It Feels Odd To Have A Bed At Last (Children and Young People Now)

After sleeping on a sofa for almost a year, Charlotte Jones has secured a supported housing place. But she is one of the lucky ones. Joe Lepper reports.

At the start of the 2010 school summer holidays, 18-year-old Charlotte Jones was a hard-working student who was about to enter the final year of her A-levels. She was living a normal family life in Woking, Surrey, with her mum and partner, and younger brother and sister. But within a few short weeks all that changed. Her mum had become pregnant again and wanted to move out of the area. It led to constant arguments between Charlotte and her mum, which grew increasingly ugly.

Charlotte Jones

By the start of the academic year, Charlotte’s family moved away to Walton-on-Thames, leaving Charlotte to stay with her grandmother in Woking while she completed her studies. Life there was far from ideal. She had to sleep on a sofa because her uncle lived in the spare room and she found it difficult to find space to concentrate on her studies. Her grades began to slip and by Christmas she had been kicked out of college. Shortly afterwards her GP diagnosed her with depression.

“It was a terrible time,” recalls Charlotte. “I didn’t know what to do, so just stayed on my gran’s sofa. I didn’t know who to turn to.” “Although I was at my gran’s, it never felt like home. I was on the sofa. My stuff was everywhere. If my uncle ever went away I’d use his room for a few days. It was the only chance I got to stay in a bed,” says Charlotte.

“It was really hard to study. I tried to stay back at college but it was really difficult. I was so upset when they told me to leave,” says Charlotte, who had left secondary school with eight GCSEs, including an A in maths and an A* in health and social care.

Back on track

She became increasingly depressed and lacked the motivation to seek help. It wasn’t until this July – almost a year after she had left home – that she started to get her life back on track. Her friend Hannah had been offered a place in a newly built block of supported flats run jointly by Woking YMCA and Woking Borough Council. The second bedroom in the flats had become available, so Charlotte applied to live there. As she was officially classed as homeless, her application was successful and she now has a guaranteed tenancy for two years. She acknowledges that she has been very fortunate. “If this place hadn’t come up I probably would still be on my gran’s sofa.”

Despite feeling lucky to get a place, Charlotte believes the past year of upheaval could have been avoided if professionals had got to the bottom of her problems earlier. “My college was particularly bad,” she says. “It didn’t help. It just asked me to leave when my grades got worse. I wasn’t offered any support. My maths teacher was quite nice to me, but no one said ‘here’s a number of someone who will help’.”

She says her GP also failed to recognise the root cause of her depression: “We talked a lot about my feelings but nothing about my housing situation.”

Grove Court, where Charlotte now lives, offers 24 beds to homeless people. Housing project manager James Alexander is on hand to offer advice on living independently. The block also has a warden, and counselling and careers advice are available through the YMCA’s Ypod youth centre, which is near to her flat. Charlotte has been particularly grateful for the budgeting advice she has received from the YMCA to ensure her income from housing benefit and wages from a part-time job stretch across the month. “They have been really supportive,” she says. “The rent is paid weekly and I get paid monthly so it could have been difficult for me. But we’ve sorted out a good payment plan so that I can then give myself a weekly budget,” says Charlotte.

Tight resources

Not all vulnerable young people are so fortunate. Deep cuts to grants such as the Supporting People funding have had a dramatic effect on the availability of housing support to young people across the country (see below). In Surrey, the Supporting People fund has been cut by 9.4 per cent from £17.9m to £16.2m, leading to further pressure on already tight resources. Terry Eckersley, chief executive of Woking YMCA, says Charlotte was able to be housed quickly due to the fact she had a relatively low level of need and a space had become available. But the problem is more acute for young people with more complex needs. “For those that need a home and more intensive support, such as addiction services, there just isn’t the funding,” says Eckersley.

He adds that the organisation is having to become “creative to ensure we can help young people at Grove Court”. For example, the YMCA housing project manager’s salary has been met through the exempt accommodation rule within housing benefit, which allows the charity to effectively receive more housing benefit to cover support for its tenants.

“He is there to help them with tenancy issues, but does more than that. He can help them with a range of issues,” adds Eckersley.

Now that Charlotte is more settled, the relationship with her mother has improved and she regularly visits her family’s new home in Walton. She is also planning to return to college in September to start a health and social care course. “I did well in health and social care at GCSE and am much more interested now in working in health or social care, looking after children, the elderly and people who need support,” she says.

But she admits that it’s taking time to get used to her new life. “It feels a bit odd to have my own room and bed at last. I’m just so pleased to have this place. I haven’t even unpacked my bags yet, it just all feels so new.”

EXPERT VIEW: Seyi Obakin

“The homelessness sector is facing an extremely challenging period. Public sector funding for homelessness charities is down by an average of 25 per cent, with some charities more significantly worse off.

This challenge comes at a time when homelessness is rising. Research from the University of York, commissioned by Centrepoint, shows that the number of young people experiencing homelessness each year has risen from 75,000 to 80,000.

For Centrepoint, the cutbacks have meant the withdrawal of virtually all government support for the health, education and employment programmes we provide for these vulnerable young people, as well as a significant reduction of basic housing support. Without this support, organisations such as Centrepoint are in danger of becoming a sticking plaster rather than offering a long-term solution.

We have to be more creative with our fundraising to fill the gap and more innovative in how we spend it.

