Social care and social work are important in end-of-life care.
Malcolm Payne's blog focuses on developments in social care and social work that affect palliative and end-of-life care. It is part of the information work of St Christopher's Hospice, London.
I’m back after working abroad for a few weeks, and I notice that the Department of Health website now has a tag cloud: see the picture:
So you see ’social care’, let alone ’social work’ there? Or ‘palliative care’? Or ‘end-of-life care’? Or ‘older people’? Clearly none of that bothers the DH.
And just so you don’t think I only go on about what the government does, I’ll say something about social work next. I looked at the NCPC and Help the Hospices websites to find something to write about there, but they all seem to have been on holiday. I hope that doesn’t stimulate a response from either or both telling me about loads of things they’ve done recently; it’s not obvious from the websites, guys.
You’ll have gathered that I have not been on holiday. It’s the conference season, and I have five lectures and two papers to give this month, which is why posts from me have been hard to find recently. In preparation, I’ve been looking at a book published (in America) for the ‘Global partnership for transformative social work practice, education, and inquiry’. Sounds great until you realise that it has two papers not from north America, both from senior white academics, Nigel Parton from the UK and Mel Gray from Australia, previously South Africa. Both significant ‘thought leaders’ but hardly signifying a ‘global partnership’ (Sorry about that, it’s a new bit of jargon I’ve found in an American book review).
You have to wonder whether the Americans have found Africa, Asia and Latin America yet, in spite of the claim of their educational validating body (CSWE) that social work courses in the US have a ‘global perspective’ and the proliferation of American texts on some variety of international social work.
I won’t dignify the book by a citation. Perhaps they need to recognise that there are some thought leaders elsewhere in the world.
Another interesting outfall from the McDonald case: this was the former ballerina who wanted a continuation of all-night care, but whose local authority (let’s hear it again for those fine supporters of dignity in old age, Kensington and Chelsea) argued she should wear incontinence pads to save them some money, even though she was not incontinent. A legal website makes the following comment:
The cost of care forms an important part of personal injury compensation awards. In the past, Defendants have sought to argue that local authorities will ‘pick up the tab’ for providing care. This ruling brings into sharp focus what is taken into account in the assessment of care needs. It reflects the divergence between local authority assessment and assessment by independent care experts, as commonly used in personal injury and clinical negligence claims. It will now be harder for Defendants to claim that full care will necessarily be provided by local authorities.
So it seems that the lawyer’s response to this is that they can argue for higher personal injury compensation. I don’t mind that, but more to the point, what price the dignity that the present and past government both said was so important? If we are to have a right to some diginity, how much dignity, and who is going to make the professional judgments that meet a reasonable standard of personal diginty for older people. Clearly not the law. And clearly not Kensington and Chelsea. So how are we going to get good social care professional decisions authoritatively supported? Another job for the College of Social Work?
The legal comment: http://www.lexology.com/library/detail.aspx?g=a1b2ebac-8df8-4e27-ae9f-7055148b398b&utm_source=Lexology+Daily+Newsfeed&utm_medium=HTML+email+-+Body+-+General+section&utm_campaign=Lexology+subscriber+daily+feed&utm_content=Lexology+Daily+Newsfeed+2011-08-11&utm_term=http://www.lexology.com/library/detail.aspx?g=a1b2ebac-8df8-4e27-ae9f-7055148b398b&utm_source=Lexology+Daily+Newsfeed&utm_medium=HTML+email+-+Body+-+General+section&utm_campaign=Lexology+subscriber+daily+feed&utm_content=Lexology+Daily+Newsfeed+2011-08-11&utm_term=
Both this and the previous post about legal cases raise the question about discretionary decisions in social matters. How are social work professional decisions to be enforced in a cash-cutting political environment, when the UK is still a rich country in which the people in the street, I think, believe in dignity in care.
The final judgment has not been published in the Condliff case: this is the man whose PCT refused to let him have a gastric bypass, because he did not meet their standard criteria. He argued the human rights case of respect for his family and private life. The Court of Appeal agreed that it was clear that Mr Condliff’s family life was being adversely affected. The PCT’s IFR policy set the rules for making decisions in exceptional circumstances, but it did not allow non-clinical or social factors to be used. Social factors included ‘age, gender, ethnicity, employment status, parental status, marital status, religious/cultural factors’.
What the PCT was doing here was trying to be non-discriminatory in making its decisions. Therefore the court decided that Article 8 rights do not confer a right to have social factors wider than the directly relevant medical factors taken into account in service provision decisions.
Of course, it might be different in social services cases, where the whole raison d’être of funding decisions is social concerns. But it does suggest that social workers should focus on using their advocacy arguments with sympathetic professional colleagues, rather than trying to go to law.
But is this reasonable? Surely all decisions made by official bodies should properly take into account social factors, otherwise we cannot respond to inequalities.
Apologies that the blog did a tizzy last week, while I was on holiday, and I’m tweaking the post on the palliative care funding review so that it reappears again today.
I’ve finally got to an overall view of the Palliative Care Funding Review, but inevitably my view of it is affected by the almost simultaneous publication of the Dilnot report on the funding of adult social care, not to mention the fairly recent Law Commission final report on Adult Social Care Law, which looks set to lead to legislation next year. People with a focus on palliative care alone may wonder why I should think these other reports relevant, but constant readers of this social care/palliative care blog will know of its aim to place palliative care within the context of wider social and health care.
The palliative care funding review here: http://palliativecarefunding.org.uk/wp-content/uploads/2011/06/PCFRFinal%20Report.pdf
The Dilnot report on adult social care funding here: https://www.wp.dh.gov.uk/carecommission/files/2011/07/Fairer-Care-Funding-Report.pdf (there are two other volumes: http://www.dilnotcommission.dh.gov.uk/2011/07/04/commission-report).
The Law Commission report of adult social care law here: http://www.justice.gov.uk/lawcommission/docs/lc326_adult_social_care.pdf
The point is that all older people know they are approaching death, so they will be receiving some degree of end-of-life care, mostly by looking after themselves and their own affairs, but also from their families and friends. Mostly, they will continue with their personal aspirations for their lives, supported by the ordinary social and health care they receive. That will be the major element of the formal help they get; specialist palliative care will be a minor element for the few. So, we should really not start from a funding review of a rather specialised, healthcare-focused provision. Instead, what we should be doing is starting from personal aspiration, informal and general social and health care during the period running up to the end of life, and seeing where palliative care for advanced illness fits. But the Review is here and central to the aims of this blog, so here goes, although to compensate for the conception, which comes from the Review’s focused terms of references, I’m going to include some compare and contrast with how I would look at it from a social care point of view.
