TO THE RADICAL ELEMENT - Is there
anybody out there?
(This is a message for those who
know they are Radical Thinkers, or who think they may be Radical
and also for those who wish to understand the role better.
This desire may either be so that you can make space for Radical
Action, or, so that you can work to defeat Radical objectives
and maintain the status quo):
Hi, Radicals, everywhere, anywhere!
Keep up the good work. We are slowly getting there but it is a never ending
battle. Watch out for tomorrows radicals, they are on our shirt tails, but they
lack confidence and are just moaning in the smoking room. They will need
encouragement.
I am glad to say we have just about
taken the banner back from the likes of Maggie and Ronald. Son of Maggie &
Ronald fight on, but we no longer have to appear 'reactionary' to their
'quasi-radicalism'. There is such a thing as Community, and together, we are
re-building it all the time :-)
Being a Radical Thinker is hard work these
days. We are relatively isolated because managers of institutions have learned
to 'mimic' Radical Action for themselves. They have taken on the 'sound bite'
and 'bullet point' presentations of the media and used these to give the
impression that they are up front, in the lead, and advancing the needs and
wishes of their clients & patients.
It is all nonsense, of course, but is is a
great money spinner - professionals are now well paid administrators of
paperwork systems, supporting a host of admin and managers, safe in the
knowledge that things are so well tied down that little can go wrong for them,
in theory.
By the time the institutions have paid, or
allocated funds, for executive and line managers, the buildings and their
services, security systems, paperwork & computerised recording systems, none
professional staff, etc., more than half of the limited funds have been assigned
from the available budgets. The actual figure can be much higher.
Of those remaining funds, which are
supposedly allocated towards the direct costs of employing professional staff,
to provide, or organise, direct services to patients and clients, the equivalent
of more than 50% of time is allocated towards administrative duties, like
recording, funding & service requests, training and attending meetings, etc.
In community services, add to this time
cost, travelling time (especially in rural communities) and anything like
60%-80% of time is taken up with activity that does not involve 'any' direct
contact, or benefit to the client, patient, or family carers. It is activity to
justify costing and to reduce risk of litigation to the institution.
Where does the Money Go? Best of luck
community.
By the way. If you hope to obtain
Charitable support, or improved assistance from a Non-profit organisation, best
of luck again. You want, instead, to get a high quality, normalised, responsive
service, at reasonable cost, purchased by yourself, for you, or your family
member? Think again.
All organisations are now required to meet
the same, contradictory requirements for providing an adequate, good quality of
service, in the least restrictive way, focused upon the individual, at best
value, at minimal, managed risk, while; Meeting the obligations of professional
bodies and registration agencies, which restrict anything but the least risky
activity. All of which is paid for by the registering individual, or service
agency and yourselves.
All services, public, private and
charitable, are now so heavily restricted in their actions and are required to
record actions and events in such detail, and operate time consuming process for
all requests for services and funds to provide to service users, that only a
relatively small fraction of the time and resources are directly available to
the person.
The agencies & institutions that are
assigned the role of imposing and managing these requirements and restriction,
themselves cost the tax payer. This cost is nominally assigned as being part of
the service provided to the person in the community. If you do a simple sum,
this means that the cost benefit, in terms of a direct service to the community,
is substantially less the 25% of the original funds allocated.
In fact, it is often much less, but you can
rest assured that it will all be fully justified, to your satisfaction, though
the Audit Commission and other, local financial audits.
Now, does this make your service safer, or
of a higher quality? Does this put service users and staff at less risk,
apparently not, risks are increasing. Has this significantly reduced the risk of
litigation towards the institutions? No - it has actually increased the level of
complaints, in spite of increased apathy. The indications are that litigation will continue to increase.
Thinking outside the box? They need putting
in one.
Being Radical, say 30 years ago, required
us to be:
- reasonably educated
and highly emotional, or passionate, about the issues that
affect people lives, including social injustice, corruption
and wastage;
- have our ears and
eyes open to the realities of life and the vulnerabilities
of our relatively isolated role;
- optimistic in our
beliefs that things can be improved but that this will
require copious amounts of time, energy and resilience and
very little thanks.
- faith in the
abilities of people to be able to change their own
circumstances, with the support of those who have
requisitioned some of the institutional power;
- secure enough in
ourselves that we can give over this power to the people we
support, sit in the background and provide a 'feed' to
community empowerment;
- confident enough in
our own abilities that we can let go of ideas and watch
others take them away and sometimes corrupt them out of
recognition;
- able to step
outside the box and think the unthinkable, risking being
described as delusional, idealistic, communist and other
rather abusive & ignorant accusations;
- an adherence to
fundamental principles and ethics, without compromise, with
politeness, good humour and humility, especially when we get
it wrong.
