Barbara Prynn interviewed by Joan Rapaport for WISEArchive on 15th October 2008
So, can you give me an outline of your career in social work?
Okay. Well, I did a social studies diploma in the course of which I did day a week placement in the first year, and then a block placement in the summer between the two years, and then I decided that I wanted to be a psychiatric social worker and at that time the APSW, Association of Psychiatric Social Workers, had a trainee scheme and so one could apply to be a trainee in a particular place where one would have a supervisor.
What date was this?
I graduated in 1962 so I am talking about the end of 1962. So I applied to three different places around the country – decided that I wanted to be somewhere where there was a university, which seemed like a good idea, and ended up in Glasgow working as a trainee PSW in the Professorial Unit in the general hospital, I was there for a year and one was supposed to do three years and some people do it for two. And then I didnâï¿½ï¿½t want to have any of this new fangled generic stuff so I applied only to one mental health course, as they were called then. I went to Manchester where I did the mental health course, and this was also located in the medical school, which is a separate building which also was a professorial psychiatric unit. This is a training place for doctors primarily, psychologists, OTs, you name it. That was a twelve month course, and of course I did placements there. And then I decided I wanted to work in London so I got a job at what was then called the Marlborough Day Hospital – which is now Marlborough Centre in St Johns Wood.
I was there for two years, in the course of which I got married, and because my husband wanted to do a PhD in Sheffield we then moved to Sheffield and I got a job as a senior mental welfare officer in the local authority in something which was comically known as social psychiatry service. Quite what this was about I do not know, but I was there for two years. Then for the third year we were in Sheffield I went to work as a senior psychiatric social worker in yet another professorial psychiatric unit, which is also part of the general hospital which was also in a separate building which is a mini stately homes in grounds of its own. I was there actually for about nine months and then my husband got a job in Ipswich and so I needed to get a job in Ipswich as well. We are now at the end of 1969, and I got a job teaching at what was then called Ipswich Civic College (but is now called something different but it is still there), and because âï¿½ï¿½ I should go back a bit âï¿½ï¿½ or maybe we will talk about Seebohm later âï¿½ï¿½âï¿½ï¿½ so Seebohm was on the horizon and I was appointed teacher on a child care course, but we were also taught in parallel with and very much more together with a course for health and welfare. So while I was there the two were kind of put together and became a Younghusband CQSW course and I was there for canâï¿½ï¿½t remember, about three years. My children were born during that time, then my marriage came to an end, and I worked for several months, maybe about nine months in Ipswich in the social services department, mostly in child care, not entirely but mostly, and then decided I wanted to go somewhere else, somewhere else where I knew people.
So I came to London which I never thought I would, and got a job as a medical social worker in a general hospital in South East London where I worked in the cardiothoracic surgical unit. I was there for two years after which I had had enough of that, it was gruesome as you can imagine, and I was looking for … I worked part time most of my working life has been part time. I was looking for another part time job which wasnâï¿½ï¿½t very far away, then the hospital in Greenwich, doesnâï¿½ï¿½t exist any more. So I saw an ad for a job in Bexley in adoption and fostering and they were amenable to taking someone on part time, so I decided I would do that. I did that for three years and decided that I rather liked it, except that adoption in Bexley was all about babies, not very interesting. Actually during this period, and I had forgotten that until now, I did a course at the Institute of Family Therapy whose name I cannot remember. The tutors were Margaret Robinson and Arnom Bentovim. Yes, I think he must have been the course leader. And this was about reconstituted families; this was a yearâï¿½ï¿½s one evening a week course and this was very significant for me. I was getting bored with doing adoptions of only babies and there were other people who were part of this course – I think there must have been about fifteen of us, who were involved in various voluntary and statutory settings in working with older children and finding adopted families for them.
So as a result of that, this was the end of 1979, I went to work in Tower Hamlets in what was then an adoption fostering team, which then became through lots of different ramifications, only an adoption team. And then when Tower Hamlets for a period of three years, I think, had a Liberal as opposed to Labour administration and the whole borough was divided up into what were then called neighbourhoods, one was then taken out of oneâï¿½ï¿½s team and placed alone in a neighbourhood where one was the resource for adoption and fostering and then one was gathered up again when the administration changed. Eventually in the last âï¿½ï¿½ and then working in an adoption team I started because I was interested in doing this, and had been since I had worked in Bexley actually, interested in doing post adoption work with adults, and also with people who had been in the care system who were now adults, I spend most of âï¿½ï¿½ and I retired three years ago âï¿½ï¿½ I spent most of the time until then working with those people, but also in the last three years since the 2002 Adoption Act in a post adoption team – which was about post adoption in the sense of supporting placements that had been made. So also with adults, but also with post adoption and in their wisdom they decided to hand the post care work to another team – so that was what I did.