Centrepoint has been fortunate to receive funding from a range of supporters. For example, the property and construction sector charitable trust, Land Aid, is helping to meet the costs of our learning services this year.

A further potential problem is the drive towards localism. We are very concerned that it will accelerate what we are already seeing – the siphoning of funds into more politically “fruitful” issues. The little support that is available to homeless young people will more than ever depend on the area they live in, potentially creating a homelessness postcode lottery.”

Seyi Obakin is chief executive of Centrepoint

HOMELESSNESS IN NUMBERS

• 57% of homelessness services saw their funding fall this year and 48 per cent expect further cuts over the next year
• 78% of homelessness services say cuts have forced them to cut the support they offer and reduce frontline roles
• 11% was the average cut to councils’ Supporting People funding in 2011/12
• 78,000-80,000 young people experience homelessness each year. This is an increase of 5,000 since 2008
• 300 complaints were received by the Local Government Ombudsman between 2010 and 2011 about councils’ failure to provide homeless people with support or interim accommodation
• 38 accommodation and advice projects for homeless people closed between autumn 2009 and autumn 2010
• 26% of homelessness services had to turn people away because they were full in 2010

80% of homelessness services are having to make greater use of volunteers

Mother care (Druglink)

Pregnant drug users not only have to battle stigma and moral panic, but also prejudice and confusion among those professionals charged with supporting them. Joe Lepper reports on a new guide which aims to improve help for mothers.

“Some of the nurses looked down at me. The way they spoke to me made me feel really uncomfortable,” says 28 year Angela of her experience of being pregnant and dependent on methadone.

Angela, who is still on a methadone programme and gave birth to her daughter last year, says hospital staff also had little regard for her confidentiality.

“When I had visitors they would mention that I had an appointment to do with the methadone programme right in front of them. I thought that was really out of order, a real breach of my privacy,” she adds.

According to Anne Whittaker, nurse facilitator for NHS Lothian and author of The Essential Guide to Problem Substance Use During Pregnancy, Angela’s experience is still far too common for pregnant women with drug and alcohol issues.

She said: “There is still a prejudice among some professionals, that is why a running theme in the guide is the importance of not making judgments.

“For example, if a midwife asks a pregnant woman with drug issues about drug and alcohol use it is important to make clear all pregnant woman are asked these questions and they are not being singled out,” she says.

Another theme of the book is the importance of empathising with “the complexity of their lives.”

Whittaker says: “They are pregnant, they have an addiction, there may be social care involvement with other children. They may also have housing problems, money problems. There is a lot to deal that those supporting them need to understand.”

This complex range of issues pregnant women with drug and alcohol problems face means successful support needs to involve professionals across health, social care, drug and addiction services as well as other areas such as housing, says Whittaker.

While most areas in the UK offer this multi-agency support to pregnant women with drug and alcohol issues, schemes vary in scope, specialist involvement, investment and organisation.

In Edinburgh NHS Lothian and Edinburgh City Council run the Prepare service for high-risk pregnant drug users in the city.

Whereas in Manchester such support is offered through a specialist midwifery service that also helps pregnant women with mental health problems and Aids/HIV.

Whittaker explains there is a lack of research as to which model works well and no two areas offer exactly the same service.

Fay Macrory, the consultant midwife who manages Manchester’s service, says the management and infrastructure of services is less important than ensuring they offer non- judgmental and honest support.

Macrory says: “When I say honest I mean we don’t mince our words. We tell it how it is around issues such as safeguarding children and explain the consequences of not protecting children or looking after themselves.”

She agrees with Whittaker that empathising with patients’ often chaotic lives is also vital. She says: “You have to understand what is going through their head. They may have a probation meeting, need to pick up methadone. If you want them to go to an antenatal class as well you have to be aware of all these pressures and stress its importance.

“One of the biggest compliments I had was one of the women saying, that I was ‘alright’ because I was ‘like one of them but without the drug problems’,” Macrory adds.

Understanding many patients’ often deep rooted  “antagonism against social workers” often from their own experiences as a child, is also important, she says.

Such fear had meant women in the past would not engage with support services and present themselves to midwife services late into their pregnancy.

“Some are very antagonistic about social workers and may be worried their baby will be taken away. You need to understand and address those fears. They cannot be ignored if you want them to engage in the service,” says Macrory.

While Angela encountered prejudice from some hospital staff, she praised the understanding approach of NHS Greater Glasgow and Clyde’s Special Needs in Pregnancy (SNIPS) service, the specialist programme that supported her during her pregnancy.

“They were really good, I felt supported and they took me to appointments as well,” she says of the service, which includes social workers, midwives, nurses and addiction workers from the charity Addaction.

Whittaker concedes though that barriers remain in providing such specialist support.

Lack of resources across the public sector is one. “I would be very surprised if there was any area where most women in this situation were seen by a specialist drug and alcohol service midwife. They will most likely be seen by a general midwife,” says Whittaker.

She concedes it would be unrealistic to expect increasingly tight public sector coffers to fund a dramatic increase the number of specialist midwives.

“This is why the book is aimed at generalists as well across health, social care and addiction services. It is they who will be offering the support,” says Whittaker.

Another barrier is access to training for generalists to cover the complex array of issues facing pregnant women with addiction issues.

