Terry  Couchman
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This outline covers a very broad area of 'person centred', professional activity and involves the evolution of diverse General & Specialist Professionals. The content will mainly be of interest to students and those who want develop considered arguments in order to challenge current practices and attitudes. How things are are often romantically tidied up to the advantage of one group or another. Usually things are not quite so 'tidy' as history would like us to believe. Check out Russian history, they learned a great deal from out tendency to adjust the truths a little.

There has been an historical split and misunderstanding of the various roles, especially between Nursing and Social Care. There has even been an element of competition between them, like squabbling siblings in a family. Sadly, historically, this competition has largely been for determining who will have the greatest power and prestige and who is in control of the biggest budget. In these circumstances the service user get pushed down in the power stakes and often get left out all together, by both sides.

These power struggles are very common and human. They are not dissimilar to the primitive and instinctive conflicts between East and West, between any two nations, races and between religions, where successful and powerful 'differences' on one side makes confidence in the  'differences', on the opposing side, feel insecure. It is insecurity that breeds these conflicts and 'destructive' competitions and it is usually insecurities and paranoia, on both side, that feeds the continued conflict. The result is costly, inefficient and often incompetent services and reduced credibility on both sides (as with any pointless squabble). In fact, as history tends to show, both sides have their inherent weaknesses and  less self-seeking strengths.

On the other hand there have been very successful cooperation's between these two disciplines which have allowed us to progress specialist services greatly, particularly in the Learning Difficulties field. The language is a little different and the philosophies may differ in respect of the fact that each are coming from differing, valid perspectives on the same issues. It is not so much that we see things fundamentally differently but rather, from different angles. The problems show their different facets to us. As a consequence we see complementary solutions. This variation is also true of our perceptual & conceptual perspectives of Service Users and Family Carer and their the perspectives between themselves and of us.

More often, our differing assessments, of the same apparent situation, are often not wrong in being different. People respond to differing approaches, personalities and 'contexts' differently, often according to their particular and previous experiences of them. Our own and others perceptions are coloured (quite appropriately) by the particular slant we have on a situations. In making our assessments and taking any action, we are required to declare this 'context' clearly. In doing so we are better able to bring together the various perspectives and potential solutions, meeting multiple, interrelated needs and risks in one package (or so we should be doing).

Like so often is the case, these different fields have more in common with each other than the perceived differences. It is more often a case of 'divide and rule' by those who have a vested interest in advancing one sector, or interest, at the expense of the other. This is no different than happens in other diverging professions, even in commerce. These conflicts are due to insecurities that are generated by each of us trying to 'empower' ourselves in a generally disempowering institutions. The Ethics, (if we take the trouble to use these as the fundamental basis for operating) are very common to all professions. They have similar roots, after all.

Common Roots in Health & Social Care:

Ironically, if we trace the recent social history of medical care we will see that the original independent medical practitioners (GP's) actually performed both medical and social roles. They became appreciated as advisors on all sorts of social as well as medical problems. There was often great confidence in this advice and the role was thrust onto GP's because of a need that was felt by these communities. Communities were experiencing incredible challenges at the time - GP's responded with the common touch, wider experience, some knowledge and intelligence (strategic information).

Before the existence of social work and social care, as discrete occupations, the community gradually recognised GP's (along with priests, Nuns and solicitors, themselves extensions of a religious constructs) as useful, educated and insightful people, directly available to them. Not only available in the surgery, but in the general store and pub (in the case of GPs). They were a general source of information, advice and support for relationships, child care, employment issues and conflict.

As with many support systems, the information did not have to be particularly accurate in most cases. Having a sense of direction and structure was enough for most people. They gained confidence and sorted most local, social problems out themselves. GPs provided a 'rational' alternative to the religion of the time. This is the case, to a limited degree, even today. Radio & TV doctors are now the rage. Watch the internet also :-).