However during all of this I was doing other things as well, like my first connection with the Tavistock was in 1984 when I did the two year post qualifying course there, which then led on to do an MPhil and PhD at UEL and while I was still working on the PhD and when the post qualifying course that I had been on, which is now an MA course, first became an MA I was asked to teach on that. So I taught social policy, child care policy on that for I suppose about – I donâï¿½ï¿½t know – ten or twelve years until four years ago they decided that they werenâï¿½ï¿½t going to âï¿½ï¿½ they amalgamated the PhD and the MA course and then they decided that they were not going to fund what they called visiting lecturers any more so that was the end of that.
So, that was kind of a background to the work I was doing.
When you were on your placements – where were these placements?
Well, I did the PSW course in Manchester âï¿½ï¿½ well âï¿½ï¿½ when I was doing the diploma I did one day a week placement in a probation office because I thought misguidedly, not knowing anything about it, that I would want to be a probation officer. And that dealt with that really. In the summer, because my family lived in Cambridge, I did a two month block placement at Fulbourn, which was an eye opener.
In what way?
Well, I didnâï¿½ï¿½t understand then, and it has only been relatively recently that I understood that David Clarke – who was a family friend was one of the people who changed the face of the mental hospitals as it was then – and one of the things that I did … I had a very good supervisor, whom I still know, who explained to me how to do visits – which nobody in the probation service had done. But one of the things I had to do, one of the things that David Clarke introduced, was a ward meeting in the locked ward of the female patients. And so this happened every week much to the dislike of the medical staff it has to be said, and so I had to attend this. I find this completely terrifying – the whole thing was completely terrifying and walking along the hospital corridors was terrifying – however this was clearly an important learning experience. So then when I did the mental health course in Manchester I did three placements; the first one (I mean I am not going to do them in order), one of them was in the unit where we were taught where everybody was kind of equal, so that there would be case discussions where patients would get wheeled in. And the people who had processed the patients would normally be a student social worker and student member of the medical staff [who] would then have to tell the professor who sat there taking snuff while all this was going on what they had learnt.
In front of the patient?
In front of everybody. And so this was again a pretty scary experience
For you or for the patient or for both
Well for me; actually I didnâï¿½ï¿½t do too badly but somebody was always getting shot down in flames by the Professor each week, and it …
For putting a foot wrong?
Yes, and you thought âï¿½ï¿½who is it going to be this week?âï¿½ï¿½ So that was one placement which went on for about four months I think, and then another placement which was in a Child Guidance Clinic in Salford where nobody really explained to me what I should be doing. I remember being told off when I was sent to visit the parents of a child who hadnâï¿½ï¿½t turned up for an appointment – no I was sent to the parent of a child – thatâï¿½ï¿½s right – and she didnâï¿½ï¿½t turn up for her appointment and so I stuck a note through her door and asked her to get in touch so she could have another appointment. I was torn off a strip by my supervisor who said âï¿½ï¿½if people are not motivated to come for their appointments then we do not send them another oneâï¿½ï¿½. So, however, that was a very useful placement where I learnt how to do social histories and where – it was a very traditional clinic – and where the psychiatrist in charge was very positive about teaching one thing, so that was good. And the final placement was in a mental health department in Suffolk which had a connection to the Maudsley, where one went to clinics every week because it was down the road. There again my supervisor was and still is a close friend, but that was a completely different experience, very busy office. I canâï¿½ï¿½t remember actually what I did there, but so I had those three placements.
Yes thatâï¿½ï¿½s right, but the busy experience – did you feel you enjoyed it?
Yes. No, no, I enjoyed all of it. What I didnâï¿½ï¿½t enjoy was being in Manchester and the tension between my political and social life and the work I had to do for courts which sometimes got in the way and that was annoying but, no no, I enjoyed all the placements.
And did you feel that the dignity of the clients was respected?
In the placements?
Yes, in the placements, especially the hospital, or for example where people got shot down in flames.