- (TO BE CONTINUED -
Please add your suggestions by email)
This combination is still fundamental to
Radical Thinking, although the education does not have to be of the
institutional kind, if fact, these days it is best that it is not.
We still need take care, to
watch out for that point where we may dismiss and otherwise put
down, the advancing of ideas & practices of our newer
colleagues. Sometimes these ideas and attitudes will contain
prejudices and may tend to be retrogressive in some ways, but
often they will include positive challenges to us all. We should
always listen & take up the challenge. This is what keeps ideas
alive and our professions advancing out of the twilight age. It
is a learning process.
It is not a required
part of the job to be 'radical' and it should never be. This
would make collective professional practice and teamwork
impossible. It is a separate role that we may choose to have and
use to press for improvements and efficiencies in the services
that we provide. There is a constructive role to be had but it
has to be accepted that it is to one, or other, side of the
debate of mainstay services and the professions. Without radical
action there is only change, never advancement.
For better or worse,
there are constant changes in these services and the
professions, mainly in terms of attitudes and practices. There
are constant pressures form media, government and community. The
responses are often 'reactionary' by contrast. That is, put very
simply; reacting to pressures, criticism and prejudice, often
without adequate thought to the wider and longer term
consequences.
These are often very
defensive reactions. The terms 'reactionary' means little more
than this. The modern radical perspective has to be well thought
out by contrast. Emotion is no longer enough but should remain
in the form of passion. The other important consideration is
that even with the most careful phrasing and illustration, those
good practices that are put forward, often become distorted by
the time Government and the Professional Bodies get 'half a
hold' on them.
When the media and
communities get to the point of saying that a 'new idea' has
failed, this is often because it was not the new idea,
but an old one, repackaged in the wrappings of a developing new
idea, often using its language. For instance; Community Care is
not failing. It is the poor integration and failed professional
understanding, often at more executive levels, and from within
the 'old school club' of institutional thinking, where there may
just be the nominal adherence to the 'notion' of the advancing
principles.
In the main, the
fragmented and disillusioned communities struggle on, still
feeling inadequately supported. This is the impression that I
get from talking with people in need in Europe and USA. And they
are inadequately supported.
The necessary resources
are there, relatively unskilled and begging to be activated.
They are becoming increasingly despondent because of the
inefficiency and limited horizons of the service providers and
funding agencies.
The funds to support most community
initiatives are minimal but control freaks have to put in a
whole raft of controls and protections. That requires a lot of
work for them - so, it doesn't happen.
(To be continues ... )
MOTIVATING
COMMUNITIES & SERVICE USERS:
If you would like some
clear guidelines on how to motivate communities, service users
and cares to co-operate to advance and improve service, then
please ask. These are available. Just indicate what it is that
you want to achieve and we will provide extensive guidelines on
how to package and present them.
The section on the
general principles involved in motivating communities and
service users, is still under construction. We are currently
taking account of the particular difficulties that are faced by
more Rural & Dispersed communities. Adventurous community
initiatives are still operating and developing in the larger
cities and ghetto's. Rural and otherwise dispersed, or isolated
communities have a harder time of it and lag 20 - 30 years
behind by comparison.
These new initiative are
best initiated for and behalf, and in the name of 'service
users' and members of the community, not in the name of
particular professions. Professionals should seed and then
support these initiative but they have to be 'owned' by the
Service User groups and community and they have to get the
credit, or these initiatives will die like all things
institutional.
Here is a useful set of
messages to give our more institutionally minded colleagues and
managers:
If there is one thing worse than
resting upon you Laurels, it is resting upon other people
Laurels. We can keep improving and keep a critical perspective
on what we are asked to do in the name of our clients. This
radical concept has been repackaged as if invented by modern
health & social care as 'Reflective Practice. The difference is,
its requires us to just reflect on ourselves, not the
institution. Both reflections are required.
There is not just a requirement for
on-going training, which
artificially includes the principle of 'reflection'. Reflection
and improvement should be a natural inclination, just slightly
more conscious than the level of 'intuition'.
Reflection
is the minute to minute, comfortable acknowledgement of what is
working and what has failed, correcting errors as we see, or
make them. Hopefully we are looking for these errors, if we are not
totally convinced we are right all the time.
The
slightly artificial exercises that we do at college are to get
us into that positive and considered way of doing our job. The
are not meant to be something we just do now and then, as an
exercise. Keep a critical perspective on yourself, others and
the institution. Don't just moan about how things are.
WE
CAN KEEP IMPROVING THINGS, LIKE OUR
BRAVE AND COMMITTED PREDECESSORS DID. THEY HAD LESS TO GO ON
WITH THAN US AND FEWER MATERIAL REWARDS FOR DOING SO.
More to come . . .
What makes us tick?
Radical Colleagues.
