Alex MacNeil

Independent Trainer and Consultant


Care. Then Act.

It's staggering to hear an elected government official slash taxes for the most wealthy and privileged in one breath, then target the ability of disabled people to go to the toilet, to wash and dress themselves in the next.

In any other context, NOT giving someone the PIP would seem to be a good thing. Maybe Osborne’s grandma issued dire warnings to him like mine did about not sitting on hot radiators (“It’ll give you the PIP love”). But whilst Maslow spins in his grave at this attack on our most basic needs, I sometimes wonder if I am Nero, fiddling while Rome smoulders and flames around me.

I am passionate about the devilish detail of eligibility and its ability to genuinely personalise care and support. I’m passionate about the rights of carers to their own personal budget. I’m passionate about the ability of the Act to deliver on personalisation. I’m passionate about wellbeing at the heart of every assessment and plan. And I am passionate about the role of social care practitioners in making all this happen for people.

But I expect Nero was pretty passionate about his fiddling.

What place has my discussion about planning in a person centred way got in a culture of 12 minute visits and incontinence pads?

Why should a beleaguered, under paid, under valued workforce care about the Care Act? Why should they care about the fact that in the Act, unlike in the budget, your ability to go to the loo independently IS important? Why should they care that your involvement in your own assessment is taken so seriously that, if there's no-one around you to help, an independent advocate will do that? Why should they care about anyone's wellbeing when it's hard enough to get money to take them to the toilet?

If I had a pound for every time a practitioner had replied “Well that’s never going to happen” each time I went through carer eligibility, or wellbeing, or rights to advocacy, or the duty to tell someone what their care plan will cost them before they agree it, then I could sort Mr Osborne out with one simple BACs transfer.

Every time we dismiss is as “clearly not working” or “it’ll never happen here” then we are letting government off the hook.

The Care Act is a good, important piece of legislation that provides a framework within which social care practitioners can push back to their employers. Their employers should, in turn, be pushing back to central government each time new case law refuses to let them off the hook[1]

So here’s what I want you to do: care and then act.

If you are a registered social worker, use your obligations under the HCPC Standards of Performance, conduct and Ethics.[2] Your obligations to report concerns about safety extend to concerns about wellbeing. Stick that in yer Care Act pipe and puff away!

Plus you have a duty to be open and honest with service users when things go wrong. Giving them information and advice about how to complain and on what grounds perhaps?

If you are not a registered social worker, remember the principle of making defensible decisions, and every time a manager or policy says no to something that you know you should be doing, write to them clearly and articulately quoting the part of the legislation that they should be acting under.

I will help any one of you find out the right part of the legislation to quote. That’s a genuine offer. For free. Just send me an email with your concern and I will help you with the right piece of underpinning evidence from the guidance, regs or the act.

And if you don’t get a decent response when you raise your concern, know that you’ve done the right thing. Maybe a tsunami of regular, legally literate reminders about what we should be doing will be enough to stop Rome burning.



Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has.
Margaret Mead




[1] R v London Borough of Haringey


For Connor

In the name of the dudes, the named dudes, and the un-named dudes.



If you are our protection, please don't show me your attack.

When you assess and treat our dudes, you don't seem to send them back.

We turn to you in crisis when we are full of pain,

You take them and you chill them, numb them, stun them. And then shame.

In ATUs the screams and shouts are loud and from the heart.

The pain of lives who need your help is silenced with "don't start".

You dose them and you watch them and you push until they crack.

You engineer so much bad shit, they'll have to be "kept back".


You say that you are "helping" "We know best" then lock the door.

You take them at their weakest and you weaken them some more.


You wreck the lives of people who had great lives in the main,

You ATUs aren't big enough to deal with real pain.

It takes grace, honour, empathy, compassion and deep love

To help a dude who needs to know that he is not alone

But you're too busy showing me that dudes can't cope "out there"

By drugging them then coaxing them to lay their anguish bare.

"You see?" You shout with glee "we said he was unfit!"

"Just look at the state of this room / her arms / his weight / take your pick"


You say that you are "helping" "We know best" then lock the door.

You take them at their weakest And you weaken them some more.


Our dudes like Claire and Steve will show the world they won't be fooled.

Wrong trousers here, no iPad there....these are your nasty tools.

Claire snuggles up with Jonjo. Steve lines up his next great song,

But the shadows of the ATU continue ever long.

The screams become too big to be contained in your four walls

You tweak a dose, you run a bath, you log all of his falls.

An ATU, an ATU? That's not where they belong!

These awesome dudes were born for Mottthehooplebowiesongs.


You say that you are "helping" "We know best" then lock the door.

You take them at their weakest And you weaken them some more.


The laws laid out to help our dudes are hapless backing tracks.

A jumbled mess of MCA Dols Sections and CareAct.

Thumb twiddling health watchdog ombudsmans of fuckery

Who stand guard overseeing dots of I's and crossing t's.

"A new review part 2 is what is needed, I'm the man!

I'll start one with the great and good, we'll write a spiffing plan!"

The croissant speckled tweed lapels are quite turned on by now,

"Establish the establishment" they whisper "we know how!"


You say that you are "helping" "We know best" then lock the door.

You take them at their weakest And you weaken them some more.


We want you to know we see you. We see you and know your names.

We see you and we'll shame you. Two can play these games.

And if you thought our dudes could make some noise, just wait and see

What happens when we learn what our collective voice can be.

You'll know us by our passion, hearts still grieving, heads unbowed,

The Stobart trucks are circling and we're coming to your town.

You took our dudes from us, you see. You bastards took our dudes.

Thomas, Laughing Boy, Nico - and those not in the news.


So show me your treatment. Show me that you care.

Show me your assessment. Give me evidence, laid bare.


You promised you would help them, you knew best, you held the keys.

You took them at their weakest then you kept them on their knees.