording a point in time which faded into the past as it was superseded by a plethora of new documents to process – support plans, med charts, meal charts, visitor logs.

I genuinely cannot recall a single 40 odd page assessment that ever genuinely informed my view on things like eligibility, need and what the right support would be. The skill of the social worker is in recognising the value of a cuppa and a chat, a frown or a joke, the mention of a relationship, a loving glance between family members. Social Workers shine for me when they celebrate that they are experts in human interaction.

So, let’s embrace our humanity and the humanity of the people we serve such as Sheila and her son. Sheila and her son were the experts of their lives. We are there to understand environmental and sociological issues and place those in a context of their human rights. That’s our role. Let’s stop wasting time spending days in the office typing up pages and pages of assessment forms and case notes which no one will read. We are the PIN number, the bleep in the machine, the questions about balance on screen and whether receipts are wanted. We are the action, not the assessment.