A similar diversification of skills was seen as 'nursing' started to develop in its more modern form. This profession evolved from the experience of various specialist assistants (often volunteers) to GPs and Clinical Specialists, and from the established skilful members of the religious orders. These practitioners were soon adopted as both general advisors and people who were able to provide important respite (sanctuary, convalescence) to the general physical care of patients. There were parallel developments in other cultures and philosophies, some of these in advance of our own developments, at times and in many ways. Complementary medicine and Counsel, reflects some of these alternative developments.

Lady Almoners have a long history and after the influence of Florence Nightingale, in particular, took on the more 'social work' type tasks within hospitals, eventually moving into and practicing in the community. Ms. Nightingale's influence is legendary, of course, and she advanced medicine by applying very simple principles of hygiene, practical care and patient focus. Very fundamental, uncomplicated, but refined and grossly undervalued 'domestic' & high level, adapted 'nurturing' & 'social skills'. They are even more undervalued today, being beneath many middle class professionals.

Rehabilitation was an integral part of the nursing remit, as was palliative care. These are not new inventions, they have been there, basically wherever there are Mothers, able and naturally, willing to turn their skills and intuitions towards adult suffering, in any emergency. Men also developed these skills also (when allowed to), but these tended to come from rather more 'rational', rather than 'intuitive', or 'emotional' foundations). This produced a slightly different, complementary style of medical care. Over the years, these two 'styles' have blended a little and, sadly, the recognition of the value of these 'intuitive' skills has been diminished. Gladly, they continue to thrive in their relative humility.

The nursing role, at this time, was generic, naturally holistic and inspiring to those suffering greatly from wounds of battle and separation from loved ones. Nightingale and her volunteers, were both nurses and social workers, literally on the front line. The profession was an emotional as well as a practical and intellectual vocation. A measure of calculated detachment only evolved to protect the nurse form too much trauma and to ensure that any 'felt' distress was not passed onto the patient. They saved lives and also advanced the quality of life they saved. They also taught the male dominated GP's a thing or two and became some of the first Female GPs. They made mistakes and learned quick. It is a human activity, risk is unavoidable, errors are there to be discovered and noted. This is how real knowledge is advanced.

Back in civilian aftermath of three, or more wars, nursing was established as a essential discipline in hospitals and the community. District nurses arose and diverged into specialist. One of these formed the basis for advising in general child rearing, eventually supporting families who were having problems, and so on. Community Nursing was early to develop because of the deprivations and lost knowledge of disbanded and fragmented agricultural communities and fragmented 'extended' families, due to losses in wars and famine and the fragmentation of communities. Industrialisation had it own serious health and social impacts, no less than poor agricultural communities. Nurses were on the front line once more.

Some of these practitioners were irritating, bombastic, pompous and often very judgmental but they had energy and knew what worked and what didn't, in these emergency circumstances. Thank god for those pushy Matrons, they certainly kept the pretentious young medical practitioners in their place, as well as the rest of us. Sadly, others copied this 'style', without the substance, and the definitive, expert Matrons role was eventually marked for the chop, when the emergencies had substantial subsided. Welcome the modern Matron, engaging the new emergencies. Copying the style without the substance is a common feature in the development of modern services, based upon and idealised, tested, model.

In parallel with this wider medical role, we saw the advance of philanthropy, the emancipation of ordinary working men, slaves and then women. There were also the development of new intellectual & scientific understandings, coupled with cultural and literary enlightenment and resulting expansion of 'good works' for the poor. This further extended support and concerns beyond purely medical and spiritual issues. Remember, medicine itself was given birth by religious and other 'spiritually' guided practices. it just became secularise as science has an increasingly determining influence.

There was gradual recognition of the importance of community health & social welfare, as being critically linked in ensuring health and wellbeing of individuals, families and communities. These were not ideals. These were practices; cleanliness, hygiene, sanitary conditions, diet and infection control, and were gradually recognised as critical to health, as any administrations of doctors. Similarly, the effects of deprivation, poor social order, alcohol and drugs, were seen to have a detrimental effect upon the 'moral' (read mental and emotional) welfare of many.