Reading the Palliative Care Funding Review alongside the other reports, Dilnot especially, the surprising thing about it is how old-fashioned it seems. The reason for this is, I think, that it is trying to do what nobody else is thinking about, or has thought about for quite a while: get the government to fund a service more. The reason for trying to do this, and for the government having commissioned the report presumably, is that the Conservatives have been fairly upfront in saying they want to fund hospices, particularly children’s hospices, properly. This is largely founded on the same sentiments that get big charitable donations for hospices and other palliative care services such as Macmillan and Marie Curie nurses; it is recognisably a good thing. So there is a bit of a policy impetus and an opportunity there. It seems a sensible move to grab the opportunity and see if we can get a bit further with palliative care funding.
Moreover, the ConDems know that there is a lot of charitable money coming into hospices and they want to encourage services that achieve this; it’s part of the big society agenda. So you could argue that palliative care is getting the reward for its big society achievements over the decades. However, knowing that the money is there probably means that the government don’t want to spend any more on them; rather they would like to get more out of them; that is also the big society agenda.
I don’t think it is an unmitigated political good that the government has recognised the amount of charitable money coming into palliative care. If I were Andrew Lansley, I’d be looking at how I could get that money transferred into funding my mainstream healthcare services. After all, people are usually happy to donate charitably to a hospital or a local healthcare service that they find useful: I don’t know that they particularly care whether their local hospice or home nursing service is run by an independent organisation so long as it is doing the job. Some years ago I remember giving a donation on the retirement of my GP for a new local hospice that, it turned out, was actually part of the local general hospital. It got its funding with no problem, and I suspect the same would be true if the NHS went all-out to define extra end-of-life care bits in its mainstream services and get charitable donations for them.
So there is a risk that moving along the path of greater involvement in the mainstream NHS will lead to greater incorporation of independent provision into a dominating NHS commissioning process. In the end that might vitiate the independence that has served palliative care so well in maintaining its creativity and lightness of foot. The social work historian in me is reminded of the ‘cause and function’ debate in social work in the 1930s: once you’ve stopped being a movement to achieve something innovative, you shift into becoming part of the functions of the state, and a bit of pizzazz is lost in favour broader security of provision.
But, I hear you say, isn’t Dilnot also trying to get the government to pay more for a service? Hasn’t the main criticism been that it will cost the government billions when austerity is the order of the day? Yes, but Dilnot is addressing an issue that is widely recognised as a major social issue of the day, that the government has to do something about. Although, as I’ve already said in a previous post, the real problems will still not be here for a decade or more, so the government can follow the grand tradition in dealing with difficult issues and frisbee Dilnot into the long grass without difficulty.
Another thing about Dilnot, that’s not true for the palliative care funding review, is that it’s helping the government’s money problems because although Dilnot will cost more, it will tie co-payment into the social care system, so that it will become the publicly-accepted norm that people will make contributions for their care. This would be a great political achievement. They already make contributions of course, but Dilnot’s research shows that it is not widely accepted. The political gain in implementing Dilnot will be that the whole adult social care system would be set up to achieve public recognition that we as individuals have all got to pay for our social care, and, on top of that, we’ve all got to pay more than we have been assuming we are going to pay. And as the years go on, I have no doubt that the system will be tightened so that we will all have to pay even more as individuals; that process has been going on since the mid-1980s, when the care home system was privatised.
The palliative care funding review is not offering that to the government: it wants to incorporate free social care into palliative care, when Dilnot is taking social care the other way into people paying more for what they get. The fear must be that if Dilnot is implemented, tying social care funding into palliative care provision will lead to creeping acceptance of social-care-style co-payment for end-of-life care services, rather than the NHS assumption for free at the point of delivery. So it’s understandable that the palliative care funding review is trying to be very clear that this should all be done on an NHS basis. However, I think there is an opportunity open to the government here of saying: ‘Well, we’re moving into end-of-life care here, not specialist palliative care, so it’s more appropriate for it to be like social care’. My suspicion is that such a view might eventually (after the next election, say) not only be applied to end-of-life care but to all sorts of what is currently community healthcare provision: ‘It’s all a bit like social care, isn’t it? No reason that people couldn’t pay something towards it.’ I hope not, but I suspect so; the more so because I hear from the financial pages of my newspaper about the possibility of an L-shaped recession (austerity is going to go on for ever).
Moreover, the palliative care funding review is saying that there is wide inequity in the provision, so that the whole thing should be more coordinated and coherent. We can all agree with that, but any astute civil servant will know that making everything coordinated and coherent will probably mean that there will have to be more of it. This is because places that have not got much will have to be brought up to the more usual level of provision. The ‘more of it’ will cost money, and so there will be upward quality creep – very desirable from the point of view of patients and palliative care services that want to improve their offering (the ‘Review’s’ perspective), but not so good if you’re George Osborne and trying to save money.
Balanced against this, the ‘Review’ offers some possibilities to meet the government’s present preoccupations. First, by coordinating effectively it has been made clear by some of the Marie Curie projects used here as case studies that you can do a lot to provide a more comprehensive service in an area without too much cost push, by facilitating more efficient delivery of care. However, if I were an NHS commissioning group, I’d be worrying about stimulating too much demand that I couldn’t meet in straitened times. Second, and I think the major advantage that the ‘Review’ can offer the Chancellor as he views the Olympic volleyball finals from his study window in number 11, if you can really get palliative care going well in home care and other community settings, you can take some financial heat off the hospitals because it’s absolutely clear that effective community end-of-life care more or less stops the unnecessary emergency admission of dying people to hospital care.
Which brings us back to social care, because a lot of that community provision is going to be in residential care homes and require integration in community social care provision, and I think the detail of how social care will knit with what the Review proposes is unclear.
One of the important aspects of that is that the Review mixes together palliative care for people with advanced illness (a relatively limited provision) and broader end-of-life care (a universal requirement) with the aim of getting end-of-life care more accepted into the mainstream of community social and health care. The problem is that these are fundamentally different animals: what I think we should be about is knowledge and skill transfer. We need to transfer knowledge and skill from palliative care, so that end-of-life care can build up its knowledge and skill resources to provide what in many areas is a fundamentally new aspect of their generalised services. This is less about service funding and more about development work. Doing this will take away the resource pressure that arises from unnecessary hospital admission, as the Review rightly says.
But it should also reduce the need for palliative care services, because better general end-of-life care provision in social and health care will reduce the need for specialised palliative care except where there are complex advanced illnesses and complex social circumstances to deal with. Putting these two together, as the Review does, makes clear the connections, but I think it does not make the argument that palliative care is the senior service. It is currently the service with the expertise, but as a service once it transfers its expertise, the need for the specialist resource has to be looked at in relation to its more limited specialist role within the wider non-specialist provision.
So to some more detail.
