Book review: Developing Research Questions

This review refers to

White, P. (2017). Developing research questions : a guide for social scientists. 2nd ed. Basingstoke England ; New York: Palgrave Macmillan which is available to buy on Amazon here (non-affiliate link). I was not paid to write this and bought the book myself.


This is a book which I picked up quite early in my ‘research journey’ and I picked it up because it was one of a number on a reading list. It was written by Patrick White who is a lecturer in the Department of Sociology at the University of Leicester.


This is a book that is best suited to the beginning of a research project as you start out. It’s focus is entirely the start of the process and how to build both effective research questions but while doing that, identify the key areas to focus on when starting with a topic and trying to narrow it down. As well as focussing on the process of defining a clearly focussed topic with an answerable research question, which is the starting point in terms of the aims of the book, it also covers aspects of this including what a good research question looks and sounds like.

For experienced researchers this is probably more than they need but it helps to clarify some of the confusion which can start at the beginning of a project when you have an idea but want to make from it, questions that are not just interesting but answerable.

When I bought the book, I read through it start to finish, which probably isn’t necessary, but I also tried the suggested exercises as I went, saving my initial thought processes into my research diary to return to and to help me understand and then reflect on my thinking early on in the process.

White gives frequent examples, which are taken from a range of disciplines, about what might make a good research question and the different types of questions one can ‘ask’ or at least, identify in research. It is written very much from a social science perspective and as that is where I am coming from, I’m not sure how translatable it is but it makes sense.


This is a book very much aimed at novice researchers but it highlights the importance of clarity of purpose in research from the very start in the building of research questions that might well be dipped into from people at different stages of their careers. As well as an explainer of types of questions in the context of research questions specifically, and how ‘answerable’ they need to be, the book covers broader areas around research design and levels of evidence, information required to answer them.

Starting from a premise that literature reviews, lead to identification of areas in need of research in order to justify the research questions being asked, White writes, taking a logical order to offer clarity in the face of what can be an surplus of information and studies and cleverly helps the reader find a path through the jungle of information to read the end goal.

While the focus is clear in the title of the book, there are some excursions into later stages of the project including whether and how one manages to answer the given research questions and use of hypotheses and what ‘counts’ as evidence and linking evidence to claims which can help to answer these questions.

This is a practical text which refers to the answerability of a question which can depend on time, resources and level of research projects. Each chapter ends with exercises and has chapter bibliographies for further reading. Personally, I found the earlier exercises in particularly, helpful in narrowing down some of my initial thoughts.

Key strengths and gaps

I enjoyed this book. The strength was in the narrowness of it’s aim, in a way. I have other books which talk about research processes from start to finish but this was focussed solely on identifying research questions which work. It is a cross disciplinary book which a focus on social sciences and the research methodologies used predominantly in social sciences.

There are some useful conceits introduced, or were for me in any case, including the ‘literature funnel’ which models broad reading across a topic, through a funnel of contemporary issues, debates and findings to establishing a relevant and useable research question.

One of the suggested exercises was to reduce your topic to 140 characters. It can provide focus but it was other similar exercises that allowed me to think about things in different ways.

Of course, many of the issues raised in this book which will very familiar to experienced researchers so this is a book aimed at novices and primarily aimed at novices in universities with access to libraries and wide ranges of reading materials.

The examples given are from across social sciences and some of the exercises might not be useful. I like the key points which were set out at different points and above all, it is clearly written and concise which only works to its benefit.

Use in practice

I’ve mentioned this previously but this was one of the most useful books I found around methodology towards the start of my research. ‘Research questions’ can be frightening and establishing a good mix between pertenant and manageable is not always easy, especially if it is a first time research project. It might be that these are the things you learn early in university careers but if not, I’d recommend finding this book.

As well as clarity of scope and purpose, it has some useful glossaries of research terms which help when learning the different professional language needed to become a researcher. Even if you are not doing the research yourself, some of the exercises and background information about types of questions can be useful in appraising and understanding the research of others and identifying distinguishing research questions in papers that you read to keep up with the subject area in which you are working.


I both enjoyed reading this book and found it useful. It is a short text and it is written with a style that is conversational and therefore not too intimidating. It has provided an additional confidence in understanding what might make research both good and logical. It has definitely helped me along my journey.

Policy review: NICE Guidance on Decision-making and mental capacity

The guidance referred to is available here.

I decided to branch out from books and papers and look at some NICE guidance and maybe some policy documents too in weeks to come. I present this as very much a ‘non-expert’ but rather as someone working in this area who wants to make sure I am aware of best practice.

NICE and the place of NICE in Social Care

As a brief introduction, it is useful to note the role of NICE. The National Institute for Health and Care Excellence (NICE) was founded in 1999 as an independent body which produces advice and guidance about best practice in medicine and health. After the 2012 Health and Social Care Act, the body was asked to provide guidance on social care and the first social care guidance was issued in 2014. It is a non-departmental government body.

Background to this guidance

The guidance on Decision-making and mental capacity was published in October 2018 as NG108 . As part of the process of writing guidance, NICE committees will involve experts (including experts-by-experience). Alongside the guidance itself, NICE publish the methodology which is useful as a new researcher to understand how to write up scoping literature reviews as well a methodology although it is in a lot more depth that would usually be necessary. It includes which databases were used for searches and what phrases and words were used, which studies were included and which were excluded. They also detail the expert testimony included and who was consulted and inputted into the formation of the document.


The guidance was written in the light of numerous reports and studies (which are detailed in full on the NICE website) which pointed to a mismatch between what the legislation and Code of Practice say about assessing capacity and making decisions about capacity on behalf of people when they may lack capacity to make those decisions in the context of health and social care. Of course, the Mental Capacity Act (MCA) and its scope move far beyond the health and social care sphere but for the purposes of NICE, that is where their scope lies. The guidance was actively commissioned by the Department of Health to help people using the Act in practice to engage with it.

The guidance is used alongside the primary legislation, Code of Practice and growing case law and provides practical assistance both to both health and social care professionals and organisations that employ them and those who commission these services regarding duties, expectations and best practice goals.

As the Code of Practice is being updated now, until it emerges, this is the most recent guidance that practitioners can turn to. Personally, I have found it enormously useful in my work, not least making me more aware of expectations. I know colleagues who have been more critical but for me, it’s been a useful tool.

The guidance specifically excludes reference to deprivation of liberty safeguards and areas of decision-making and mental capacity for under 16s which have different legislative frameworks.

Summary of key recommendations

The guidance divides along the lines of key recommendations and divides them into recommendations for individual practitioners, for service provides and for commissioners. So reading this, one can choose the parts that relate most to the area that impacts.

Regarding individual practitioners, as that is where my interest lie, I was disappointed that some of the key ‘know the law and apply the principles’ has to be stated. It shouldn’t need to be part of formal guidance. Some of the guidance is stuff that shouldn’t even need to be said but perhaps reflects where some of the drive has come. Areas like, ‘make sure you document past and present wishes, beliefs and preferences’ may seem like they don’t need to be said but by expressing, them it ensures expectations are clear. When we are writing records, we are not just writing for tomorrow, but also for 10 years in the future.

The guidance also emphasises the importance of sharing information including information about accessing advocacy services. Obviously I won’t list all the recommendations here as a lot of them are ‘do what the Code of Practice’ says but there is a stronger emphasis on recording reasons for decisions and involvement.

The other area that I saw was strongly emphasised was the importance of advance care planning. By nature a lot of work in a busy organisation happens when it needs to and perhaps this is more focussed on social care staff who may be working in a more preventative capacity to think about and document advance care planning and give people the opportunities to understand and make advance decisions.

When explaining the process of actually undertaking an assessment of capacity, the guidance emphasises the need for collaborative approaches to be taken and refers to particularly difficult situations where someone may have a brain injury which affects executive functioning which may call for a more structured assessment.

The guidance is clear that a documented assessment of capacity must exist before a best interests decision is made. Some research has reflected that this has not always been consistent in practice. There is also a specific section of the guidance devoted to involving family members and those who are involved when best interests’ decisions need to be made. Although this might be obvious for people using the Act and Code of Practice, it strengthened the clarity of challenge when these steps are not taken.