Social Issues were recognised to be closely linked with these community health problems and the likes of Charles Dickens fathered concern for social deprivation & injustice. He also showed how these had a direct impact upon the prosperity and security of the wider culture. He was a social researcher and newspaper editor first. The most important community improvements gradual came about from the intelligent, creative and inspired adaptation of practices, by insightful workers, often by trial and error. Observers and researchers simply chronicled these and tidied them up.

Sadly, many of these developments included a great deal of misplaced moralising, with the associated prejudices and injustice. These were not part of the fundamental developments. They were more the result of the later influences of sophisticated, intellectual chroniclers, who plagiarised the original ideas and practices. These motivations may have been wrong, imprecise, or misguided but the general trajectories were fortunately, though not accidentally, correct (because the fundamental developments were bound to happened in spite of the superficial posturing). These errors of interpretation were partly because of the religious nature of the disciplinary source of many of the practitioners, quick to pick up on a good and profitable idea.

This problem of misunderstanding, or misrepresenting 'causation' was also partly because of the misguided & impatient interpretation of, genetics and other biological & social theories, competing, with some urgency, against the prevailing religious beliefs of the time. In any event, improvements over the existing health & social miseries prevailed and hard fought, progressive, radical steps have brought us to the improved (but imperfect) situation we have today. Some of these significant improvements were gained through early trade union activity & worker education.

The development of modern Professional Ethics along with greater, improving insights, then transformed many of these old ideas, incorporating within them the concepts of social justice, rights and entitlements. This was taken up by the more insightful General Practitioners and Nurse of the time. They 'lived' the evidence and produced the early community services, operating through Community Hospital. They 'Cared', not just practiced and nursed. Other practitioners separated off and refined the science, producing the more 'rationalised', detached and 'clinical' forms of medicine, interpreting ethics in a much narrower vein, justifying bad manners and disempowerment or patients, as being the only truly scientific method. One 'justifying' religious influence ended and another was created.

From Ethics to Human Rights:

Before proceeding, with what is often referred to as the Post-war Health & Social Care developments, it may be useful to reflect upon the underlying ethics & philosophies that were prevalent over this period. I will simply exemplify these by describing the styles of approach (& practice) towards health and social issues. Firstly through, from about 1840 and up to & just beyond, the second of the Great Wars. Then I will illustrate the kinds of Health & Social Care approaches that developed, subsequent to these radical transitions and during the current transformation (see: adaptation; transformation).

I believe, that there is a underlying transformation, still in progress, that arose (and continues) because of these wars, rapid industrialisation & technological revolution and serious economic crises. These events and processes had serious negative health and social impacts but also precipitated some very radical responses, to newly perceived problems. The current, radically new transformation, with its enhanced perspectives, is not complete yet, disrupted and deferred by institutional resistance and fear. It parallels recent technological advances, and is associated with them but is a transformation more substantial than just 'assistive technology' (which is very badly used anyway).

The current transformation is to do with our fast developing, fundamental understanding of the adaptive capability of the human mind and its interactive influences on our general health (our bodies). Spiritual healing, hypnotism, acupuncture and voodoo, are ritualistic manifestation of an already discovered and highly effective internal health care system. Science can't adequately explain it yet, but like gravity and the placebo effect, it did exist before the Apple (and Isaac Newton) discovered it. It is imperfect because our natural inclinations have been intellectualised away. The folklore that evoked and perpetuated these rituals, has become simple, quaint entertainment, with no real substance.

