| GENERAL NOTES ON THE GENERATION OF PARANOIA & 'CONSPIRACY THEORY': There are such things as Conspiracy Theories, that is why they have been given this name. If you can give it a name then it exists, if only in the minds of those that share it by that name. The point is; Is there any substance to them individually? :-) Mostly the arrangement that are described as such; are actually 'cock ups' we continue to experience in health and social care and are due to institutionalised, collective ignorance rather than conscious design. These are the consequence of blaming others, without reflecting upon their own inadequate practices. Conspiracies? There are probably a few loose ones, but mostly it is collective cock-ups and institutionalised, 'non-thinking', automated reactions, along well established, self congratulating and self-interested, protectionist lines. I hope I am not being too hash on us all. We are, after all human and tend to trust, unless that trust is thoroughly undermined by events and experience. Lets face it! It has been. Other important 'points' Relevant to this subject (in the end) - Take a deep Breath: This does goes on a bit and there is a lots in here. I have tried to make it a little more entertaining than the bare evidence, but please don't assume flippancy. I hope this succeeds. There are those that will say it could have all been said more briefly and to the point. Don't worry those who can only handle bullet points and sound bites, these will come, after the detailed evidence. Incidentally, I have tried this 'bullet point' approach. It didn't work, so it was bad advice. I won't be taking that advice again :-). Bullet Points can easily be 'shot down'. It is 'evidence' in fine detail and logical associations to support a sound argument, which win the day, in legal terms. What I have reproduced here, for your interim entertainment, (and that of the general reader) are summaries of the 'evidence' and 'logic' (and sometime people's illogicality's) that I will use to support the all important Bullet Points you could wish for. I too like summaries, unfortunately they can be easily dismissed as 'opinions' and I can not afford to have too many opinions, or have my points 'summarily' dismissed, if you will excuse the pun. In 'legitimate' business activity, it is necessary to substantiate, or support the 'Bullet Points'. They are, after all, summaries of more extensive material that has been made available. The fact that the Tabloid Press can use them without evidence is not an adequate excuse for suggesting, or requiring those of us putting forward complex ideas, or rather, 'alternative perspectives' to do so! This whole 'Sound bite' culture & approach to life is divisive and produces many of the problems that Institutions experience. It is lazy and 'hides' important context & perspective. The idea here, on this website, is to collect the evidenced (over years, through operational research), record it competently, translate it into something that is half readable and acts as pointer to your 'own' evidence, obtained through your experiences. The task is then to get 'feedback' and further evidence and produce summary, interim conclusions, that focus us on 'substantiated' bullet points and 'sound bites' that adequately impress Professionals, Service Users, Family Carers, the Media, the Internet Browser and the like. Here we go; On a journey of 'Collective Experience':When Institutions in general, and some individual Professional Practitioners; refuse, or neglect, to give honest, down to earth, 'person centred' explanations for the inadequate, or inappropriate availability, or complete absence of a service; it has a tendency to make people a little angry & paranoid. ie: When there is no service transparency but a 'felt' urgent need for professional help - this generates fear and confused ignorance - fear and ignorance, unresolved, creates further anger & paranoia - and, in turn, 'Conspiracy Theory'. These explanations of the availability, or non-availability, of services should be 'up front' and in plain English. The very evident shortfall (whatever their cause) must be expressed in terms that they can reasonably understand and accept as an adequate explanation for the shortfall. Where the requirement is for a service intervention 'for someone else', and the request is inappropriate for the person, because of their human rights and entitlement to privacy, this again, should be fully explained, preferable 'before' the event, or it sounds like and excuse. As with the recent cases of identified and acknowledged 'institutional prejudice' (in the police force); there is institutional prejudice in all institutions. Where client / patient groups are relatively powerless, they are particularly susceptible to this prejudice. It is rarely deliberate and often takes the form of condescension. This style of approach is historical and comes from the 'charitable' roots of health and social care. This approach was understandable at the time but is quite inappropriate in current