picture from looseends I spent this morning on an advance visit for a holiday I'm planning in the summer. Every summer I lead a holiday for deafblind people. I've done it for ten years, next year will be my eleventh. As I'm starting to plan the holiday - a group of nine of us (four deafblind people, four volunteers, and me) are going to canoe up the Thames for a week - I'm also starting to think about the advantages of being an amateur. Working with deafblind people isn't my day job, and so my ten weeks of leading holidays gives me less experience than someone professional would have after their first three months in the job. I know people who work full time and their skills far outweigh mine. Most of the volunteers share my lack of experience. Why should deafblind people want to come on holiday with us. So what are the advantages of doing this as an amateur. The operational and organisational advantages are obvious; Sense runs more holidays when people want them than they could do otherwise. The personal advantages are, likewise, obvious; I learn a lot and really enjoy it. However these are all side benefits - they benefit the organisation running the holidays, they benefit the volunteers but there is no reason for the people going on holiday to care about this. It seems to me that the key benefit is actual the key disadvantage - I really don't know what I'm doing. I've learned enormous amounts from many of the deafblind people who have come on holiday with me - and mainly what I've learnt is that people with significant sight and hearing impairments, and significant intellectual impairment, and (in some cases) no or very little formal language are better at communicating with me than I am with them. Not being in charge, not being a skilled communicator - none of these are situations I'm good at or familiar with. Many deafblind people with learning disabilities live a life filled with experts who plan programmes for them. Every outing is a learning exercise, every meal a life skills practice. This is useful, important, and valuble. It's equally important to give people the experience of being in charge, of being more competent, of being the boss. As I'm planning I have to remind myself that what my lack of skill brings is a chance for people to be in charge, to dictate and to control - and that's why it's good I don't know what I'm doing, and have to slow down and pay attention to the real experts.
Gardan's Steelyard: A rule of thumb attributed to Fraa Gardan (-1110 to -1063), stating that, when one is comparing two hypotheses, they should be placed on the arms of a metaphorical steelyard (a kind of primitive scale, consisting of an arm free to pivot around a central fulcrum) and preference given to the one that "rises higher," presumably because it weighs less; the upshot being that simpler, more "lightweight" hypotheses are preferable to those that are "heavier," i.e., more complex. Also referred to as Saunt Gardan's Steelyard or simply the Steelyard.(Neal Stephensonin Anathem)
I've just finished re-reading Anathem - a book that repays regular re-reading as it is dense with ideas and concepts, as well as having the characteristic of absorbing you into its world view. This adoption of different world views is one of the reasons I love science fiction.
The main reason for this (short) post is that, this time round, the thing that's stayed with me Gardan's Steeyard. It feels easier and more natural (for me) as a way of conceptualising and understanding Occam's razor than the original. This is a celebration of metaphor as an aid to understanding.
Occam's Razor. "entities must not be multiplied beyond necessity" (William Ockham)
"Ethical axioms are found and tested not very differently from the axioms of science. Truth is what stands the test of experience." Albert Einstein "Home is something you make, not something you find. Something you're always leaving, and somewhere you're always looking for or returning to. It's part of growing up, and not the best part." Neil Gamian "If I had had any idea when I was a child the degree to which the adults running everything have absolutely no idea what they're doing, I would have been so frightened I would never have gotten out of bed." Jonathan Schwarz "We exist by successive approximations of fail better" Elizabeth Bear “Were we to evaluate people, not only according to their intelligence and their education, their occupations and their powers, but according to their kindliness and their courage, their imagination and sensitivity, their sympathy and generosity, there would be no overall inequality of the sort we have got used to” Lord Young of Dartington
Repression of War ExperienceNow light the candles; one; two; there’s a moth; What silly beggars they are to blunder in And scorch their wings with glory, liquid flame— No, no, not that,—it’s bad to think of war, When thoughts you’ve gagged all day come back to scare you; And it’s been proved that soldiers don’t go mad Unless they lose control of ugly thoughts That drive them out to jabber among the trees.Now light your pipe; look, what a steady hand. Draw a deep breath; stop thinking; count fifteen, And you’re as right as rain... Why won’t it rain?... I wish there’d be a thunder-storm to-night, With bucketsful of water to sluice the dark, And make the roses hang their dripping heads. Books; what a jolly company they are, Standing so quiet and patient on their shelves, Dressed in dim brown, and black, and white, and green, And every kind of colour. Which will you read? Come on; O do read something; they’re so wise. I tell you all the wisdom of the world Is waiting for you on those shelves; and yet You sit and gnaw your nails, and let your pipe out, And listen to the silence: on the ceiling There’s one big, dizzy moth that bumps and flutters; And in the breathless air outside the house The garden waits for something that delays. There must be crowds of ghosts among the trees,— Not people killed in battle,—they’re in France,— But horrible shapes in shrouds—old men who died Slow, natural deaths,—old men with ugly souls, Who wore their bodies out with nasty sins.. . . .You’re quiet and peaceful, summering safe at home; You’d never think there was a bloody war on!... O yes, you would ... why, you can hear the guns. Hark! Thud, thud, thud,—quite soft ... they never cease— Those whispering guns—O Christ, I want to go out And screech at them to stop—I’m going crazy; I’m going stark, staring mad because of the guns.Siegfried Sassoon http://www.oucs.ox.ac.uk/ww1lit/collections/document/9855/9738
I was nineteen and this seemed like a rebirth and a moment of hope and joy. I'd grown up knowing I was going to die, that we were all going to die, in a burst of mutually assured destruction. I spent nights at school debating whether it would be better to die quickly or slowly. I knew about local targets (or thought I did). I watched Threads and knew it for a future history. Like many of my contemporaries the Cold War was an ever present oppression. That evening, and the next day were a release from a childhood nightmare of terror and fear. It was, and is, more complicated but now what I want to remember is the sense of lightness and possibility.