Our instincts and intuitions have been subverted to the greater god of, first of religion, then industry and now science. It would not be so sad if it were not for the fact that following rituals in no way affected the science anyway, or vice versa. Never mind we will just have to get them back in our repetitive, ritualistic way. Modern, ritualistic forerunners of what is to come, like CBT (by comparison), is a kind of chant, as is any reward systems. These are 'inducing' rituals, arranged to influence thinking (and feeling), and they work (when applied appropriately, in the right direction). Ritual do serve a purpose, often forgotten. We not only forgot the purpose, we forgot the importance of rituals.

The period between the late 1800's through to the 1960's saw a much bigger technological revolution than is perhaps appreciated. It paved the way for the later IT revolution but actually (and much more importantly), it revolutionised change in social order and in emancipation. The rapid rate of scientific development and wider, associated technological understanding, was so great that (along with the associated breakdown of old values & rigid institutional constraints), people were ill prepared to utilise their new freedoms. The changing social structures, industrial development, even educational philosophies, and health & social care practices, raced ahead without fully appreciating the potential negative impacts that result from these, often badly these thought through, transition. These were world wide human experiments.

In the following section I am attempting to be factual, generalising about actual practices that arose from the ethics and philosophies at the time. These were felt, and rationally appeared, absolutely fine in the context of their time, understanding and circumstances. Reflecting from a generation, or four later, the earlier practices may seem abusive, through to exemplary, depending upon your philosophical viewpoint. I would hope, obviously, that the reader (especially if they are within health and social care), would see the later illustrations of practice as preferred over the former. That said, we can not read the future. There could be and will very likely be, advances on this, or else, the catastrophic recycle, through the old destructive social process once more (longer term history has already repeated itself many times).

I will be trying to apply the principle of 'evidenced based learning and practices'. Else where on this site I have much of the evidence to support my generalised observations and conclusions. I am inclined, however, to ask you to recognise the evidence from your own experience and from your own researches. A good approach is to attempt to disprove my statements and the basic thesis, by finding evidence (not opinion) that contradicts these statements. I really don't hold much with opinions these days, even my own. They can be interesting in dialogue but carry little weight in effecting changes and promoting advances. That said enthusiasm, optimism and aspirations are fine in association with the confirmed facts. So, here we go:

Success and Failings of Modern Ethics, Organisation and Practice:

Such things as basic Health Social Care and Education did not lend themselves to commercial practices. They never did and never will. This is not a political dogma. History shows that the ills of a small minority have a tendency to 'infect' the wider communities of the majority, and good sense usually leads all persuasions to agree to a Free at the point of need, Health, Social Welfare and Education service (in the UK) and other, assisted 'welfare systems', in advancing cultures. The human experiment has been running long enough to recognise that there are currently only five basic ways to 'treat' any 'ill' and stop the epidemic of these ills from rampaging through a general population, destroying some, disabling others and disrupting, or undermining, the social order and general welfare of all.

To use a medical analogy, as a crude vehicle for philosophical ideas. The first and crudest of these interventions is to cut off the offending limb, or pluck out the offending eye (the social equivalence being: euthanasia; capitol punishment; war and genocide). The second is to isolate the infection &/or the afflicted person (the social equivalence being: ghettoise; institutionalise; imprison; ostracise; ignore and neglect - then disenfranchise and caricature). The third is to treat the symptoms and method of transports (the social counterpart being: let them eat cake; the poor house; asylums become 'bins'; re-training according to class / status; charity cases; pre-judgment & condescension and powers based, 'reactive' and judgmental, professional interventions).

Now we can move into the modern strategies. The fourth method is to treat the underlying causes of the problems (the equivalent social strategies are: comprehensive medical care, free at the point of need (or according to means), social support and educational opportunity (according to need); reactive legislation and education towards tolerance and justice; provide for basic and other reasonable needs for all (according to means); reduce inequalities, including the relative poverty that affects equal opportunity and felt injustice; 'enforcement' of the entitlements and responsibilities under Human Rights and other Social Legislation. These kinds of strategies are still being developed.