circumstances. The current generations have grown up with the reasonable expectation that they will get the help they need, when it is needed. There is also a reasonable expectation that they can expect early intervention, in order to avoid situations going into crisis. For reasons that are discussed else where, our services have become 'crisis' services. We do not intervene until there are risks apparent and current. People doing the referring see the imminent nature of the problem and attempt to get an early assessment. Sometimes it is not clear who to approach. Each service has its own 'criteria' for consideration of a referral, these are open to interpretation and vary from one service to another, one team to another. It is little surprise that Service Users and their Carers become confused and frustrated. It even confounds some Professionals, including those working within the guilty service. It may seem very tidy to the administrators of a service but it is gobbledygook to the Service User and Care, especially at times of 'their' crisis. Terms and services like 'Single Point of Access' and 'Triage', are all well and good. If they genuinely inform and direct people to the appropriate service, and enable the smooth transitions between services, they have done a good job. When they are used, as they often are (people tell us this & we see it for ourselves) as a means filtering out 'non-critical' cases, they fail in their purpose. People then either have to exaggerate, or wait till they go into serious crisis. It is not acceptable practice. So, What are the 'Reality' Consequences?:If, under these circumstances, and especially where they are cursorily assessed to not be 'substantially or critically' in need of a service, they then complain and get more 'crap', which effectively tells them they need to effectively 'justify' themselves for these services; 'by being a bit, or a lot worse than they are now', is it any wonder that tempers flair and paranoia reigns further? Of course this is not actually said to people! It is the ridiculous conclusion that they can draw, from being offered nothing, when the reasonable expectation was that they would; having paid their taxes and perhaps put all the effort into getting the services where they have, individually and collectively (as a community culture, culture, or society). Having saved for their old age provides little comfort. Unless you are very rich, the service you will get is about the same as if you were supported by local authority and health care. These kinds of frustrating encounters are so common now, in health services, in social services, in education, social welfare, criminal and legal services . . . . What happened to prevention, or preventative intervention? If the 'naive' Service User (Patient, Client, Family Carer, or pupil, parent, victim) gets this kind of reaction from each service they approach, is it any wonder they think there is a conspiracy? Just look at the repeated evidence presented on this site and else where, and in your own personal and professional experiences (leaving aside your justifications for a moment). They have not got as far as getting 'a service' yet and they are already quite disturbed by the process and barriers. Dare we now tell them of the distress that these services can cause them, if they don't 'fit' properly into the 'institutional jigsaw'; if and when they eventually get a service they think they are requesting? Some will be fine, they never complain about anything and often put up with worse (for some strange reason - or, is it so strange?). It is an intellectually and emotionally 'biased' referral process. Professionals know that and persist. You know that too. What 'they' (Service Users & Carers) don't always Know (or fully understand) but 'sense'; is that the services are not working as described! This produces, what Professor Elliott Jaques (and I & a few others) call: Paranoia-genesis: In the UK we have 'district' social care funding from 'County or Borough' sources, fed by Government Community Budget and local taxation. We Health Care funding from Central Government, allocated through various Health Trusts. Eventually, Primary Care Trusts (GP Service level) provide the Local Health Care needs with separate Special Health Care funding to support services in statutory, private and charitable sectors, as alternative to 'institutions'. Supposedly 'within' and as part of the Community. This extensive funding is also supposed to be available to support the continuing 'Care in the Community' (for people at home and in residential homes, who need a special nursing input, etc). It does not happen adequately. Its inadequacy helps makes these so called homes 'mini institutions', effectively separated off from the community & almost self contained & isolated from the other community services. They are in a Catch 22. This even happens in a person's own home, when inadequate services leave people socially isolated. Social Care funding restrictions have a similar effect, although their explicit