Ouch Too

Forum => Welfare Rights => Topic started by: Fiz on 23 Sep 2021 11:57AM

Title: The three conversations model
Post by: Fiz on 23 Sep 2021 11:57AM
The three conversations is fast becoming the go-to model of needs assessments for care and support and hey ho it's not about providing care, it's about saving the country money.


https://www.scie.org.uk/future-of-care/asset-based-places/case-studies/three-conversations

A relative has their 100 year old mil living in an annex to their home and adult services have refused care support when my relative had a radical mastectomy and more recently surgery for bowel cancer based on the fact that her DH is there. Who's not able to care for his mother. It absolutely shocks me.
Title: Re: The three conversations model
Post by: lankou on 23 Sep 2021 04:36PM
The three conversations is fast becoming the go-to model of needs assessments for care and support and hey ho it's not about providing care, it's about saving the country money.


https://www.scie.org.uk/future-of-care/asset-based-places/case-studies/three-conversations (https://www.scie.org.uk/future-of-care/asset-based-places/case-studies/three-conversations)

A relative has their 100 year old mil living in an annex to their home and adult services have refused care support when my relative had a radical mastectomy and more recently surgery for bowel cancer based on the fact that her DH is there. Who's not able to care for his mother. It absolutely shocks me.


What is the "three conversations" model?
Title: Re: The three conversations model
Post by: Sunny Clouds on 23 Sep 2021 05:20PM
It's the current in-thing in social work assessments.  The government promotes it.

Basically the three 'conversations' are (copied & pasted) -

Conversation 1: “How can I connect you to the things that will help you get on with your life – based on your assets, strengths and those of your family and neighbourhood. What do you want to do? What can I connect you to?”

Conversation 2: “When people are at risk what needs to change to make you safe and regain control? How do I make that happen? What offers do I have at my disposal, including small amounts of money and using my knowledge of the community to support you? How can I pull them together in an ‘emergency plan’ and stick with (like glue) to make sure it works?”

Conversation 3: “What is a fair personal budget and where do the sources of funding come from? What does a good life look like? How can I help you use your resources to support your chosen life? Who do you want to be involved in good support planning?”

(edited for minor typo)
Title: Re: The three conversations model
Post by: Sunny Clouds on 23 Sep 2021 05:31PM
I hadn't heard about it before this thread and went away and looked it up.  There's some criticism of it out there, including by social workers, not least because of the jargon.

E.g. if you're a social worker, are you actually supposed to say "How can I connect you to...?"  What will the person needing help understand by being 'connected to'?  If not, why use that word in the model?

If I've read Fiz right, she's commenting on the emphasis in the model on money.

Personally, I think that's one aspect of the model that's a logical part, but I don't think they need three conversations.  One would be quicker.  "I've got next to no money in my budget to help you with, just lots of  jargon, so is there anything you need help with that I can find some non-state help for or encourage you to find non-state help for?"

At least it's not quite as bad as the SIM model of dealing with people with mental distress seen by the emergency services as a pain in the neck - roughly summarised, it's "Get the police to divert them away from health services and send them home."  But that's going out of favour slightly since various health professionals including A&E doctors got uppity about it.

Come to think of it, though, it's not really different, it's just SIM = "No, we won't help, you're a nuisance, now bog off" and 3C = "We've no money and can't help, so here's some jargon instead, now bog off."

(edited to tidy/shorten)
Title: Re: The three conversations model
Post by: Sunny Clouds on 23 Sep 2021 05:32PM
Of course my views above are my interpretation from the outside.  My guess is that Fiz has just had this annoying twaddle thrown at her.
Title: Re: The three conversations model
Post by: Fiz on 23 Sep 2021 07:38PM
My post included an scie link to full explanation but it appears tiny in comparison to my text but is there
Title: Re: The three conversations model
Post by: KizzyKazaer on 23 Sep 2021 07:46PM
(SCIE = Social Care Institute for Excellence) *ironic laugh*
All sounds like a load of old toot to me  :f_erm:
Title: Re: The three conversations model
Post by: Sunny Clouds on 23 Sep 2021 07:52PM
I'd like to mention that while the link may show up on other people's screens, and whilst I've already got my screen magnified, I had to enlarge it to 300% (see note below) screen size to realise that the link was what had looked like just a line. 