To organisations that provide services and employ health and social care staff, there are specific guidelines which are highlighted. These include ensuring that staff have access to better training (they talk about more investment in training). They should also ensure there are robust monitoring procedures in place including outcome measures which involve people who have been assessed and the level of collaboration in decisions being made.

They are also tasked to ensure that the systems they have in place have a clear way of recording preferences and advance care planning including advance decisions.

Commissioners have recommendations which vary in strength from asking them to ‘consider’ increasing the scope of Independent Mental Capacity Advocates (IMCAs).

There are some areas of oversight that are emphasised and recommendations about systems being in place to ensure good practice is followed but there has to be a will to change in order to do this and that is probably not the priority of some who commission services.

Thoughts on the recommendations

Generally, I’ve found the NICE guidance helpful. Although I hope it doesn’t tell people using it anything new, it is a clear representation of some of the ‘how’ in terms of carrying out a mental capacity assessment and taking best interests decisions.

Recommendations, like all NICE guidance, are just recommendations in the end. The call on commissioners and service providers to provide more investment in training is something that requires analysis of the training which has taken place and why it hasn’t been useful. I have my own theories but this probably isn’t the place for them.

Given what the scope of the project, I think the recommendations remain unambitious. Yes, we should involve people but investing in training needs outcomes of training to be measured. Having key people in place to push mental capacity as a necessary knowledge set is key and shouldn’t rely on champions who have been picked because no-one volunteers. For me, work around capacity and best interests is a fascinating area of power dynamics, control and push between state and individual which needs to be explored in more depth and given more life in practice. If it is presented and trained through online tick boxes as if it’s just another burden to complete rather than a way to work with an individual and their family or people important to them in a collaborative and exciting way, it can influence attitudes to the processes.

But that’s probably outside the scope of the guidance!

Use in practice

I have found this to be eminently useful in practice, from the clear examples given about how to involve people in decision-making to the retelling of the legislation with recommendations about how they can be used better. Some of the recommendations can be completed by individual practitioners today, others need financing and systems to be changed but anyone who is involved in assessing capacity or working with patients and service users to build pictures of individuals through care planning and incorporating advance care planning can find the guidance immediately useful.


I have probably not explored relevant NICE guidance as much as I should have and this is the first guidance I have seen which directly influences my day to day practice. It has been useful to read through and I have a copy on my desk at work which I direct people to. One of the key uses for NICE guidance, particularly when there are recommendations for organisations, is to highlight through management when they are not being adhered to (I’m terribly popular with my managers!).

However, even for the key steps of assessing capacity, there is useful, clearly written and up to date guidance and for that, this is worth both accessing and using actively.

Paper review: Health and social care practitioners experiences of assessing mental capacity in a community learning disability team

This paper, authored by Daniel Ratcliff and Melanie Chapman, was published in the British Journal of Learning Disabilities 2016 Vol 44 (4) p329-336


This is an article which is very much located outside the ‘social work research’ space although it is occupied with a topic which is very much in our areas of interest, indeed, my own research is focussed on the Mental Capacity Act and ways of assessing it so there may be a tilt towards articles in this area. And this one has been enormously useful.

The premise of the paper is to look at the experiences of different professionals when undertaking the assessment task. It’s interesting to note that the study was undertaken by one practitioner (Ratcliff) and one academic (Chapman) working together. This adds another layer of interest to the paper and its analysis.


The study was very much located within the qualitative space, exploring the experiences of eight professionals, from health and social care backgrounds, using semi-structured interviews which were then analysed using thematic network analysis.

All those interviewed worked within a community learning disability team and had done for at least seven years. In terms of professional breakdown, there were three nurses, a physiotherapist, a speech and language therapist and two social workers. All of the team members worked in the same team and had received the same in-house training.

The data, which was the transcribed interviews, was analysed using thematic network analysis. Thematic analysis looks at identifying common themes which emerge from the data and the researchers focussed on networks within the data which linked to the themes identified.


The paper starts with a brief literature review relating to the current situation regarding the use of the Mental Capacity Act (2005) in England and Wales. It identifies, from previous research, that there are known variations in the quality of work around use of the MCA in practice including gaps in knowledge and lack of confidence in implementation of knowledge and that despite training, this had not, seemingly, led to improved practice.

The Mental Capacity Act (2005) while being generally acknowledged as a positive move in legislation relating to those whose capacity to make specific decisions may be doubted, has led to continuing conversations, over 10 years after implementation (which was in 2007) about the lack of embeddiness in health and social care services. The Act is used in all areas of health and social care practice (apart from under 16s) but it has been particularly used relating to adults with cognitive impairments, whether permanent or temporary. In terms of social work practice, this is most commonly identified in work with adults with learning disabilities and work with older adults where deteriorating cognitive functioning may be identified, for example, with some dementias.

Key learning points

The study identified five significant themes which emerged from the thematic analysis of the interviews.

  • Systematic barriers to assessment
  • Capacity assessment as a challenging process
  • Person-specific challenges
  • Protective practices
  • Protection of a fundamental human right

Basically, there were organisational and structural issues in place which might impede quality assessments. This could be about the workload pressure of staff or the ethical tensions between organisational need and outcome of specific assessments, particularly noted around attitudes towards risk

…there was service level pressure to ensure that risks of harm to individuals were limited as far as possible, thereby conflicting with the practice of positive risk taking and allowing capacitious individuals to make unwise decisions.


There was also an expression that a ‘capacity assessment’ could take time and effort to ensure it was carried out in the best way, particularly with involvement of carers. While the legislation explicitly encourages family involvement it can be more challenging when there are differences around the decisions made.

Practitioners raised the challenge of difficult decisions where it was not a straightforward outcome but where there might be a different interpretation, for example, relating to specific decisions.

Participants noted that joint decision-making was helpful and support from other colleagues in thinking through the processes. They also said more specific guidance could be helpful.

There was a general positive response to the impact the MCA had made on practice. It had put into legislation, some of the importance of emphasising the individual and their human rights. There was a feeling it had improved practice and the rights of people who used the services they provided.

The researchers identified a ‘global theme’ which enveloped the data collected as ‘freedom to act versus restrictions on action’. Without understanding more about the coding process, I relate this back to the initial title, which summarises the experiences of those using the MCA in this setting.

Reflections and gaps

The study is acknowledged to be a small-scale study which has taken place within one team where professionals have worked with the same organisation and often with the same people (they have all been in the team for a minimum of seven years). This means there may be a further risk of extrapolating from this data where practises and the culture of the team and organisation may have embedded and reflected on the responses.

Language, attitudes and values can be shaped by the organisation as well as the individual attitude. The study does not reflect (possibly because it is not different and the same size was so small they could be identified) if the professional background of the interviewee was a factor in reflecting the differences.

It is useful to see practitioners directly involved in research, particularly noting the interviews were carried out by the practitioner. It would have been useful, although this might be for a longer piece, to know if he had links to the team in which the research was taking place. It makes no difference to the outcomes, but it an interesting context in which to place the research.

Use in practice

It is good to see an example of research of practice taking place involving a practitioner and academic working together, particularly as the issue is one that can have an impact on the way teams work.

There were a number of issues identified in the study that I can take with me to practice. One is about the usefulness of support. Often this can be looking at supervision and training but the key that this piece draws out is those informal conversations with colleagues, highlighting a need which emerges from the paper, for a consideration of peer groups among professionals. Personally, I’m wondering if there is a scope for multidisciplinary peer groups which a focus on learning from each others’ practice and reflecting on potential improvements in practice together, in my work setting.

Training is necessary for legal literacy but use of training can vary. It is worth considering how understanding and knowledge can be on a continuous basis rather than a snapshot in time. I come back to the peer support groups and wonder whether this is an aspect that can improve.