purpose is to re-integrate and maintain integration of individual with their local families and communities. This fails, except in the more critical cases, cases where they would not have become critical, had there been more appropriate, user friendly support, earlier on. As a professional, trying to get services from other professional bodies, it is often bad enough, especially if these are also outside our geographical areas, or on a county boundary, or even across professional boundaries (all directions). The paperwork exercises, time constraints and rural travelling involved, significantly draws professionals away for their clients & patients. One size does not tit all. Rural and Suburban domains are worlds apart, physically, strategically (in terms of organising local services) and in terms of differing attitudes to community and help (I have worked in both). These administrative responsibilities; take hour and sometimes days each week. They do not always get the service required and requested either, and all the signs are this will get worse. More effort for less effect, and things are bad enough already. A good administrator is 'worth their weight', in ensuring smooth access to resources and in planning & recording. Why are we not employing them adequately at the service level? I cherish the competence of a good administrator, serving my role as Manager, or Practitioner; in turn, serving the client, or patient. As an example: Continuing Health Care (CHC) Funding request, required for special health care needs, including 'challenging need' that may put people at risk as Vulnerable Adults & those special nursing needs of terminal illness, can take 20, or more, hours for each person assessed. The basic screen (required for all placements in Nursing Homes and often in Residential Homes), can take hours alone. Service users & Families are explicitly included in allowing this assessment to happen. They have expectations, reasonable ones. They are often severely disappointed, given the reasonable expectations this raises. (this feeds paranoia & anger) The chances of success in getting appropriate CHC funding for mental health, or behavioural problems, are basically minimal. These have to be pretty 'exceptional' special needs to get a look in. The chances of CHC funding to support someone 'in the Community' are negligible, people have given up trying (they should not, but I can't blame them, I have). Social Care agencies have little effect here, even 'Specialists' are often deemed 'unqualified' for the purpose. Professionals are often working their buts off for minimal effect. In doing these additional assessments; it also requires the funded 'Service Providing Agencies' (mostly nursing homes) to attend to more paperwork exercises and, in the process, taking them away from client / patient centred work. Even independent 'Charitable' organisations are now being pushed down these 'paperwork' avalanche paths; To justify their support and funding. Even the best Professionals feel criticised, (even by me), because they are 'sensitive' to the failings cause by piecemeal institutional processes & inefficiencies. The processes are there, the Policies, Permissions and Expectations are there. However, the relatively limited, barely adequate funding, granted by Government, is largely swallowed up in 'executive administrations'. That's about it; the administrative process often take priority over the direct care needs. The debate in 'committees' and 'Funding Panels' is one concerning the linguistic and semantics of requests: What comes out at the end of the delayed requests & punishing hurdle race, are more expensive requirements that barely meet the now 'demanding' needs of demanding Residents / Client / Patient, never mind their 'good quality liberated care'. Why? Because of the neglect of early intervention & lack of good 'person centre', community based provision, for meeting joint specialist nursing & social care needs. Distrust is already set in, any 'excuse', however reasonable, will be rejected. The resulting costs to us all are phenomenal; in terms of lack of individual liberties of Service Users, Clients, Patients (call they what your will - People); Unreasonable Stress on Professionals & Carers, and substantially wasted funds to the Community and the Nation. This cost will rise as demands rise but will significantly increase because of lack of Professional Trust (within & between professions), protectionist practices and poor cooperation between the managed services. A Recent Government Initiative: An attempt to improve the poor consistency of decisions and funding, by Primary Health Care Trusts (PCT's - CHC funding), throughout the country (part of the Post Code Lottery); has produced new forms and processes (definitely better than those before) and with a decision strategy that indicates improvements; But this has also been met with greater uncertainties and with longer delays than was previously the case. The 'Mental Health' need of patients are better addressed in the new