What would a College of Social Work do? And what would it look like?

The Social Work Task Force (http://publications.dcsf.gov.uk/eOrderingDownload/DCSF-00752-2009.pdf) is recommending a leadership body for social work called the College of Social Work. Perhaps more realistically, the Children etc Parliamentary Select Committee on training children’s social workers (http://www.publications.parliament.uk/pa/cm200809/cmselect/cmchilsch/527/527i.pdf)
is recommending reforming existing social care bodies to create a body like the Training and Development Agency for teachers, which has apparently in politicians eyes helped the image and standing of teaching, although most teachers I know haven’t noticed.

Why call it a college? In England, a college is a fairly low-level training institution, although the term has a history of being a community of scholars. You will see from my public gallery of photos that the university I work for in Poland calls a lot of its sections or buildings ‘collegium’. Perhaps we should be moving into Latin as the high-prestige title: Collegium Socialis Laboriae. A bit too redolent of new Labour, you might think?

My photo gallery of Opole University at: http://picasaweb.google.co.uk/malcolmpayne080/OpoleUniversity?authkey=Gv1sRgCNGRuZ-R1tyQ9AE&fgl=true&pli=1#

The aim seems to be to have a authoritative and independent voice for social work in public debate. This has been a constant gripe of social workers since it became clear in the 1970s that the British Association of Social Workers was not getting the level of support in numbers, money nor effort to represent social work fully. The directors’ associations have done this quite well on occasions, but when speaking they have to defend the services they work for, so it comes across as self-justificatory, and they tend to speak for greater resources for their service, which doesn’t sound good in a public debate.

The problem, it seems to me, is that an independent level of authority to speak needs to come both from united professional support and from a widely recognised knowledge and skills base. So we would have to get people to join up, and we would have to collect up people who actually could speak lucidly and strongly, but most importantly with authority for social work.

Where would such spokespeople come from? Why can’t we find such people now? Partly it is because social work is socially and politically divided and would find it hard to agree on what should be said; there would always be snipers from the sidelines. Partly it’s because not a lot of people want to be high-profile public voice.

The main reason, I suspect is that there is no wide agreement that the public want a social work; most people think they do it themselves, and think badly of people who cannot cope with difficulties in their lives. The Task Force’s statement about what social work is in normal language recognises this by their sections starting: ‘You may think you already do this for your friends and family but…and You may think that you’ll never need a social worker but… (p 10)’.

Moreover, there is a political issue: people on the right are particularly committed to people helping themselves, and to the view that it is weedy and pathetic to need help, and right-wing newspapers and politicians promote this position. For similar reasons, they attack any services and anyone who does it, and anyone who has any sympathy for these ghastly people who cannot organize their lives properly. So social workers, who provide these services and seem to have sympathy for these ghastly people are always going to eb the target of right-wing vilification; everyone can see that they need teachers, doctors and nurses at times, provided they’re not pathetically soft (‘…it never did me any harm…’ etc). People who stand on their own two feet all the time are not about to have any sympathy with weepers and wailers.

Presumably the aim is to have some prestigious group like the Royal Society for scientists; you would want the letters after your name. We already have the Academy of Social Sciences, which academics can be nominated for. The problem is that this is an elite body: what effect is it going to have on standards over the general run? And most such bodies are basically academic groups; you get elected for academic achievement. Something like the Royal Society for Literature is broader, but again it is basically public achievement that is recognised. How would you set up a system to recognise practice achievement in a relatively private activity like social work? Ad remember that prestigious organizations have spend decades getting to the point, with a lot of criticism along the way. There is not going to be an instant result.

Another thing to remember is that social work is a relatively small fairly low-paid profession – we’re not talking about the huge number of incredibly poorly paid, inadequately trained and supported care workers. There are not enough people in social work to sustain, financially and with personnel, the kind of bodies that huge numbers of teachers and nurses in their professions can justify. And although it occasionally hits the headlines, the quantity of its work doesn’t justify the cost of a huge infrastructure.