What, then are the detailed arguments in the Review for developing end-of-life and palliative care?
- Postcode lottery: there is wide variation in the funding, so that the minimum spend in PCTs is about £0.2m, the average spend is £3.1m and the maximum £21m. the cheapo PCT spent about £181 per death in their area, while the Rolls Royce PCT spent £6213. The average spends less that £1000 a death. I’m a bit doubtful about the extreme variation of these figures: while I believe the average, I suspect that there may be variations in what is being counted in different PCTs.
- Complicated and variable funding mechanisms for hospices mean that there’s a block grant in many areas, spot purchasing sometimes and 97% of independent hospices thought that the NHS did not pay fully for their patients. All too true, but if an NHS commissioning body looked anew at that, they might decide that they would prefer to stop funding beds in hospices and spend more in the community, in care homes and in hospital palliative care, where the major lacunae are. As a result, it might be able to reduce a lot of demand on and criticism of its emergency services by having a more secure universal end-of-life service. More rational funding does not mean more for beds in hospices, although their part in community services might be secured.
- Funding is further complicated. Palliative care is done in hospitals, hospices, people’s own homes (using GP and community nursing services) and care homes, and they are all funded through different processes. Not to mention the major (and largely unfunded) contribution of self-care and informal caregiving by friends and family. The Law Commission on adult social care law is recommending a reform of the rights of informal carers to assessment and service provision to improve their own well-being. If more government money is going on them, an NHS commissioning body might find it beneficial to focus on supporting informal carers and general community services. Again, simplification does not necessarily mean more beds in specialist palliative care, or a funding priority to palliative care responsibilities.
- Crucially, there is a chance of saving money – always a good move to say this to governments…
- …and it is because too many people are being admitted to accident and emergency units inappropriately, when if they were properly cared for in their own homes and in care homes they would not consume expensive NHS resources at the end of life and, even more wonderfully from a politician’s point of view, they would prefer it.
The last two items point to a virtuous circle: we could save money if we did what people like: better than a slap in the face with a wet gurnard (you’re supposed to be enjoying unfamiliar fish dishes so as to preserve endangered fish stocks; get the behind me codfish, and look with favour – but according to BBC Good Food, not with flavour – on scorpaeniform fishes in the family triglidae).
What is not clear is that savings in accident and emergency would pass to fund better end-of-life care: they are more likely to pass into the hands of Mr Osborne. So better end-of-life care might have to be funded from existing resources in palliative care.
The last time work was done on this, we got to a system of paying for each patient for a period (perhaps about 12 days) in a hospice. This Review had research which has come up with a much more sophisticated model. Basically, the idea is that bits of the NHS that are treating people for a medical condition get the money for doing that, and when it is decided that they are also dying, they get another bit for palliative care services. It’s a bit like James Bond and the man from Smersh in a struggle on the clifftop: they sway to and fro between the condition money and the palliative care money, until they fall off the cliff, the man from Smersh dies (and so the money stops) and James meets a nurse and sails off in a rubber dinghy into the sunset. There’s a diagram of this – a wavy line goes up and down with more condition money giving way to more palliative care funding and then back again, as the patient’s needs change.
The amount of money is worked out on patients’ needs. These in turn are calculated by allocating patients to a category. The main thing is the stage of the disease (stable, unstable, deteriorating, dying); but added to this is whether they have a specialist or non-specialist provider, low or severe problems, their functional status (can they walk or sit up?) and age (over or under 60). This produces 13 classifications for adults. The same principles are applied to children, but I won’t go into the detail.
The first stage is that it is decided that the patients require palliative care; this means that they get the money for that added to their disease money. Every time they enter a new stage of the disease (pay attention: from stable to unstable, unstable to deteriorating or deteriorating to dying and so on), their service provider gets another slice of money.
There are two things about this: one is that the healthcare system is much more used to doing this sort of thing than social care. The decision about whether you require palliative care is the ‘surprise’ question (would you be surprised if this patient died within the next – whatever period you decide – perhaps 12 months?). Care homes and adult social care staff tend to ask that sort of question about their clients even less than healthcare staff (because they generally don’t have a focus on people’s overall physical condition) and they tend not to have the kind of good evidence that would mean that you can trust the decision, as you would trust a GP or district nurse thinking about it. In particular, it’s easier to ask if you have a clear medical condition and even more so if, as in palliative care, you have an advanced illness, where the stages of progression are well mapped out. I wonder if this will mean that people who are getting frailer in the community and mainly being looked after in social care will not get the palliative care money because nobody will be thinking clearly about their end of life. There is evidence that many people in care homes who pay for themselves do not get a lot of attention from professionals; for example social workers do not review them regularly because the local authority is not paying. So they might not get assessed. Alternatively, what may happen is that there will be a demand from adult social care departments for GPs to make this assessment, or ticklists will be set up for social care staff to go through to do the assessment. This could mean that the decision-making for people outside healthcare will be more rocky and inconsistent than the Review assumes. This feeds into my next point.
This system is a big incentive to put people on the palliative care money as soon as possible in their illness career. I reckon there will be phasing drift. Social workers, care home managers, and other commissioners will put people on this extra money as soon as they can. Who will the commissioners be? GPs and their friendly local hospital doctors and other healthcare professionals will be running the commissioning show, so there will be a financial incentive to get their hands on the palliative care money, and speed up the shifts to the later and more lucrative stages of the palliative care money. This means that people might be progressed up the levels of care quicker than necessary; not a good outcome for the psychology of patients in my view. Care home proprietors and social care staff will realise that if they can get someone on the palliative care money they will get enhanced funding and, if the Review’s recommendations are accepted, anyone they get onto palliative care funding will get free social care for which they would otherwise have to pay.
The report specifies various scales that will have to be completed for assessing the funding group, but as I frequently point out, scales are just forms filled in by human beings; they are not evidence. The people filling in these forms, and the people they are filling them in about, will have a strong financial incentive to look for reasons for extra funding for this patient.
Following on from the previous points, how social care is funded and organised is clearly going to be a big issue for many people moving into this end-of-life care system. The proposal is that social care will be a ‘clip-on’ to the palliative care money. Once someone is defined as ‘end-of-life’, all their social care would be paid for by the NHS.
