In the latest university podcast, the school’s Jackie Lelkes, discusses her work into care for older people.
Jackie also talks about her role in the Hearing Aid podcast, a resource for health and social care professionals working with older people.
I work with the social work students, so we run a number of programs. We have an undergrad social work course and a postgrad social work course. But we also do quite a lot of continual professional development courses as well. For example, once you’ve got your social work qualification, there are certain roles where you then have to carry on training. So if you want to be an approved mental health practitioner, for example, you need to then come and do training for a year to do that. I’m involved in what’s called the deprivation of liberty training, for example, which is where, under the Mental Capacity Act, somebody lacks the ability to make a decision themselves and they’re in residential care, they’re not allowed to leave, there’s a legal process called depravation of liberty. So we do continuing professional training as well, so I’m involved in a range of courses across the university.
I will go into detail about some of the focuses that you look at a little bit later on – there is quite a lot to get stuck in to. Can you tell us about your background then before you got to the university?
Okay. So I did my A-levels, went to university and did a degree in sociology. I then was a care assistant for just over a year working with people who were tetraplegics, so no ability to move from below the neck, and then I decided to train to be a social worker. So I went to the University of Liverpool where I did my social work qualification. This was different then because you had to have a degree and experience and then you could do it in a year. Now it’s three years. And after that, I then worked as a social worker for a very long time in practice. When I first qualified, social work was generic and I worked in a hospital. So we worked with adults and children. So from pre-birth right through to end of life, that remains the same. It’s just now you have to specialize. And then I was involved in setting up intermediate care teams, which are specialist rehabilitation teams working with people who have been in hospital who are discharged earlier. The idea being to get people back to independence at various points. I was team manager in local authorities as well and then I decided that I wanted to get into education. So I was a practice educator where you support students doing their placements. We still have a system now. And then I worked for the Open University while still working in social work practice and then I got a position here. And so then went from part-time to full-time. I’ve been here, I think for nine years, full time now. So no longer in practice, but up until that I was. So over 25 years as a social work practitioner.
Your focus on how we think about and work with older people is a very sensitive area, as social work areas are, and it would take a very particular type of person to have that kind of job, I guess. How do you prepare your students to be prepared for what they’re going to experience in the workplace?
I think, well, obviously, placement is hugely important. Social work. Students do two very long placements. They do a 70-day placement in the second year and a 100-day placement in their final year or first year if you are a MSA and final year. And that’s really where a lot of the preparation comes because they have to actually do the job. So it’s not an observation placement there. They’ll have their own cases to work with. And so actually, the time that you spent with service users obviously helps to prepare. I think one of the nice things about Brighton is all of the lecturers here, we come from practice, so we’ve all had first-hand experience of working with people. So we’re able to use, I suppose, that lived experience as well to help them to understand what it means to work with service users. And also, you’re privileged, aren’t you, I think when you’re working with service users, because by default you work with somebody because they’re in a difficult place at that moment in their lives and if you can help them to turn that around, so there’s a privilege in being able to do that. But also, it’s not all sad, and you can hear some wonderful stories and people have such exciting lives and if you listen to them and you hear those stories, then obviously there’s a lot of joy as well as sadness. But I think like lots of things, sometimes you just have to build that emotional resilience through doing the job, really. And then thinking about your own emotional health and well-being. We talk to students quite a lot about, well, what do you do outside? How do you relax? Also, techniques about how can you sort of park your work until the next day when you sort of pick it up again. So we talk about these things and hopefully that way and through experience, you learn become slightly more emotionally able to deal with the challenges of working with people who obviously you can see some difficult things in practice.
What’s behind your decision to go into this field in the first place?