Whittaker says: “There are some very good courses out but there is no national standard. Areas are doing it themselves. In some cases specialist midwives are running courses aimed at generalists. There is a demand, but it can be hard for people in already demanding jobs to get time off to attend courses.”

Across the UK Scotland has the most coherent approach to training. The Scottish government has commissioned the University of Glasgow and Drugscope to run Scottish Training on Drugs and Alcohol (STRADA), the country’s drug and alcohol training body.

The body, which does not have an equivalent in other UK regions, covers issues such as challenging prejudice and clinical problems associated with drug use.

Such clinical issues, which are also covered in Whittaker’s book, include neo-natal abstinence, where babies are born addicted to the drug the mother is using and go through a period of withdrawal.

Inserting a module covering drug and alcohol addiction, pregnancy and family life in all entry- level courses across health, addiction services, education and social care would help improve professionals’ knowledge markedly, says STRADA head Joy Barlow.

Already STRADA runs a University of Glasgow elective course for trainee teachers on supporting families that have drug and alcohol issues. “But this is just one course, it’s not compulsory and its for just one profession,” Barlow adds.

The public sector’s “silo mentality” is another barrier to effectively supporting pregnant women with drug and alcohol issues, says Barlow.

She welcomes the focus of Whittaker’s book on the importance of partnerships involving all professionals involved with pregnant drug and alcohol users. “Currently teams of social workers and drug advisers still work in their silos even if they work in the same building. That needs to be addressed,” says Barlow.

Another focus of Whittaker’s book Barlow welcomes is the importance of involving fathers.

Barlow says: “Pregnancy is about relationships, between couples, between parents and a child and with professionals. The father is part of this.”

For Whittaker she is convinced where support services for pregnant drug users are coordinated, work well in partnership and offer a stigma-free service then “women find it invaluable” and a help in tackling their addiction.

Angela agrees: “Before I had my daughter I was topping up on the methadone with heroin, I don’t do that anymore. I have to think about my daughter, put her first and make sure I’m there for her.”

 

Facebook Disasters

A communication and media studies student from Bournemouth University interviewed me earlier this year about my social media use. Afterwards it struck me just how big a part of my life social media, and in particular Facebook, had become.

Most of the time Facebook is wonderful, keeping me in touch with friends around the world and handy for work with many organisations posting to Facebook and Twitter first and through the old fashioned press release method later.

But this year  I had a bit of a Facebook disaster,  my first Facebook death.

Paul Culnane was someone who I had not even met but his death was very real to me. Australian Paul  befriended me after reading an article I’d written for the music website  I co-edit Neonfiller.com. I’m not in the habit of making friends with strangers, but with Paul it just seemed right.

Paul Culnane's FB profile picture

What followed over the next two years was a virtual friendship, with his regular posts and our chats becoming a highlight of my Facebook experience.

He was an engaging, open and very funny man who had an encyclopedic knowledge of music from old 50s rockers to latest acts. He will be sorely missed by his 1,600 Facebook friends, who still regularly pop by his page to speak to him from beyond the grave. Those that knew him, especially his family, have been left devastated, as have the hundreds like me who never even met him.

Feel free to share your  stories of  the wonderful people you’ve met through social media.

Emotional Overload (Social Work Now)

Social workers come under intense pressures that can have a profound effect on their emotional wellbeing. Joe Lepper explores the techniques workers and managers can employ to manage the complexities of the role

Joe’s problems started after dealing with a particularly difficult abuse case. He received death threats from the child’s father, which stirred painful memories from his own childhood, and soon he became obsessed with the child’s plight.

His other casework began to slip, which lead to resentment among his children’s social work colleagues. As a result, the promotion he craved slipped even further from his grasp.

He turned to alcohol to help him cope. Excessive drinking caused his marriage to begin to fall apart. Within six months, he became totally demotivated and switched off emotionally. No longer able to do his job properly, he was signed off on long-term sick leave. Joe had become yet another social worker to suffer stress-related burnout.

Emotional instability

According to a survey by BASW – The College of Social Work last year, two-thirds of social workers said the job caused them emotional or mental instability and just under half said they had taken time off due to stress.

In Birmingham alone, social workers were signed off ill for an average of 24.9 days a year in 2010, almost three-and-a-half times the national average.

Gail Kinman, professor of occupational health psychology at the University of Bedfordshire, says: “Social work is intrinsically tough. As well as dealing with difficult situations and decisions about families’ lives, you have the added pressures of constant change in policy and negative media coverage.

“The media coverage is particularly stressful. We interviewed one newly qualified social worker for our research who said that when she told her neighbours she was a social worker, she had a brick thrown through her window.”

Kinman believes those working in inner-city areas are more likely to encounter a wider range of traumatic cases. This will include cases ranging from female circumcision to supporting children who have survived terrorism and war.

The first stage of dealing with stress is to understand how it affects your mental health, says Kinman. “Burnout is a psychological process that unfolds over time,” she says. “Recognising it is unfolding is the first step to tackling it.”

In 2005, the study The Experience of Work-related Stress Across Occupations examined the phenomenon of stress across a large and diverse set of roles. It identified three common stages that workers experiencing problems undergo. The first is emotional exhaustion, which leads to lack of energy. The second is a tendency to depersonalise clients as objects. And third, workers feel a poor sense of worth and personal accomplishment.