The effect of this is that people defined as at the end of life would be accepted as being eligible for what is currently NHS continuing care funding. It’s a nice idea that people should get social care within their NHS services and indeed my experience of dealing with continuing care applications is that most people feel this is fair. Although the system distinguishes between healthcare needs and social care needs, most social care needs are off-shoots of health problems, and people find the distinction drawn by the present system non-intuitive. It is also true, as the Review rightly argues, that most people are beyond social care once they are receiving palliative care, so there should not be a massively increased cost to the NHS. However, while I think this argument is right, I don’t think it is how continuing care is played by most commissioners at the moment. I know civil servants are rather gung-ho about their wonderful rational national assessment system for continuing care, but many people who are applying for it find that commissioners tend to resist very strongly too much drift onto full funding. Therefore, although if you look at the criteria, most palliative care patients should get it, and so the extra cost of this proposal is not great, the reality of how it is allocated means that actually many people are not treated as eligible and phasing drift and the increased comprehensiveness of a universal end-of-life care service may mean much greater demand to deal with. Moreover – back to the point that most people pay for their social care, and particularly for their care homes – this proposal will be very much at odds with the way in which the government wants to take the social care funding system, which is to get people to pay more, not less. I would be very surprised if the government will go along with allowing people to opt out of their own contributions and shift the burden onto the NHS; that’s not the signal that they want to give the public about being responsible for your own care.
Reading the document, I do not get a clear sense of what ‘clip-on’ means; the implication is that an extra sum to fund social care will be added to the palliative care money. But where is this money going to come from? NHS continuing care budgets? Or will it simply be a call on the palliative care money that you get at the different stages of your progression towards the dying phase. If so, money could actually be taken away from palliative care funding for, say, hospices, to fund social care costs. More likely, the whole thing will be lost in a translucent general budget allocation, which over time will be increasingly squeezed, so we will not be quite clear how much money is being allocated for each patient at all; it will all become very discretionary. Which goes against what the Review is trying to achieve.
Finally, the main focus of the Review is on funding the end-of-life care system, but just a question about social work (which,m as opposed to social care, is little mentioned in the Review), because it is not clear to me how psychosocial and social work needs will be met within a system like this. I think the intention is that formally assessed needs will be met in a coordinated system commissioned by an end-of-life coordinator from adult social care departments. When someone is defined as ‘end-of-life care’, the palliative care money will snap in, paid presumably to an end-of-life care coordination body in the area, commissioned through the healthcare system because that’s the focus of the report. So where a frail older person is receiving a continuing adult social care service, for example regular reassessment in their care home or community setting, will this be pulled out in favour of a new palliative care service? I suspect an adult social care department will ask for money and if they don’t get it, they’ll be over the hills and far away, because, the report says that social care is being paid for by a clip-on to the palliative care money, although not (in alignment with Dilnot) accommodation costs. The Review reports that stakeholder views saw social care, along with other non-healthcare elements of multiprofessional palliative care as it is currently conceived as something that should be ‘supported by a combination of the state and society’ (p 17). It’s not quite clear what that society might be or how much might not be funded by the state: presumably social care and related things would not be an NHS-funded provision, but resources would be recruited from elsewhere and coordinated by the NHS service, including the voluntary sector and adult social care departments. But if this is not funded, it may well be hard to integrate comprehensively. I don’t say this can’t be organised, but I don’t think the working together can be left to organise itself and I suspect it will mean money from the extra palliative element of the payment.
Which brings me finally to my concern about the way in which the Review rather elides major differences between the direction of the adult social care system as a part of a universal end-of-life care system and palliative care as a specialised service for people with clearly identifiable advanced illness.
As I look at the Law Commission on adult social care law, I see the proposal that there should be a legal focus on wellbeing in social care provision. It is also proposed that provision should come from a legal duty on local authorities to provide both a service user and carer assessment. It is not clear how this would interact with the single assessment for palliative care. The outcomes proposed for the legislation that an adult social care department will have to achieve are:
(1) health and emotional well-being
(2) protection from harm and neglect
(3) education, training and recreation
(4) the contribution made by them to society
(5) social and economic well-being; and
(6) securing their rights.
These are very broadly phrased and include some aspects which would be unexpected in health care or palliative care. Many of the broader outcomes would also tend towards the things that the palliative care funding review would see as provided by ‘society’ rather than the state (although this distinction is reported from stakeholders rather than pursued by the Review). However, note the inclusion of rights. The Law Commission points out that under the Human Rights legislation, people receiving care services under a well-being principle are entitled to demand their rights as follows:
Among other matters, it emphasises that the Article 8 rights of disabled people to participate in the life of the community and to have “access to essential economic and social activities and to an appropriate range of recreational and cultural activities”.
This is a quotation from a legal judgement. If we are to include social care into a palliative care service that respects patients’ human rights as defined in the proposed social care legislation, it will need to respond to needs very much broader than a healthcare definition of what should be provided in end-of-life care, while the Review, presumably because of its terms of reference, rather focuses on such a healthcare definition. The Law Commission assumes that a necessary outcome of a social care service is the provision of ‘social, leisure, communication, education and training activities’ for patients. While some palliative care services, St Christopher’s pre-eminent among them, have made great strides in including arts and personal development into what they provide in hospices, care homes and in the community, this is not generally what the NHS sees itself as there to provide, and what Mr Osborne will see himself paying for.
The end-of-life care provision proposed in the Review is firmly focused on financing healthcare objectives in alliance with broader NHS provision and commissioning. It is not clear that this is going to allow for the broad understanding of social care that human rights legislation and the proposed social care legislation requires, not to mention fulfilment of the aspirations of many in social care, and I believe also many in palliative care.
I reprint the following post from one of my other blogs (http://intsw.blogspot.com) which comments on social work sisues as they come up round the world. This has relevance to palliative care, not least because many palliative care practitioners do their work because of some religious commitment. There are also some palliative care providers who are based in particular religions. All hospices are enjoined by quality regulators to accept and implement equalities policies: so would a Catholic hospice say they can’t continue to provide services because they are required to provide them equally to gay and lesbian people as to people in heterosexual relationships? I don’t hear that they are doing so. Most hospices are open to all faiths and beliefs as a matter of principle.
An American Catholic archbishop has made a speech that raises issues that should be considered by Catholic social work agencies, agencies and social work practitioners with other religious or denominational commitments and anyone who is thinking about: ‘what is the nature of social work’?
The main point he is making is that if you are going to call yourself a Catholic social agency or Catholic social worker your practice has to reflect and espouse your Catholic beliefs. Otherwise stop calling yourself a Catholic.
I think there are some problems with this point of view. To start with, I know some Catholic agencies that say: ‘we are Catholics providing services for everyone’. I remember Catholic Social Services in Liverpool, when I was involved with them as saying this: I don’t know what their policy is now. I also remember some children that I was responsible on behalf of local authority who were ‘in care’ (being ‘looked after’ in current jargon) in a children’s home run by nuns from a Catholic children’s agency; again, Catholics helping children in general rather than just Catholic children.
There are many care and aid agencies that operate with wider communities in this way. If they are going to do social work, they will have to accept different denominational and cultural beliefs and values and behave in a neutral way about these; thus not including their Catholic emphasis in everything that they do. The aim of a social agency is not to be ‘useful to the Gospel’ as the Archbishop puts it, in this way. They are useful to the Gospel by demonstrating that Christians care about everyone, whoever they are.