To have public authority, such a College would actually have to do something. What would its role be? I guess it would have to look something like the old National Institute for Social Work, which the present government abandoned at the end of the 20th century. Its leadership generally never acquired a public face, but it was a nice billet for a research unit and for a few academics who had a period outside universities, mainly running courses and day conferences for managers. None of its leaders became professional leaders: they got on with getting the grants and doing the research or teaching the courses and pursuing their academic interests. Social care is not a big deal nationally, and people are not going to go to some small institute to achieve the kind of prestige and standing that will make them leaders of the profession. People with leadership potential want to be where the action is, not some quite academic backwater.

Rather than a college of social work, what we need is to collect up a number of lucid telly performers who are already in senior public roles or who have specialist knowledge, train them to represent social work effectively and promote them to the media.

This week has seen both the interim report of the Social Work Task Force, the English investigation of the state of social work. this is another of those occasions when social work seems up against it, and the government feels the need to do something about it.

The Report is on the internet at:
http://publications.dcsf.gov.uk/eOrderingDownload/DCSF-00752-2009.pdf

This week also the Children etc Select Committee of Parliament published a report on the training of children and families social workers, also on the inernet at:
http://www.publications.parliament.uk/pa/cm200809/cmselect/cmchilsch/527/527i.pdf

From their early consultation, they came up with six themes; these are the worries they are addressing, which I’ve edited slightly.

1…social workers feel they do not have enough time to devote directly to the people they want to help. They feel overstretched by staff shortages and tied up in bureaucracy.

2…social workers feel frustrated by some of the tools and support they are given to do their jobs.

3…new social workers are often not properly prepared for…the job and …the education system does not effectively support ongoing development and specialisation.

4…social workers do not feel that their profession speaks with a strong national voice or is well supported at national level.

5…[performance management] systems are not driving quality first and foremost.

6… social workers feel that their profession is undervalued, poorly understood and under continuous media attack, …making it hard for them to do their jobs and hard to attract people into the profession.

Summing these up, the diagnosis is that there are not enough social workers, even if more money could be found to recruit more, the job is over-bureaucratised, which is mainly the fault of local government processes, central government’s target-setting culture and dreadful computer systems, they are ignored and when not ignored persecuted by people who don’t care about our citizens in trouble. Oh, and nobody speaks up for them and the education’s not up to much.

Some of this is just the usual whinges, and as I’ve said before, some powerful people in society, and a lot of the press, think people shouldn’t need the tax-payers to pay for services to help the weak and inadequate do things that people should do for themselves. This is a standard political position, much like ‘the middle classes who’ve worked and saved all their lives should not have to pay for the inadequates who haven’t saved up to pay for their own old people’s care’. In that way, it’s the same as last week’s issues. This stance neglects the reality that education and healthcare are big political priorities in most people’s minds and the relatively less significant need for social care does not get the political priority or the priority in most people’s minds, because most people hope not to need it. Middle class people can cope with a lot of the problems that social workers deal with in their own families because they have just about enough money to throw at it and enough human resources with the capacity to sort out many problems. But a lot of poorer people don’t have these financial or human resources and need help if things get too much.

In an rather good statement in normal language about what social work is and does, the Task Force tells people why they might sometimes need a social worker:

PUBLIC DESCRIPTION OF SOCIAL WORK
Social work helps adults and children to be safe so they can cope and take control of their livesagain.

Social workers make life better for people in crisis who are struggling to cope, feel alone and cannot sort out their problems unaided.

How social workers do this depends on the circumstances. Usually they work in partnership with the people they are supporting – check out what they need, find what will help them, build their confidence, and open doors to other services. Sometimes, in extreme situations such as where people are at risk of harm or in danger of hurting others, social workers have to take stronger action to protect them – and they have the legal powers and duties to do this.

You may think you already do this for your friends and family but social workers have specialist training in fully analysing problems and unmet needs, in how people develop and relate to each other, in understanding the challenging circumstances some people face, and in how best to help them cope and make progress. They are qualified to tell when people are in danger of being harmed or harming others and know when and how to use their legal powers and responsibilities in these situations.

You may think that you’ll never need a social worker but there is a wide range of situations where you or our family might need one, such as:

• * caring for family members
• * having problems with family relationships and conflict
• * struggling with the challenges of growing old
• * suffering serious personal troubles and mental distress
• * having drug and alcohol problems;
• * facing difficulties as a result of disability
• * being isolated within the community; or
• * having practical problems with money or housing.