I’m very conscious that, you know, students are just getting excited or just had their exam results, aren’t they? And I basically messed up my A-levels completely. And so I took I took sociology as an additional level and really enjoyed it and that led me to do so sociology as my degree and that Len led me to becoming a carer. And I really loved that role. And then it was so where was the natural progression from there? And I’m very nosy. Social workers, I think have to be quite nosy. And so I was just really interested in what could I do? What job could I do working with people. And I think that just sometimes I think you fall into a job that turns out to be the right job.
Do you naturally fall into focusing more on older people? Was that just a decision that happens during practice or when you came into education?
It happened during practice. So as I said, when I went into practice, I started in hospitals. So as you imagine, big general hospitals cover from birth to end-of-life. And so I was involved in working with children and I realized that that wasn’t what interested me in a sense. Also, because I think I was for social work at that time, I was very young. You had to be 24 before you could start the job and that was that I was the youngest you could possibly be. That’s the only thing I sort of focused on doing. And I found that quite difficult as quite young without children of my own. Also I naturally gravitated towards my grandparents and their stories and things like that. So I think I naturally gravitated towards wards that were for older people and having the time to work with them. So, yeah, it just it was very clear to me that it was not that way. And some people just, you know, you’ve got to go, haven’t you, where you feel you work best. And children was not where I felt I worked best.
I think everyone can pretty much relate to a lot of your focus on adult social care. Most people, you know, a family member who has had or has dementia, has had a stroke, or is frail. The emotional and financial side of being able to deal with care.
It’s extremely hard, isn’t it? Absolutely. I think, you know, it’s interesting isn’t because I worked with adults for a long time. And particularly if you’re going to work with older people, you’re quite right, there’s a high percentage of older people about have dementia. And actually, my mother then got dementia and I realized it really made me think about my work that I had done with people with dementia when I actually had that lived experience of working. And I have a real interest in the Mental Capacity Act. That’s the subject of my PHD. And it suddenly dawned on me that I’d done a lot of assessments of people under the Mental Capacity Act. And actually then I was on the other side of the fence, as people were doing these assessments, with my mother. And it really made me stop to think about how would I reach some of those decisions and what was impacting on me, which actually looks very different if you’re the relative of somebody as to the professional. It’s really made me rethink a lot around things like that, around mental capacity and how we do those assessments.
So what are some of these key findings then?
Well, I’m still working on it at the moment; I’m only in the first year of my PHD. So age is no barrier to carrying on with your education, which I think is a really important message actually around, you know, we can study at any time, can’t we, as long as we find something that really interests us. Actually, one of the things that I’ve sort of been thinking about is things like emotions. And actually, how do you detach yourself from those emotions and actually what you can do to an extent, you can never completely detach from your emotional side, even as any professional, it doesn’t matter what your profession is. And actually, one of the things I’m interested in looking at is our own emotions? How do they impact on how we make decisions? And also, you know, our social workers. The Mental Capacity Act isn’t just about social workers. It can be doctors, nurses, OTs, everybody. But obviously I’m concentrating on social workers. But, you know, how do we can do we actually truly detach all of our own lived experiences when we’re doing these assessments?
I mean a lot of people are having to make decisions on behalf of their family member at the moment but one of the toughest areas is when the line is kind of blurry, when it’s not really particularly obvious whether that individual can make their own decisions or whether family has to. Is that where it gets really tricky?
At that tipping point. And where does that tipping point exist. From being able to say that somebody can make this decision and somebody can’t make the decision? And obviously the point of the Mental Capacity Act is to allow people to make as many decisions as they can make. It’s not a blanket. You can’t make any decision. But it’s really difficult, isn’t it? Where does that where does that tip over? And so what I’m interested in trying to find out is what’s influencing practitioners when they make that decision and they tip from saying, yes, you can make this decision to no you can’t, because there are huge consequences, aren’t there, then, of deciding that somebody can’t make a decision? If you think about your own lives and suddenly you get told you can’t make a decision and somebody is going to make it for you, there’s a huge impact there. And because mental capacity is from 18 up, so any of us can fall into that at some point where we may not be able to make those decisions.