The paper talks about the need for organisational changes to ensure that there is sufficient time to ensure that work can happen in the best environment. This could be written about any aspect of health and social care and isn’t something we can often change as individuals. There is an aspect about usefulness of templates and examples which might be able to be shared to make the decision-making better informed. Perhaps sharing some model anonymised good practice examples which are referenced with up to date case law and research. Sometimes the time spent searching for new information can be saved if it is well-disseminated.


This is a useful study and a useful paper in all. As someone who has developed an interest both in how the MCA is used and understanding different research methodologies, it has been an interesting piece. The research is clearly explained and the gaps identified.

I think while the literature review is well-presented, the sample size is small but produces some useful content which reflects some of the previous research in the field. The commentary around the piece including the themes identified, in some ways seems more useful than the specific data. It is very useful to see practice-focussed research. I’d like to see more about any differences between professionals and how that links to attitudes to the legislation as well as the experiences of people who have differing levels of post-qualification experience.

Saying that, the paper is useful, particularly as the researchers identify explicitly, the potential use in practice. It does leave us begging a lot of questions for more research in this area though.

Book review: Research and Evaluation for Busy Practitioners : A Time-Saving Guide

This is a review of Research and Evaluation for Busy Practitioners by Helen Kara first published by Policy Press in 2012. I have a copy of the first edition so I have reviewed that but there is a second edition available.


This book is written by an independent researcher and writer, Helen Kara, who has written a number of books about research. This book fills a space because it is very much aimed at practitioners who are employed in ‘non-research’ roles, like, well, social workers but by no means only that, who are thinking of starting research and/or evaluation projects in a work setting. Through writing the book, Kara interviewed 20 different professionals who contribute. The writing is interspersed with key ‘advice’ quotations which stand out from the text. I have to say my favourite one was

You don’t have to read the unreadable


Research is useful, doing research is an important professional skill and using research evidence is necessary to stay current in work environments. However, not all research is good research and critical analysis needs to accompany the reading/writing/doing of research, just as it does in practice environments.


The place this books inhibits is partly about a guide to research for non-researchers and partly taking people who are confident and experienced practitioners and putting them in a ‘research’ space.

I found the most useful part of the book was the tone. Often, and I have read a lot of ‘how to research’ and ‘beginning research projects’ books which are entirely aimed at first year undergraduates or at least, early stage postgraduates.

While I have an MA in social work, and for that, I needed to complete a dissertation, it was entirely using secondary data and as part of a qualifying course, research methods and methodology was not emphasised beyond the immediate need and the push to make things as easy as we could for ourselves in getting through the degree programme.

Kara is able to speak to people like me. I am not new to my subject (in this case, social work) but having qualified in 2000, I have not been used to the language of academia. There is a particularly useful glossary at the back of the book which gives very short, one or two sentence definitions for research terms which will be second nature to those within academia but can increase the distance for those on the outside. Often, in many sectors of work, knowing the language and the terms is such a key part of understanding what is being said and how to say things. Finding the common language is key and that’s where I’ve found a lot of this book incredibly useful.

Key points

This book, as the title says, takes the busy practitioner who has a job alongside research, through the process of defining what project it is that will be undertaken, looking for research questions and better defining the tasks and best way of gathering data to answer the questions, gathering the data, including use of interviews, focus groups and quantitative data sources. Then glances through data analysis and dissemination.

These are all the same key points that would be made in many research texts for those who are new to research. What sets this book apart is that it is not aimed at academics or students. There is a useful pragmatism and an acknowledgement that perfect isn’t possible in a messy world with competing priorities. I had never read, for example, the distinction between a document review and a literature review or thought about why designing a research project on the basis of what is most feasible is not a ‘get out of jail free’ card but an entirely legitimate approach.

Kara touches on all the key parts of research, including research ethics and involving people who use services you might be working in including a breezy nod to the importance of being a practitioner in the development of emancipatory research and action research as well as an explanation of the difference between them.

Use in practice

The whole book is very much built about being able to use its contents in practice but for me, the key take-aways, apart from the additional knowledge of research and the language it uses to sometimes create a veil of mystery around the work of researchers, has been a re-stating of the idea that research doesn’t sit in a box distinct from practice. It is a challenge to integrate research into practice until you realise what you are doing anyway is using a lot of research skills, particularly if you are involved in audits and evaluation work.

As practitioners we have interviewing skills, skills to manage groups, skills to discern quality of evidence provided. These are all research skills.

There are some handy practical tips as well, such as managing information, making notes and keep track of references which has been immediately useful. The book also addresses issues such as funding and allowing time (or not) for research alongside work, often full-time.

One of the areas which is probably a bit outside the scope of the book that I think I’d have liked to see more of, was less about the doing research which is very robustly covered and a bit more about using the research evidence in practice and tying research into practice contexts, particularly when there isn’t time or support to carry out full research projects. Some more examples of the small projects which have to run alongside work would be useful.

Saying that, I found this an incredibly useful resource and it is a clearly written text which occupies a gap in the market and as such I’d definitely recommend it.


This was a book which spoke to me because it catered to a professional, skilful audience who are just not in synch with the language of academia and some of the skills of research. Although one of the key takeaways that I found particularly helpful was the idea that often use the same skills that are needed to undertake research and evaluation, in a work environment but don’t always recognise them as such. We have conversations (interviews.. ), we write assessments (reports), we analyse information which is provided to us and determine the output based on evidence.

Being spoken to, as this book does, as a skilful and knowledgeable professional who just wants to know more about how to do research in a work environment which may not always be supportive, rather than as an 18 year old undergraduate who is at university for the first time, is a great relief.

I have read a number of Kara’s books, which no doubt I will return to at other times but if you fall into the category of ‘wanting to start research but not really sure of some of the things that everyone takes for granted’ this is a perfect place to start. Even in the third year of the studies, I found it a refreshing.

We need research in practice and we need to undertake research in practice. We need to understand the basis of evaluation work and need to speak the language of evaluation and research to thrive in a professional context and this book is a great start.

The book can be bought here (I’ve linked to the second edition on Amazon – this is not an affiliate link – although I may add some later, I will always state explicitly when I use affiliate links).

Paper review: The Mental Health Act Assessment Process and Risk Factors for Compulsory Admission to Psychiatric Hospitals – A Mixed Methods Study

This post refers to ‘The Mental Health Act Assessment Process and Risk Factors for Compulsory Admission to Psychiatric Hospital : A Mixed Methods Study‘ – Wickersham, A, Nairi, S, Jones R and Lloyd-Evans, B. Published in British Journal of Social Work in April 2019.


This paper presents a mixed method study using data from mental health act assessments followed by interviews with AMHPs (approved mental health professionals), s12 doctors and some AMHP managers in a focus group.

A Mental Health Act Assessment is a formal process in England and Wales, which relates to the provisions of the 1983 (as amended 2007) Mental Health Act. It is the process by which a person can be compulsorily detained in a hospital which is registered to provide care and treatment. An application for detention is made by an AMHP (who is a social worker, nurse, occupational therapist or clinical psychologist who has received additional specialist training and is approved by the relevant local authority) and it requires the recommendation of two doctors, at least one of whom should be independent (the other can be the treating psychiatrist or can be a GP) and who has preferably received additional training under section 12 of the Mental Health Act.

This process is commonly known a ‘sectioning’ a person.


The study is described as ‘mixed methods’ because it integrates elements of quantitative and qualitative research methodologies. The researchers took a range of data from AMHP reports following Mental Health Act Assessments and the information held on electronic databases within the trust to analyse some characteristics and outcomes of people who were assessed under the Mental Health Act within a specific time period. 150 records were analysed, including retrospective case record audits of which 146 were included. The researchers noted that there were fewer, and less complete records for assessments which had not resulted in detention which meant they covered a longer period in order to ensure some were included.

Only assessments which took place in the community were included and anyone who was recalled on a CTO was excluded.

Some of the characteristics identified or used to differentiate included what, if any, diagnosis the person assessed had, whether the reason for assessment was due to concerns about risk of harm to self and/or others and whether a ‘lack of capacity or insight’ was noted (I’ll come back to this).

Then the researchers undertook semi-structured interviews with 4 AMHPs, 4 section 12 doctors and ran a focus group with 3 AMHP service managers. These were subject to thematic and content analysis.