The depersonalisation stage is particularly concerning for social work, as it can affect the challenging decisions they make for vulnerable families. “The brain is putting up barriers to protect itself,” says Kinman. “Suddenly, from caring too much about their work and the clients, they stop caring at all.”

Once an individual has reached this stage, it can be difficult to return to work, she warns. “If a social worker hopes to return, the first thing they need is time out and have that emotional distance. Only then can they look at exploring their feelings.”

Dangerous situations

Iain Bourne is a psychologist and director of Impact Training and Consultation, which provides courses to help a range of professionals to cope with dangerous and stressful situations.

He applies the theory of psychologists Robert M. Yerkes and John Dillingham Dodson, known as the Yerkes-Dodson Law, which acknowledges that a certain amount of arousal or stress is needed to perform particular tasks well. But if the level of stress becomes too great, performance will decrease.

Bourne says: “For example, if you were to run 100 metres, a high level of stress or arousal is necessary to complete that one physical task. But for a social worker you have to juggle a variety of tasks. A high level of stress will result in emotional exhaustion and the person shutting down.”

The concept of “emotional labour”, developed by sociologist Arlie Hochschild in her book The Managed Heart: Commercialisation of Human Feeling, applies to social workers as well. The theory recognises the stress involved among customer service staff in managing their emotions publicly.

“Although originally looking at areas of work such as cabin crew, it can easily be applied to social work. This exhibiting of fake emotions leads to a suppression of your true self and can be emotionally exhausting,” says Kinman.

A culture persists within some teams, argues Bourne, where social workers are reluctant to show their true emotions for fear that it will be seen as a sign of weakness. “Social workers are in the job because they want to help,” he says. “It can be tough for them to ask for help.”

He is also critical of managers who focus too much on caseloads and performance. “Sometimes managers forget that they are social workers as well. When they get into management, they think they should become focused only on statistics and forget to actually supervise staff,” says Bourne.

Louise Grant, a social work lecturer at the University of Bedfordshire, urges social work managers to take time to carry out reflective supervision with social workers.

Reflective supervision, she says, gives social workers “the opportunity to look at what is happening in a case, how it impacts on them and some of the emotional aspects of their life that they are bringing into work”.

Managers do need to be aware of their limitations though when supporting staff. “For example, if a social worker had an issue with their own experience of child abuse, it would be wrong to act as a psychologist,” says Grant. “The manager must know when it is time to recommend outside support.”

At the University of Bedfordshire, social work students receive a range of training to prepare them for the emotional aspects of the jobs.

This includes time management training, relaxation techniques, meditation and cognitive behavioural therapy techniques, which involves looking at how situations could have been dealt with differently.

Better supervision

Social work consultant Andrea Warman is currently researching how supervision in social work can be improved further. She says: “Social workers are being trained to cope, but it is for nothing if they do not get the supervision from managers.”

One model she is exploring is holding regular discussion groups led by a psychologist. “It has been shown to promote professional confidence and improve decision-making,” she says.

“There is a good case for piloting this approach with line managers of children and family social workers, who were initially trained in an era where there was less focus on the emotional side of the job.”

Such a move would help change the culture among the many social work teams “which sadly are ignoring the emotional burden of the role”, she adds.

As for Joe, he did eventually return to social work after receiving help from Bourne, but he pursued a different path working with adults with learning difficulties. Bourne says it was necessary to “unravel all the stress factors one by one” in Joe’s life before he could start practising again.

PROFESSIONAL SUPPORT CASE STUDY

“It is critical that people understand how much the job can affect social workers emotionally,” says Rebecca Brewer, a senior social worker in Milton Keynes Council, who was appointed three years ago to support colleagues with emotional issues.

The role has been created as part of Milton Keynes’ involvement with the Children’s Workforce Development Council’s newly qualified social worker programme and helps new recruits manage their caseloads and understand the emotional aspects of the job.

New recruits are given oneand-a-half-hours of reflective supervision each month to discuss any personal issues that are affecting their work and concerns around particular cases.

“It helps them to develop a professional shell and resilience to stress. If they have a particular problem or are involved in a difficult case, then sometimes we meet each week,” says Brewer.

As well as supporting newly qualified social workers, Brewer also supports more experienced colleagues and arranges training for managers and aspiring managers.

She also provides advice on time management. “What we want to avoid is that feeling of being overwhelmed by the job,” she says, adding that “the focus is very much on giving people the chance to reflect about the job, cases and decisions they take. We want them to be able to step back from it and have the time to do that”.

Regular group sessions, held either monthly or bi-monthly, are now being planned to allow social workers to discuss concerns and the emotional side of the job with their colleagues.

“For some situations this will not be appropriate, but the feedback we received after consulting staff was that the opportunity to reflect in a group was something they wanted,” says Brewer.

Resources

- The Emotionally Intelligent Social Worker (2008)
- The Experience of Work-related Stress Across Occupations (2005)
- The Managed Heart: Commercialisation of Human Feeling (1983)
- The Social Work Supervisor (1996)

Landlords urged to fill housing support gap left by council cuts (Children and Young People Now)

Social and private landlords must do more to fill the vacuum in housing support for vulnerable young people that has resulted from significant reductions in funding and the end of ringfencing, according to the Joseph Rowntree Foundation.