Talking from our own experiences of family members that have dementia, where that becomes tricky, I imagine, is when your family member may be in a little bit of denial about the situation that they’re in. So then that person will get frustrated and maybe that sometimes makes you make a decision for that individual and actually they probably could have still made it themselves. They just come in, finding it hard to come to terms what they are going through.
It’s not uncommon, if you love someone you want to try and keep them safe. And sometimes families want to make decisions because actually they’re concerned about the safety of that person or actually their life is just very difficult. If somebody is ringing you up five or six or seven times a night, all through the night, and you’re getting no sleep, it’s quite difficult because obviously one of the things that somebody with dementia may not have is a time-frame that they may not realize that it’s 2 o’clock in the morning. And so, you know, all of these things can impact on anybody saying, I think the best thing would be, for example, for somebody to go into residential care, whereas actually the person may not want to do that and they might still be able to not have to go into residential care if the right support is provided around them. And what’s that right support? But then that’s not going to mean 24 hour support in your own home? And that can be a quite difficult concept for family when they make you think it’s with the best intentions but if you think about your own life, if suddenly you’re being told that you can’t do something and you’ve got to move into residential care, that’s, that’s emotionally and psychologically quite difficult. And we had that with my mother. It just got to the point where she had to go into residential care. And then you’ve got to deal as a family member. You’ve got to deal with the anger that comes at you because you’ve had to make a decision, which is the right decision. But actually, you’ve still got somebody then who’s very angry at this decision, because I don’t think it’s uncommon for family members to try to ask people to promise never to send them into residential care. I see you still hear that from practitioners; promise you’ll never do that. And that’s a really difficult promise to make, isn’t it? Personally, I don’t think you can make that promise because none of us know what’s going to happen to us as we age. And any of us could get either dementia or have an accident or whatever that might mean that we can’t make those decisions. But yeah, anger, the anger that comes back, obviously, is you’ve got to then think, well, how do I deal with this anger?
And then another thing you have to deal with is the financial side of this. Let’s talk very briefly about the current state of play with adult social care in England. The fact that we don’t know where that is right now, there’s a paper has been promised for a while, hasn’t materialized. Our Prime Minister, Boris Johnson, stood on the steps of Downing Street when he first became prime minister and said he was going to fix the social care crisis once and for all. What do you think? I mean, what needs to be done?
I think it’s a difficult one because I think adult social care has always had less money. So if you took the social care budget, which I was just looking it up, it’s something like 21 billion or something. That was a few years ago now. I think you’ll find the latest figures. But then you take the budget, the social care budget and you break that down. The amount of that money that then goes to adults is quite small. And you’re rights. And that’s a big difference, isn’t it, between NHS and social care, which is quite a stumbling block is NHS care is free, social care is potentially not free. And for most people, there’ll be some element of cost for that, whether it’s the full cost or whether it’s part cost. We’ve been promised all sorts of things. I mean, we’ve been promised like a cap on how much of your funding that you would need to spend. They came out when the Care Act was introduced and they said, oh, we’re going to set this limit and you’ll only spend X amount. No fi. And we’re still waiting. Still waiting. And that’s, you know, 2014 when the CARE Act came out. So we’re still waiting for that. This is the most that you will spend. So if you have to sell your property. This is the maximum that you will spend. It seems that there are always lots of promises that never then materialize in terms of we’ll give you extra funding. I suppose the thing that I hear all the time at the moment is, “well, we’ve given you extra funding” and then somebody says, “yes, but that was the money that was already promised. It’s not extra funding.” And it’s really difficult because whilst I may not be in practice, I obviously spend a lot of time talking to social workers because as I said, we do continue in professional development courses and they’re really struggling. And we hear it all the time about budgets being cuts and having to save so much money. And when I talk to my friends and colleagues, they are really struggling to be able to find the funding. And the CARE Act introduced this idea of creativity. It’s actually written in the CARE Act to be creative. I think social workers have always been creative, but if there are less voluntary organisations as well, which obviously is struggling, it becomes more difficult, doesn’t it? Money, I think, potentially will help but I think we’ve also cut a lot of the services that has provided the support that’s desperately needed. Quite. You know, I know this isn’t older people, but you look at mental health services, I suppose, for all ages, and they’ve really reduced their support that’s been provided. And then we have additional difficulties, an increased number of people with mental health difficulties. Not uncommon. And suddenly we’ve seen it even in the university in terms of increased people with increased mental health needs. And really difficult. Then where is the support available to those people?