My first thought was that it was a small group of interviews and that it might reflect a lack of balance in the importance of each conversation but the number of AMHPs within one trust is small so as a representative sample of 53 AMHPs employed it was a fair percentage.

The paper refers to the outcome of the study being discussed with the AMHP leads and involving ‘a research colleague who has lived experience of using services and working as a peer support worker in the participating trust’ but that just begged a few more questions in my view.


This study took place in one London trust. It is described as an ‘inner London trust covering two local authorities’ which, for anyone who knows London mental health, narrows it down to one trust. I had to try to stop myself being distracted by this because I was an AMHP in one of those boroughs, in that trust, so kept thinking of people I used to work with, but that’s not the best perspective from which to start reading a paper in a neutral manner. However, it does emphasise the truism that we don’t read papers in isolation of our own experiences and knowledge of situations. So while, in one sense, I am trying to move away from that and read the paper as if I had no idea where it was and who might be being interviewed, I am also able to acknowledge the role that self, and background knowledge always plays when we read papers and research.

The aim of the study was to focus on potential increases in the level of detentions and to look at any barriers to alternatives to admission or what might or might not influence decisions to detain someone under compulsion which is an extreme action regarding the deprivation of liberty of another person in the context of state infringement of the human rights of another person.

Key learning points

Some of the themes identified will be familiar to those who have worked in this field for any length of time. One related to the potential difficulties caused by not having three professionals assess at the same time. A doctor may make a recommendation and this can be followed up by an assessment with a doctor and an AMHP attended at the same time. One of the issues identified was that the first recommending doctor may be influenced to recommend detention, as the paper states

‘ one doctor suggested that, as the first to do an assessment, it can feel safe to recommend detention and pass responsibility to the second doctor’


This was followed by the further discussion that the AMHP and second doctor may be influenced by the first recommendation.

Issues were raised as well about the individual different in attitudes, experience, knowledge and confidence with understanding risk thresholds which can be key to the outcome. Personality and unconscious bias may play a role in the outcomes of assessments.

One of the key themes to emerge, unsurprisingly, was that the impact that lack of alternative options to admission, made on the decisions to detain. If there were no places in crisis houses, capacity in crisis resolution teams, day services that met the needs of the person who required support, family and informal support in place, it could have a significant impact on the outcome and decisions made. Lack of access to substance misuse services may also have an impact on some decisions.

It may also be about the assessing team not knowing what the alternatives are for that person. One of the key pieces of learning the researchers emphasise is the potential difference in outcome when someone has a member of their community team present, or a family member or someone who knows the individual. This can help to identify both options and the lack of suitable options.

There were some issues raised around poor operational processes including the role of inpatient services. This included poor discharge planning which led to hasty readmission and poor continuity of care between community and inpatient teams. There were some additional factors which might be more relevant in the type of area it is, around access to support for people who are non-UK residents. This is an area which may include some people who are visiting the area.

Reflections and gaps

The paper identifies some of the difficulties in identifying data in the assessments considered for inclusion and reflects that out of the 150 assessments analysed, 22% had missing or incomplete AMHP reports.

The identification of ‘lack of capacity or insight’ as one of the categories in which the assessments were sorted, indicates to me a lax approach to the term and use of ‘capacity’. I never want to see the term ‘lack of capacity’ in any document that doesn’t refer to what the lack of capacity is for. I accept this is my pedantry, but is if it ‘lack of capacity to consent to an admission to hospital for assessment or treatment’ it wouldn’t take many more words to say so and these phrases add to the general misconception around capacity and/or insight, that it can be applied broadly, or maybe it’s me not understanding the implicit suggestion that this is specifically capacity to consent to admission.

The sample size is local to one trust so the findings can’t necessarily be used to evidence situations in other geographical areas. The interview sample sizes are small which can attribute far more importance to one or two, what might otherwise be, throw-away lines. That doesn’t mean that the importance of what is said isn’t valuable. It is, but it needs to be recognised in the context of the sample of assessments and the sample of interviews.

The involvement of management staff was key to understanding some of the context in which the study happened and the management team reviewed the data which was prepared for inclusion but that does offer a consideration about any self-imposed restraints that those interviewed might have felt in terms of criticism of the organisation, given that the sample size was so small. However, saying that, there was a fair bit of criticism for the organisation coming through but it may have been a factor.

The study only looked at community assessments because the focus was on avoiding hospital admissions. This meant that the voices of those who are detained in hospital and views of inpatient teams are lost. It is possible, especially with longer admissions, that some inpatient staff may have built up a different perspective about blockages and this aspect was intentionally lost. That is due to the limitations of the study rather than a lack of thought in the process.

This is research which is about the outcomes of Mental Health Act Assessments and the process of completing them. The study was focussed on professional views and records. There was a researcher who was there to review, who had lived experienced and the purpose of this research was to present a professional perspective but I wonder if there are more gaps around involving people who have experienced detention, in the processes of research and using social work research as empowerment. I know there are other studies which have and are doing this so it does feel like an unfair criticism but I felt it would be remiss to ignore it totally.

Use in practice

So what does the paper tell us that we can use in practice? The key headline and of course, this may be increasingly difficult in the face of cuts in services, is the importance of having someone who knows the person being assessed, present as part of the assessment, whether that is the care coordinator, or a family member or person who works with them through a third sector organisation.

It is also preferable to have the assessing team carry out the assessment at the same time. Often this is not lacking because there is an intention to make the process more challenging but due to availability of staff who are more frequently pressed by competing needs. It is useful to point to a study which evidences this as a factor.

The other aspect is to keep pushing for better options around prevention. This isn’t something that everyone can change but we can keep advocating and shouting for improved services which lead to better outcomes . I don’t know how much difference this makes when it is a factor that is far bigger than the individual practitioner, team or even organisation but it always needs to be referred to and having the evidence to do so is helpful.


This was a very useful paper to me in a lot of ways. It helped to show the way that mixed methods can be used effectively and how they can form a cohesive approach to understanding a problem. The outcomes and concerns raised were ones I recognised and I suspect will be recognised by those of us working in this space. Did I learn new things? Possibly not, but I found I have evidence to back up some of the assumptions made and that is key to pushing changes and improvements. If organisations can be presented with evidence linking the lack of capacity in the service, to involve people who know the person being assessed in the assessments and show that this leads to more admissions and therefore more cost, it may be a trigger to change systems.

And even if it isn’t, it allows us to talk about about what we see with more authority.

Book review: Street-Level Bureaucracy – Dilemmas of the Individual in Public Spaces

This is a review/reflection of Street-Level Bureaucracy : Dilemmas of the Individual in Public Spaces, first published in 1980 by Michael Lipsky (Russell Sage Foundation – New York). I have a copy of the first edition so am referring to that.


‘Street-level bureaucrats often spend their work lives in a corrupted world of service. They believe themselves to be doing the best they can under adverse circumstances, and they develop techniques to salvage service and decision-making values within the limits imposed upon them by the structure of the work’

Lipsky – Street-Level Bureaucracy : Dilemmas of the Individual in Public Spaces (1980)

The aim of this book is to frame the role of the public sector employee in particular fields, where there is direct contact with members of the public, as a ‘street-level bureaucrat’. This includes social workers, obviously as that has been my focus in the reading, but also teachers, members of the police service, people working in benefits offices and many other examples of those who are responsible for putting government policy, both national and local, into action.

These groups of people have enormous impact on the outcome of policy decisions of the state as they are the ones making decisions on a day to day basis. The book looks at presenting the role of this group of ‘street-level bureaucrats’ within the role of having understanding of where and how decision-making can follow them, understanding how they work and make decisions and oversight and controls in place to guard against poor decision-making which can be discriminatory and full of individual bias, organisational structures which can concede control (not always a bad thing) but which can lead to vastly inconsistent outcomes for those who have no option but to engage with the work of street-level bureaucrats.