Oh I think so. There were people who were doing very interesting things there, and my tutor, a well published PSW quite famous in her field, had done a lot of work herself, and one of the psychiatrists ran a clinic for people who wanted sex changes, for example, which was probably one of the first clinics in the country where they did this. One was involved in some of the assessments of the people, as to, you know, whether they should be allowed to have the surgical intervention or not. So this was very much about respecting people, you know, how people wanted to see themselves, and yes I think so.
Do you think it was taught, or do you think it was implicit?
It certainly wasnâï¿½ï¿½t taught, explicitly. I mean most of the people on the course … I mean I was not seconded, I had a state scholarship and I found a job afterwards. Most of the people on the course – I mean there was one person a month younger than me – all the others were between I donâï¿½ï¿½t know anything up to twenty five years older, and they were mostly people who worked in mental health departments. So the teaching was very much geared towards that. Obviously the placements werenâï¿½ï¿½t, so that, no I donâï¿½ï¿½t think there was anything explicit.
But it was implicit that you felt clients were respected?
I think so, yes.
In terms of their lives and forward planning?
Yes, I think so.
On the course were there any similar concepts that were part of the curriculum?
I donâï¿½ï¿½t think so.
And so the subject wasnâï¿½ï¿½t explicitly touched on at all?
I donâï¿½ï¿½t think so, although there were explicit lectures, seminars on issues to do with admitting people to hospital, for instance, because I never saw that and wisely, as being part of my life at all I paid no attention – so I canâï¿½ï¿½t actually answer any questions about that.
When you reflect on your years as a social worker what would you say were the main differences in practice when you started out and when you came to the end of your career?
Well, I think one very important difference is to do with supervision. I think that certainly in the PSW sphere, the idea of having supervision – which was partly policing of course, but also educational – was absolutely essential in terms of what one did. And so one could go to oneâï¿½ï¿½s âï¿½ï¿½ and one was also expected to write process recordings all the time about everything that one was doing and oneâï¿½ï¿½s supervisor would go through these with a fine tooth comb.
Was the process record ever explained to you, what it was?
Yes, it was part of the course
And what was the explanation you were given?
You mean as to how one was to do it, or why it was done?
No, well both really. Were you given âï¿½ï¿½ was it just verbatim or was it actually more than that?
As far as I recall it was verbatim âï¿½ï¿½ I mean what I do remember is when I went to work as a trainee the process recording was also âï¿½ï¿½ this was even before I did my training of course âï¿½ï¿½ this was something that I was expected to do and I can remember starting off a report âï¿½ï¿½ I could also type because I did a secretarial course in an earlier life, so life was fairly simple and there was always a typewriter, I didnâï¿½ï¿½t have to hand write these things. So I would start off every report with âï¿½ï¿½ âï¿½ï¿½I went to the ward and collected miss so and so and we went back to my room and then we started to talk,âï¿½ï¿½ So this was …
It was what you remembered; you were not actually taking notes in front of the client?
I took notes on home visits because I could also do shorthand, very useful, but not âï¿½ï¿½ no not in my room which in that instance was a form of sluice of the EG records, which is another story. But, no, I didnâï¿½ï¿½t take notes while people were talking; but this is also an exercise in memory.
So that one would learn to remember to be able to regurgitate what happened.
You would have to remember the significant bits really.
You would have to remember as much as possible or otherwise it wouldnâï¿½ï¿½t be a process report.
So that wasnâï¿½ï¿½t done in front of the client, did the client know that they were having a process record taken from them for example?
I donâï¿½ï¿½t think at that stage the clients knew at all that something was being written about them. I think whether they had any idea that they were medical notes. They would have known of course that there were nursing notes because you have the cardex on the drug trolley; and of course they were all on drugs of one sort or another, plus other things like ECT for instance was very common, very frequently done, the fact that I would be writing the notes I am sure never occurred to them.
Or I doubt if it did.
In your working life at the beginning it was implicit, at the end of your career how was dignity encapsulated, if at all?
I mean there were issues that âï¿½ï¿½ I mean there have been still live issues that one is expected to think about, which are to do very much with political correctness I think, that one has to respect – and this is explicit peopleâï¿½ï¿½s family background – difference, respecting difference, is one of the major tenets as to how much peopleâï¿½ï¿½s dignity is actually respected, is something else, I think. For instance if one thinks about the adoption approval procedure, sometimes called vetting, very difficult to think of a good word to call this process- assessment is another word – people know that they are being assessed and they know that something is written about them because, of course, they have to see what is written about them.