We only occasionally
have the chance to meet up but our objectives remain mysteriously the same:
Is it your desire to empower yourselves and other service users? To adapt
professionally to changing needs and demands?
In doing this, do
you seek to do so without loosing the essential qualities that gain the
respect of those we assist? Are you willing to take calculated risks, in the
interests of others, sharing this with others & acknowledging when you get
it wrong?;
Then you are
radical enough. Please email us with what other qualities you think are
important and criticisms of our site and these ideas. Apathy and grumbling
have no potency and feeling frustrated and powerless is a disservice to our
clients. We own it to them, ourselves and our colleagues, to remain sharp and positive.
NOTE:
Remember also, there are such things as Conspiracy Theories,
that is why they have been given this name. The point is; Is
there any substance to them? :-) Mostly the cock ups we continue
to experience in health and social care are due to collective
ignorance rather than conscious design.
These
are the consequence of blaming others, without reflecting upon
their own 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 protecting and self-interest lines.
Conspiring take to much effort , requires dynamic organisation
and quite sophisticated thinking. It is unlikely to ever happen
in health and social care.:-)
See: Conspiracy Theory.
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RADICAL
NEWS UPDATES:
Primary Health Care:
UK GP's
have got a great deal, as have Consultants. The Junior Doctors
situation has also improved a little over the last few years.
Best of luck to them all. Unfortunately, established GP's have
also lost energy, having won a personal lifestyle battle. We can
expect less Radical Action form them these days. PCT's (Primary
Care Trusts) are now mini institutions in their own right, self
protecting and self congratulatory, like their Hospital and
Local Authority counterparts. They are run by mainstay GP's and
professional administrators. Its all about accounting &
litigation. Its about 'control'.
UK Junior Doctors seem to have retained
their radical streak, however. There is some hope for the continued
development of Specialising Expert GP's and the future of 'Radical Elements'
within Consultants is also reasonably assured. There is also hope for the long
promised, truly multidisciplinary Neighbourhood Teams, some time in the future.
Presently, I fear Neighbourhood Teams and GP Clinics will be little Empires of
closely allied professionals and under-trained, underappreciated, social care
workers, who the mainstream GP can maintain some control over.
PCT & Continuing Health Care:
Returning to PCT and considering CHC (Continuing Health Care) funding; What is
going on? First you have it then you don't! After years of playing God with
allocations of funds and services to people who are desperately in need of them,
the Government (who persistently underfund services) sends out and edict, with clear guidelines to ensure a more
consistent and fair allocation of funds to those desperately in need of
specialist, or intensive health care within the community.
With the usual fanfare of optimism and
enthusiasm, we all get trained up on the new systems, with promises that there
will be a farer allocation of funds and clearer criteria for identifying health
care needs and funding entitlements.
All the indications were that this had been
achieved, at last, with a challenge 'to get it right' in terms of Metal Health
and Dementia Care. In our patch the assessment process was effectively limited to Nurses.
Other, specialist health care workers, including Mental Health Social Workers
were effectively excluded (contradicting the guidelines). This may have
something to do with the fact that we tend to challenge decisions more.
The result! Little difference in the actual
fair allocation of additional funds within the community, especially for specialist health
care needs & particularly Mental Health. All the more strange when you hear the
argument that Mental health is, by it name, a Health Care issue. Once an
institution always an institution. Change by virtue of the changing of the names of
processes only. Same old protected and unjust service to those with the greatest
needs and least ability to vocalise them.
Get a life will you, health care
administrators, try to remember your original 'ethical' & moral commitment, and
while doing this: Do you recognise the bit in the CC&HS legislation where it
describes how we are to 'assess according to (clinical) need', without
consideration of costs, 'then' identify the resources required to meet the need,
'then' allocate appropriately that which is available, 'then' record, publish
and feed back to Manager & appropriate government agencies, the identified
shortfalls.
Some 16 years ago I remember having this
discussion with a Team Leader in a CMHT. In that instance the assessments were
being done 'explicitly' on the basis of the resources available to the service
at the time. Staff were instructed to do so, by Memo.
I explained to them, that doing this would
mean there was no way to identify if there was a shortfall of resources. It was
clear, even then, both in Health and in Social Care, that there is an active
tendency, by some managers and a few practitioners, to protect resources in this
way (WE ARE REQUIRED TO PROTECT RESOURCES, AS RESPONSIBLE PRACTITIONERS).
By pretending that there is NOT a
particular level of need and demand we are doing a disservice to our patients
and clients, hiding the need and demand is dishonest (IT IS PROFESSIONAL
MALPRACTICE BY PRACTITIONERS AND MANAGERS). We are obliged to find and use an
honest method, disclosing to clients & patients how we can not meet their
legitimate needs in the way we assessed as most appropriate. It is also stated,
local policy to do this, although how its is to be practicably done can be
problematic.