Having this statement so well written is a real asset.

Overwork is a frequently recurring issue in social work. We have never had the resources to recruit and train the number of social workers we were thought to need over decades. And every piece of research about social workers’ caseloads going back to the 1960s that I’ve ever seen has always shown a high proportion of time being spent on administrative tasks and between a fifth and, optimistically, a third of time being spent in direct contact with members of the public. This is true also of other professions: they all have their meetings, forms, records, letters, phone calls etc etc. When you’ve seen a ‘service user’ or someone else from what the Americans call the ‘client system’ (family and carers), you have to follow that up with the application on their behalf, the letters and phone calls to get what they need, coordinating things with other services and so on. We really need to distinguish between unnecessary bureaucracy and the indirect aspects of doing social work, which are a bit part of the whole.

Then you need to look at the computer systems. It’s clear there are a lot of badly designed computer systems in social care, clunky, slow and inappropriate. Many computer systems have been set up to meet the management’s needs, not the social workers. When we set up an electronic records system here at St Christopher’s (we’ve just had the first anniversary), we spent ages consulting with all the different professional groups to make sure it met their needs, and had to do masses of training. But the most important point is that it created a different way of thinking about what you wrote, and more pithy and focused records, which is probably better than in the past.

Something else I’ve learned through several decades of working with written and computer records is that you can’t use a record system to control people’s practice, they ignore it, get round it, twist it or slow up coping with it – sometimes all four. Instead, decide on how th practice is and can be realistically represented, and make it helpful. One of the things we did when we introduced our new system was to find ‘easy wins’ as our computer guy puts it, things that will be an immediate benefit to practitiotners.
But look at Twitter – follow me at: http://twitter.com/MalcolmPayne – It’s easy, and a good discipline) to put most things in 140 characters, and it shows how flexible and useable computer systems can be.

More on the college of social work proposal and social work education on separate posts.

The Department of Communities and Local Government has published local authority budget estimates for next year, which show, p 3, that expenditure is planned to rise 4 percent, a bit more than some other activities, but not much bearing in mind the rising numbers of older people.

The paper is on the internet: http://www.communities.gov.uk/documents/statistics/pdf/1299471.pdf

I have copied a pie chart that shows that social care (including children which central government budget-wise seems still to be classified separately from education) is about 18% of local authority expenditure, second to education at 37%. My question is, would you realise its financial significance to local government from the press reporting in your local paper (if you still have one)? Another Table shows that expenditure on older people’s social care is going to be far more than that on children. Would you realise that comparative importance from press coverage?

Twas always thus, but it’s worth reminding ourselves of the relative importance of the size of different social care activities.

THe copied material here: LA Expenditure 2009/10

People who are interested in advance care planning may like to know that things are happening in the US. There’s a, what in the UK would be called, private member’s bill, the Advance Planning and Compassionate Care Act 2009 before Congress, with interesting proposals that include include a hotline that tells people it would be a good idea to provide for, what in the UK would be, powers of attorney. It is similar to some of the provisions in the Mental Capacity Act.

Then an authoritative report for Congress has been produced by the Department of Health and Human Services. This is a very good 300+ page aummary of the state of play in the US, covering particularly advance decisions.

Link to information about the proposed act:
http://www.govtrack.us/congress/bill.xpd?bill=s111-1150

Link to the HHS report to Congress:
http://aspe.hhs.gov/daltcp/reports/2008/ADCongRpt.pdf

You may remember that on 7th April I mentioned the end-of-life care integrated care pilot. Now there is another aspect of this programme, personal health budget pilots, where they are going to try out social care type personal budgets, including the possibility of direct payments in the NHS. Don’t get too hopeful because the DH documents on personal health budgets are very strong on telling people they probably won’t get real money from the NHS (as opposed to social services). They seem to emphasise notional budgets. It’s not clear whether this is because they are taking into account the reality that a lot of people don’t like the idea of managing their own care, or whether they are anxious about losing control of paying out money.