format, but are no better understood. Decisions are still unbelievably crass and ignorant and often internally inconsistent. There is greater consistency in application and processing; but there is no consistent improvement in making the decisions, or providing resulting services. The funds allocated to 'individual' services have actually been reduced. Squeezing the Service Providing Agencies further. There will be effects on Service Users, with 'guaranteed' reduction in the quality of service. CSCI will increasingly intervene and criticise but inappropriate funding levels will not be part of their remit. This is called regression to the mean - everyone gets an averaged bad (or good enough) service. It is a well know and recognised psych-social phenomena. A least its fairer, I suppose, in a sick kind of way. More time (and money) spent in 'executive administration' of course, and in putting things right, when they inevitably go wrong. Never mind, we can blame the incompetence of Service Users for not planning their lives and their retirements better. We can also blame them for being fat, smoking & drinking too much, and for being too soft. "But we fought for and struggles to get it and paid in to it all our lives!" Institutional response: "No you didn't - You paid off the Debt created by providing the service to the previous generations - sucker". Institution Speaking: Who is going to pay for you!? - There is not such thing as Community, remember? We are ok, we get paid well enough to get private health insurance and have a protected pension. Not that we need it, we are part of the 'club' ". Community Speaking: "Oh no your not - some of us see you at the other end of this wonderful process of life - Lots can happen, and usually does - you are in the same hole as the rest of us". Well - you get the general idea, hopefully. There is a safety net for us all and, some of us are sitting on it, sawing through the support cables. Others are on the ground saying; 'Stop - you will hurt yourself (and others). It is going to be so expensive repairing the damage also". Built in Redundancy was once an established good practice. Contrary to how it sounds, it actually means that you build your bridge, your building, or your 'system', with greater strength and resilience than is absolutely needed on a day to day basis. The idea was (learned over thousands of years of biter experience) that you leave some reasonable margin for the various catastrophes that will happen, however much you improve you science and maths. Taking this sensible strategy and making it slightly more efficient, would be useful in designing any Care Services, wouldn't it? (I could tell you how; so could many a housewife, or half competent DIY enthusiast - in general principles, anyway; and these have been good for some thousands of years too). Some Service Executives pretend that they have done this; until their system collapses under the weight of Paper & Colour Cards, contained in the Policy & Practice Documents and its various Supplements and attendant Memos & printed out eMail copies. Even the shelves weren't built with enough resilience, for that catastrophe of mind blowing, pretentious tosh, most of which could be applied to educated common sense, and 'good practice', where the 'basic principles' of good professional and responsible practice are taught, promoted and appropriately supervised & lead. But, instead: The 'micro management' is designed to stop now the top heavy system collapsing in on itself. Perhaps some basic physics could help here. Actually, maintaining vacant posts to save money is not quite what the 'engineers' had in mind', when after thousands of years of painful experience, he/she learned that heavy on top and slight on the bottom does not work unless you build in a hell of a lot of 'redundancy' (as described above, of course; not in terms of the Managers' continued employment). No, the idea is to have: Slightly more staff than immediately needed and slightly more beds and other resources, than there is demand for right now, etc. Modern robust systems don't have to be heavy though; like an old hill fort, or a redundant Super-tanker, almost impossible to steer, or to stop. Now days it is in the way we build the interconnecting 'structure' of our systems that can make them more resilient. Built in fails safes and flexibility to withstand the occasional but often devastating social earthquake. The extension of this idea is to make 'getting good people employed' as 'higher priority', than trying to 'get rid of, or side tracking the ones you think you have made mistakes with'. The idea now, is to promote and hold onto innovation, thinking outside the box and honest & frank critical debate. Where is it? Where did it go? Who is producing new, fresh invigorating talent? Colleges do their best but student have to come into the real world and the contradictions to that which they are taught. You then train everyone up, in using their initiative: in subjects and areas that make them more self reliant, robust