The charity’s latest report, Improving Housing Outcomes for Young People, found that money for many successful housing schemes for young people, including foyers and supported lodgings, is becoming scarce as a result of government cuts and the removal of ringfencing to local authority budgets.

Report author Rachel Terry urged councils to prioritise housing support for all young people and called on social and private landlords to do more, particularly at a time when youth unemployment is continuing to rise and young people’s wages struggle to keep pace with spiralling living costs.

“Private landlords can do more, such as become more involved with approved lettings schemes for young people,” said Terry. “At 16 it may seem wonderful to have your own place but it is really difficult. The schemes (highlighted in the report) recognise that and their success proves the support they offer is very much needed.

Among the examples of successful projects were those where social landlords had worked closely with schools and youth groups to help young people better understand independent living and personal finance.

At a time when finances are tight, such schemes are cost-effective because they reduce the risk of young tenants defaulting on rent or breaking the terms of their tenancy, the report states.

Choice-based lettings schemes are another example that offers accreditation to private landlords of vulnerable young people. The report said: “This is good for prospective tenants in providing more choice, and some reassurance about the landlord, as well as for private landlords in gaining free advertising of their vacant properties.”

Terry said councils have been “slow” to involve private landlords in such schemes, but added that even with financial restrictions there is still a lot that local authorities can do to ensure housing support continues.

As well as involving social and private landlords she anticipates councils will have to focus more on cheaper “floating support” through a support worker, rather than more expensive permanent support such as foyers.

Coventry-based social housing landlord Whitefriars Housing has developed an Open College Network course to raise awareness of social housing and to teach young people the skills to manage a tenancy.

Whitefriars also distributes booklets on independent living for use in personal, social, health and economic education lessons. In addition, it runs a specific programme for teenage mothers in Coventry. Karen McDowall, head of customer excellence at Whitefriars’ parent company the WM Housing Group, said that as a group, teenage mothers are likely to become tenants.

McDowall acknowledged that in austere times social housing groups and private landlords have a greater responsibility to support young people with housing issues.

“For a small financial contribution and staff time to go into schools, we are helping our tenants of the future,” she said. “Already we are seeing the benefits with young people who live on our estates being really community-focused, asking questions about whether there are enough bins on the estate, for example.”

Financial pressures

John Perry, policy adviser at the Chartered Institute of Housing, said the threat hanging over council-funded projects was a concern for housing professionals and for vulnerable young people.

“A number of schemes that prevent homelessness, including those for young people, are at risk because of financial pressures on councils,” he said. “There is a central government fund for homeless work that is safe, but for every £1 spent from that £10 should be spent by local authorities.”

He also agreed that housing associations have a lot to gain from supporting young people. He said: “Looking at examples such as Whitefriars shows that such support is not vastly expensive and can bring real rewards to the association and tenants.”

By Joe Lepper

Carving out a role in GP commissioning (Independent Nurse)

The Health and Social Care Bill is set to transform the NHS, wiping out PCTs and handing their health commissioning role to GPs.

As the bill progresses through parliament the government is already trialling this new form of commissioning through 141 pathfinders, which were set up in December and January.

But nurses’ role in this new commissioning structure is unclear. The bill offers no guarantees of a place on consortia’s management boards, or that nurses should even beconsulted on local commissioning decisions.

Among pathfinders there is evidence that nurses are involved at a senior level. In Nottinghamshire the local commissioning pathfinder Principia has nurses on its management board as well as in advisory roles (see case study box).

Other options being considered are to have a small GP led management board with nurses advising it through ‘a clinical senate’.

Lynn Young, the Royal College of Nursing’s primary care adviser says that ‘nurses can get too hung up on getting a place on the board ‘ adding that, ‘they could find themselves with more say as advisors.’

She says: ‘Large boards with lots of different factions can end up being talking shops where nothing gets done. There are certainly merits in having a small board with some kind of expert panel advising it.’

NHS Alliance chair Dr Michael Dixon is seeking to reassure nurses they will have a strong voice in local commissioning under the planned changes.

‘To be successful they have to involve the experts for each service, whether that be physiotherapists or nurses,’ he says.

He also agrees that having a nurse on consortia’s management board may not bring greater power to the profession. ‘What you need is a system that channels their expertise, not a system that is gunged up with old thinking and obsessing with who has a seat on the board,’ he says.

However, he does acknowledge in some areas nurses are feeling isolated from the work of the pathfinders. ‘But that is because many consortia are being formed from practice based commissioning groups. Once the structures are sorted then nurses will see themselves much more heavily involved,’ says Dr Dixon.

Ms Young hopes that a benefit for the profession under GP commissioning will be greater funding for nurse led services.

‘We saw this under GP fundholding and I can see it going the same way under thismodel,’ she says.

Charlie Keeney, programme director for GP commissioning support at the NHS Institute for Innovation and Improvement, says the squeeze on NHS budgets is also likely to lead to more nurse led services being commissioned by consortia.

He says: ‘What GPs need to be looking at closely is reducing acute budgets and seeing what more can be done in the community and surrounding prevention. This is where nurses are the experts.’

Support is being offered to consortia by the Royal College of GP’s centre for commissioning, which is run jointly with the Institute.

Taking place this year is a series of roadshows to explain more about the commissioning process. Within months a series of training modules for consortia will also be published.