Oh, though how much they can influence what goes into the finished product is another question and probably depends person to person as to how amenable they are to changing things or taking things out, but the way in which people âï¿½ï¿½ in respect of doctors for instance – are talked about in the workplace is another story entirely and I think they are not always accorded as much dignity as they should have I think âï¿½ï¿½ I mean bearing in mind that adoption like other areas in social work is a very sensitive business and although there are many guidelines and a lot of research I donâï¿½ï¿½t think that workers on the ground pay attention to any of these things. There is a great fear – particularly now in the era of targets etc. etc. which adoption agencies have to meet like any other social agency – I think there is a great fear of making mistakes but people also (because sadly it is rather hit and miss business) that adoption workers sometimes work with people they like so they want to push them forward, perhaps because they like them or something. And there are people that they donâï¿½ï¿½t like; and so the conversation about applicants, we have approved people or they may be sniffy as they are now, and why not? Because they are a different class of person than they used to be, who may object to being done over by social workers and make demands, particularly for resources, which there may be few of – that sometimes the way they talked about behind their backs is âï¿½ï¿½ you know doesnâï¿½ï¿½t afford them any dignity at all and is actually very negative. I realise that this is a function of the difficulties of work and this applies to many things in social work but it is also harmful and social workers need to protect themselves and the agency perhaps, needs to protect itself. But I donâï¿½ï¿½t know, there is something unsavoury about this.
Do you think that there is an issue about supervision there?
Oh, indeed there is. I mean I said before when I started out supervision, you know you had to have a supervisor and you saw them very regularly every two weeks, and they went through everything. You know they wouldnâï¿½ï¿½t hesitate to point out that you werenâï¿½ï¿½t doing it right, and you could ask them things, because hopefully you might have a good relationship with them. With the advent of Seebohm I think things âï¿½ï¿½ there started to be a downward slide when it came to supervision, when supervisors or team managers or team leaders or whatever they were called became team managers and they had people âï¿½ï¿½ you know they had to watch their backs because of people above them and so supervision changed I think.
In what way?
It became less frequent – became more about, you know, particularly in the last ten years perhaps, became more about whether you were going to be targets. I mean I have had a couple of complaints, or nearly complaints made about me. So oneâï¿½ï¿½s manager was always concerned about there being complaints that might stick to them, and so that supervision wasnâï¿½ï¿½t at all about âï¿½ï¿½why donâï¿½ï¿½t you see Mrs so and so?âï¿½ï¿½ more often for example, or what you actually do when you see her. And there wouldnâï¿½ï¿½t be any looking at oneâï¿½ï¿½s files. In fact the way files, childrenâï¿½ï¿½s files, are created now, when they come to look at them when they are older, and want to look at their files they are not going to learn anything, as there wonâï¿½ï¿½t be anything interesting. It is more about what the social worker did and after the social worker had finished the interview they would then tick off that they had seen them, and tell somebody else about it in one paragraph as opposed to quite a lengthy process about what conversation was about. So I think supervision has changed drastically, for the worse.
Right, having had a knock-on effect on the dignity of the client?
I think clients, or service users or whatever one is wishing to call them, kind of hardly come into the picture at all sometimes. I mean when I was supervising people in the workplace, which I have done, I did read their files and I did talk to them about what they were doing etc. etc. I know from my own experience of it that not everybody does this, and I guess as time went on … I mean one of the things that has changed of course, is … I mean I moved around a great deal, as you gather, in the early part of my career as one did, and as one could, and then didnâï¿½ï¿½t for all kinds of different reasons. Whereas when I started out, people would perhaps have one or two jobs in their working life. One is rather looked down on for having stayed in the same place for a long time, regardless of what one might have done during that period. Because people donâï¿½ï¿½t stay around for very long, they are busy sort of moving up etc. etc. So you know for a long time I have been in a position of being supervised by people much younger than me, with much less experience, who may be were intimidated, but maybe not, but whom I wouldnâï¿½ï¿½t, I have to say, have dreamed asking advice about what I was doing, because I knew they werenâï¿½ï¿½t going to be able to help, but whose interest in supervision was completely different. So yes, things have changed a lot.
So, in spite of the rhetoric, the service user and carer voice or dignity âï¿½ï¿½ there is a downside – there is another aspect to it in terms of the quality of the support that the worker is being given.
I think so, and I think also that whatever you call any of this, the power relationship between the social services department, or whatever one calls it, and the client population hasnâï¿½ï¿½t changed and it canâï¿½ï¿½t.