Do you have faith that something will happen? I mean, it is a devolved issue isn’t it? So in Scotland they have more funding for this. Residential care is part funded, isn’t it? Do you think much is going to happen here?
It’s an interesting one, because I was in practice for a long time and there was always lack of funding. I’m an eternal optimist, so hopefully, yes, so hopefully we’ll be able to sort it. Otherwise, we’re all looking at a pretty bleak future because, you know, we all in a sense know probably at some point are going to need some level of support. So I would hope that it’s sortable. I think we I mean, it’s how we’re going to do it. And obviously, we need politicians that will support what we require to be able to do that.
Here we are recording a podcast. Jackie, this is something that you’re pretty used to. Can you tell us about the Hearing Aid Podcast?
So I’m involved with the MDT podcast, Hearing Aid. So which was set up by two consultant geriatricians, Ian Wilkinson and Joe Preston, and it’s funded by Health Education England. The idea is that we’re a faculty so that there are few members from the University of Brighton so there’s myself as the social work professional, but we also have Occupational Therapy. Tracey and SJ in physiotherapy, based over at Eastbourne, and we also have nurse input as well. That’s the sort of main faculty, but we can then pull on lots of other people from different disciplines. So what we’re interested in is raising the profile of health and social care for older people only. So it’s designed to help learning for anybody really. So from medical staff through to social care staff to try and help them just to understand the complexities of working with older people. So I think we’re in Series 7 now. I think of it. We’re also on Twitter and you can get involved in Twitter discussions. Last time I asked, I think we had over 5 million hits on Twitter. So it’s growing all the time. And so some of the episodes are quite medicalized. But I listen to them. And every time I listen to a new one, I learn something new about older people and the complexities of how to look after their medical needs. But we’re also looking at areas of social care. So, for example, I’m not sure it’s out yet, but it will be soon. We’ve just we’ve just recorded an episode on homelessness and older people, which is growing stale to people. So that was those areas are quite interesting to look at because I think of to be may associate, for example, homelessness with younger people if we’re walking around Brighton. If you walk around Brighton, you can see an increased number of people who are having to sleep on the streets. But actually, interestingly, there are also higher numbers of older people not necessarily on the streets, but obviously sofa surfing and things like that. And also, if you look into it, there’s the history behind some of those reasons about why might people become homeless. Obviously spans across all age groups. But again, increasingly amongst older people, breakdown of relationships, loss of home, those things leading to it. So we’re also interested in those things like identity and how that’s formed. So there’s hopefully something for everybody in terms of the health and multiple illnesses and etc, or different or one of the illnesses, but also the interesting bits about social, what’s happening in terms of social and people to people as well.
I will put the links to that in the podcast description for this one as well. I’m also seeing that you’ve been involved in a wellbeing research projects. And so wellbeing from concept to practice – what were you working on? What were your findings?