The public information leaflet on personal health budgets is at: http://www.dhcarenetworks.org.uk/_library/Resources/Personalhealthbudgets/292457_Personalhealthbudgets_acc.pdf

The DH has recently announced the personal health budgets pilot sites. Two of these are specifically in end-of-life care only, so presumably they will have a very strong focus on end-of-life care issues: South West Essex and Southwark. Another is for end-of-life care with Asian communities (an example of bidding where your strengths are): Bradford & Airedale Teaching.

A lot of others have mentioned NHS continuing care as the focus of their pilots, logically, since this is directly analogous with local authority community care where personal budgets have been steaming along. This could affect how palliative care teams deal with NHS continuing care in these areas. More positively, it may mean that end-of-life care gets a look in when people are thinking about broader care needs, but don’t bet on it, since they haven’t mentioned end-of-life care specifically.

PCTs mentioning end-of-life care as part of a pilot on NHS continuing care, long-term care groups or a range of services are: Ashton, Leigh & Wigan, Barnet, Camden, Eastern & Coastal Kent, Greenwich Teaching, Havering, Herefordshire, Hull Teaching, Medway, North East Lincolnshire, Nottingham City, Oxfordshire, Redbridge, Richmond & Twickenham, Sheffield and Western Cheshire. Presumably, in these pilots they are going to aim to do something special on personal budgets for a wide range of long-term groups.

You can look at the Department of Health Care Networks website for more information about all sorts of ‘integrated care’, that is health, housing, social care and social security working together. This also leads you to information about personal health budgets (at the bottom of the long list of integrated care topics):

http://www.dhcarenetworks.org.uk/

However, don’t forget that this is an international trend and has been going on in adult social care for some time. A recent SCIE (Social Care Institute for Excellence) report tells you how it’s been going in social care:

Carr, S. (2008) Personalisation: A Rough Guide. London: SCIE.
http://www.scie.org.uk/publications/reports/report20.pdf

and the SCIE website has recently updated its information with several briefings for different groups of professionals on personalisation:

http://www.scie.org.uk/publications/ataglance/ataglance06.asp (this takes you to a summary, scroll down for a clickable list).

If you want real academic information, look at the academic evaluation of individual budgets in the social care field, where you get a very nuanced view of the pluses and minuses, even though it’s been done by all the usual suspects in the DH client researchers list:

Glendinning, C., Challis, D., Fernández, J-L., Jacobs, S., Jones, K., Knapp, M., Manthorpe, J., Moran, N., Netten, A., Stevens, M. and Wilberforce, M. (2009) Evaluation of the Individual Budgets Pilot Programme: Final Report York: Social Policy Research Unit, University of York.

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_089505

From this website, you can also download a DH response to the evaluation. Part of this includes a suggestion that including NHS continuing care in social services independent budget arrangements might improve integration and help to remove barriers. As with the funding issues I’ve been discussing in the social care green paper, we need to remember that such suggestions may take away the right to free NHS care at a fairly generous rate and fold it into the social care discretionary system, with less generous provisions. We saw this happen with social care over the last twenty years. Governments of all stripes have an interest in cutting costs in this way.

Interestingly, one of the healthcare trade unions had the same thought:

Unison (2009) Personal health budgets: 68 pilot sites selected. London: Unison.

http://www.unison.org.uk/healthcare/pages_view.asp?did=8909

They say: UNISON believes that personalised healthcare plans are achievable without the introduction of budgets and that budgets will create a consumer culture in the NHS and may ultimately lead to means-testing… With the use of direct payments there is a danger that patients will be tempted to ‘top-up’ payments for their healthcare with their own cash, potentially leading to two-tier health service.

The Green Paper: Department of Health (2009) Shaping the Future of Care Together (Cm 7673)London: TSO.

This came out yesterday and is another stage of trying to convince the public that something must be done. There’s a consulatation with a multicoloured logo called ‘the big care debate’

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_102338

The Care Support Independence website which covers these issues. there is a video (which I haven’t seen because it doesn’t work) and all sorts of consultation things on what ‘the Big Care debate’, including a blog called ‘understanding the need for change’, on which you can respond to what they’re saying.

http://careandsupport.direct.gov.uk/

There’s also quite a nice website on the history of different forms of care – good for students:
http://careandsupport.direct.gov.uk/homepage/history/early-forms-of-care/

When I’ve absorbed all this, I’ll do a resource document, and also a document on the press response.