The fifth treatment option is to 'intelligently' eliminate the underlying causes and to advance 'built in' protection and prevention. The social prerogative requires the rigorous practice of equal opportunities, truly equitable social justice, active informed choice, the very least restrictive practices and the rigorous application of the underlying principles & spirit of Human Rights. This includes the 'attendant responsibilities' in enjoying these rights, on all sides, in all community practices and in all interventions, including the policing of these rights and responsibilities. These principles and responsibilities also being doubly incumbent upon Executives and practitioners, representing the institutions that provide for, administer, monitor, or otherwise apply these rights, entitlements and responsibilities.

There is one further Ethical 'qualification' which is difficult to understand, or comprehend some times. That is the contemplation of letting go of all this and allowing patients and clients to live their lives as they choose, having been provided with all the informed entitlements above, as best we can. In our letting go and standing to one side, having ensured their basic needs are met (and any other that they will accept), we may perceive them to make choices that are not in keeping with our own aspirations, or understanding. This includes the decision of some, when the time is right, in spite of their potential to keep going a little longer, with reasonable comfort and enjoyment, to let go of their lives with dignity & satisfaction. It is an experience that you can only regularly gain in the nursing & social care professions.

People tend to aspire to live longer, overcome serious trauma and recover from serious conditions and do so with increasing success. Quality of life is now understood as an integral part of medical and social care, although we may not yet be fully competent to enable this in difficult cases. There would appear to be a retreating horizon, in terms of longetivity, with improved aspirations and ambitions for later life. Children are being born into families later in life and other life enhancing activity extends well into the third age, for increasing numbers of people. There are increasing number of people (in advanced societies) who had the good fortune to gain the life experiences that make these ambitions tenable. If science, medicine, social care and individual positive aspirations can work together (as I believe they do) to prolong active and personally meaningful life, in spite of pervasive disability, then we have a big problem and challenge brewing for our communities, societies and the professions.

Freedom of Speech and Expression:

The application of the 'Spirit' of Human Rights is important here. Human Dignity and the wider tolerance of self expression, including emotional expression, is fundamental in ensuring people feel they are 'being heard' and that their needs, wishes and rights, are adequately understood, even where intellectual understanding fails, because of relative naivety, lack of capacity, ignorance, prejudice, or perceived injustice, on either side of the conversation. Anger, distress, fear and injustice often go hand in hand. The emotions are legitimate human expressions, which, when thwarted (by ill considered., or unjust actions), are predicated to become violent in some measure; eventually, and this is true for the vast majority of people, if provoked enough, for long enough, or else until despondency and resignation sets in.

Many of the provocations I speak about here are persistent and 'cumulative'. They often remain hidden, denied, ignored, or dismissed in large measure and so are not apparent to us at the point of crises that we eventually engage the person at. This is very widely understood but rarely accounted for, except in legal mitigation, after the fact. The assumption that all people should behave 'reasonably', in all situations, irrespective of the absence of dignity, consideration and respect, is absurd and again, this is understood and is also respected under the Human Rights Conventions. The ignorance of these precursors to 'reactive' behaviour, is inadequate excuse for a 'abusive mechanism' of intervention (by any citizen, or professional), which is use to actively undermine and de-value legitimate 'emotional' expression (short of violence), at a 'reactive' personal, collective, or cultural level.

There is the common situation where 'mind games', prejudice, intolerance, blinkered thinking and and individuals illegitimate need for 'control', are used to provoke responses that create an imbalance of interpersonal power, often by the unjustified use of 'assumed', or 'assigned' power. This is identified as Bullying. Domestic Violence and all personal and cultural abuse situations, and even Policing and Mental Health interventions, often fall foul of this error. By deliberately, or inadvertently, provoking reactions, in this way, it is possible to 'illegitimately' use an otherwise, justified 'reaction' as evidence' to support the original focus of an investigation, intervention, or criminal process. I have observed these kinds of 'perceptive' interventions on many occasions and observed their unethical & illegal consequences.