Lipsky published this book in the United States in 1980. While it isn’t hard for me to remember that as I read it (I have a battered, old copy of the first edition which I bought second hand!), it is important to remember the times within which he was writing, forty years ago. There are changes that need to be allowed for in terms of time as well as location. Lipsky’s background is as a Professor of Political Science. He is writing from a broad perspective and expertise around policy and policy-making (because that’s exactly what politics is). His view is very much from the ‘how is policy implemented’. Reading this, as a ‘street-level bureaucrat’ adds another layer through which to analyse the role we play and the power we have in nipping at the heels of poor policy-making or even how we can dissemble the best intentions of good policy making, in practice.

Key points

While it is a classic in the field, it is one I picked up with an expectation of duty rather than enjoyment. I felt a sense of guilt in the amount of discovery I made because it is a 40 year old text. It is not a difficult read. It is written in a style that does not need an understanding of someone who is well-tuned to the language and style of academia.

The usefulness of the premise and content, reflects the thought that I have attributed to it. Lipsky considers the impact of street-level decision-making by the individual in one of those roles who need to be both thoughtful and autonomous enough to make differential decisions on an individual basis yet simultaneously adhere to guidance, eligibility criteria and standards which allow for consistent implementation of policy in relation to the citizen who is dependent on them.

He has space to differentiate between the role of the street-level bureaucrat who is in direct contact with citizens, and the role of the management and organisation within the processes of allocating resources, oversight of practitioners and, in a particularly pertinent chapter, which doesn’t seem to have aged, the role of goals and performance measures in guiding practice.

Lipsky contends that the place of goals, whether organisational or relating to individual workers, will always have some ambiguity and fuzziness because working with people is different to working with things. As he says

The ability of street-level bureaucrats to treat people as individuals is significantly compromised by the needs of the organizations to process work quickly using resources at its disposal

Lipsky – Street-Level Bureaucracy : Dilemmas of the Individual in Public Spaces (1980) p44

Lipsky covers the challenges faced as all those working in these public facing roles consider themselves to be ‘doing their best’ when that effort itself may need to be rationed. Sure, advocacy can be a key part of the role across the board, but advocacy as a street-level bureaucrat, can, he argues, focus on work with an individual to the detriment of other individuals because the time and resources available to the practitioner are rationed and some people may need more time. How are the decisions made about where priorities will lie? This is the power of the street-level bureaucrat who possesses, what Lipsky describes as ‘unidirectional power’ in relation to members of the public using their services.

The book is far more wide-ranging that I’ve been able to give credit but I was struck by the amount the spoke to me having worked in these roles for over 20 years. Lipsky has enabled me to place my practice as a social worker in a far broader context of public functions and professional roles including teaching, prison officers, police and benefits administrators, including call centre personnel – although he doesn’t refer to them, but in an updated version, they would be the people making some of the immediate responses and being the face of the government vis a vis the individual.

In terms of challenges faced, the context of the book being written 40 years ago when professions and semi-professions referred to would operate in different ways, probably needs a different focus. As public sector work is increasingly farmed out, and I am thinking of probation services, and prison services as well as social services, the element of profit-making hasn’t been taken into account in terms of the pressures of work as a street-level bureaucrat in the 2020s.

Lipsky is writing from an outsider context as well. I don’t see this as a disadvantage, rather an as a vantage point which differs. Indeed, it can be both positive and helpful to draw on expertise from a range of areas. One of the most interesting aspects for me has been to draw parallels that he did, with other public service professions.

Use in practice

When I read, I always read within the context of trying to understand what I have read that will change my practice as a result of the reading. Of course, not everything does.

With this, it was about drawing links with other public-service professions as a ‘street-level bureaucrat’ and draw out the similarities between social work and policing, teaching etc which are subject to continual policy changes dependent on which way the political climate blows. This is why it is useful to read from the perspective of political science rather than social work specifically.

Social work is politics and vice versa but politics is action. Every decision taken to prioritise one piece of work, or patient (because I work in a hospital), means that resources including time, may be limited to another. This does not mean these are ‘wrong’ decisions, but they are decisions and it is right that we should be accountable. In thinking about this book, and it’s message, it makes me consider who is actually holding me accountable. It might be the organisation or management through supervision but that is dependent on my interpretation and perspective on framing the work I do.

In a previous job, when we were working to Fair Access to Care Services (FACS) criteria, I used to joke that I could write an assessment to get anyone to meet ‘substantial’ need. And honestly, I pretty much could, because it was about how to wrote and interpreted criteria. Was it ethical though? Did it mean other people weren’t getting services? Individually, I didn’t see this because I am not an organisation. My role was to advocate for those I was allocated to.

I was also particularly struck by the role that unconscious bias can take in the decision-making at an individual level and the role that perception including race, gender, language and accent, even might take on assumptions that are built into the daily decisions made. While I don’t think I choose to discriminate, I work in a context of institutionalised racism and discriminations which may well be internalised so being aware of the impact and actively making decisions to own any internal prejudices is key to me challenging those assumptions and practices myself.

Will the book change the way I practice? I don’t know if it will change my decision-making but it will make me more aware of the context in which my decision-making takes place.


Coming at one a well-recognised and classic text, has been a useful refresh of some of the ideas I had germinating in my head for a while. It has been particularly useful to read the book in the context of broader views of professional groups beyond health and social care, where most of my reading has been located to date, and also beyond the UK.

Lipsky notes that people who have most contact with street-level bureaucrats are more likely to be poorer and have more services imposed on them. It is a responsibility, in all these areas, to own that and try to work within it.

I’d definitely recommend it if you are looking to broaden the perspective of the environment in which we work, bearing in mind the age of the text. I understand there is a second edition which has some updates and may well try and track it down.

Paper Review: An Australian perspective on Community Treatment Orders

A review of  ‘Using Social Work Theory and Values to Investigate the Implementation of Community Treatment Orders, Australian Social Work, 66:1, 72-85, DOI: 10.1080/0312407X.2011.651727‘ Lisa Brophy and Fiona McDermott 2013


By looking at this paper, I am reviewing some of the content to make it more accessible and combining a summary of what I find to be the key points, with my own understanding and interpretation. I am no expert and I am no academic. I am interested and with that proviso, I will continue.

I came across this paper as I was looking at the way that ethics and values reflect on social work decision-making and while my focus is more on decisions made about best interests and mental capacity, there is a clear line in comparison with studies completed in other areas, particularly the use of compulsion in social work and how we, as practitioners respond to it. I found the explanation of the methodology and the theoretical approach clear and helpful in my own thinking on two levels.

I’m interested in research design and comparing the robustness of the evidence gathered and different approaches taken, and secondly, when looking at how I integrate theory, both social work theory and broader social research theories into both my own practice and my research work, the most useful learning is reading papers where it has been done and other doctorate level theses available through EThOS (British Library free repositary of over 500,000 theses – and worth checking).

Background to the study

This is a paper written for Australian Social Work. It is looking at the use of community treatment orders specifically in the state of Victoria, Australia. It seems that CTOs have a longer history than their use in the UK and at the time of writing, the authors claim that there are around 5000 current CTOs. The paper looks at how compulsion links with social work values and practice particularly around theoretical perspectives. It is useful as it links the use of theory to practice in a setting where compulsion is used and reflects the tensions in the social worker’s role. It was definitely something that spoke to me, not just in terms of the research, which is useful for my own work in this area, but more interestingly, perhaps, for me when I go to work on Monday to consider with people I work with who do not choose to work with me and, indeed, are compelled to do so.


Looking at the methodology, it is a mixed methods study. This means that there are both qualitative and quantitative aspects to the study. I tend to enjoy reading the methodology parts of papers. To me, it is what distinguishes research from opinion and most of the papers I read are pure qualitative studies, not by design, but because I am trying to learn more about qualitative research so approach this by reading more papers where these approaches have been taken.