Archbishop Chaput’s point, though, is a bit different. He is commenting on a situation that we have also experienced in the UK, and will probably be a worldwide issue. That is, if equalities legislation says you cannot discriminate against gay and lesbian people in an adoption and fostering service, you shouldn’t run an adoption and fostering service.
There is a practical problem here: how far does a Catholic go? Do Catholic social workers or agencies have nothing to do with a child care system that accepts decision-making on these grounds that are so anti-Catholic. In that case, Catholic people rule themselves out of engagement with increasingly wide swathes of social provision. Or do they accept that some of it goes on, but avoid direct involvement with it. You can almost see the Catholic working in a school, jumping back faced with a child of gay adoptive parents saying: ‘Ugh, no! We cannot teach that person, they are contaminated’. Well no, most Catholics I know and most Christians, maintain a concern for others and do their job with others, even though they may not like the social trends reflected in some of the things that happen. So a Catholic agency or a Catholic social worker should not be saying: ‘we don’t go there’.
The Archbishop is quoted as saying: ‘Catholic ministries “have the duty to faithfully embody Catholic beliefs on marriage, the family, social justice, sexuality, abortion and other important issues. And if the state refuses to allow those Catholic ministries to be faithful in their services through legal or financial bullying,” he added, “then as a matter of integrity, they should end their services.”
There’s a broader ethical point: if you agree to provide services to the public, you have to accept that the society in which that public lives may not agree with you about many of the things you believe, and a public service means an equal service for all the public, not the ones you happen to agree with. If they don’t agree, and the law, which enacts the general settlement in a society about an issue, supports them, a Christian should not just take their bat and ball home. To me, then, this stance is not Christian, and so therefore cannot be very Catholic.
More important, it is not and can never be social work. The whole point about social work is that it is concerned with achieving more solidarity and resilience in social relationships among all peoples. An agency or a practitioner that says: ‘We don’t do these kinds of social relationships’ cannot be a social work agency or practitioner because their social preferences detract from general social engagement.
Of course, any agency can decide on an admissions policy that limits the range of people and issues that that they deal with. I know several Jewish agencies that focus on providing services for Jewish people in their area only and several Muslim and Hindu agencies whose style, presentation and policy means that they are only likely to attract clients from their particular community. but they don’t say: ‘We’re not going to have anything to do with the way in which most of society wants to play ball’. You’re cutting yourself off from that society, and with a good deal of arrogance too.
A bit of Christan humility means taking part in society, and not rejecting fundamental principles about how that society is run, such as equality with people who you don’t like and don’t agree with. I don’t want to see Christians of any kind (or any other religion) cutting themselves off in this kind of way. What does a Catholic social worker who is committed to equality and who wants to work in adoption and fostering, a vital and valued service, do? Catholic agencies are closed to them, does it mean all practice in this area is closed to them, too? I suppose the Archbishop would say that in their professional practice they are not pursuing a ‘Christian ministry’. Yes, but can’t a valuable social agency do the same thing?
The account of the speech by Archbishop Chaput: : http://www.catholicnewsagency.com/news/archbishop-chaput-warns-about-catholic-institutions-losing-religious-identity/
The third Sector online newsletter has an interesting interview with Julian Le Grand – people may know him as a social policy professor at LSE. But he has also been recruited by the government lead a ‘task force’ to help staff in NHS and social care develop mutuals, small scale social enterprises, along the lines of GP practices, to provide local health and social care services.
You can just imagine Clare in the Community, Harry Venning’s comic strip social worker setting up a social enterprise to run her local child protection or learning disability social work service can’t you? However, the government is keen on this, and Le Grand has had some experience with pilot projects helping social work teams to do it. You can see why they might want to do this; a group that wants to provide a quality social work service can get out from under the more stupid excrescences of local government management. As he says: ‘We developed five pilot projects with the Labour government, which involved social workers spinning out into independent practices, and we discovered that they had more flexibility and were able to make better decisions. It has worked well so far.’
However, they foundsome problems.
Social workers don’t like getting into business planning, he says; that is, working out their decisions according to what people will pay for rather than what they think as professionals should be done, and selling what they think social services agencies should pay for, like quality and well-trained staff. I think this is not where social workers are now, but as soon as you start up the greasy pole in local government or voluntary organisations nowadays, you soon get into business planning anyway. And when as professionals they can see greater influence on the quality of what they do coming through independence, many more imaginative social workers will leap at the chance. You can business plan for quality . GPs have never had trouble persuading the public to pay for a good quality service, and people will value social work more as they see practitioners getting a grasp on a flexible response, instead of a local authority ‘no’.
I recently edited a very interesting article by a private care home operator who was reviewing her experience over 20 years or so. She was very clearly focused on financial and business planning, but had the same sort of professional aims as most social workers would have and had achieved them, even though her approach to what she was doing was very much: what makes business sense. We can all learn from this kind of experience. One of the benefits of this sort of business approach is when a ’small is beautiful’ philosophy is possible, because this leads to good influence for service users and flexibility for staff. To her, and to me, a strong focus on training and staff development is crucial to good quality, and you can provide for this is you plan a business effectively. Thinking about it as a business quality issue is just as valuable as thinking about it as a local authority policy issue and small business operatos are closer to people’s real care needs that a lot of policy-makers, who are only intereeested in political ideas.
The article: Patricia Prior (2011) developing srervices, knowledge and skillls; the 21st century challenge. in Brągiel, J., Dąbrowska-Jabłońska, I. and Payne, M. (eds) Social work in adult services in the European Union. London: College publications: 21-8. http://www.collegepublications.co.uk/other/?00018 or from Amazon.
However, we will lose this benefit if we go into giant businesses like the troubled Southern Cross care home group, where the motivation is financial manipulation rather than concern for the people who need care. So I’m up for the mutual social enterprise model if it stays small-scale.
Another of Le Grand’s problems is that unions and management oppose it. Le Grand says this is because of self-interest (on the part of unions, they lose membership and can’t use collective power so easily) and management (they are into telling people what to do, not commissioning them for flexibility). I think this is wrong. I’m sure some people in trade unions are concerned about maintaining their influence, but the main reason most people are opposed to this move is that they are opposed in principle to the break-down of state responsibility for the people most in need in our societies. A crucial requirement of developing mutual social enterprises as providers of social care is to set up the system so that it is absolutely clear that this is a way of providing a comprehensive public service, responding to democratic decision-making.