and accountable professionals; taking sensible, responsible decisions without constant references back to the managers, supervisors, solicitors and accountants (who don't actually have a clue where the services and funds have the most effective, risk managed and least costly impact, even when they are good at what they do). Specialist skill have to be updated of course, and then further advanced, but a fundamental understanding of Human Rights would be a good basis for understanding the basics of much of what is currently the health and social care domain. This is presently incompetently being micro management, from what we can tell from our collectively experience. Direct intervention and social care becomes unattractive to professionals, it appears cheaper to get them supervising less well trained 'support workers'. Ask Intel, Microsoft, Hewlett and Packard, Virgin. They have better health and social care systems then we have and better management and employment strategies, with improved working conditions and Environmental Health & Health and Safety strategies and protections. They have their fault and failing, of course but they remain robust & flexible at the same time, or they wouldn't survive. Why do we not copy these strategies, rather than the economic, or commercial practices. For god sake Don't ask Alan Sugar, or continue to develop your management styles upon the likes of Gordon Ramsey. Bill Gates and Sir Richard Branson are much better models and they have a much improved attitude and philosophy regarding support to the community and towards community responsibility. So, why didn't you think of them? You Did? Why didn't you put it into practice then?!!! They don't go bankrupt any more, they learned their lessons and stayed light, innovative and robust. They don't just follow dried out, pathetic commercial strategies, instigated by two, or more dried out, pathetic dinosaurs, left over from the era of Hovis, The Bakery Bike and the Lone Ranger. When you don't trust people you employ, or trust your ability to manage them well, you find yourself writing reams of Policy Directive, Memo's and Emails. Each time there is a crisis you write some more and insist people read & digest it. You put in place systems for ensuring people are doing this properly and for disciplining them when they don't. To our surprise there are more crises, each one slightly, or greatly different to the last, hopefully rarely quite the same. You send out further adjustments and supplements to Policy & Procedures and new, tarted up forms. More Micro-management. Then you start to get other kinds of problems coming along, they get bigger and impossible contain. You start chase your tail and write still more policy and ask people to stick to procedures again. Funds are getting low, resources more limited. More complaints and judgments from external bodies. The conclusion; we need more of the same! Wrong. The more you do this, the more things seem to slow up and become increasingly costly and decreasingly effective. More complaints rather than less, unless you have managed to disillusion and de-motivated everyone so much that they are stunned into silence (and relative inaction). Fewer, more disillusioned staff, rather than the same, or more motivated staff. Fewer, impoverished and depressing services, rather than dynamic ones, which seem to feed themselves. More depressed and distressed Service Users and Family Carers, who are now less motivated to support themselves, having become institutionally dependent, often before their time. Not just physically (although much of this could be avoided). But intellectually, emotionally, socially and spiritually dependent. Everyone taking less initiatives. This is the consequence of micro management. I was of the mistaken belief that everyone knew this! In our Health & Social Care System, Micro Management: Appears to operate through Re-Written Edicts & snippets of Government Requirements and Recommendations. Like; Best Practice; Least Restrictive Practice; Mental Capacity; Mental Health Law; Child Care Law; Environmental Safety; Health and Safety and a Mass of Employment and other legislation. All these Laws have 'qualifying' constraints upon the 'unreasonable, unnecessary, excessive and erroneous interference in normal human right & natural entitlements', that underpin these Laws - ie: Human Rights, Social Responsibility and Personal Accountability. Add to this the peculiar and intricate Edicts of each of the increasingly institutionalised and stagnating professional bodies and the Supervising Agencies of Health and Social Care and it then looks like an awful lot to handle, doesn't it. Its not. You just have to go back to basic. What are we here for?: Do you know? Are you right? We provide supportive services, to Service Users; in the form of Patients, Clients, Carers, other Professionals and the Community at large. That is it writ simple. It is the more effective 'line administrators' who actually make this all work effectively, in spite of the stupid