This project started with a broad-ranging cluster analysis of 164 people who were on the community treatment orders used in Victoria, Australia. Cluster analysis is a specific quantitative methodological approach to using statistics to establish common ‘clusters’ of data, in this case, types of people who would be subject to community treatment orders. The specific methodology may be related to creating clustering algorithms and assigning different features so that the types or clusters emerge from the data. With some biographical and socioeconomic factors being allowed to emerge from the data, this allowed researchers to use the emerging key ‘clusters’ to identify a smaller group of people, reflecting some of the key ‘clusters’ identified, to be interviewed in more detail using semi-structured interviews. This was followed up with additional interviews of family or carers, case managers (presumably, although this is not explicit, who would be for the most part, social workers) and doctors involved.

There were then follow up interviews conducted after 6-12 months with people involved around the use of CTOs including those subject to them, professionals involved in working with them and family or carers. Additional interviews were undertaken with those involved in tribunal (or equivalent) hearings, senior managers and those involved in policy.

This is a brief summary so does not include all the complexities but it does reflect the thought process behind the choices of methodologies involved and reflects back how social work theories have led to each of these steps, including the involvement of people who are subject to these orders being at the heart of the process of researching about them.


The paper identified ‘significant clusters’ relating to being ‘connected’, ‘young males’, ‘chaotic’. The research team used these differing clusters to recruit for the interview stages of the research study.

The researchers, linking back to previous studies which had looked at the use of CTOs, identified five principles which could improve practice based on the interviews. While, they identified that these principles reflected some of the guidance currently in use in practice, the difference that the research was able to tap into was to highlight diversity within the groups of people subject to CTOs. I think these principles are valuable to reflect on and while this research is about a specific intervention in Victoria, Australia. It isn’t an enormous leap to see how they may reflect some potential to improve practice in areas where compulsion is used by and with social workers.

The following are identified on p78 of the paper:

  • Use and develop direct practice skills
  • Take a human rights perspective
  • Focus on goals and desired outcomes
  • Aim for quality of service delivery
  • Enhance and enable the role of key stakeholders

Theoretical perspective

The paper establishes it’s focus on the framework of critical theory, which allows a discussion about the role of power in social work and particularly in areas of social work where compulsion is used. This is also carried through to understanding the role of power within research. The authors have acknowledged this and reference their awareness of the principles of emancipatory research by ensuring that those who are subject to CTOs have been central to the research design. One of the principles the authors reflect, is that of empowerment and by giving people a voice through research carried out about them, it is enabling change to be made.

Additional reflections and gaps

I think of this research both in connection to my own studies and my own work. The first thing that jumped to my mind is that the need to have an international perspective when it is relevant but to be aware of the differences as well. This study is very much about one system of compulsion within mental health with adults. I don’t know the age range or diagnosis types of those who were interviewed and didn’t need to for the scope of the study. One thing that struck me, which may, very well reflect differently to a social worker based in London, is the analysis of race. This is not as a criticism of this study but one which might have different focus in different settings. Critical theory looks at the differing, sometimes competing and often co-existing ‘labels’ determined by studies and organisations to typify people who receive different types of input and I am particularly interested in where internal biases from professionals might impact outcomes.

Learning for practice

The key learning that I have taken from this study is an understanding of how we work within paternalistic frameworks of compulsion as social workers and I found some of the discussion around theoretical approaches and particularly the use of critical theory, to be most useful in both identifying this tension and acknowledging some of the hypocrisy between values which say they promote empowerment but work within frameworks which can be the most oppressive. The authors acknowledge this tension in trying to pull out ‘best practice’ guidance using the input of those subject to these interventions, while also acknowledging the purpose of the study was not to challenge the existence of CTOs and frameworks of compulsion, but that doesn’t mean we can’t and shouldn’t, indeed, we should, continue to constantly challenge the way we work with compulsion in mental health care and look at other options.

Regarding the specific good practice identified, as listed above, some are about organisational needs, such as ensuring that social workers have specific training and space to reflect on the use of compulsion in practice, rather than just being expected to ‘pick it up on the job’. As social workers in the UK, if we are trained as AMHPs, there will be a focus on this as part of the training, but that doesn’t mean there isn’t room for more learning as this training is not necessary to work with people who are compelled to work with social workers. And it is not enough in itself to give people training at key points and then leave them too it. This is the way one can become overly familiar with compulsion as a tool and desensitised to it. We need to guard against this which can be done through supervision and reflection.

An interesting aspect of the human rights perspective, was identified as well – which recommended ensuring people who are under compulsion are aware of their rights and why the limitations to liberty have been imposed. The study refers to procedural fairness and thoughtful decision-making being a key factor. This phrase is something we can always work harder on.

Involving other stakeholders, and in my role, I am thinking particularly of family members, friends, carers, is something that I can always do better. It is true that sometimes the conversations are not easy and there are issues of confidentiality around information sharing but support can be offered and must be in order to work best for people. There are other stakeholders in the form of commissioners, regulators etc but for my own work ‘on the ground’ the involvement of those people around the person I am working with is the key learning.

Finally, the importance of being able to deliver a quality service when people are compelled to have treatment is something that I might not be able to change individually, but it is key factor and it certainly reflected my concerns as an AMHP when I was practising as one (I am no longer warranted). If we compel someone to a hospital admission but the hospital care is poor, we can be complicit in harm rather than help. It is difficult to justify compelling someone to treatment when the treatment is of a poor quality. This is something we must always challenge and complacency can be easy.


I am no academic, but sometimes finding papers which can speak to me in practice can provide a real motivation to the value of research and the importance of being aware of what research is and has happened around the world that can lead to better outcomes tomorrow. What’s more, we can tell our managers that we can link our need for additional training (for example) to evidence.

I’m not pretending my analytical skills are on a par with any academic, they aren’t. But by trying to portray what I can take from this paper, I am hoping that it will encourage others to read more where the papers are accessible, at least, and learn about the profession and how it has and will continue to grow.

I’m absolutely sure as I’ve read through this paper, there are key points I’ve missed, misunderstandings and poor analysis. I am not setting myself up as a font of knowledge but rather, in my ramblings, hoping to take an opportunity for others to try to learn with me but the original research is always the best place to start, rather than any commentary I might be able to ramble through.

Reflecting on ethics and social work practice

We all think we act ethically. Whatever the context, we are able to justify our actions to ourselves. As part of my research, I am interested in understanding the different ways that we interpret values, as well as our personal values and where they come from, the professional values which are more explicitly expressed. I have done some reading about this but wanted to write about the thoughts I have had rather than referencing particular articles and books which have led to my thinking. This is not the ‘academic’ way to write but I think by expressing these thoughts and where I am at the moment, I can take my ideas through as more of a ‘work in progress’.

Personal ethics

What makes us who we are? We draw our values from our biographies – our upbringing. Thinking of this, as someone who was raised in a religious background, part of my ethical make up is very much based on my living and learning about Jewish culture, heritage and history. I took religious studies (because it was compulsory) in my school and it was exclusively learning about the Old Testament, Talmud, Mishnah and the other, more recent commentaries and debates. There is a Jewish tradition of ‘argument’ which I don’t think I understood fully, as being ‘different’ until I left home and studied philosophy, including philosophy of religion, at university. There is no one line that can’t be improved by arguing it out.

This was around how my ethics were formed and why I moved away from religion after school as well. I disliked hypocrisy and the religion that birthed me and raised me is couched, like many, I suppose but don’t know better, in contradictions that didn’t make sense to me.

How could religious people, who really believed and had faith, be (objectively in my child-like eyes) be ‘bad’ people. Surely, the purpose of religious codes of ethics is to teach people to be ‘good’ but then going to the religious services and hearing the same people gossip about who was wearing the nicest clothes/house and who was going through relationship difficulties etc, didn’t strike me as a ‘good’ thing.

While the religion no doubt, formed a basis of personal values, this was augmented by experiential knowledge. I saw that people who told webs of lies, got caught out. I knew that when I was mean or did things that did not link with my personal ethical code, I felt guilty which was not a feeling I enjoyed. There was a selfishness in my personal ethical values and there still is. I don’t want to feel bad about myself so I try not to do things that will make me feel bad. This isn’t altruism, it’s selfishness. I think it’s possible to extrapolate this to my working life as a social worker. I went into this line of work because I want to make the ragged edges of state intervention in the most personal and difficult moments of that person’s life to be as gentle and as clearly explained as possible. It won’t always be possible to soften the pain and it isn’t always my job to do so but it is my role to make the interaction with social work as straightforward and as clear as I can. When I do ‘good’ pieces of work, which make someone’s life easier or less harsh, I go home feeling better.