In fact, the circumstances that precipitate an intervention and that which precipitates the subsequent 'reactive' situation, need considering separately. It may be that the investigator, or the person intervening in any form of social crisis, is Ethically (and possibly legally) culpable in terms of the consequences of their 'precipitating errors'. These complex considerations are explanations for the injustices of the past but they are also warnings of the continued injustices of today, in spite of all the guidelines, directives, training and Human Rights legislation. From this level of consideration we can look at the current ethical objectives and the complexities of divergent 'expert' professions. It is this 'divergence' of professional roles that was partially designed to reduce injustice and provide 'expert' perspective on these and other situations.

There are still some professionals, who are appropriately trained (or not) &/or, are demonstrably aware of the potentially 'provocative' character of their actions, who non-the-less choose to continue to take inpatient, provocative actions, believing the situation deserves this, in spite of human rights and ethical implications. There are others who, having had training and gained experience, who none the less remain relatively ignorant of the provocative character of their interventions. Both groups will often record the  'reactions' as behaviour that was unreasonably initiated by 'the other person'. These are features evident (and again professionally ignored) in many interpersonal relationships, where the consequences is family breakup and distress to children and their relationships with their parents. That is bad enough.

Within professions this must constitute unethical &/or incompetent behaviour, irrespective of the seriousness of the 'assumed', potential aggression that may be expected in a situation. This is why we develop the interpersonal skills that allow us to hold back, intervene and withdraw, with the minimum of trauma and danger to the person, those around them and to ourselves. I have observed these interventions and the very serious legal consequences, or implications of them. The precipitated behaviour I have observed have all increased the risks to all present and constituted significant degree of initial ignorance and reflective dishonesty. The results have been miscarriages of justice, due to inept professional behaviour and interpretation, often miss-understood by defence solicitors, or under appreciated by other professionals; being dismissed as being best under the circumstances, or else expediently ignore by practitioner & supervisors.

It is my assertion that, in more recent times, specialism's have become even more divers as clinical and social knowledge has advanced. There is too much legislation, knowledge and other information, for any one individual, or profession, to encompass effectively. Appreciating a person's wider Human Rights, when providing a service, or when otherwise legitimately intervening for the state, is divided between these expert professions. In many ways the addition of detailed policy and practice guidelines, of the institutions, have made this problem fare worse

On the other hand, communication and 'translation' between professionals has not kept pace with this divergence. As a consequence there is often inadequate 'expert' information available for some professional to make appropriate judgments, or reflect upon others professional's actions, in challenging situations, especially relating to the a person's fuller legal entitlements, assessed capacity, or appropriate responsiveness (or refusals) to interventions. If, instead, we stuck to the basic principles of human rights, augmented by unambiguous, but very limited exceptions (as allowed by law) these problems would be lees likely to arise and the largely confounding discussions we are having, would not be necessary.

Some of the important specialist professions are due to divergences into various 'types' of health, communal, or social problems. Others specialists disciplines are adapted to suit the various 'locations' in which these new professions could usefully practice; hospitals, clinics, schools, prisons, police cells, courts & the community, etc.. A further important, parallel divergence is the fundamental one between general (generic) and expert & specialist practitioners itself, in each of the two main-line components, of health care and social care, but also within other professions, such as the police, probation and immigration services.

With the more modern, enlightened perspectives, there is some gradual recognition of the negative effects of some forms of  intervention; human rights infringements, the effects of institutionalisation and the felt sense of alienation, exclusion and powerlessness. There is also the re-awakening of the critical importance that 'community' had originally played in peoples' general welfare. Older communities had fragmented and collapsed and the more complex, less cohesive and frequently dispassionate, modern replacements; in the form of 'systems' and 'services' (Big Brother, Nagging Nanny, or Authoritative Aunty ), failed to gain the service user's confidence and respect. These appear equally fragmented and increasingly disempowering to disadvantaged service users and the general community.