No, right. You mentioned Seebohm. Was there any impact from Seebohm?
Oh yes, I mean when I was in Sheffield in the sort of run up to Seebohm there was a very lively multi social work group, a sort of precursor of BASWA which included people from all social work agencies – including probation interestingly, which then in England and Wales was not part of the new department, although it was in Scotland of course. And so we were already building up relationships between the different groups and I remember going to a very good seminar group where we discussed cases where there were senior people from all different social services agencies at the same time. And then of course when Seebohm actually happened I was teaching and this was very good because I visited students in placements, who were in all sorts of different placements having been brought up to do different things. Because some of them were kind of ex-university students who hadnâï¿½ï¿½t worked in the field and some much older than me at the time, so I had a pretty good overview of what was going on. I mean being in Suffolk we had a lot of students and placements in East Anglia and also in London, so I did a lot of visiting placements. Then I must say when I did my post qualifying course at Tavistock and explained how pleased I was to be able to go and work as a medical social worker, my supervisor – who of course was a PSW – my tutor I should say rather than supervisor, said âï¿½ï¿½well PSWs were always able to do …âï¿½ï¿½ because we were always the top of the pile and so we would always go and do whatever we liked. But for me, not having thought about it that way, this was liberation and I could then go and be a medical social worker or be an adoption social worker or whatever, yes.
So your core training was multi-purpose.
No, my core training was a mental health course.
But in fact it served its purpose?
Oh yes, it did
Transferable skills par excellence.
How was information about service users and clients gathered? You have mentioned about the hospital where you had a rigorous social history, do you wish to say anything more about that in terms of …
Well, the social history idea continued throughout my course, and certainly continued when I was at Mulberry day hospital …
What about towards the end of your career?
Interestingly, if one thinks about the adoption field and the forms that have to be completed for prospective adopters and foster carers, I mean one could construe these as being social history. I certainly would and again I think they are written in different ways depending upon who writes them and depending upon the manager of the team, and some of them have a lot of information some donâï¿½ï¿½t. But interestingly I had always seen them as being an excuse to produce social history and I would always ask the applicants in the same way as I did many years ago for their life story, yes.
So, in the adoption side of things social history is honoured.
It is not called that, although in a bid to get it right, various agencies had done different things, I mean for instance the adult attachment interview has been used, is being used, in some adoption agencies mostly voluntary and not statutory, as a way of trying to assess better prospective adopters. And although this isnâï¿½ï¿½t a social history in a sense it is, it is [?] history I suppose.
It is just very interesting that point you have mentioned. Would you like to say any more about how people were assessed?
How people were assessed âï¿½ï¿½ well I suppose I didnâï¿½ï¿½t actually, until I went to work in the social psychiatry services, which was in the health department. I wasnâï¿½ï¿½t involved, I canâï¿½ï¿½t think that I was involved in assessing anybody for anything at all. I was âï¿½ï¿½ you know I had a case load, and I suppose to keep things ticking over and help whatever it is one is supposed to be doing, but I wasnâï¿½ï¿½t actually assessing whether a service would be provided for these people or not. Clearly when I was in the mental health department, where I was involved in admitting people to hospital, I was involved in assessing whether they should be admitted to hospital or not.
So that was some years ago, the admissions?
Yes, that was in the late 60s.
When a social history would have been taken?
Not if one was called out in the middle of the night.
But was it quite regular then for a social history to be taken in the 1960s? You would make a social history if you saw the client on a longer term basis?
If I was the first social worker, yes, I would think so. I donâï¿½ï¿½t have any clear memory of that.
Okay, thatâï¿½ï¿½s helpful. And how were people cared for or supported do you want to say anything more about that, I mean because there are two types of service you have got here, arenâï¿½ï¿½t there the mental health and then the adoption, are there any contrasts at the beginning and end
A Well I suppose, I mean by the time I had moved into the adoption field I had really been working quite a long time, and I suppose although my training wasnâï¿½ï¿½t at all psycho dynamic, the Mulberry [?] Day hospital certainly was. I mean, I started the post qualifying course at the Tavistock in 1984 and I saw this as a bringing together. I mean it struck me with surprise that âï¿½ï¿½ you know what this was doing was bringing together the adoption child care field that I was working in with my earlier work in the mental health field was kind of surprising in a sense … sorry I have lost what you asked.