The University of Brighton with Sussex University and East Sussex County Council and Brighton and Hove City Council. We were in a teaching partnership together, which was money that the government had made available to support training and closer collaboration between universities and local authorities, because obviously local authority is hugely important in terms of supporting training for social workers. And part of one of the things that we wanted to do was to help practitioners to develop their research skills. And so I was involved with the projects with Anna Bouch, who works with one of the local authorities. And we did a piece of research looking at wellbeing. So the Care Act has an underlying principle of wellbeing. So what we were interested in trying to find out is how do social workers define wellbeing? Because I love English law; it’s one of my passions. Quite a lot of stuff I teach is around law, but the law is great at not really giving you answers. It tells you to do this, but then doesn’t define what it is that you’re meant to be doing. So well-being is a good example, says main principles, somebodies well-being, and it gives you some things like, you know, housing, nutrition, etc. but doesn’t actually define well-being. So we did it with a group of adult social workers. And we were just interested in, we just asked two questions. So we were interested in, how did they define well-being for somebody with capacity and for somebody who lacks capacity? So we did individual interviews and then we did a group interview with them as well, because we were also interested to see if you put people in a group do you change how you define your understanding of well-being. So it was very yes, it was interesting. So I think what was striking was for somebody with capacity, then there was obviously lots of discussions around well actually you define your own well-being. You define, I define my own well-being. We all have a different definition of what well-being looks like for us. But actually, when we then ask the same question for somebody who lacks capacity, we lost the person and I became very driven by being risk averse and wanting to protect the person. We define them as artists and formulists. So the artists were quite open to the idea of entertaining, thinking about how the person defined it themselves. But the formulists were much more about processes and organizations. And so that was our main sort of finding. One of the things that we thought would be interesting to do is social workers may be working with a different service user group and see if they had different ideas about what well-being looks like. So it’s a very small-scale project around introducing, helping to think and develop how people undertook research.
There has been a focus on well-being from universities like ourselves to students for employers, for individuals. It’s had a lot more focus on it over the last few years. People are thinking a lot more about their wellbeing. Is that because, what do you think, that people find it quite hard to switch off from their work and personal lives now, so people are having to think more about looking after themselves a bit more?
I think that’s partly it but I think maybe we’re much more open to talking about how we feel. I think if you go back generations, people didn’t tend to say, did they, as much about how they’re feeling. It was all a bit sort of cloak and dagger and closed up, I suppose. And I think people are hopefully much more able now to say around what works well, what doesn’t work, how they’re feeling in themselves. Hopefully people feeling more able to say that maybe they’re under stress because of the nature of the work, the caseload that they’re carrying, for example. And I just think that there’s much more online as well, isn’t there, about wellbeing and trying to think about your own health. And I think also there’s I think people are also hopefully more aware of the importance of looking after yourself freely. And that’s one of the things I often say to social work, social work students, is if you want longevity as a social worker because of the emotional difficulties of, you know, working with people and the very difficult lives that some people live. You’ve really got to try and think about your own well-being as well. And what works for you. Whether that’s going for a 10-mile run or whether it’s, you know, going to the sea, what is it? What is it that works for you? Reading a book, whatever it is, you know, what is it that works for you that will make you be able to leave some of that stuff behind and really think about what’s good.
And I think the university has also begun to acknowledge the importance of, coming to university is stressful, isn’t it? It could be the first time somebody has left home. I mean, I remember going to university. How do you cook? How do I pay bills? It’s all of those things. And I think, you know, hopefully we’re much more aware now of the need to support young people as they come away, as they move and potentially move away from home and learn all of those life skills. But also, there’s something about the freedom that that gives us, isn’t there. And also that realizing that you’ve still got to do university assignments and things like that, it’s not all about go blow your budget in the first few months and then wonder how I’m going to do this. It’s sort of that learning, I think, and I think the university got much better at thinking about those things and how do we support people.
And students will be starting university now. There is great advice as well, online. And we have access to our wellbeing coordinators, so students can go and chat to them, the student services as well.
There is access to support there. And you know and also all students have tutorial support from the lecturers. So again, with us being able to advise them to go and talk to somebody in Student Services as well, to get support, and to find out what’s available out there and also I think, you know, peer support is available, mentoring support. And obviously the Student’s Union also provides quite a lot of support to students as well.