I wonder why it came out so small? Is there a setting I can adjust on this site that would show links larger or with a symbol next to them without making the rest of the text bigger?

ETA - experimentation shows that I can see it by enlarging to 250%.  But it was a nightmare trying to read stuff even at that, because once I'd enlarged it, some text disappeared completely off my screen, even when I scrolled.  The site would be unusable if I kept my screen set when on it to large enough to distinguish between a line and that link.
Title: Re: The three conversations model
Post by: Fiz on 24 Sep 2021 06:41AM
I've added links before which have been clearly visible. I've no idea why this particular link is so tiny and I can understand why people missed it. My post must have appeared bizarre without it!



Title: Re: The three conversations model
Post by: lankou on 24 Sep 2021 10:02AM
It's the current in-thing in social work assessments.  The government promotes it.

Basically the three 'conversations' are (copied & pasted) -

Conversation 1: “How can I connect you to the things that will help you get on with your life –




£1 million in used notes in a suitcase.
Title: Re: The three conversations model
Post by: Sunny Clouds on 24 Sep 2021 11:06AM
I've added links before which have been clearly visible. I've no idea why this particular link is so tiny and I can understand why people missed it. My post must have appeared bizarre without it!

My only concern was whether I'd got my settings wrong.  As things going wrong with posting messages, your tiny link is an, erm, tiny problem...

ETA -  I just re-read my earlier post on this.  It sounds like I'm grumpy with you, Fiz, whereas I my grumpiness was about what I thought were site settings or something and with my inability to recognise the link.  I apologise. 
Title: Re: The three conversations model
Post by: Sunny Clouds on 24 Sep 2021 11:08AM
...£1 million in used notes in a suitcase.

But make sure you spend them quick before the government does an 'India' on us and suddenly invalidates whatever sort of notes they are.
Title: Re: The three conversations model
Post by: Fiz on 24 Sep 2021 04:11PM
It's the current in-thing in social work assessments.  The government promotes it.

Basically the three 'conversations' are (copied & pasted) -

Conversation 1: “How can I connect you to the things that will help you get on with your life –




£1 million in used notes in a suitcase.


That would certainly solve almost all of my problems
Title: Re: The three conversations model
Post by: Sunny Clouds on 25 Sep 2021 04:03PM
Quote
That would certainly solve almost all of my problems

But how long for?

I'm thinking about when Dad was in a care home and then briefly in a nursing home.  I'm trying to remember what it cost and can't but typically round here a care home is £30k - £40k a year.  I think some nursing homes may come in at under £40k, but I wouldn't count on it.

Now factor in extra costs.  E.g. I used to take him to his psychiatric appointments, but the nursing home rearranged one and took him to it.  They charged a ridiculous amount for staff time that wouldn't have been needed anyway had they not done what they did.

And with a shortage of care home staff, firstly from the loss of many EU staff, then from the pandemic.  We can argue until the cows come home about how reasonable it is for the government to say care home staff should be vaccinated, but personally, I'd like the choice of being cared for by vaccinated staff.  This is on top of investors having, for a number of years, been buying up care homes and nursing homes and asset-stripping.  That's already hitting them, but will get worse.  I reckon care homes will be coming in at over £60/year soon.

If you get cared for at home, well we know how that can pan out.

Yes, this all sounds negative about the ridiculous costs of it all.  Personally, I'm only getting through all this financial nastiness by clinging onto my belief that there is, mediated by the extra networking the internet can provide, a level of community mutual support growing that is fighting back.

Round here, more and more mutual support.  That's our hope for making what I'll broadly call extra needs affordable.

I've ranted elsewhere about intergenerational divides and mentioned merged care homes & student halls of residence.  Here's when I get personal.  My parents were able to buy a house because we had lots of lodgers.  Students.  It meant one of my grandmothers slept in the living room and I slept in the dining room, which was also my mother's study.  But it worked.

I've also been an au pair and would have been as happy looking after an elder as looking after children.  Or looking after a disabled working-age person.