Saying that, I don’t know if my values are the ‘right’ ones. Indeed, to many people they would not be. I am sure I do make many mistakes of judgement that can have hideous or painful consequences and fundamentally at work, in a resource and time-limited world, I have to prioritise some work over other work. Which means prioritising some people over others. That is why my values are important to my work.

Professional ethics

When we learn to practise our trade, specifically with other people who will not, for the most part, choose to be in a room with us and will not have a choice of which social workers they are allocated – although there are areas of social work outside statutory settings, and those who may have more scope – there are few people who would decide, if all options were available, to engage with social work (fostering and adoption may be an exception).

I tend to see this as an additional responsibility as our role is very much linked, intrinsically to the power we wield with an ID badge around our necks. We can be representatives of The State or The Agency including those of us working in the third sector. Our professional forebears were the religious communities, the benevolent societies, the ‘saviours’ of those who had fallen on bad times or misfortunes. This is the root of social work and it is very much key to the way we need to interpret our roles today and how we are perceived. This power relationship with people who work with us is unavoidable. We cannot work ethically if we do not acknowledge our power. I have written about this previously but it is the core of what social work ethics are.

Looking at the definition of social work and the way that ethics interact with practice, we have this from the International Federation of Social Workers as a definition:

“Social work is a practice-based profession and an academic discipline that promotes social change and development, social cohesion, and the empowerment and liberation of people. Principles of social justice, human rights, collective responsibility and respect for diversities are central to social work.  Underpinned by theories of social work, social sciences, humanities and indigenous knowledge, social workengages people and structures to address life challenges and enhance wellbeing. The above definition may be amplified at national and/or regional levels.”

International Federation of Social Workers (accessed 26/12/19)

And this from the British Association of Social Workers’ Code of Ethics

Ethical awareness is fundamental to the professional practice of social workers. Their ability and commitment to act ethically is an essential aspect of the quality of the service offered to those who engage with social workers. Respect for human rights and a commitment to promoting social justice are at the core of social work practice throughout the world.

British Association of Social Workers (accessed 26/12/19)

Of course, I moved immediately from this to the ‘social justice’ phrase, I’ll come back to human rights later, but I think, I try to adhere to this. But if there’s something this last electoral cycle has taught me, it’s that my interpretation of ‘social justice’ is something that is specific to me. I think I am committed to social justice but don’t we all? This is part of my concern about the way that professional ethics are held up as being something specific to social work – my hope and, to be fair, my experience is, that many nurses, doctors, occupational therapists and psychologists I work with are committed to these values, as much, if not more than social workers.

What is it about this definition that specifically makes it about social work? Promoting social change and development? How do I do that in my role with individuals? Do I do this? Am I a social worker at all, or am I someone who undertakes social work tasks that actually can be trained. Am I paid for the tasks I complete or the learning and experience I have in order to make decisions about how to prioritise my tasks? When I undertake a social work task, am I making different decisions to another social worker? In that case, why is ‘my’ social work decision-making better or worse?

We need to be able to broaden and not restrict social workers to those who define social work ethics narrowly. I know I believe I work ethically. but anyone would say that if asked – and if they wouldn’t, they shouldn’t be anywhere near a person who needs social work interventions.

Lipsky’s Street-level bureaucracy first published in 1980, reflects on the importance of the power left in the hands of individual practitioners, like social workers and the impact the those ‘small’ decisions of prioritisation can have on practice and impact on individuals who have far less power in the world which is defined by actions and interactions with organisations that hold power. Any social worker who feels disempowered should pick up a copy of this book where much of it still holds true, despite talk of levelling hierarchies.

I don’t have an answer to what it means to practice ethically and the influence that professional ethics and our understanding and interpretation of these ethical standards, but I am interested in the way that these values and ethics, impact on our practice. Will a person get a different service to someone who interprets their professional responsibilities in a different way from me? How do our conscious and unconscious biases come into play?

I’m going to veer into politics briefly here and say that Corbyn doesn’t believe he’s ever been anti-racist in his life. Ask the majority of the British Jewish community and they might have a different opinion. Is this about understanding unconscious bias, perhaps? This is why we always need to question our own values and ethics and be constantly challenged on the biases we may not be aware we have.

Organisational ethics

This is a difficult one to see, sometimes from the outside, especially if you haven’t had experiences in different organisations. Most large organisations will be able not reel off lists of values that they claim to live by. I went for an interview at an NHS trust (I didn’t get the job) about a year ago and I was asked, in the interview, what the trust values were – I hadn’t remembered, so I invented some of the usual ones, like involvement, excellence, integrity – because they can be a bit ‘cut and paste’ but how do organisations evidence ethical practice, especially large organisations? From the view of the service user/patient, it will be the impact of the individual member of staff.

From the member of staff working within the organisation, it’ll be their immediate manager and possibly more senior management staff. But one part of an organisation can have very different values to another. One ward of a hospital can have a different ethical approach to another ward next door. It might be about interpretations of guidance and policies, it might be about individual interpretations of values in practice. This is why good governance processes are essential within a well-run organisation.

How does this inform and change our practice as social workers? It’s about the value placed on professional development, supervision, training needs and space to reflect and understand how to improve our practice. It’s about the value placed on the voices of people who use services and how well-embedded co-production is, beyond a tick box which needs to be completed to meet a need.

Good governance is something that perhaps isn’t something that comes into our focus as social workers in direct practice but it is the key to establish an organisational culture that works.

Final thoughts

I have no answers. The thing I learnt in my studies of philosophy is that sometimes the value of questions isn’t finding answers, as there may be no answers, but it is asking the right questions in order to aid enquiry. And this leads me back to the previous post about research questions. Currently, I think I’m where I want to be with some of my questions but when I go to work tomorrow with the aim of ensuring ethics guide my practice, I’ll not ever know if I am getting it right or not.

Social work is not a profession which has sufficient confidence to challenge itself regarding the fundamental ethics of some of the practices that have persisted, although some of it happens around the edges. While I hope this will inform some of my research work, I hope that I don’t ever end a day or a week, without thinking, how did I ensure that I thought about the actions and priorities I took and considered this within an ethical framework, whether utilitarian, Kantian or virtue ethics.

We have to understand the decisions we make, ethically, in the context of the decisions we don’t make but we have to know that our values can never be pure, perfect or altruistic. We wobble and we need to know, for the sake of those who rely on us, how to wobble less.

Finding research questions

When I started along this journey, I had a topic which I wanted to cover. I had some ideas about the direction I thought my research would take me. I didn’t have a particularly well-developed ‘research question’. As I’ve read more over the last year or so, it has been relating a lot to the importance of a robust research question and that the research question itself needs to be at the core of the topic but also focus on what the purpose of the research is.

At the end of the last academic year, I was pretty happy with the way my research questions looked. I’d been tinkering with them for a while. Then I read a few more books about the process of research (I’ll post some reviews of the books I’ve been reading at some point) and reflected on how the topic I was focusing on had changed through political developments (Mental Capacity amendments going through Parliament at the moment and the discussions around that) and realised that maybe the questions didn’t do quite what I wanted them to do in the way I wanted them to.

I have tweaked them pretty much on a weekly basis since then. I started with some exercises suggested in some of the books I read and worked on some ‘brain storming’ processes where I wrote down (or typed because I actually did this on OneNote – so I could go back and ‘remember’ my workings in the weeks/months/years to come).

Sometimes I tweeted my random thoughts as well – when I was considering how to approach the topic and refine the detail. One of the books I read suggested as an exercise to ‘encapsulate’ the core of the research in a ‘tweet’ of 140 characters (pre-twitter changes!). I tried that along the way – even thought the exercise wasn’t meant to be an actual tweet – rather getting to the core of the issue you want to explore in a few characters. The responses I got from the tweet led me thinking along different lines.