A priority of the centre is to encourage more GPs and other clinicians, such as nurses, to get involved with consortia.

Mr Keeney concedes that ‘it can seem daunting, but we are trying at our roadshows to make it more manageable and take away some of the fear.’

But Ms Young believes many GPs will remain unconvinced and will struggle to find the time to become a commissioner.

She believes that a likely scenario is for GPs to drop out completely in some areas and hand over responsibility to more experienced commissioning managers currently working within PCTs.

She says: ‘There are lots of GPs that were not interested in practice based commissioning and I can’t see them being interested in GP commissioning either. I think it will be likely that no GPs at all will be involved in commissioning in some areas.’

Dr Dixon believes clinicians will still take the lead but concedes that in some areas they may be little change around commissioning. ‘Where a PCT already works well with local clinicians there probably won’t be much change. The consortia will want to keep the expertise of PCTs and the same people will continue to work together commissioning,’ he says.

However, in some areas where the relationship between PCTs and GPs ‘is less good’ he can see GPs turning more to ‘the corporates’ for that management and commissioning expertise.

Somerset is among those areas where commissioning pathfinders are being set up, with the county exploring a two-tier model.

Wyvern Health, formed from the county’s practice based commissioning group, local medical committee and PCT, will look at regional commissioning covering an area of 75 practices and half a million patients.

It will then link up with two smaller pathfinders, of 11 practices in Bridgewater and three in East Mendip, which will advise Wyvern on specific commissioning needs in their areas.

Wyvern Health chair Dr David Rorke, believes this could become a popular model in rural areas like Somerset. ‘It makes sense to have a county wide commissioning focus and smaller commissioning groups being set up that really know their local population,’ says Rooke.

Wyvern is now consulting on the consortium’s structure, with Dr Rooke favouring a small board with a clinical senate advising it. ‘This could reduce bureaucracy and mean decisions can be taken more quickly,’ he says.

He agrees that under the GP commissioning, primary care nurses could be in greater demand in Somerset. Already in Bridgewater GP practices have set up a complex care pilot working in nursing homes.

‘This is the kind of local service with a strong nurse involvement that we as clinicians are looking to commission,’ says Dr Rooke.

Dr Rooke is also adamant that nurses will have a strong voice in commissioning in Somerset, whichever management structure is agreed. He says: ‘It would be impossible for us to commission services for areas such as long term conditions without nurses’ expertise and involvement.’

CASE STUDY

As practice nurse leads at Principia, which was named as a GP commissioning consortia pathfinder for the East Midlands last December, Diana Buck and Sarah Hartley see themselves as champions for all practice nurses in the region.

They have been working in similar roles for the last five years advising commissioners at both PCT level and Principia, which was set up as a GP, nurse and community led social enterprise to commission health services in Rushcliffe in 2006.

Nurses are also represented at a more senior level at Principia, as a health visitor andcommunity matron sit on its management board.

Ms Buck says: “Our job is to convince the commissioners of the benefits of investing innursing. It is difficult in the current climate as they do not have money to spend, but we have made some progress.”

Among projects and services Ms Buck and Ms Hartley have helped commissioners develop have been a Bank agency scheme for practice nurses, to help practices cover sick leave. They also organise nurse training sessions, with a recent course covering the treatment of asthma.

“It is difficult though. We couldn’t get the money from the commissioners for a recent training course, so we ended up turning to the pharmaceutical industry,” says Ms Buck.

Ms Buck remains sceptical that GPs as clinicians are best placed to commission local health care and believes they will find it difficult without drafting in management expertise from PCTs.

She says that both her and Ms Hartley are struggling to keep within their seven and half allotted hours work for the consortia on top of their clinical roles. Ms Buck works as senior practice nurse at the county’s HMP Whatton and Ms Hartley is a practice nurse through the Bank scheme.

“To attend the meetings, look closely at training and the other work, we either need more hours or more of us,” Ms Buck adds.

by Joe Lepper

Creating a website using WordPress – Part 2

This is the second part of my experience of creating a website for my music website neonfiller.com using WordPress. In Part 1 I explained how I selected a web host and switched domain name.  I had easily uploaded WordPress onto the admin panel (or cpanel) of my host, using a simple uploader button that it provided. (All web hosts will have a different method). Fortunately the process of transferring the domain was swift and was completed within five days of requesting a transfer.

Choosing and uploading a theme

The first thing to do is choose a theme that suits your needs. There are some really good themes out there that can make the site look less blog like. Some premium themes cost around £100 or so, but there are many good free ones. We decided to opt for a magazine style theme supplied for free by Woo Themes called Premium News. This fitted the music magazine feel of neonfiller.com. All sites will be different.

To upload the theme

Press the download button on your selected theme. This will download a zip file onto your computer which needs to be added to your site. Here is an easy guide from WordPress.org that helped me do this.

Getting started

This part is short, not because I’m lazy, but because the process is startlingly easy.  In the dashboard there are various sections. Premium News had its own, which controlled the layout of the homepage. WordPress has its own, the most important being ‘posts.’ Just add your text, images and videos in the main text box, remember to tag them and categorise them and press ‘publish’.  You are underway. I have spent the last few days prior to writing this having to upload around 150 articles from our previous website at Mr Site. That process is finished and Neonfiller.com has been reborn. Hope you like the results as much as we do.