So when I read all these expletive gimmicky ways of handling people who need help that, bluntly, various people don't want to provide, whether that's politicians with their policies or frontline staff with variously exhaustion or bias or, sometimes, horribleness, I say if they're not going to provide the help we need, we can at least cling onto hope.

And who knows - maybe at some point we'll have care homes, residential units etc. that are run either by a different sort of government (local or regional) or by community groups.

As I say this, I have a lovely notion of a group of students arranging their digs, looking at renting a house and thinking "If we 'adopted' an oldie, would they chip in a bit more than we do in exchange for us helping them with stuff?"  I keep using student + 'oldie'  or child + 'oldie' illlustrations, but there are multiple alternatives that aren't about those demographics.  What about working parents with children + people with certain sorts of disabilities?  Depending on the age, savvy and independence of the child, the adult could actually be quite significantly physically disabled.

I nearly forgot - could you set me up a couple of 'companies' based in tax havens and put the bulk of the funds in their accounts, please?  Oh, and to be on the safe side, could you give me £5million in mixed currencies?
Title: Re: The three conversations model
Post by: Fiz on 25 Sep 2021 06:31PM
A million pounds would do me. I have no plans to stick around long enough to need residential care hence being a member of dignitas and a million pounds would cover that cost and help all my loved ones overcome their problems. Thankfully the BMA has finally taken a neutral stance on the subject of assisted dying rather than being against it so hopefully one day people can choose to go when they feel the time is right.
My recent attempt to get care at home showed me it's not available. Or only the help they have available at times to suit them whether or not that care is the care you need and not at the times you need it and that's as good as hopeless. Worse than hopeless. So once I am no longer able to function then I am happy to bow out, I know where I am going thankfully.
Title: Re: The three conversations model
Post by: Sunny Clouds on 25 Sep 2021 08:06PM

*** warning triangle added as post contains discussion of suicide***(KK)

I've got a book that gives information on how to kill yourself safely.
It's a difficult issue, because understandably a lot of disabled people (and I've no idea what proportion)  are concerned that allowing assisted suicide can be a step towards eugenics-motivated killing.  On the other hand, in my darker moments, I can't see that not allowing assisted suicide is going to make much difference, given disabled people starving to death when denied benefits they're entitled to or the sort of attitude exemplified by the powers that be playing 'siege of Caffa' with covid patients and care homes, or by the likes of Tim Martin having posters displayed in his Wetherspoons pub windows that I'll summarise as "People should be allowed to come and keep my business running because it's only the clinically vulnerable [= sick, disabled and elders] that are dying anyway [and they don't matter]"

The irony of it for me is, as I think I've mentioned on here recently, when I was going through perimenopause and making repeated suicide attempts, always within 48 hours of the start of a period, to the frustration of my GP, he couldn't get the gynae team to give me HRT because they just said my premenstrual crashes were due to my bipolar disorder.  Like hell they were.  But when it wasn't the time of the month, I might have felt ghastly but I was no more likely than anyone else to try to kill myself. 

But then look how there were guidelines drawn up for hospitals on how to care for patients at end of life, to give them as kind and gentle an ending as was possible when they were dying anyway, and parts of the media attacked the guidelines over and over and over, putting across the idea that they were about killing people, leaving doctors struggling to do anything except doing everything they could to keep patients alive as long as possible, even where all it was doing was prolonging pointless suffering.

I still feel that if you want someone not to kill themselves when they feel suicidal, the answer isn't to come down heavy and lock them up, the answer is to give them kindness, hope, support, life worth living.

Analogy - article I read by a youth worker who said on the subject of teenage pregnancies that he'd never met a teenager who'd got intentionally pregnant where it hadn't been because they wanted someone to love them unconditionally, so if you want teenagers not to  have babies, don't give them lectures, give them love. 

I want the right to end my life when I'm ready with meaningful, non-coercive (either way) support so that I can make a proper, balanced decision.

But I think this will always be politically sensitive and difficult.
Title: Re: The three conversations model
Post by: Fiz on 25 Sep 2021 08:19PM
I've got a copy of the peaceful pill handbook also.


