The Big Picture

by Blair McPherson, a former director of community services at Lancashire Council

Why such optimism about integration? It has been promoted for the last 30 years and we still only have isolated examples of best practice.

From my experience when people from health talk about integration they mean integration of NHS services not health and social care. The whole integration case was based on removing inefficient duplication and providing a seamless service for the customer thus providing a better experience. But with the move to reduce the public sector's involvement in providing public services this seems an outdated agenda.

What's more, if integration means health has more say in how care services are delivered I for one would point out that health is not good at providing care. Have we forgotten what has been happening to older people on NHS wards?

Disruptive goal

An integrated inspection service for health and social care has not been a success and why should we encourage health to commission care services when the experience and skills already exist in local authority social service departments. Let's not divert more management time to this outdated, unnecessary and disruptive goal.

Unnecessary because both the NHS and social services are about to embark on a transformation which further separates commissioners from providers and which seeks to reduce the public sector's role in providing public services.

We can see it in the increased numbers of NHS patients treated in private hospitals. Local authorities have already trodden this path with the closure of their own care homes in favour of buying care in the cheaper private sector.

Real integration?

There has been integration of sorts in community health and social work services. Combined mental health teams have long led the way. But a closer examination of the way they work reveals that many are only integrated in that the teams operate from within the same building.

The characteristics of integration that you might expect to find - one manager, one budget, one computer system, one case file - are most often absent.

The extent to which inefficient duplication has been reduced is more likely to be dependent on the state of the personal relationships between line managers and the extent to which staff from the different professional backgrounds get on. What's true of mental health is also true of learning disability teams and older people's teams. Where duplication has been removed it is just as likely to have come about through budget cuts as from a commitment to integration.

Local arguments

It is possible the introduction of commissioning in the NHS could provide the opportunity to look at combined heath and social care commissioning. This might stop some of the local arguments about the long term funding of care for a small group of very dependant people on very expensive care packages.

It might also be attractive to hospitals that are currently reliant on social services to fund the care packages for patients being discharged home or to care homes. Of course if the real problem is the amount of budget available then joint or an integrated commissioning arrangement won't solve the problem.

Demise of local authorities?

Not only is integration unnecessary it is undesirable if the price of an integrated health and care service may be the demise of local authorities. A local authority's adult social care budget makes up almost half of the authority's total budget if you take account of the fact that the education budget is passported direct to schools.

How viable would many local authorities be if they lost half their budget? And yes that would be a bad thing for local democracy which in turn would be a bad thing for older people, disabled people and their carers who would end up having even less say about the help and support they get.

Blair McPherson is author of books on the public sector the latest of which is Equipping Managers for an Uncertain Future published by www.russellhouse.co.uk  

by Peter Beresford, professor of social policy at Brunel University and chair of service user network Shaping Our Lives

With what confidence can social care service users and social workers look forward to 2012? With very little it seems. It's not just the generally negative welfare and public policies that seem to be hitting disabled and older people the worst. As 2011 comes to its gloomy end, the Coalition seems to be committing itself to a do-nothing approach to social work and social care. Such an approach has always been disastrous in the past and there's little reason to have any more confidence for the future.

Modest proposals

First, the government has made clear that it doesn't intend to support a key recommendation of the Munro Review into child protection - the early intervention duty. The final report of the Munro Inquiry was hardly a demanding document, with no mention of resources, despite all that we know about their critical importance for positive child care and child protection policy.

Yet even its modest proposals seem too much for the Coalition. Then there are the rumours that the government is putting back social care reform until 2025, despite the common agreement, to which even it has signed up, that the present system is broke and unsustainable.

An alliance of more than 20 key social care organisations have already expressed their serious concern about this in a letter published in the Daily Telegraph, one of the papers that first broke the story.

Again the Dilnot Commission offered a modest set of recommendations, but apparently the Treasury has baulked even at them and the figure of an additional £1.7 billion which Andrew Dilnot said will be needed from the public purse. That amounts to less than one third of the £6 billion that Vodafone was reportedly let off paying in tax by the Coalition. Yet only last week, Jo Cleary of the Association of Directors of Adult Social Services, said: "the funding system for adult social care is broken. It could bring down local authorities it is so serious".

Commitment and enthusiasm

It increasingly looks as though this government has decided to park social work and social care. If so, what does it mean and what should we be doing? 'We' is the important word here. And all is not doom and gloom. Jo Cleary made her disturbing statement at the annual Social Worker of the Year Awards where she was one of the judges. Held in the gilded surroundings of the House of Lords, the awards were a showcase for all that is good about social work and social care. We saw centre stage the commitment, the enthusiasm, the sheer hard graft of a dedicated and diverse workforce. It really did make you feel proud to be there. Hilton Dawson, chief executive of BASW, summed it up in his closing remarks when asked where he saw the social work profession in five years time. He said, 'Where social work is in five years, is down to us. We can make it or break it'.