forms they are told to use. Just bloody good housekeeping and budgeting. Bring it on home, don't scrimp and scrape from one crisis to the next and go bankrupt like the risk loving entrepreneur, who has little to loose that he can't regain later. The most Effective Entrepreneur Systems & Strategies: takes account of sick leave (which will reduce), vacant posts (which will reduce and the need for agency staff reduced, with consequential reduced costs) and costly 'grievances', and potential strikes, and spanners in the work, due to unreasonable, Health & Safety level of stress. Of course, there is also the very real potential for Litigation on Health & Safety Grounds, because of neglect of duty in protecting employees from unreasonable workloads & contradictory demands. I could go on for pages, believe me (pay me). Built in Obsolescence: is a modern industrial / commercial idea that seems to have been picked up by Modern Service Managers (actually, that is not true, in fairness, they have always had this tendency). Staff are 'dispensable', we all believe this now, don't we. It flows off the tongue and means we can go on holiday and retire with clear minds and without feelings of guilt, or responsibility. "No one is indispensible". Who the F**k has the right to suggest this in the 'Caring Services'. Where did it come from - Commerce of course. Tell Pasture he was dispensable, tell Florence Nightingale, Albert Sweitzer, etc. What a F**king awful way to run 'People Centred Services': Sorry, how disempowering must that be? It almost have me convinced for few months - not too bad after 40 years of service. (nearly convince, with the exception of myself own dispensability, of course). Look, I know what you are trying to say. We should all be able to do our job well and knock off and take a break, without having to take our professional worries with us. That does not make us dispensable, it is our entitlement for being part of an indispensible and effective team and service. Don't listen to this Crap. It is Managers that are dispensable: Professional Teams and independent, cooperating professional Practitioners carry on for significant periods of time without managers breathing down their necks and sometime they invent something better than was being managed. They also often shorten Waiting Lists, get better Service User satisfaction and obtain greater 'Job Satisfaction', become More Responsible, More Accountable and improve their Higher Level Social, Managerial & Leadership Skills. It is part of good professional - Supervision remains critical, of course, but that is a partnership. In Local Authorities and County Councils; Each 'service request' (even for the smallest change) can require a further assessment and form filling; 'funding requests', requiring those people who are lucky enough to be considered for a 'proper' service, to participate in further 'means testing' (unless the professional actually defies Policy and interprets the information from hearing the person say what they think the problems are, in their own expert terms). How the hell do we expect people with learning difficulties, mental health problems, older age memory loss, stroke problems, cognitive difficulties, carer stress and just plain worn out and disillusioned, to fill in the simplest of forms, or even, with help, answer impertinent questions about intimate and sensitive issues, often in clinical terms, identifying them as having problems in 'other peoples terms', rather than their own? A good professional practice; Is to hear what the person is saying for themselves, ask pertinent questions to clarify uncertainties, use our eyes and ears (and any other senses that we have available and are in touch with) and then translate these into terms that our colleagues may better understand and that will get the necessary services in place. Why do we do the reverse of this; expecting Service Users and Family Carers to under stand our terms & categories? Requiring them to translate for us! Some things never change, do they? Given these kinds of problems; I find it difficult to get up the motivation to fill in a direct debit form, or my mileage claims, pay a phone bill and the dozens of other things we have to do on a daily, or weekly basis. So much effort for so little effect and benefit, it makes you want to just let it all go. How do you think Service User's and family Carers must feel. They have these same daily burdens of complex modern life, plus all this other crap we throw at them, before we even provide the service. Sometimes that 'form filling' is the service. Who Knows what is going behind the scenes: Until we try to tell them, assuming we have half an Idea, while relying on paranoia & rumour to fill the gaps. BUT they sure as hell know something unhealthy is going on, don't they? - Paranoia sets in deeper, anger gets stronger, frustration grows & shows itself as aggression from time-to-time. Speculation is rife, economic cycles come and go, one economic cock up after another, greed following power, power following