This is the follow up post to my last one on the topic of care planning discussions whilst Court of Protection proceedings are ongoing. You can read that post here.
We’re not talking about Z today, but about U. U is in her 40s and has been diagnosed with a number of complex mental health conditions which interact in ways that can be very difficult. But she is also articulate, aware of her needs and the rules that social care operate in, and often very witty. At least when speaking to me, because U and I get on pretty well. She can present very differently when distressed, and so her relationship with professionals and support workers can be challenging.
We were in the Court of Protection seeking best interests decisions as to U’s care and residence. By this stage, the residence issue had fallen away. There was only one placement on the table which, thankfully, was the placement that U wanted. What the proceedings were focussed on at this point was care decisions. We were exploring what restrictions need to be in place to keep U safe, and whether the restrictions were proportionate to the risks. Over the years, U had experienced everything from being entirely on her own, to being in a residential placement with 24 hour 1 to 1, and everything in between. Each has failed, for a variety of reasons.
In this case, I had almost the exact opposite problem to the issues in Z’s case. During the proceedings it became apparent that the professionals seemed to think that the involvement of myself and the Official Solicitor meant that they didn’t need to speak to U at all. Because, you know, that’s someone else’s job.
Whilst it is true that U had a better relationship with me than she did with her social worker, and found it easier to have some conversations with me than it would be with any of the professionals involved in her care, the reason for that was quite simple. I had spent a lot of time and energy building up a relationship with U where she felt I listened to her, and understood her. Whereas the social worker, well, not so much.
And I really don’t mean to be unkind to the social worker because this was a difficult case and I know workloads and cut backs are only getting worse. But also, legal aid solicitors aren’t exactly rolling in resources and I have to justify every 6 minutes of time I spend on this case. I digress though.
Anyway, there’s a few reasons why the approach taken wasn’t actually helpful.
Firstly, it created an inordinate amount of delays. Because the judge would direct that a care plan, transition plan or other necessary piece of evidence was to be created and then they’d disappear off to work on their plan. 4-6 weeks later they’d send the plan to me. I’d speak to U about it and she’d tell me she wasn’t happy with a certain part or parts of it. I’d put that in a statement, which would go to the court and the parties. We’d have a hearing and the judge would direct that the document be revised, in light of U’s views.
I’ll be clear the judge wasn’t saying they had to do what U wanted. But the judge was saying that the professionals needed to show that they’d considered U’s views and explain why their plan was still in U’s best interests.
So we’d wait a few more weeks for a revised version of the document. There’d be some changes that U would then have comments on. And round and round and round we went. So much time and energy and public resources expended rather than just sitting in a room with U and discussing the care plan with her as it is being drawn up. Which, incidentally, is very much in keeping with the Care Act and statutory guidance, but anyway…
The cost of the barristers attending one hearing would probably cover a week of U’s care. And it was all tax payer money since U’s representation was through legal aid and the other parties were all public bodies. By the time you factor I’m solicitors’ time, the judge’s time and court staff… It was painfully wasteful.
Secondly, this did absolutely nothing to repair the relationship between U and care services. In fact, it very much reinforced with her the idea that the professionals weren’t interested in what she had to say and the only reason she was having any say at all was because of the judge and I. Except the judge and I will, at some point, stop being involved. We’ll walk away into the proverbial sunset.
But U will always need some kind of support. And that would be a whole lot easier to deliver if she has some trust and faith in the services. It’s lovely that she gets along with me, but social services are for life, not just for proceedings. If she decided she never wanted to look at my face again but felt she could speak to just one health or care professional, I would honestly call it a win.
What really frustrated me though, I mean what really had my whole office wondering what on earth was going on, was that when I queried why U hadn’t been involved in the creation of her care plan. I mean, the care plan said it had been created with her input but when I spoke with U, it was apparent that it was the first time she was hearing any of the proposals. And no, her condition did not result in any memory issues so this was not a case where the social worker had discussed everything and U simply forgot. So I questioned this, explaining that not involving U was really just slowing everything down, making her angry and making everyone’s life a bit harder. The response?
“Yeah, we read the statement with her views but, erm, we actually didn’t want to share the care plan with her so, like, why did you do that?”
I don’t know, maybe because it’s really hard to get someone’s views on something without them knowing what that something is.
The sheer contrariness of that approach really just wound me up. Such a have-your-cake-and-eat-it approach to expect me to do all of the liaison with U, and then complain about how I am doing that. The social worker had been given ample time to prepare a summary, or discuss the care plan with U themselves. But no. Apparently this way is more productive.
Besides which, last time I checked, the provisions within the Care Act and statutory guidance about transparency, being person-centred and starting from the idea that the person knows their needs aren’t caveated to “unless it’s easier to not do so”.
The thing is, there are plenty of cases where I wouldn’t discuss the detail of a care plan with the person the proceedings are about. A lot of the time they aren’t interested in, or aren’t able to understand that level of detail. But U was very anxious about decisions being made without her input. Any perceived loss of control caused an emotional reaction that had a ripple effect on all aspects of her care and support. She not only wanted to know what the plans were, but needed to, so she had time to process before decisions were made.
The social worker just knew U would be unhappy and rather than trying to anticipate and manage that emotional response, she tried to side step it until such time as decisions had already been made and U wouldn’t be able to meaningfully object.
In Z’s case, there may well have been good reason for reducing information sharing. But U and Z are very different people.
In case it isn’t obvious from the fact I still haven’t identified the authority I used to work for, or the organisation I now work for, the views expressed on this blog are my own opinion and not the opinion of that local authority or organisation.