That truly is the point. Waiting for the politicians and policymakers to get it right, will have us waiting for a very long time indeed. Social workers, in alliance with service users and their organisations, must see themselves as holding social work's future in their hands. It is a massive responsibility, in very difficult times. But it is undeniably the way to go. Seeing those award winners, meeting my new social work students earlier this year at college, certainly gives me hope and confidence. Having confidence must be at the heart of our resolutions for the future.

by Jeremy Porteus

Dylan Thomas urged older people to rage against the dying of the light.

For too long, however, the limited housing options open to people with age-related care needs have robbed them of independence and choice. Many are forced prematurely into expensive residential care.

If social care's commitment to personalisation means anything, the sector's commissioners should be working with counterparts in housing and health to develop housing with care strategies.    

Care and support should be shaped around people's lifestyles and housing choices - not the other way round.

Care managers, meanwhile, should not see residential care or traditional sheltered housing as the default solution for older clients who can no longer live in their existing home.

There is mounting evidence that less institutional forms of accommodation - such as extra care housing - are good for both the individual and care budgets.

An evaluation of local authority-led extra care housing partnerships, to be published next month, is set to confirm that residents valued the independence, security, availability of care and social interaction the schemes provided.

It is also expected to conclude that this model is a viable alternative to residential care for many older people. Credible research at Kent university personal social services research unit suggests that delaying entry into residential care by one year could save up to £26,000 in non-care costs.

The Association of Directors of Adult Social Services has recognised the potential benefits for both older people and care budgets. It has worked with my organisation to create a resource pack that will help guarantee social care authorities and their partners develop housing with care strategies and set about delivering them.

If they fail to do so, they can expect an older generation demanding choice, quality and independence in care services to rage against more than the dying of the light
.
Jeremy Porteus is director of the Housing Learning and Improvement Network

by Blair McPherson, a former local authority director of community services

It can be a fine line between befriending a client and getting too close. One in five social work misconduct cases concern inappropriate relationships with clients. The General Social Care Council (GSCC) thinks social workers need more guidance.

It is never acceptable to take advantage of vulnerable people or abuse your position of authority but when the aim is to get to know someone, to build up trust, to offer help and support then it is not always clear where the professional boundaries lie.

Having a sexual relationship with a client is clearly totally unacceptable but the boundaries can get blurred without ever going this far. Recent misconduct cases have involved taking a client to the pub and complimenting her on her looks, taking children out on individual treats for a meal or to watch a football match and encouraging someone to break away from a religious group. All of which could be perfectly innocent but in these cases weren't.

The motivation may be entirely honourable but due to inexperience or over-involvement the worker crosses a professional boundary leaving them open to allegations of misconduct. 

Being open about your actions is good advice. It gives colleagues and your supervisor the opportunity to point out how your actions could be misconstrued by the client or others. If you don't feel comfortable sharing what you are doing then you probably shouldn't be doing it.

Early career

In my early career I worked in a number of residential settings where by the very nature of the work you get close to those you care for. Every year the staff would take children to spend Christmas in their household. The advantage was that no-one had to work over the Christmas period. The younger staff like me took a child to spend Christmas at their parents' house.

For two years running I took Terry who was only six years old home for Christmas. My brothers and sister still refer to it at any large family gathering. My mother sent Terry a Christmas card and birthday card for many years after I had stopped working at the children's home.

While working at a residential home I took a 10 year old to London for the day to watch his favourite football team as a birthday treat. His first ever football match. The birthday allowance wouldn't stretch to cover the costs so I paid out of my own pocket and the staffing was such that it could only happen if we went on my day off. Would that still be considered appropriate in the current climate?

Double or quits

Playing pool or table tennis with adolescent boys may sound an easy way to earn a living but of course the activities are just a way of getting to know each other and stopping the fights. This particular troubled and troublesome lad was very good at table tennis so that's what I thought I would do with him. Only he wouldn't play me - I wasn't good enough. So I said I bet you fifty pence you can't beat me if you give me a ten point lead. I lost. Double or quits, I said. By the end of the evening he was giving me a fifteen point lead and I owed him £20! I had made a big mistake. He wanted his winnings. I tried to laugh it off by saying you didn't think I was serious did you? I didn't give him the money, he felt aggrieved and our relationship was awkward from then on.

When money gets involved it changes relationships which is why you shouldn't lend money to clients or borrow from them.

I have known of social workers lending or giving money out of their own pocket to clients and in doing so they cross a professional boundary.  As I became more experienced I came to recognise it was not being a disillusioned cynic to recognise that despite the empathy I am not your friend I am your social worker.