lies and self deception. Same old story that got us where we are now. Oh no, Not Again; Now patients and clients are going to loose out again and it will be their faults again, because they didn't get private health insurance, or save enough of their relatively pathetic income, after paying for School Lessons in unimportant Subjects and Activities; like Music, Art, Nature Rambles / Field Trips & the Kids University Educations; or Health Costs like; Dental Treatment, Prescriptions and Alternative Therapies (Safer than getting MRSA). Not to mention: Food costs and Fuel Costs! (On your bike Tebbitt, and I hope you fall off and have to get treated in a NHS hospital, on a Standard MRSA ward ....) Keeping up with the expectations of Kids, who's school friends have got this, that and the other, because they had seen some fantastic thing on the TV Commercial (Not there for the kids you understand, but for mature adults to filter and make considered judgments about). Somehow it got back to the kids, when some harassed parent weakened, somewhere along the line, encourage all this spending of money that should be saved to meet the unexpected, unpredictable, progressive failure of the Welfare State; Which didn't stand a chance anyway because no one appreciate something that is free (Free - it cost me an arm and a leg! What are you talking about). As for "Community Care" - "What Community?" - Commerce and industrialisation killed most of that years back. Don't waste ya pennies. Conspiracy, My arse! Something is going on!!!; where is all the money the Government is talking about. Look at the salaries of GP's. I rarely see him now! He/she takes 12 weeks holiday a year and goes on training convention about thing like; how to set up and run 'Neighbourhood Schemes', funded by drug companies (Saves us some money, I suppose Drugs cost enough though and side effects are often worse than the benefits, must be doing it out of Guilt). When I attend the GP surgery, or the Hospital (even Schools, or any Social Welfare Building), having waited for my appointment to be made as late as possible, to keep the waiting list / times as short as possible (waiting list for waiting lists), I am often confronted with a sign: "Any verbal, or physical aggression (including banging on the desk) will not be tolerated and you will not obtain a service and may be escorted from the building - by the 'Security Guard' (Notice by Security Service?)" How did this happen? For what possible reasons did we suddenly need Security Guards in Hospitals and Schools? Did we recently have a 'shoot out' in the UK that put us all at risk in attending Hospital, Schools, DHSS building? No; People got fed up with waiting, in pain and distress for their themselves, or their loved ones, with the feeble excuses, feeling disempowered (without knowing what this is, or how it happens; drip, drip drip), frustrated, meeting condescension, disillusioned by promises broken and false representation of their interests, sometime outright lies and very, very bad excuses?". Something is seriously wrong and people know it. Some people are just not willing to keep listening to crap and decide to make a noise. If literate, confident and still adequately motivated, they do it like this. If worn down to the point where they are lost for the 'clever' words to counter the 'clever' words they 'bang on the desk and raise their voice'. If they are righteously angry they may sound aggressive (it is known to get legitimate attention; ask President Krucheff, he used his shoe for greater effect. Ask many UK MP's in Parliament and Senators and Congressmen (and Congresswomen) in the American Senate and Congress). If the Health Service or Social Service worker listening is not 'listening', they respond by judging the angry person in the same category as the Drunk and the Football hooligan (who professionals have been managing quite adequately for years). Others become more paranoid, self effacing and disempowered, so do the patients. "Its the System, it get you down"; "Its a Conspiracy, they know what they are doing and they just want to save money". "I don't count for anything any more, because I am not famous. It has to be conspiracy, doesn't it?". No, sorry - its just plain ignorance and incompetent management. Possible Responses to these Sign: "What bloody service, I am banging on the desk because I am not getting a bloody service", or "Does it count, if I am angry because I feel that I am being treated in a condescending way"; "Does it make a difference that I am unhappy because I am effectively being told I am fat and need to give up smoking and drinking, if I expect to get treatment"; "..... and as I can afford to do these things, are you suggesting that I can pay for my own health service (I am paying for it already, through my teeth - which, incidentally, I have to pay for now anyway, or I would not have any)". INTERIM CONCLUSION: Service Users, in the form of Patients, Clients, Family Carers, Professional Carers and other Professionals and the wider