The iron law of institutions says that organisations start to become dominated by people interested in power within that organisation - rather than the power of the organisation.
Re-structuring and re-organisations are happening all over the place at the momentI. 've been watching with dismay reorganisation at a place used to work, many friends and collegues are in the middle of change and we're in the middle of a re-organisation at work. It's been prompted by the combination of substantial growth over the last few years and our expectations of constriction over the next few. Pausing and re- thinking has been a valuable exercise.
We used to be a small organisation - 10 staff, a couple of whom did management as well as delivery. We're now larger, about 30 people, and this growth has brought challenges. The natural response to hitting the upper limit of the number of people who can be managed by a single manager is to have multiple managers, who then need to spend a chunk of their time coordinating rather than organizing the primary workers. The nature of our growth, from winning contracts to deliver services, also encouraged us to appoint task based managers - we've got anew service; let's appoint someone to run it. This meant we had an innefficient spread of management capacity and our structure encouraged silos - different types of service didn't work together as well as they could.
Restructuring gave us the opportunity to think about creating an organisation shaped around people who use it (personalisation creates a market incentive to do this and gives us the possibility of being able to deliver what people what, not just the latest funding fad).
But, as we move to appointing the people who will support service users, volunteers, and delivery staff to make the organisation work, I find myself increasingly preoccupied with how to find people who are interested in our mission, and not just their situation. Being aware of the iron law is the first step in resistance.
I've just read an article in Pulse about personal health budgets. This says that when people are choosing what to spend their personal health budgets on "NICE guidance will ‘still apply where relevant’ but only alcohol, tobacco, gambling, debt repayment and GP/emergency services are specifically excluded from direct budgets in the guidance." This raises one of the tensions in implementing personalisation in mental health. There has been a substantial amount of research about what works for recovery. In general, in mental health, we are getting better at knowing what works. The slow advance of science in social care means that we are increasingly being commissioned to provide services on the basis of evidence. We also know what doesn't work (one example amongst many). So what happens when the value of individual choice comes face to face with the fact of what works. Should people be able to choose (with collectively provided resources) to purchase"treatments" that won't work?
We're in the middle of a series of management and organisational changes at work. We're also facing (like a lot of organisations with statutory funding) a whole series of changes in the next year. There are a lot of external factors influencing these potential changes. These include the recession, commissioning intentions from our major funders, fund-raised income, service demands, and multiple other changes in local provision. We know about what a lot of these factors are, we know (roughly) the range of possibilities we face, and we have some ideas about potential solutions - or at least the range of potential solutions we have .... But, how can we adequately consult about this complex situation whilst making sure that people have enough information, and understand which bits we (and therefore they) can control , and which bits are like the weather. The key question comes down to how much information is't enough, and how much information is too much.
Exploring the move to personalisation as a provider means exploring different ways of charging for our services. We've always been very conscious of the bottom line (as a small organisation with few reserves we've had no choice but to be aware of profit and loss for different activities). Personalisation means moving from a few large income streams to multiple small ones. Overall we think that this will be good for people using services and create should create more choice. However we wil stil need to charge and we want to have a charging structure that makes sense for us, for funders, for brokers and care managers, and (most importantly) for the people purchasing the service. I've been thinking about our options and there seem to be three basic options. I'd be interested to know of other ideas. *Subscription* The gym membership model - you pay a set subscription each month and can use as many of our services as you like. The advantages of this model are simplicity and flexibility. It is simple to explain to people, simple to administer, and easy for staff to understand. It is flexible as people can increase, decrease, or change their use of our services without changing their personal budget. It would contain an element of cross-subsidy as people who used more of our services would pay less than the actual cost of what they used and people who used less of our services would pay more. My feeling is that this is acceptable in mental health as peoples need flucuates and the person who needs more this month is the person who needs less next month. *Item charging* The "everything costs extra" model, where every intervention is costed and charged for specifically. You decide what you want and pay just for that. The advantages of this model are transparency and clarity. You get what you pay for. There is no cross subsidy and low users pay less. It may align better with levels of funding provided to individuals. It is, however, less flexible (in a personal budget context) as changes in use would require a renegociation with the broker or care manager. *Mixed* A mixture of subscription and specific costing. There are two main ways of doing this - a core cost with add ons or different levels of subscription.
I run a charity that supports people with mental health problems into employment. I'm interested in new ideas, improving services, and creating useful projects.
Everything here is a personal view and doesn't represent the views of my employer. All the mistakes are my own.
picture from looseends