While I’ve never been one for mind maps, or at least, I didn’t think I was, I transferred my brainstorming into a mind map. The mind map grew and actually being able to visualise where the branches and connections were, really helped me make sense of what I knew, what I wanted to know and how to try and make connections between them.

Mind maps and doodles and notes can be very personal. I mention it because it was something I hadn’t really used more than superficially but making sure I ended up with more than a bundle of random scribbles was important to me as I needed to be able to refer back to all the dead-ends and the paths which I decided not to go down. I should mention as well, as context, that at this point, I had done a lot of reading around the topic areas and reading recent research to check for ‘gaps’ so it wasn’t entirely taking a stab in the dark.

The mind map has become a central document now to my approach to this piece of work. I have refined questions and am still tweaking. I expect more tweaking constantly, but I like to know I have a starting point – even if that starting point can change.

So while I’m pretty sure that I still haven’t ‘found’ my research question/s as they will look in a year, or two years or three years time – I’m relatively happy with the work in progress that I have and by reading about the importance of robust research questions in research design, which is very much the point at which I am focusing now, I am happy to work with that.

On failing

My nervousness at starting research at a higher level might be confusing in the context of me having a Masters (MA) in Social Work. I’m not backward about openly talking about the journey of my Masters’ which may not be entirely typical. I started it in 1998 and it was a two year course which combined the Masters qualification with a postgraduate DipSW (Diploma in Social Work) which is what one needed in order to practice as a social worker.

It doesn’t feel like that it was that long ago but in the life of an average social worker, I guess it is. This was before there was any professional regulation of the profession so anyone working in social care could call themselves a social worker – and even if you weren’t working in social care you could call yourself it. There was also no such thing as a ‘newly qualified social worker’ or AYSE or whatever came through to support people when they qualified. We just left uni and took on whatever casework was going. If you were lucky (and I really was) you went into a team which had a strong core of experienced social workers who would be help you understand ‘what’s what’ and the practicalities of the job but no-one expected you to know everything when you started.

And at the university I attended (which will remain nameless for the moment), we were strongly encouraged to undertake secondary research/literature review-type dissertations.

I decided (and this was in 1999/2000) I wanted to write my dissertation about the emergence of internet self-help forums for people with mental health needs and the role of the professional in providing support in this context. It was a new area and there wasn’t much about it. I read a lot about the emerging internet culture and about group-forming in other disciplines and found some interesting case studies which had been done. Anyway, to cut a long story short, my supervisor, who never really took to me, was a bit sceptical but he read through my dissertation and said he thought it was ok. It wasn’t going to win any prizes but it was adequate. And off I went, submitted, collected my receipt for the submission and started work in a local authority a couple of weeks later – because I’d been awarded my DipSW in the meantime.

A couple of months went by to result time for the dissertations. We went into the university, I worked nearby and it was nice to catch up with colleagues but when I saw my name on the list, it said that I had failed due to lack of submission.

I called my tutor and he confirmed that he had never seen my dissertation at all. Obviously, I wasn’t happy but I had the receipt, right – which proved i had handed it over to the person in the university. So I took the receipt back to the university and they said they would try and sort it out. They called me a few days later confirming that my dissertation had been collected by my tutor the day after submission, along with 3 others. It wasn’t as if he collected 40 and couldn’t track them all down. He collected four.

Meanwhile, my tutor called me and told me that if I wanted to make a complaint about the process, it was better to do so before I had any marks in case it looked like I was complaining because I got a poor mark. Then he said he could ‘offer’ me an average of my grades over the previous two years as I had proved I had submitted the dissertation but it had never been found. I said no. I regretted that later – but felt it was a matter of principle. Sigh.

Anyway, a couple of weeks pass and I get a call from my tutor. He’s found my dissertation. It was in the corner of his office. Oh, he isn’t sure how that happened. He hasn’t marked it and he should have a second marker check it first as he was my supervisor but if I agreed to him marking it, he could do it and then it would be marked more quickly. I said yes. At this point, I was working as a social worker in a local authority team and it was busy. My dissertation wasn’t my biggest worry.

A little while after that, he called and left a message with our team secretary, asking me to call him because I failed my dissertation. Yes, I wrote that correctly. He left a message saying I’d failed. Now, me being me, everyone in the office knew the story of my dissertation so it wasn’t a ‘secret’ and I didn’t really have a problem with anyone knowing but it didn’t seem like particularly good practice. Oh, and I failed by 2%.

I was tired at this point. Really sick of the whole thing and felt really hard done by. I felt angry as well. How could he ‘lose’ my dissertation for months and then suddenly ‘find’ it in his office when the submission receipt was found. Oh and he was my tutor – he’d read the dissertation – or at least most of it before I submitted and hadn’t told me it was failing.

Anyway on I went with work. Then I got another call from him. Apparently he had had difficulty finding a second marker but he met someone he knew who could do it. They were meeting at a party or something (yes, he told me that). Right, so we had movement on this.

Unsurprisingly I got another call a while later saying the second marker had confirmed that I’d failed.

And that was it. I did write a complaint to the university via the head of the department and I copied in my tutor. But I never received a response. I suspect I may never have sent it to the right place.

I felt very hard done by and quite angry. But I had a job and it wasn’t one I disliked. It was busy.

I was working through an agency and my manager offered me the opportunity to apply for a permanent job. I didn’t accept. I saved my money and after exactly one year of work as a qualified social worker – I moved overseas for a couple of years. I was still angry.

There is a postscript of course, because I now have an MA in Social Work. When I came back to the UK, I got another agency social work job very quickly. Despite one year experience and two years away. I was very lucky to land in a good team with a great manager. I applied for a permanent job there when one came up.

I enjoyed it, never thinking about my qualification. I started my PQ1 and had an amazing mentor who was a social work manager in a different team. She encouraged me to think differently.

I used to go to Community Care Live every year and that year, I bumped into a couple of lecturers from my university (not the tutor I had). They asked me how I was getting on and I told them. I can’t remember how it came up, but they hadn’t known I didn’t pass the dissertation and expressed some shock (I’d done well academically through the course). One of them said I should go back and retake. I had 5 years to do so and this meeting was in the fifth year.

And so that’s what I did. I enrolled at the university. I was allocated a different tutor. I wrote a dissertation about the poor take up of direct payments for older people and the impact of ageism in the policy itself. And I passed. So I have my MA and on my CV it is down as being awarded exactly 5 years after my postgraduate diploma in social work.

Looking back I don’t want to say my original dissertation should have passed, but that process and the power at play, sure wasn’t a demonstration of the values one might expect in a social work professional – or any professional. It has been a very valuable lesson in power though. And one I’ve been able to reflect on and use.

When I consider myself to be a cog in the wheel of a large organisation or a system of policies that I am asked to implement in my role which make me feel utterly powerless, I recall those feelings of powerlessness I had and realise that I am not as powerless as I think I am. I have a voice and I have a knowledge of the systems and the policies. I can make my challenges. The power I have is and can be enormous and I need to constantly remember that and recall the feelings over powerlessness in order to make the comparisons. 

My confidence is much stronger now and I’d be able to speak out but it also reminds me how much I’ve grown professionally and personally since I qualified.

There are many routes my life has taken since 2000, some of which I wouldn’t have taken if I hadn’t had that period of confusion, challenge and failure. 

Failure isn’t a point in time, it isn’t unusual and it isn’t ‘other people’. If we fail, it may be because other things are happening which have to be prioritised, like our health and wellbeing – it might mean that there are more interesting routes ahead of us and different challenges to face. 

If I could see myself now, from the view of myself as a newly qualified social worker who had their confidence bust to shreds and a caseload of 49 – wondering if I could ever be as competent as my peers, I’d tap myself on the shoulder and say, nearly 20 years later, you will still have a lot to learn, but you don’t have as much to prove – you’ll be fine. 

The growth comes from continuing to learn and wanting to learn. We never ‘qualify’ ready to practice because the only thing that makes one ready to practice is practice. 

And now I’m back to study further and longer. And maybe to prove something else to myself that I am capable of this. 

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