Community, may expect to to obtain an Assessment of a person's needs and risks, provided that they know the mechanisms and the language required to obtain that service. People who have an adequate language and expectations that 'fit' the services available and who meet the 'criteria' for that service, can then expect a services to be provided, to the level that resources allow, when the are available. Those who do not have an adequate language, are in denial, have lost faith and trust in 'the system', do not meet the 'screening' criteria for services and are then unable to assert themselves in a language that is acceptable to professional assessors, do not get a service. Those people who have multiple problems and disabilities, each of which do not meet the criteria for a particular services, may find themselves referred on, or advised to approach another service, perhaps a voluntary service. The fact that their overall presenting problems, difficulties and risks are Substantial, or Critical, gets missed. How many this affects we do not know. With greater support to the police, we may get a better idea. Not everyone who gets into crime and drugs does so because of a desire to do so. Some go there out of practical need and self medication, following neglect. It is difficult to distinguish the two groups apart, after a few years of indoctrination, misguidance and neglect. The vulnerable become incorporated into culture of crime and have the resentment of neglect to fuel their anger and mistrust towards all institutions. It is possible to identify those who are not too damaged by the process but someone has to be looking for the exceptions and the Police & Legal System has to be more informed of what to look out for. Vulnerable people will often admit to anything to reduce the stress on themselves, to get credibility with their subculture, or even to get clothed, fed and shelter. For a recent account of how our systems fail Service Users: Go to Recent Example Authors Note:
Conspiring takes up to much effort, requires dynamic organisation and quite sophisticated thinking. It is unlikely to ever happen in health and social care. MOST OF WHAT I DESCRIBE ABOVE IS COCK UPS AND SELF DECEPTION. The consequences are the progressive result of too many promises with too little insight and little realistic commitment, matched by allocating resources to protect the institution and the 'body professional', at the expense of the Service User, in the pretence that it in the Service Users best interests CRAP, CRAP CRAP - Conspiracy, my arse - blind ignorance is more like it. :-) T Couchman. (© 1974 - Feb. 2010)  This page is in the stage of preparation.
| NOTE: This Document is still at some stage of development. You are invited to respond and comment on its content and its logic. If you return to the document at a future date, you will be able to see its continued development, hopefully reflecting your own and others commentary. I thank you, in advance, for any contribution that you make. Please also feel free to visit and contribute, in any valid way, to these and other social issues, through our Forums. There is also a Chat Room and protected Chat Space for more serious group discussions and individual counselling. Please feel free o use this space for your legitimate activities. Copyright: Although you will see very few reference to other formal writings in this document, I acknowledge general recognition to the discussions and debates that I have had with students, practitioners and clients over the years. Most of the ideas and theory has evolved through this rather pragmatic process (operational research), rather than any formal reading. If any content of this document describes concepts, theory, or ideas that have been established else where, (prior to my writing, either here or else where - in part or in full), I acknowledge their entitlement to claim them as their intellectual property for financial purposes, if they can evidence this. I also reserve the right to retain them as my intellectual property, with due recognition to those who have made direct contributions, including other writers, should I identify such a past influences. Other than this, I invite you to share and copy any content, to the benefit of intellectual debate and the benefit of individuals and groups, without restriction, other than it be used for constructive purpose, in the wider context of my writing. Should you wish to use any material presented here 'as is', I ask that you then make reference to myself and the web site. The 'Reading Date' would be a useful 'publishing date' for the Current Edition. 1980 is the core publishing date for most of the basic ideas and theory (unless stated otherwise). This 'Reading Date' may be an important part of this 'reference', as the document (by its 'internet fluid' nature) will be constantly changing and this may affect meaning and interpretation, for those following up on such a reference at a later date. Thank you for your cooperation. TRC. eMail: terry.couchman@visitweb.org |