As for management, my thirty years or so experience of management is that a lot of it is about being relaxed when people do things in ways different from the way in which you would do it. while trying to help them. Only sometimes do you need to say, that won’t do, and that’s ususally about quality of response most social workers don;t start out from a ‘can’t be bothered’ attitude that you get from servers in low-budget cafes. Social work is a personal thing and needs to respond to the personalities, practitioners and clients, involved in it, otherwise it won’t work.
He also comments on pensions: staff won’t be able to pay for expensive, defined benefit local authority pensions with them. I think you have to accept that a lot of people come into social work because it provides a secure local authority job – society is always going to want social workers and we’ve never produced enough of them, it’s an interesting, stimulating job and it’s reasonably flexible when you have child care responsibilities. As an academic, I’ve seen a lot of people going through social work courses for these reasons, not for reasons of dedication to the public sector or social concern; nothing wrong with that. So you do have to respect people who want to make sure they and their families are properly looked after. But most people in the voluntary sector have not had a defined benefit pension scheme for years. And most people have a collection of pensions from a variety of places. If you have a reasonable start in a defined benefit scheme from your period of local authority work and you pay a sensible sum into a money-payment pension scheme, you’ll still get a reasonable outcome. The crucial thing is paying in a reasonable sum. Le Grand should be making a start on his task force that by ensuring that it is accepted that a good employer contribution is paid into staff pension schemes by mutual social enterprises. Because if not, he’s not going to get very far. And quite right too.
The interview here: http://www.thirdsector.co.uk/news/Article/1075751/Interview-Julian-Le-Grand/
I commented a while ago (March 30th) on the Law Commission consultation on reforming social care law, and in recent months, the final report has come out. You can see it here:
http://www.justice.gov.uk/lawcommission/docs/lc326_adult_social_care.pdf
The Law Commission also has a website with various interviews on why it’s a wonderful thing (and links to various versions of the report, if you want a summary):
http://www.justice.gov.uk/lawcommission/adult-social-care.htm
The government’s response in a cautious statement by Paul Burstow, the LibDem care services minister, is supportive, but indicates that this reform will be tied in with their planned white paper on personalisation, which also connects to the ‘Big Society’ Bill that they are going to bring forward later this year – social care is a big part of this, probably because they haven’t been able to think of much to do about the big society (see my Big Society blog for details of its irrelevance to real life). Therefore the whole area of personalisation is in for a blaze of publicity because it means that people can buy their own care, instead of having it organised by the state. It remains to be seen whether the government’s approach will be to force people to buy their own care (on the record of the NHS reforms this seems likely to be the Lansley approach) or whether the Bill will affirm the right to choose whether to do this or not (which the research shows is a better way of going about it).
Department of Health statement here: http://www.dh.gov.uk/en/MediaCentre/Statements/DH_126667
How the reform pans out will also be affected by the Dilnot Report on social care funding, because the Law Commission, as a politically neutral organisation, claims that it role is to tell the government how to enact what it wants to do, rather than suggest to the government what services might be preferable. As I said at the time, this makes for interesting reading, because you get a careful analysis from the Law Commission on what you can do with a law and what you can’t, and one of the things you can’t is write a law that provides for aspiration.
However, what really stimulates these comments is a legal report which shows what we really need a new social care law for. In a Court of Appeal case, Brent Council won against a man suffering from a personality disorder that occasionally affected him. This guy apparently wanted to talk to a social worker! Yes, believe it, it’s in a legal report: the client ‘…alleged that the assessment was flawed for failing to consider his need to discuss aspects of daily life with a social worker…’. And Brent Council wouldn’t let him because his ‘…condition was reasonably stable and he was capable of seeking professional help if his mental state deteriorated, and as he did not need assistance with daily living tasks, the council concluded that he was not eligible for support under section 21 [of the National Assistance Act 1948]‘.
The Report says: ‘The court approved of the council’s assessment considering [the client's] needs “at the time” of the assessment. Although there is scope for local authorities to provide services under section 21 where the need is imminent here, at the time of the assessment, the council concluded [he] was not in need. The fact that an episode of mental illness may have arisen at some future point, so as to place [him] in need of care and attention, was not sufficient to trigger the duty under section 21 at the time of assessment.’
I don’t expect the law to enshrine anything about good social work,because I’m sure the Law Commission would tell me you can’t write a piece of legislation to do that. However, I think social care law should provide that local government should provide social work assistance to people who need and want it, and should accept the standards of the social work profession on what good soical work is. One of the things about social work is that, where people have long-term conditions, the social work provided should be consistent and coherent as part of a continuing relationship that allows trust and security to build up between client and practitioner. So in the end, I expect that a College of Social Work and anyone with reasonable standards of practice will tell even a local authority as hard-pressed as Brent probably is, that one of its duties in social care is to offer such a standard of social work that people with long-standing mental health difficulties, learning or physical disabilities or problems that arise because of their ageing, can have an appropriate and supportive relationship with a social worker. They should not have to wait until they have an imminent problem. That’s not only not good social work, it’s not sensible service provision. Much better to have a continuing relationship with people who have occasional difficulties so you can head more serious problems off at the pass.
That’s one of the things we need a social work law to say, and one of the things that the College of Social Work needs to make clear, is that continuing engagement with members of the public who experience problems in their lives is the basis of a good social work service.
Here’s the report: http://www.lexology.com/library/detail.aspx?g=48c917ba-bad9-44b3-b85a-36f7270ca68a&utm_source=Lexology+Daily+Newsfeed&utm_medium=HTML+email+-+Body+-+General+section&utm_campaign=Lexology+subscriber+daily+feed&utm_content=Lexology+Daily+Newsfeed+2011-06-20&utm_term=
I always think it’s a bit unfair that sometimes there’s a comment in other places that readers of the blog only may not get to see. So I reprint here a series of exchanges on Twitter (cutting out all the Twitter technology so that you can see the comments more clearly and spelling out the Twittering abbreviations and missing words – indicated by [ ]). I was abroad for some of this time, so I don’t know I’ve seen all the points people made; in any case, unless you are continually on Twitter, you’re quite likely to miss some of what people say.
The debate here is about perceptions of a ‘local government social work’. Is it an over-generalisation to say that social work in local government is all bad? I didn’t say that, but I think an important issue is being raised. Should we be critical of the impact of the local government environment on social work practice? And is social work in a specialist environment, such as palliative care, always better?
The conversation on Twitter was about this post on April 25th, 2011: Palliative social work damaged by child protection controversy. You can read it in the archive.
Monstertalk retweeted one of my tweets drawing attention to the post.
Itsmotherswork saw this and commented to me and Monstertalk: [I’m] not at all comfortable with sideswipe at the end towards local government social work – as though it’s all bad.
Monstertalk re-read the post and could see the point that Itsmotherswork was making. I thought this was about a different post and tweet and, rather on the hoof, replied: Local government social services: [the] evidence (and my experience) is in general that many [people in local government social services] need to skill up on end-of-life care.