Creating a website using WordPress – Part 1

Around two years ago I co-founded the music website Neonfiller.com for a number of reasons. Writing about my passion for alternative and independent music was one, but so too was the chance to  improve what little skills I had in web development.

Sadly web design and development has largely passed me by for much of my journalistic career.  I’ve used content management servers for uploading news stories onto clients’ servers before but wanted to go on to the next level and create my own site.

We started with the most basic of web hosting and content management kits, supplied by Mr Site for around £19 for the first year, about £35 for subsequent years.

Mr Site is simple to use, provides an easy to manage content management system. But as the years have rolled by so have its limitations. It does not link up with certain ad spaces, or more familiar blogging platforms like WordPress or Joomla. In fact its pretty much on its own, with  its limited widgets and layout. That’s not to say its poor, just limited.

We are now in the process of moving neonfiller.com to another host so that I can get to grips more with wordpress, a far more flexible way of creating a website. I’ve taken on this task myself, but will be ably assisted by my co-editor at Neonfiller.com should I need his help.

For the new site though I’ll be using wordpress.org, which is more complicated than the wordpress.com designed site you see before you. While wordpress.com is a simple to upload free content management system and bloghost in one, wordpress.org is aimed at providing content management while using another host. It is far more complicated and allows ads. For more on the difference between wordpress.com and wordpress.org click here.

Seeing as I’m new to this I thought it useful to share my experience, my highs and lows along the way and hopefully offer some advice and tips to others like me, who may lack experience in web development but not the enthusiasm. If you are an expert reading this please feel free to offer any further advice in the comment box below.

Here’s the first couple of stages…further updates will be up online over the next few days.

Stage 1– Select a web host.

After a google search using phrases like “top ten UK web hosts” I’ve opted for UKwebsolutionsdirect and their basic £3.99 a month web hosting package. (At the time of writing I managed to take advantage of a three month for free offer). So far I’m impressed. Before and after signing up I had a number of questions for them such as how do I transfer my domain name? They responded by email within minutes. At one point I was getting responses within a minute. Now that’s service.

Stage 2– Switching domain name.

To switch all I had to do was contact Mr Site, get them to unlock  the domain and supply an EPP code that I can hand over to UKwebsolutionsdirect. I then received an email via UKwebsolutionsdirect that I had to respond to confirming that I own the name.

Once approved it takes a few days for the transfer to be completed, or propagated as it is known.  In the interim Ukwebsolutionsdirect has given me a temporary url, so I can play around with the new format.

During the first 24 hours after applying to ukwebsolutionsdirect I’ve found my options limited until the domain name is fully transferred. I have managed to use the temporary url to download wordpress as a content management system for the site and load up this free magazine style template I’m keen on using.

Until the domain is transferred I can’t  do much else and cannot access the admin panel on wordpress on my temporary url. The script will not work until transfer is completed, UKwebsolutions direct tell me. I now play the waiting game  and hope the transfer doesn’t take too long.

What’s next: In part 2 I’ll be sharing my experience of creating the new site and moving over nearly two years worth of music news, reviews and features.

Introducing News and Features Ltd

Welcome to the website of News and Features Ltd, the trading name of freelance journalist and copywriter Joe Lepper.

With more than 13 years experience in journalism Joe writes for a number of websites and magazines covering a diverse range of areas from social care and health to music and personal finance.

To read more about Joe visit the About section.

Beneath the bright lights (Children and Young People Now)

Thousands of young people are believed to be sexually exploited each year, yet only one in four local authorities has set up specialist services. Joe Lepper reports on the steps local authorities such as Blackpool Council are taking to prevent sexual abuse.

The disappearance and suspected murder of 14-year-old Charlene Downes in 2003 sent shockwaves through Blackpool.

As police began to investigate Charlene’s disappearance, they discovered that she and a group of friends had been targeted by a group of older men. These men had sex with the girls, sometimes in exchange for cigarettes and food. As the investigation continued, police were convinced Charlene had been sexually abused and murdered.

What also became clear was that there were potentially more young people like Charlene in the area being targeted by sexual predators.

To tackle this the Awaken team was created in 2004 to bring together police, social workers, schools, licensing officers and nurses to target perpetrators, support victims and prevent abuse.

In late November, the project won the Stay Safe prize at the 2009 Children & Young People Now Awards for the work it does in schools and other settings to identify and prevent young people from becoming sexually exploited.

Charlene Downes

In addition to handing out contact cards to young people that feature a hotline phone number, the team targets so called “honeypot” locations such as amusement arcades and shopping centres where men target young people. Some of the cases the team deals with are shocking, admits Awaken manager Andy Shackleton. “Some involve gang rape, abduction or statutory rape and the sentences handed down are life in some cases,” he says.

Protection and prosecution

“We recently had a case concerning the targeting and sexual abuse of paper boys. It was two men who were on the sex offenders’ register. They were successfully prosecuted and because of their background, their crimes and the risk they pose have been given indeterminate sentences,” he adds.

Internet grooming is among the main areas of Awaken’s work. One recent case involved boys being targeted by a man who used software to give the impression that he was an 11-year-old girl. He would get them to commit sexual acts. During the investigation, the Awaken team found that he had around 50 young people on his “buddy” list.