Euthanasia is very different to assisted dying
 Assisted dying is a person's choice and they take the action needed. Euthanasia being someone ending the life of another I do not agree with unless it's been stated in a previously drawn up advanced directive that the person created previously that in the very circumstances that person is in they wouldn't want to live. Even in those circumstances I personally wouldn't be the person who took action to fulfill that person's wishes. It's not something that I could do but would provide emotional support to anyone choosing to end their lives.


More and more countries are allowing assisted dying and we'll get there but whether that's soon enough for me, I doubt.
Title: Re: The three conversations model
Post by: Sunny Clouds on 25 Sep 2021 09:50PM
Euthanasia is, I believe complicated.  Caution - describes an old man dying, and end of life dilemmas.

Take the instance of my father.  In hospital, barely breathing, unable to eat or drink, kidneys failing, veins collapsing, heart arrhythmic etc.  Suffering.  Not likely to live much longer.

Decision made to withdraw tubes.  No further nutrition.

He had no say in it.  Why?  Very advanced dementia, incapable of understanding.

But let me illustrate something.  I would sit with him.  "Who's that?"  (said anxiously) "Sunny."  He'd grab my hand.  Moments later, he'd thrust it away with extreme anxiety.  "Who's that?" and so it would go until I realised he was more distressed by my presence than without.

Can you imagine the distress he felt as doctors tried to get cannulas into him?  As people tried to change his incontinence pads?  Etc.

But there would those that would argue that removing the existing drips and not putting fresh cannulas in or, alternatively, finding a way to put a gastric tube down or something, amounted to euthanasia, in that some would argue that removing nutrition is euthanasia.

If he'd been clearly able to eat and he'd been in a hospital, we'd probably have seen it as murder to deny him food.

I believe that what was done was technically euthanasia - providing a good death.  (Eu = good, thanatos = death.)

Socially we call it euthanasia if someone objects to it.  But the problem with that is the issue of inability to consent.  My father had no mental capacity to give or withdraw consent to treatment or lack of it.  Decisions had to be made.  I had a power of attorney but actually that didn't really come into it.  It was down to the doctors.  Do we force him to survive in extreme distress, or do we withdraw those things that in effect force him to suffer?

I wish it was a neat and tidy issue, but I dont think it is.  The most we can so as a society is to set out to help everyone to have the best quality of life possible, including things like love, kindness, acceptance, relief of physical & emotional pain etc., and then be supportive if they can't take any more.

I have physically saved lives.  You don't know if you stop someone dying when it wasn't their choice that their life was on the line whether they wanted to live or not, but sometimes as you're slapping on field dressings or pulling someone out of the water or getting them away from fire, you act then and ask later if they wanted to live.

But sometimes the decisions we make over these things are difficult because it's not clear cut.  What we can hope for is to help people through life's horridnesses so dying 'early' isn't what they feel they need, and then when dying happens, make it as peaceful as possible.

Incidentally, when you get stuff after news articles that tells people the Sams' number, I wish they'd also mention things like prayer lines and chat lines and specific condition and circumstance lines.  I think, for instance, that Ataxia UK made a huge difference to my sense I could continue to face life. 
Title: Re: The three conversations model
Post by: Fiz on 27 Sep 2021 01:47PM
It struck me that while Chris Whitty acknowledges this, what is happening in that local charities and organisations are doing the support and picking up the tab rather than the government helping people and solving problems is exactly the plan in the three conversations
https://www.bbc.co.uk/news/uk-england-sussex-58627335
Title: Re: The three conversations model
Post by: Sunny Clouds on 27 Sep 2021 08:36PM
Yes, a good example you've linked to there.

It occurs to me that this is touching on issues I've mentioned elsethread, where I touched on Cameron's disconcertion when he was so keen to push 'big society' to solve problems, visited a charity I was director of, and realised that, oops, a lot of the services we provided were publicly funded services (council, government, EU), just on a not-for-profit basis.  But that wouldn't compute for him.  A range of other services we provided shamed his ilk for what they didn't provide. 

I suppose that's why disabled people have been chanting Rights Not Charity! for so long.  I'm a believer in charity, but not as a substitute for proper state provision, and not as a substitute for state funding.  Sometimes it can be a vehicle for providing public services on a not-for-profit basis, but where it provides extra services, it should be extras and a bit of safety-net, not essentials.