How were people cared for and how were they supported âï¿½ï¿½ yes âï¿½ï¿½ so I think the psycho dynamic view – and I have also done various family courses etc. and as part of my post qualifying course we had to do which everybody at the Tavistock does, infant observation – which was very very significant for me in my work in every sense subsequently and remained so. So that the kind of observation one had to do in terms of taking social history and being able to write process recordings for instance, is something that I started off with and I am just remembering that when I did my placement at Fulbourn my supervisor said that David Clarke always says one has to listen a third ear (actually this is a quote from Freud, but never mind) so that one has to listen therefore to what is behind what people are saying, but one also has to notice what one sees, both in terms of the individual and the family group. There is more than one person one is looking at, or in the room with, so that has kind of stayed with me and that has influenced what I have done even in the situations where nobody else was doing this or cared tuppence about whether I thought it was an important thing to do.
So that is your care really isnâï¿½ï¿½t it, you are watching …
You are watching to see what peopleâï¿½ï¿½s needs are and paying attention to them, and then trying to do something about them.
And you carry this on to this day. But do you think others around you are doing that, your peers?
Well, I mean what is interesting âï¿½ï¿½ I am on sort of swings and roundabouts really – is that when I was teaching at the Tavistock it is … well I mean okay the groups are small … but the groups that I was teaching were people who were mostly in senior positions in various aspects of social services or sometimes voluntary agencies, who felt that there should be something – more that what they were doing wasnâï¿½ï¿½t satisfying. People would say âï¿½ï¿½well I didnâï¿½ï¿½t come into social work to be ticking boxesâï¿½ï¿½. You know what it is people say. And so there is a sort of slightly comforting feeling that there are people who think one should work in the way that one was trained to do, and can take advantage of that when it is laid out for them that it is important to write comprehensive reports when you see people, and important to take note of what is in front of you when you are with a service user. But there are people who welcome this and hopefully take it back to their agencies and encourage other people to do the same.
So it is not dead yet âï¿½ï¿½ but it is?
No, not at all.
But it is having a struggle …
Oh, definitely having a struggle yes.
And were there sufficient resources in terms of helping people and also I think we need to do a sort of beginning of your career and the end of your career.
Certainly. I mean, well, in most of the mental health agencies I worked in I think initially there were sufficient resources Whether when I was a mental welfare officer there were sufficient resources to provide the client population with the different things they might have needed I am not sure. I mean it was a kind of all or nothing approach. There were attempts at after care but not much. I mean this was the middle sixties and sort of the beginning of the revolving door and so I guess there were resource issues. I mean subsequently in the adoption, fostering, field there is always a tension between the needs of the child and in terms of new families and whether or not new families are the right new families whatever the flavour of the month happens to be. And there are never enough foster carers for the children. I mean this is a balancing act and so, yeah, I think there are serious resource problems there. And certainly in the post adoption field, where adoption agencies have to provide for educational health and social needs for all members of the adopting families until all the children are eighteen, there are huge resource implications, with local authorities not wanting to provide what they see adopters wanting or other agencies suggesting they should have; in a way because if an adoptive family moves from one area to another, a new area which perhaps knew nothing about these people then has to foot the bill for any of their subsequent needs once they have moved into their area. It is a bit like moving people from one poor law area to another in a way, except … so that there are issues there.
Smacks of the National Assistance Act doesnâï¿½ï¿½t it?
Intending to move?
So there are never enough resources.
I think not.
And does this mean there is a lot of hardship or children who need foster care?
I think they donâï¿½ï¿½t always have the right placements and the placements are not always supported appropriately or sufficiently.
So that is a knock-on effect on dignity again.
Oh, indeed yes.
Respect for their needs.
Yes and not to mention their parents.
Yes, we are coming on to retirement âï¿½ï¿½ have you an example of being treated with or without dignity for yourself or relative or someone close to you in a care setting?