“Something like this involves considerable work in helping the victims to recover from what has happened. This has been far easier for us to manage as the police and social work sides work closely together through Awaken,” says Shackleton.

Among the statistics Shackleton is most proud of is a zero pregnancy rate among the girls the team has helped. “We have a specialist nurse who can talk to young people about sexual health and has helped fit around 50 contraceptive devices.”

Awaken’s prosecution success rate of 96 per cent of cases it deals with is another area of pride. Over the past three years, the team’s efforts have led to 56 prosecutions.

Sadly, the perpetrator of Charlene’s murder and disappearance is not among this list. In 2007, two men stood trial: one accused of her murder and another accused of assisting with the disposal of her body. However, the jury failed to reach a verdict in the first trial and the retrial collapsed. An Independent Police Complaints Commission report criticised the handling of the investigation, which Shackleton says Awaken was not involved with.

While the efforts of the Awaken team have been praised by Barnardo’s, the charity says too few areas have such specialist support. Its report Whose Child Now?, released last month, found that only 20 per cent of local authorities provide any specialist work for sexually exploited children and young people and called for more action to be taken.

But Colin Green, child protection lead for the Association of Directors of Children’s Services and director of children’s services for Coventry, says the report “doesn’t tell the full picture”.

He says: “Councils are offering support to victims of sexual exploitation; it is just they are not labelling it sexual exploitation. Sometimes this is through wider youth programmes or sexual abuse services.”

Specialist teams

Areas such as Coventry, where police and social workers offer support to sex workers, also focus on young victims of prostitution, he adds.

But Lynne Cardwell, deputy children’s services manager for Barnardo’s Sexual Exploited Children’s Outreach Service in Middlesbrough, takes a different view.

“What we found is that you need to have a dedicated team looking at sexual exploitation who can work with all agencies and whose prime concern is this issue. More general services don’t have the expertise to pick up the problem,” she says.

Nick McPartlan is manager of Engage, a sexual exploitation project in Blackburn with Darwen that last month picked up the Integrated Working Award at the Children & Young People Now Awards. He believes specialist teams are needed due to the complexity of the cases.

“Sexual exploitation is often not organised, which makes investigating harder,” he says. “Typically, cases of exploitation start when a young girl is targeted by a man or group of men. The young person thinks they are in a relationship and then they are sexually exploited, perhaps asked to have sex with a number of men,” says McPartlan.

Engage was launched originally as a Lancashire Police operation in 2005 in response to the high number of reports of young runaways being sexually exploited. The team of just a detective and social worker focused on supporting the victims and attempting to prosecute perpetrators, but with 1,220 missing children reports in 2005/6 this was always going to be a struggle.

Then, last year Engage became a multi-agency operation, encompassing a 15-strong team of children’s services, health and voluntary sector workers, including representatives from Barnardo’s and the Coalition for the Removal of Pimping (Crop). Now, on average one perpetrator a week is prosecuted and each week it deals with four referrals. Of these at least half are found to be at risk of sexual exploitation.

“Having a multi-agency team means we can really focus on our core aims of protection, prevention, and the icing on the cake, prosecution,” says McPartlan.

“One case we dealt with recently involved a man who was a semi-professional sportsman living in the area. Police were alerted after he was seen with a young girl in his car. When officers checked his phone they found at least six numbers of girls we were supporting,” he adds.

A core element of its work is prevention and early intervention. Staff from the team go into schools to explain issues such as grooming in personal, social, health and economic education lessons and work closely with young people who are known to regularly run away from home or truant from school.

Education

“Another problem is that the young people do not see themselves as victims or their relationships as involving grooming or exploitation,” says McPartlan. “Many of these young people are under 16 and leave home for a period of time. They are often taken out of the borough, but still live nearby, so it’s also not easy to class it as trafficking in the traditional sense or running away,” he adds.

And it’s not just the young people themselves who need support. Their families can be deeply affected by what has happened to their child.

Last year, a family support worker provided by Crop was added to the Engage team to work with parents. “We were victim focused, but this means we can really specialise in helping parents as well,” says McPartlan.

Sarah Lloyd, senior practitioner at Crop, believes further national research into sexual exploitation is desperately required to discover the true extent of the problem and that clearer targets need to be set.

“Nationally there are performance indicators for councils such as cutting the number of missing children, but nothing that is specific to sexual exploitation,” she says. “Some areas have looked into the issue and gathered figures, some haven’t.”

Crop wants a national performance indicator that requires all police forces to assess and tackle sexual exploitation. “Until something like that happens it is very difficult to know the true extent of the problem and provide good support in all areas,” she adds.

McPartlan also has a warning for councils that don’t think sexual exploitation is an issue in their area. “It happens everywhere,” he says. “Councils that deny it is a problem are misguided.”

FACTS ABOUT SEXUAL EXPLOITATION

There are no national figures relating to sexual exploitation, but Barnardo’s estimated in 2005 that in London alone 1,000 children were at risk

Just 40 out of the 209 councils and children’s trusts with responsibility for producing children and young people plans either commission or run specialist sexual exploitation services for young people

70 per cent of adult sex workers entered prostitution when they were children or young teenagers

Three-quarters of children abused through prostitution regularly truanted from school

Of the 140,000 children and young people who run away from home around 10,000 are hurt while away

Sources: Barnardo’s, Coalition for the Removal of Pimping and The Children’s Society