Changing How Social Workers Work With People

Colin TurbettIt's doubtful if many people outside social work have much understanding of what social workers do apart from general notions around helping people with problems, and their role in the protection of children and vulnerable adults at risk of harm. Beneath these concepts are fairly universal government frameworks setting out how help and protection is provided – most of which tie social workers up in endless bureaucracy – form filling, recording and lengthy report writing. Many social workers agree that much of this could be cut away with no great loss to anyone – especially the people relying on the various services for help. These processes are also quite demoralising and take workers away from what they are good at, which is using relationships to talk to people and to help change their lives for the better.For adults and older people, the way in which issues are approached took a particular turn in the 1990s with the introduction into social work and social care (by a Tory Government) of business models and a market - known as “assessment and care management” (ACM). Whilst the aim was to look at individual need, offer choice and establish a care plan, the reality was that ACM and social work quickly became dominated by eligibility criteria and specialisation. This means that services became only available to those with certain types of need, and if you don’t fit then you are either denied a service or referred on elsewhere. Put austerity into the mix with its never-ending cuts in service, and you finish up with long waiting lists and anger: resulting not surprisingly in justifiable demands for personalisation and self-directed support. Inevitably services become crisis led – only available to those with urgent need or where they are needed to free up other stretched health resources – moving older people out of hospital into care home settings being the classic example. The model also took social workers out of communities and into centralised settings typically inaccessible to people requiring help. Common Weal have covered these themes in “Caring for All” and “Struggling to Care”.Members of Common Weal’s Care Reform Group have been engaged in recent months in discussion looking at ACM, and how we might move beyond and away from the model, to bring social workers back to relationship-based preventative work in communities. Our discussions have involved the main trade union, UNISON, Social Work Scotland (the social work leadership organisation) and the Scottish Association of Social Workers (the professional association), and are continuing within and beyond these bodies as these words are written. To move this forward, Social Work Scotland have just published a paper (in long version and short summary) to stimulate discussion within and beyond the world of social work. It can be found here.The paper “Assessment and Care Management – Its History and Context within Social Work in Scotland Today” offers a detailed account of how social work got to where it is today, why it needs to change and how that might be achieved. One issue is that ACM (and the generally accepted need for eligibility criteria) are so embedded that few people can see an alternative. There is however enthusiasm for exploring alternatives and the paper offers some examples from across the UK. These include Torfaen Council in Wales who have run a different model of adult care social work services on a localised basis for the past seven years: eligibility criteria and referral screening have been abolished and an emphasis put on prevention – with solutions found through social workers who know their locality and take as much time as it takes to work with people using services, their carers, and the wider community. They now have no waiting lists, caseloads for staff are manageable, and people in the community are generally happy with the service.Experiments in Leeds and (quite recently) Northumbria, suggest that others are looking at relationship-based practice based on exploring strengths in individuals, families and communities, rather than assessing risk and focusing on deficits. These examples share a belief that solutions are found over whatever time period necessary, rather than processed quickly to comply with turnover expectations and bureaucratic requirements. This centres on an individual journey that takes as long as it takes, rather than a service-based method focused around an expected service outcome like social care or residential care. In Torfaen it has been found that such commissioned services can often be avoided. The preventative approach can avoid social and health breakdown that leads to the hospital admissions that currently drive political interest and social policy – in Scotland as elsewhere in the UK, and which was such a disaster during the pandemic.Social work doesn’t need to be the way it is now. The National Social Work Agency is being established through the flawed National Care Service Bill (consequently subject to a very slow process through parliament). It could offer an opportunity to take social work forward as a supportive and preventative profession that works within and on behalf of communities. That will need to be based on a new vision and changed methods of doing things: leaving ACM behind will be an important component of necessary change and we now need politicians who are brave enough to see that this should be part of a new National Care Service.