I made this point since it is a crucial element of the Social Care Framework document of the National End-of-life Care Programme; I was on the advisory group that contributed to this document, so I endorse its contents, although not uncritically. When I came back to a computer, I realised that Itsmotherswork was not tweeting about the social care framework, so I commented: [I] now realise you commented on a different post. No criticism of local government social work [intended]; all social work needs to get support from all specialisms.
Itsmotherswork then helpfully tweeted the part of the original post of concern and explained the critique of it: It was this remark: ‘…and one could only wish that social workers in local government children and adult social care would look to the social work specialisms for evidence that social work can very easily be seen as a good thing, if you work at achieving a very high standard of practice in all that you do.’ …which seemed to imply that local government social workers of all types (it didn’t specify) don’t work hard at achieving good practice. That’s a bit sweeping!
There was then an exchange between Itsmotherswork and Memma_pie; I think I have not found all of this in my Twitter feed, but Memma_pie obviously asked about what Itsmotherswork was saying and there was this exchange between them:
Itsmotherswork said: That’s how I read it, but in fairness, it sounds as though it’s not how Malcolm meant it. I’ll retweet the original. Memma_pie then replied: It feels a little disparaging having read it in full, but I understand the gist and agree. Sadly.
I think this is a really important and worthwhile exchange of views; so, now I’m back at my computer, I’d like to extend the discussion a little to talk about the connections between local government and others locations for social work practice, with particular reference to palliative social work, which is what I’m supposed to deal with in this blog.
The most important point to make is that, in most European countries, local government is the main location of social care services and therefore of social work practice. Therefore, the responsibilities and organisation of local government has a significant impact on the form of social work in any particular country. In many countries, and this is certainly true in the UK, social work is very much defined by the kinds of social work practised in local government.
The peculiar characteristics of local government, as it is everywhere, therefore have a significant impact on how social work is practised everywhere. I work in a number of European countries, and wherever I go I find social workers complaining about stifling rule-bound requirements of practice in local government, compared with the freedom and flexibility of ideas about how social work should be practised. They also talk about how they are burdened by excessive workloads because their local government services are under-resourced to meet the requirements laid upon them by imaginative and forward-looking legislation. I was recently asked to give a lecture on ‘Social work: vision and reality’ the keynote topic of a conference in Slovakia. Talking about the topic to people at the conference, it is clear that the difference between vision and reality for them was just this distinction: between the vision of an empowering therapeutic social work and the reality of a constricting local government system.
In UK local authority adult social care the constriction is about workload and the highly tick-box oriented assessment part of the care management system and in children’s social care it’s about workload and the highly defensive practice promoted by media and political pressures around risk in child protection. I think everyone accepts that the focus on child protection has deviated much children’s social care from what used to be a child and family care service. You can exaggerate this, of course, because you can see a lot of very positive achievements in fostering and adoption work, in family support and work with children in family centres and in the community, in children’s residential care and in working with children in child and adolescent mental health services.
Equally, as I talk to people in any country, I come across practitioners who describe how they are doing imaginative and empowering social work with clients and community groups. Sometimes the way they have achieved that is by setting up a specialised agency that provides help for a restricted user group; sometimes it is by developing the skill and self-confidence to practise in an empowering way with their excessive caseload in a local government agency.
The same is true in the UK. I talked to a patient at the Hospice who told me that they had a wonderful care manager in the local authority, who really helped them to come to terms with the change of family lifestyle caused by dealing with their elderly mother’s increasing frailty. It quite changed their fantasy views, garnered from the gutter press, about what social work is and how it can help. That’s not the only example I have come across, I regularly meet people who sing the praises of their local authority social worker.
The problem is that I also come across a lot of care managers who tell me (just like all those other social workers across Europe) that their local authority is so controlling that all they can do is fill in the forms they have been given within the time limits required, and the extremely restrictive computer system that ties them to their desk.
By the way, this fantasy that social workers once went out and spent most of their time with their clients is just that: a fantasy. All the research that has ever been done on social workers’ workloads, going back to a study I remember but can’t now cite on child care officers in the 1960s, shows that most of the time always was taken up by meetings and paperwork (and, you hear less mention of this but it was always true, travelling to get to home visits). It’s self evident, if you think about it. An hour’s visit means at least the equivalent in travel, a further hour again in making notes and phone calls in following up, and if the agency has to be run, a further hour in meetings, coordination, cover for absent colleagues and training averaged out over the client contact you did that week. Twenty percent of your time in contact with clients is probably about average in any kind of people working.
I was involved in the introduction of care management and wrote a book about it and its possibilities (Social Work and Community Care, Macmillan, 1995) which to my astonishment is translated into other languages and still sells in the UK sixteen years later. Back in the late 1980s, care management was the personalisation of the age: it was going to lead to flexibility, imaginative creative practice and was going to be the foundation of a new adult social work (which was always the inferior branch compared with child care and family work). Just like personalisation now: forgive me for being a bit doubtful about fantasies that this will lead to a sea change in social work.
Well, adult services care management has led to a new adult social work; it has institutionalised social work assessment and service coordination skills as an integral part of the care system in this country. And well done, as it sometimes is, it can be life-enhancing to people in very difficult situations. I believe it has made a major difference particularly for people with learning disabilities, but also for other client groups. Even routinely done, as it often is, it enables a wide range of services to be provided and coordinated to a lot of people who really need and benefit from them. We all do the routine much of the time. For most of my practice career, I have done the job and provided the services as required. At any time, there have been a few families who have been at the point where I have something to offer them and you see a major shift in their lives.
When we comment on local government social work in any country, therefore, we have to be clear that the backbone of any service is doing the everyday job adequately. It is important also to be clear that there is always the chance if we can take time and space in the everyday job when there is a need, when there is a possibility, when people are ripe for it to make an extraordinary impact on people’s lives. I don’t think that is the difference between a ‘good’ local authority or practitioner or a ‘bad’ one. Whatever the setting there is always a chance to step up to doing a wow in a particular instance. The best practitioners are always looking for occasions when they can do this.
But we also have to accept that local government in general is over-burdened with responsibilities and under-resourced. It is also burdened with a management system that is primarily about rationing resources. Generally, throughout Europe, this is done by tight administrative controls that practitioners complain about. It also means that UK central and local government has chosen an administrative form of care management that international research has shown is not particularly effective at making a significant difference in the lives of vulnerable people, whereas there are other forms of care management that have a history of being much more successful at having an impact, but they are more expensive of money and staff resources. If you want that greater success, government, you have to pay for it. And if you want to connect with that research and my commentary on it, try my very well-reviewed book: Social Care Practice in Context (Palgrave Macmillan, 2009).