Of course the 'professions' as receivers as well as practitioners of these services, do not have these experiences (in the main). It is their universe. The wider awareness of these failings increased as the populous gained more enlightened insights, complained, highlighted and demanded better, for themselves and for others. Around this point, more insightful professionals and community representatives, saw the opportunities to improve the 'model' of Health and Social Care and other provisions. To this end the model of Community Care (and Care in the Community) was developed and slowly introduced. This is still happening. It has been quite a struggle to obtain consistency and justice. The struggle continues but becomes increasingly and unnecessarily complicated, leading to confounding arguments, like these.

Modern, reintegrating Health & Social Care still has its specialist practitioners, with each providing  an 'expert' contribution, in a loose network of community support. Attempts by government to generate consistency of care, to enforce cooperation and reduce litigation, have produced the same effects as in past attempts. If you micro manage social systems and its professionals, you end up with a very 'poor average' performance. Excellence is achieved by allowing excellence to excel, not by 'dragging it back', because its unfair that some people get a better deal than others. This is effectively what happens when institutions become defensive and protectionist. We have been here before.

We are supposed to be modelling ourselves upon best practice; but copying existing models, by following scripts and diagrams, misses the essence of good practice, which is almost impossible to describe but much easier to show, or to home grow. Trying to manage professionals by a kind of IKEA or MFI flat-pack diagram is really inept. Like the flat-pack, it is often cheaper but falls apart regularly and has to receive constant attention to keep it fit for purpose (unless it it is just left to be, as an ornamental piece of furniture - there for show only). Legislation and government guidelines are usually minimum standards to which organisations and practitioners are required to aspire. Not the optimum standards by which to ultimately measure ourselves and our effects. Ethics requires a higher standard, but these professional actions are often constrained by micro-management. Some professional groups are becoming infantilised and disenfranchised.

This is what the 'govern from the top' approach does. Extensive micro-management, using rigid, detailed Policy and Practice guidelines, often conflict with patient / client centred working. It means that managers are constantly watching their backs and are supervising practitioners on the basis of the criticism of 'risk' that may arise from responding to individualised 'risk managed' situations, rather than the apparent Zero Risk prerogatives of institutionalising policies. This gives rise to 'zero risk' scenarios, rather than 'Identified & Managed Risks'. The relatively low level of poorer and even lower catastrophically bad practices, that these 'controls' are supposed to address, actually interfere in the efficient, flexible, responsive implementation of good practice. Regression to the mean ensues. Community Care appears to fail because of perceived weaknesses within it.

This new, institutionalising processes disempowers professionals and removes their professional autonomy and the associated ethics. The paperwork and monitoring structures become top heavy and displace valuable resources away for the direct support of service user service and family carers. Administrative support is often reduced, as supposedly 'self filling', electronic forms and computerisation are introduced. The services gradually become too expensive and ineffectual and the community want their money back (quite appropriate to the commercial systems being emulated).

In response, commercially indoctrinated institutions want more for less (to save costs) and this has a stressing effect upon employed professionals and supporting agencies and institutions. Health and Safety principles are breached, staff become distressed and ill health increases, inefficiency and lost working hours ensue, staff turn-over is increased, frozen post opportunities arise, often used as an artificial opportunity to reduce costs once more. Expensive temporary staffing is employed to meet the predictable shortfall in ameliorating risk to service users and to support overstretched line managers, at significantly greater cost than the original post.

Good quality, well established staff move on in frustration and less fussy, desperate, or freshly enthusiastic replacements are found. Pockets of high quality practices are lost and with them, the model required for the other parts of the operation and new staff coming in. So the cycle of deterioration progresses and the services to clients suffer further, with increased risk to them and greater risk of complaint and litigation. In addition, executives and some line managers, expect the Ethics of professionals to induce them to continue to take up the increasing slack that these management practices have generate. This strategy generates greater risk of litigation from employees, concerned at the health impact of the increasing, unreasonable and distressing workloads, or else forces early retirement on health grounds, or negotiated redundancies, often deliberately hiding the problems in termination of employment agreements.