Yes I do; one that I was aware of some months ago which has stuck in my mind because it was appalling I thought. These are friends, not relatives, who are both 90 and who moved into a care home in the middle of April. Because there are two of them – most of the people in care homes are single and so they have a room – because they are a couple they have two rooms, one of which is their bedroom and the other their sitting room but they are on either side of the corridor. Because I mean I was there in the middle of the day for some hours – I assume whether this happens at night but it certainly happens during the day – all the doors are open. So whereas their living quarters are separated by this passageway there are people going up and down the passageway. There are lots of staff and lots of people with their Zimmer frames going up and down but I notice also that the other âï¿½ï¿½ all the other doors were open to all the other rooms âï¿½ï¿½ and some of the people were in bed or doing personal things or whatever. It struck me as not being fantastic. I was pleased that my friends had two rooms but âï¿½ï¿½ and on the door of each room and this is in some ways helpful and some ways it isnâï¿½ï¿½t there is photograph and the full name of the person who inhabits the room. Well I guess this is good because it means that the staff who go into the room will know âï¿½ï¿½ wonâï¿½ï¿½t make a mistake perhaps, because there is a picture as well as a name, and my friends because there are two of them had two rooms, her label is on one door and his on the other. Okay so we go and have lunch, and this looks like a brand new, not very old care home, and we sit at lunch at little tables and we sat at a table the three of us. What I noticed then, deeply shocking, is that the husband who is a professor – or was – has his, not sure I canâï¿½ï¿½t remember whether he has his title on his door, she certainly doesnâï¿½ï¿½t, but the staff serving the food and came and brought him his pill etc etc when he had finished eating consistently referred to him as professor, not by his name, just professor which âï¿½ï¿½ I am sure âï¿½ï¿½ this is not what he would like at all. But what struck me as being deeply shocking was – and I hadnâï¿½ï¿½t realised – that the wife who all her life has been known by [one] first name, also has another first name which happens to be her first name. She had always been called by [her] second name, and when the care person who was presenting her with her food came and talked to her by the name which is actually her first name I thought who is she talking to? And then âï¿½ï¿½ I mean she is losing it a bit, not much, and maybe she didnâï¿½ï¿½t hear the name, and I thought surely one should ask people what they want to be called. The idea of her spending her declining years (because this is what it is going to be) being called a name that she has never in her entire life been called by, while her husband is called by a name which has to do with his status and not him as a person âï¿½ï¿½ I found absolutely appalling. I didnâï¿½ï¿½t of course say anything about this, I am not âï¿½ï¿½ they have four children who visit. Hopefully they will eat with them and they will notice it and they will say something. I didnâï¿½ï¿½t feel that it was my place to say something to the staff and I didnâï¿½ï¿½t want to upset my friends by drawing attention to this but I was and remain every time I think about it (which I do quite often) deeply shocked by this. How demeaning it is not to consider that somebody is a person and how they would wish to be considered.
That is so vital isnâï¿½ï¿½t it, oh dear. Right, how can we raise awareness and understanding around dignity in care in relation to the training and education of staff today?
I suppose one needs to think, thinking back to first principles and ?? And all of that looking at the client as the client is, taking things at their pace and all that, that one is enjoined to do, that to try and see past the political correctness which presents one with somebody who is a black woman single parent, homeless person for example – to actually to see that person not as a series of categories but somebody who thinks of themselves in a particular way. And to find out from them how they think about themselves and then to think about what the discrepancy is. Perhaps between how they think about themselves and how they are presenting themselves and what the agency may or may not be able to do for them, and also to be honest about what the agency may or may not be able to do for them and to try and be open minded about âï¿½ï¿½ and having things on the table about what the limitations of the agency. Maybe they would be better served by going somewhere else or maybe their problem, problems canâï¿½ï¿½t be dealt with and may be helping them to deal with that. Because I think you know there isnâï¿½ï¿½t a way of curing every problem and I think you know the way things are set up indicates that perhaps there is – if you only tick the right boxes you get the right answer. Well living with uncertainty, dealing with uncertainty, is something that social workers need to learn to do and be helped to do by supervision etc etc etc so that they can then help the service user.
Wasnâï¿½ï¿½t there something about helping the client to come to terms with …?
I guess …
Their situation – was there something that was done I think in the 1960s and so it was very much a message I think are you agreeing with that?
And so I think you have probably said it, but what would be the most important message you would like to pass on to younger social workers?
To make time to think about the people that you are working with; to make time to think about why it is they are âï¿½ï¿½ you are in a room with them âï¿½ï¿½ what do they really want and to try and separate that from what you think you can do for them âï¿½ï¿½ and yes to try and find somebody you can talk to about how people can be thought about, because it is from thinking that there will be change and some result will arise.
Really reflectivity and also …
Absolutely, the reflective practitioner.
And supervision too. Thank you unless there is anything else you want to say I think this is the end of our interview.
Barbara Prynn interviewed by Joan Rapaport for WISEArchive on 15th October 2008