Blair McPherson is an author of books on management development and equal opportunities www.blairmcpherson.co.uk

by Sarah Brennan, chief executive, Young Minds

The recently published Mental Health Strategy - No Health Without Mental Health - highlights that half of adult mental health problems start before the age of 14 and has a strong focus on the critical importance of early intervention to support children and young people. Intervening early for children with mental health problems has been shown to both reduce health costs and realise larger savings over time from improved educational outcomes and reduced unemployment and crime. Helping young people to flourish and become nurturing parents for the future can in turn break cycles of inequality and child poverty running through generations of families.

As part of the government's policy on local determination of priorities, a strengthened voice for service users and the increased role of the voluntary and community sector (VCS), the Department of Education will be providing up to £3m for a two-year sector led programme which will build the capacity of VCSOs to deliver early intervention mental health support to children and young people, including building resilience and emotional well-being. The programme will also support and sustain VCSO engagement with the system in the longer term, along with expanding choice and provision within the sector.

The BOND Consortium, led by Young Minds, believes that the VCS offers timely, flexible services which are responsive to need and are often more easily accessible than statutory services particularly to children and young people most at risk of poor mental health, such as those in BME groups, children in care, care leavers and young people in touch with the criminal justice system. However, as the government has recognised in creating this opportunity, the VCS needs help to develop its capacity without excessive burden or cost and to increase the confidence of all commissioners to invest sustainable funding in the sector.

Over 2,000 schools, 500 VCSOs and 100 commissioning NHS and LA organisations will be engaged and involved in identifying barriers and developing sustainable solutions to achieve our vision.

We will deliver a broad range of benefits including; in-depth capacity and capacity building in at least five pilot areas through a bespoke package of support aimed at strengthening the local market whilst at the same time developing local commissioning; a range of more targeted support will also be offered to black and ethnic minority organisations, school and teenager services and others delivering to the most vulnerable children and young people, helping them to become commissioning-ready through training, coaching, online forums and links to specialist websites; guidance, facilitation and training for commissioners and VCSO's on new approaches and delivery models such as social enterprise and VCSO consortia tenders, and how to engage effectively in delivering the national mental health strategy including the increased access to psychological therapies (IAPT)

Our vision is a thriving and competitive marketplace of children and young people's preventative and early intervention VCSO service providers, local and national, small and large, equally valued and equally able to compete for sustainable funding to provide quality assured, evidence-based services.

by Nick Berbiers, social work interim manager

Where are we in social work and where are we going?

If you wanted existential answers last week, there were two very different places to find them.

One was a state-of-the-art conference centre, with speeches from the sector's movers and players; live video feeds; instant news reporting - but very little participatory debate. The other was cyberspace, with practitioners, students, academics, campaigners, journalists, policy-makers and sector organisations coming together for a live debate on social workers' role and professional identity.

There was a big picture visible at both the National Children and Adult Services Conference 2011 and the inaugural Social Work and Media Network live social work Twitter debate on Tuesday night: just not the same one. On one screen played money and reform: on the other, identity and intervention. In one setting there were lengthy orations frequently filled with esoteric jargon: in the other, rapid-fire exoteric debate.

The problem with the NCAS conference was the capacity to stay engaged with this overarching world of templates, eligibility thresholds, personalisation indicators, supply and demand paradigms, etc., etc.

Yes, I know they are important issues, but I cannot help the irksome little voice at the back of my head asking what any of this has really got to do with the practice of social work, and would Joe Public understand what on earth anyone is on about - which does matter very much, I think.

The challenge with the Twitter debate was keeping up. It moved very fast, not least as the result of the 140 character limit. Questions, issues, and observations moved extremely quickly over the 90 minutes. But, boy, was it exciting, fascinating and unexpectedly exhilarating to hear so many views and opinions on our role and identity as social workers, past, present, and future-aspirational, in one place.

So where is social work?

If one was viewing through the NCAS conference prism, it would appear as a profession that operates to and within big-idea policies (primarily governmental), where it must achieve more for less.

Looking through the Twitter debate window, it would appear as a profession whose role and values have become far more diffuse than participants would wish.

If those summaries are correct, then issues of leadership and direction are highly pertinent to both. Where is social work? As ever, it is somewhere in the midst of where social workers and policy-makers want it to be. And that is always in tension and flux. That is why there has to be the NCAS conference's and the Twitter social work debates, and all other variations thereof.

Governmental policy-makers will inevitably have their steer because of their public-policy action relationship to social issues, statutory social work functions and the shaping effects that has on independent and third-sector social work services. Social workers need our steer, because we also have a professional identity and values separate to the state - just like doctors or lawyers.

Where social work goes to next is up to us all.

Nick Berbiers is an interim children's services manager and consultant

➔ The next NCAS conference will be in October 2012. The second @SWSMedia live social work Twitter debate, "Developing Leadership in Social Work", will be next Tuesday, 1 November, at 8pm.

By Dean Woodward, assistant director of Lambeth Specialist Youth Services