Community Heath Care:
The development of Community Health Care services continues. Some of these are
closely managed by GP's but there are also relatively independent practitioners
& teams, within the community already. In fact, Community Health Care
practitioners look to become more definitively independent practitioners than
their Social Work counterparts.
This has to be good news for Health Care
Services. Any moves like this will tend to reduce the tendency towards
institutionalisation and provide the opportunity for practitioners to be more
responsive to patients needs. This aids the potential for Radical Thinking and
provides potential for further challenge to the general institutionalising and
quasi-commercialising tendency of health services.
The increase in Community Health Care
Specialists is good news but these tend to be tightly 'managed' within
specialising Health Care Trusts. This means that the tendency towards
independent practitioner status is inhibited. Specialist Health Trusts tend to
be quite conservative, protectionist and defensive. The tendency towards Micro
Management takes away Professional Autonomy and reduces professional
initiatives.
Radical Thinking under these circumstances
is very difficult. The professional roles tend to become very defensive in these
circumstances. Such Trusts are tending to fail, however, and we may see newer,
more 'open' systems for managing Community Health Specialists in the medium to
long term.
Hospitals Services:
Everyone seems to like to knock hospital services at the moment. It is the
privatisation of the hygiene & hotel services that started the current
deterioration in standards. Poorly paid and poorly trained staff, working with
little respect, or appreciation. Little in the way of recognition as part of an
important health service, in spite of being perhaps the most important bit of
it, when it is done well and with adequate resources.
Paramedic Services:
More work, more
responsibility, more accountability, more commitment, more enthusiasm, more
rules, more don'ts than dos, poorer work environments and conditions for
relatively poor wages and significantly less say. Less colleagues, less
vehicles, less support. Come on fellas, speak up for yourselves. We know what
you are up against
To Come.
Definitions:
Radical:
Why do we describe ourselves as Radical? This stems from a very clear
definition of the term, as used in science. Free radicals are 'open'
[shell], highly reactive and keen to bond with other radicals & reactive
entities, while retaining their own special character.
Thus, this concept of Radical
is associated with the potential to be open to change: responsive and
reactive to knowledge, experience, ideas and other perspectives. While being
thus, they also remain true to their own character and expanding knowledge &
experience.
‘Change is in all things sweet.’
Aristotle
(but never change for change sake. Terry C.)
Positive Change:
In this way Radicals fit into the existing dynamic system and
promote improvement changes (as knowledge develops) and ensure the established
system (of the time) remains fresh and energetic; avoiding stagnation and decay.
Anyone that effects positive change, over the blind
maintenance of the status quo (or self interest), can consider themselves to be
Radical. If this describes you in any way, please join us and support the cause
of alternative, person and community centred, perspectives and practices.
‘We
must change in order to survive.’
Pearl
Bailey
Mal-adaptation:
This mal-adaptation of some individuals to their families,
culture and communities, extends to most serious 'mental illnesses' and
much criminality. This includes schizophrenia, bipolar conditions, clinical
depression, & most addictions; All of which can be 'pragmatically' identifiable
as negative consequence of the mal-adaptive expression of our more creative
human propensities.
Social Dynamics, Rule 1 is; to every action there is an equal
& opposite reaction (external &/or internal). Rule 2 is: In circumstances, where
there are restrictions on the positive, or constructive expression of inherent
abilities (of any kind); distorted, distressing & destructive expression will
ensue; in some identifiable form.
This will be evident in the internal psychodynamics,
expressed thinking, gross behaviour and the general social dynamics of
individuals and groups. The more immediate, consequential 'reactions' can be
directed inward or outward, but the ultimate consequence is a negative social
outcome. a destructive outcome or loss of social benefit.
See Genetics Unplugged
Adaptation:
More of this is explained else where. Our role here is to
help you appreciate the potential, skills and knowledge you possess and get our
cultures & communities to appreciate the positive potentials more fully,
allowing you to realise a 'healthy' adaptation of your propensities &
abilities, within your cultural and community milieu.
It is our broad argument that human adaptation extends beyond
mere biological determinism. The adaptation is two way and human beings are
adapted to be adaptive. We have the extraordinary ability to adapt our
environment and our bodies, to our prevailing personal / social dispositions &
inclinations. We can even 'actively' change our body chemistry, through our
behaviour and thinking, or through medical interventions.
Many animals can do this in some measure but we are so close
to this capability that we are largely blind to it. Our abilities are
principally expresses as anecdotes and 'alternative' explanations, rather than
serious scientific explanations.
See Genetics Unplugged
‘Those
who have changed the universe have never done it by changing officials, but
always by
inspiring
the
people.’ —
Napoleon Boneparte
(No I'm not deluded, Or paranoid. And of course, if you stop inspiring the
people, 'they' change the Leaders (one way or another)
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