There are just such tight administrative controls on practice in specialist settings such a palliative care social work, or in forensic social work, another specialist area where I have been involved in the past. However, most of these services have fairly limited caseloads and an opportunity to use social work more fully, more broadly, more of the time as part of the everyday job. Many of these services are also part of healthcare, which is generally much better funded than social care in the UK (and elsewhere). So the expectations of professional colleagues in nursing and medicine are of a higher standard of everyday practice, because they have the resources to achieve it more often. High expectations tend to lead to stronger achievements. It ill behoves people working in these specialised services to complain about the everyday ‘good-enough’ standards of the more resource-constrained backbone local government social care, because it does provide the backbone, without which specialised services are likely to be flimsy in their achievements.
But what I was saying in my post was two things. First, specialist social work operates in settings that mean it has to develop credibility with colleagues in other professions. By meeting their expectations of good practice and using their generally better resources, social work can demonstrate to the world that social work can be and often is widely valued by other professions, service users and the managers and policy-makers who develop services. That demonstration of the value of social work in at least some settings should enable us as a profession to say in relation to local government social work: ‘Hey, this social work stuff can be a really good thing for people and as part of services generally’. We can say it to buoy ourselves up in our down moments and to show other people that social work does not have to be minimalist as under-resourced local government forces us to be. Second, it enables people in local government to point to valued social work and say: ‘Give us the resources and we can do more of that too.’
I come across palliative social workers who moan about what it was like when they were adult services or children’s social care social workers and say how pleased they were to work somewhere like a hospice and do ‘real social work’ or they complain about the bureaucratised attitudes of the care managers that they deal with who aren’t doing ‘real social work’.
Let’s be clear: ‘real social work’ is the local authority backbone of adult services care management and children’s social care. Because of the massive number of people that local government provides services to, the everyday backbone job makes a crucial difference to the generality of people’s lives in this country and elsewhere. And the times when there’s a chance to do a really good job in that setting means that a lot of people have really good experiences of social work in those settings too. Specialised social work settings, like palliative social work, provide the opportunity to add into that a social work that is relevant to the particular needs of people with very special needs. Because of the special needs, that kind of social work is different again.
I’ve stopped talking about social work, instead I talk about ‘social works’ of all different kinds, relevant to the setting and the role. That’s true when you talk about social works that we in the UK are not familiar with, like social development practice, or social pedagogy, or cultural social work; these are all well-established practices in some countries. It’s also true about the different social works practised in the UK. None is a ‘real social work’; all are a social work.
An interesting article by Jonathan Walters on an American children’s safeguarding case in which social workers have actually been threatened with prosecution for manslaughter for failure to protect children has taken my interest:
Read it here: http://www.governing.com/topics/health-human-services/punishing-social-workers.html?nlid=h110412
I’m intrigued by a certain amount of American social work anguish about this, because it so happens I’m writing a paper about the effect of thirty years of criticism of social work in child protection cases for a for a conference on parenting in Poland at the moment, and this post is based partly on a comment on American discussion on LinkedIn. You tend to think of palliative care social work as about social work with adults, but I think one of the things about palliative care is that you find yourself dealing with the issues that are facing a whole family, most of which are not about the fact that someone’s dying. So palliative social work is actually just as generic as social work used to be in generic social services departments were in the 1970s, when we were trying to deal with all sorts of social work issues.
High public concern on child protection is of course justified (or as the jargon seeking a positive spin has it nowadays ‘safeguarding children’). Anyone ought to be concerned about abuse or neglect of children by adults and thinking through what we should do about it is an important concern of the public. Social workers have experienced opprobrium on child protection for thirty years, since the case of Maria Colwell in the early 1970s; Maria was killed by her stepfather in 1973 when being supervised at home by a social worker, and this has been damaging to the whole image of social work in the UK.
Since then, there have been many cases that have led to public scandals about child protection issues, including the Cleveland cases, when the public found out about the extent of child sexual abuse for the first time and the recent Victoria Climbie and Baby P cases. At least after Baby Peter, there has been a serious effort in government, maintained by the present coalition, to think carefully about what kind of social work we actually want rather than knee-jerk vituperation. Some thoughtful work is being done by the Munro Review, which alongside the Social Work Reform Board developments (a continuation of the Task Force) and perhaps the hopes for a College of Social Work might well help. Some links at the end to websites on this issue.
The main damaging result of justified public concern about child protection has been a naive proceduralisation of social work in the UK, to formalise and manage communication between agencies, to incentivise effective action by professionals and to share decision-making (and blame) among the agencies involved. It is as though if you tick boxes properly damaged human and social relationships can be This has led to a system in which child protection and the surveillance of parents is more important than providing good child care services and family support.
And public attitudes towards parental rights and responsibilities have also swung to and fro. The historical position was that parents had the right to bring up and discipline their children and nobody, least of all the state, should interfere with that. Over the last thirty years the law and public opinion has shifted towards a position that with that right goes responsibility for doing it well. But that hasn’t always meant that people feel that the state should interfere, and certainly there has been doubt about social workers doing that, not least because they have lost credibility because of child protection failings.
So social workers have continued to be the main target of criticism. This is partly because, in the UK system, children’s social care services are usually the agency with legal responsibility for taking action, so the police, doctors and nurses are inevitably less responsible.
But I believe it is also because of a political view among right-wing political parties, such as our Conservatives, US Republicans and German Christian Democrats, that people ought to be competent to manage their own lives and look after their children, and the state should not have to pay for a social work service to help them. So when people cannot look after their children, the political and media reaction is punitive to the parents and then also, when cases go wrong, to social workers for not intervening decisively enough and for being supportive and kindly to parents instead of representing a punitive public morality about parental responsibility.
So the criticism of social workers is also a frustration on the political right about the need for state intervention in family life. By setting themselves up as a profession that can help families deal with their problems, social workers have put themselves in the firing line.
The frustration for palliative social workers is that they have actually done a good job of convincing colleague professionals that they make a worthwhile contribution to multiprofessional practice in our field, but malking progress on this is held back by the continuing damage to the reputation of social workers by this semi-political issue about child protection. It;s important to keep plugging away about the positives, and one could only wish that social workers in local government children and adult social care would look to the social work specialisms for evidence that social work can very easily be seen as a good thing, if you work at achieving a very high standard of practice in all that you do.
The Munro Review website here: http://www.education.gov.uk/munroreview
The Reform Board website: http://www.education.gov.uk/swrb
The College of Social Work website: http://www.collegeofsocialwork.org
You’ll be aware perhaps from previous posts that BASW is, somewhat ludicrously, trying to claim the credibility to run the College of Social Work itself, rather than cooperating with everyone else; this is its website, but to get a balanced view of the issue, look at others as well: http://www.basw.co.uk