The irony - zero risk is unattainable and seeking it generates frustration, conflict and rejection of support services. It is not real life. All life engages calculated risks and generates them where there are no natural ones. It is part of the human (and other intelligent animals) condition. It is what keeps us alert and alive. That's as true for professionals and clients alike. Attempting Zero Risk scenarios actually increases the risks, due to the rejection of professional interventions and consequential failure of trust. Service users are increasingly savvy. They can see that services are disempowering and institutionalising. The more sophisticated service use (and they will increasingly become so with time), will not accept the second rate restrictive, low quality services that are available from the state. 'Give us our lives back' they say.

Get a life Managers and let others keep theirs. Let go the Power & Relative Status battle. You are welcome to them. Stop using funding and other finite resources, as excuses for promoting bad, defensive and defective practices, blaming the problems on front line staffing. Its not what you have that is most significant but what you creatively do with what you have. Use resources well and more will come. Lead rather than simply 'manage'. Management has become a derisory term; "I am managing (just about, I suppose)".

Think outside the box and encourage others to. Make this your primary Policy Directive for professional staff engaging with clients, along with an instruction to follow their Code of Ethics and the Principles and Spirit of the Convention on Human Rights as efficiently as you can, appreciating that these underpin all the latest and existing government guidelines on good professional and community practices. Creative thinking aligned with a service user focus, produces the most cost effective, efficient and professionally effective services.

Be critical and reflective of yourself and only then fully expect it of others. Be honest about situations and then hope to generate honest responses. If you hide away the problems being faced, then you will be seen as dishonest when all the inefficiencies and cock-ups comes to light, after you have displaced and dismissed the culprits. Worse still, don't fool yourself that you are always doing a good job. Clients tell use we are not. Often (mostly) they are right and we know there are good reasons for this view, even if, because of lack of capacity and institutional frustrations, they express this poorly. We have to be honest with them too.

Giving the impression, to vulnerable and often mentally distress clients and patients, that the service is adequate to their needs and demands, when it is not, is inept and abusive. We are supposed to be guardians against the abuse of our service users. Giving the impression and requiring, by incredibly expansive, intimidating and defensive policy edicts, that the increasing professional workloads, with increasing challenging demands, coupled with requirements for increased accountability and the further requirement to do most of your own administration and much of that of the organisations, is also abusive, bullying management style.

In general, these quasi-commercial approach fails to maintain the Dignity and Respect of employees and generate unacceptable levels of work stress, with cumulative and knock-on personal and family consequences. I have observed better practices in large successful commercial operations, who also put in place better health and work stress management services than the statutory services do, and they are supposed to be the experts in these fields. Such unreasonable demands and inadequate safeguards, generates what the American Litigation Lawyers call 'Overwhelm'. The problem is with managers, not the practitioners, whatever errors they may make.

Further more, instigating disciplinary actions against those who buckle under these unreasonable pressures and progressively were allowed to fail to meet administrative and then more basic requirements, is doubly abusive and makes executives culpable of miss-management, even before litigation in such matters is instigated. Intimidating and dishonest management styles work for a period but like the Emperors Clothes they are eventually seen to be naked when metaphorically uncloaked.

Community, Health and Social Care services can survive and thrive in the current circumstances but it will take a greater degree of honesty, greater humility and open management and governance. The services are in crisis and radical transformations are necessary. Piecemeal changes and repeated tendering for lower cost services are poor approaches to resolving these problems. We need to stop the institutionalising rot now and take a more proactive approach to community support. This takes courage and insight - give way to the qualities in others if you do not possess them yourselves.

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

For More Information Contact: Your Choice - Phoenix Support Services