We end every podcast with five questions and talking points away from your work. So the same with every podcast, the first one would be what advice would you give to your younger self?
I don’t know. That’s quite a hard one, isn’t there? What would I advise my younger self to do? Maybe not to quite crash my A-levels, the way I did. So maybe, you know, I should have spent a little more time studying, and then maybe I would have got here a bit quicker. I don’t know. But then again, I think that’s quite difficult because I think sometimes we only learn from the mistakes that we make and actually it’s the mistakes that we make that turn us into the character that we are. And I had to think about this question a while ago, not that question, but was there anything about my life that I regretted? And I actually came to the conclusion – No, I didn’t, because I realized that like everybody, I’m only human and I’ve made lots of mistakes but I’ve learned from those mistakes and I think it helps us to grow.
Can you pick a favourite place in Sussex?
I’m not sure that this is in Sussex. So this might be a slight cheat, but it’s certainly on the border. So Kingsley Vale, I grew up in Hampshire and so it was a place that I was taken to as a child. And it’s a place that I’ve taken my kids to. And it’s a place that I still go to. And it’s got everything really, if you like walking out in the countryside because it’s got very ancient yew forests there. But then you can walk up the hill if you’re feeling energetic and they’ve got ancient burial sites and then you can sit on the top of the hill and you can look down over to the sea and see right out and it’s just beautiful, and it’s beautiful in all sorts of weather as I was last there in the snow last at the beginning of the year. Yeah. So I think it might sit on the border.
But I just looked this up and you’re safe, it is in West Sussex. I grew up in Chichester, so I was there in Kingsley Vale a lot of the time as well.
And then you can go to the Weald & Downland and get a cup of coffee.
What are you currently reading, watching and or listening to?
So I wrote this down so I didn’t get it wrong. So I am reading H is for Hawk by Helen Macdonald, which is a story about a young person who’s training a goshawk. But also it’s sort of an analogy with dealing with the death of her father and training. I have just watched Killing Eve, second series, very good and finished watching Keeping Faith, as well. So I’m afraid when I watch telly, I tend to veg out on a bit of escapism. Maybe that’s one of my ways of dealing with my own well-being. That or health documentaries. So yeah, that’s what I’ve been watching and that’s what I’m reading. I do have the first Game of Thrones by my side on my bed. I’ve never watched it, so I thought I’d try reading it.
kay. Describe your perfect weekend?
It would have to be with family and spending time with my family. Extended family and just, you know, come round to have a meal, sit in the garden. You know, there’s something about being with siblings, isn’t there? About, you don’t have to go back to the beginning and you can just be and then and then you start laughing and then your kids never quite understand what you’re laughing about because it’s some old history that something’s reminded you of. So, yeah, with family.
And finally, if you can invite three people to dinner, past or present, who would they be and why?
I’m afraid I really am going to cheat on this one. I got away with the last one but I’ll have to cheat on this one because I’ve thought about this and thought about this. So my father died when I was in my early 20s. And so I would like to invite my father for a number of reasons, which would be A, Who is he now? And obviously there’s always an element, I think of, what do your parents make of you as you’ve grown up? But also, I would want to invite my two kids because they never met him. And this is where the cheat comes in, I’m afraid, because I’d also want to invite my father-in-law. So if I was to pronounce my name in Hungarian, it’s Lelkes. And my father-in-law has this very, I’m pretty sure, a very interesting history because he was taken by the Germans to dig trenches and then has this history through the war of arriving in England. So I would like to invite my husband and my children to that because he never told us the story. And we only have some letters in Hungarian that have not been translated for a number of reasons. And I would love them to actually know what happened to him through the snippets we have of a really interesting history, but like lots of people never really disclose the full facts. And I think it would be a fascinating story. We went to the National Archives and opened a file and it’s intriguing. So I’d really love them to hear his story, but I’m afraid I’d have to invite my dad because I’d love them to meet him as well.