Daisy Bogg on how social care can avoid being marginalised in multidisciplinary teams

This article examines the social work role in partnership trusts. As a profession we have become disenfranchised and cannot afford to rest on our laurels. Professional identity is placed at risk only if we let it. As we move towards integration, the validity of the social care perspective becomes ever more vital in the switch to person-centred care.

It was supposed to usher in an era where health and social care professionals worked more closely together in partnership trusts. But the multi-disciplinary concept espoused in the Health Act 1999 remains just that – a concept, an idea, a woolly buzzword that does little to advance service delivery.

For many of us this is due to a lack of understanding of what each profession can bring many social care and social work staff within trusts have a fear and loathing of being in the NHS. The new management structure and the dominance of the medical model are just two of the many areas where anxiety is rife, and the call of “losing professional identity” is common.

Social workers are renowned for being vague: it can be a defence mechanism against targets and those dreaded performance indicators which we see as a corruption of our principles and ideals. But we need to stand up and be counted, to turn to our health colleagues and say we have a contribution to make and this is what it is.

The international definition of social work is: “The social work profession promotes social change, problem-solving in human relationships and the empowerment and liberation of people to enhance well-being. Utilising theories of human behaviour and social systems, social work intervenes at the points where people interact with their environments. Principles of human rights and social justice are fundamental to social work.”(1)

There is little here that anyone could argue against, so why are social workers and social care staff generally seen as alien to NHS organisations and vice versa?

Social work and social care centre on the social model of disability. Within this context the role of the practitioner is to enable the individual to access their own resources as well as those based within the community or services, and to engage in the process of self-efficacy, improving quality of life, and increased personal choice, control and independence.

The social approach is a holistic one: it encompasses all areas of a person’s life with the philosophy that all interactions – psychological, social and biological – affect the individual’s functioning. This makes the social perspective an inclusive one, whose scope is far-reaching. The social care workforce is based on the principles of putting the person in control of their own life and providing protection only when essential.

The terms social care and social work are often interchangeable. There is, however, a difference: “The term ‘social care’ refers to the wide range of services designed to support people to maintain their independence, enable them to play a fuller part in society, protect them in difficult situations and manage complex relationships. Social care works in partnership with many other public services, and often acts as the ‘glue’ that joins these services together, around the needs of the service user, as well as having a role in its own right.”(2)

Social care is a practical and assistive activity it covers a range of services and is largely community-based. It could be argued that many of our health colleagues provide an element of social care, along with colleagues from criminal justice, education and other public services.

Social work, on the other hand, is a specialist activity that can be categorised into a few main areas of intervention:

● Assessment and care planning according to the social model.
● Casework, including direct therapeutic intervention and counselling.
● Information and advice provision.
● Advocacy.
● Partnership and inclusive working.
● Working with individuals, families, communities and organisations to help identify, clarify, express expectations, strengths and limitations.(3)

These activities aim to achieve a change in someone’s life or improve their life opportunities to keep an acceptable quality of life for someone as long as possible in the face of infirmity or adversity and to keep people safe from harm and from harming themselves or others.

The title of social worker is now protected and, with registration and continued professional development, social workers are expected to continually engage with the development and expansion of their skills and knowledge base, including using theoretical and evidence-based approaches in their work. This situation is also expanding to cover social care workers and should be fully implemented in the next few years. This is a development that will improve service delivery.

So here comes the crunch: what can social workers bring to community teams? What is different about us and why should we be listened to? In simple terms we bring a perspective that views the person’s situation as a whole. The individual has the control and has choices to make – the worker points out the consequences and potential outcomes and then supports whatever choice is made, both emotionally and practically.

As the Association of Directors of Social Work said in its response to the 21st century review: “By using the medium of their relationship, social workers work with people on a number of levels – thoughts, emotions, relationships – helping people to use their own strengths to resolve problems and change their physical circumstances.”3

The profession is one of independence and autonomy. We bring a view that does not centre on diagnosis or medication but rather on what an individual can do to help themselves and improve the quality of life that each individual experiences. This does at times involve protection, as in the case of interventions under mental health legislation, or in the case of protection of vulnerable adults. But wherever this is the case, decisions are based on thorough assessment of the circumstances, full consideration of the views of individuals and other involved parties and ensuring that the individual and human rights of the person are observed.

In conclusion, the social care and social work role does not need to be in conflict with more health-oriented approaches. The location of the profession within the NHS is designed to improve co-ordination and strive towards the ideal of a “seamless service”. The misunderstandings and professional preciousness on both sides seems to me to be a waste of energy in a field that is already overworked and overstressed.

The identity of social work is only at risk if we let it be. As social care staff we need to stand up and say what we stand for. The values, principles and perspectives we bring enhance the service user experience by making the multi-disciplinary view one that is person centred. The diagnosis is important, but so is the experience of the individual, and this is what social work brings to the metaphorical table.

Daisy Bogg is consultant practitioner in mental health social care for Bedfordshire & Luton Partnership Trust. She has long-standing experience and interest in both mental health and substance misuse. She has worked within integrated services since 2002. Before this she worked in the voluntary sector.

Training and learning
The author has provided questions about this article to guide discussion in teams. These can be viewed at www.communitycare.co.uk/prtl and individuals’ learning from the discussion can be registered on a free, password-protected training log held on the site. This is a service from Community Care for all GSCC-registered professionals.

References
(1) International Federation of Social Workers, Definition Papers: Definition of Social Work, 2000 
(2) Department of Health, Options for Excellence: Building the Social Care Workforce for the Future, TSO, 2006
(3) Association of Directors of Social Work, 21st Century Social Work: The Role of the Social Worker, 2004.

Further reading
● S Asquith, C Clark, L Waterhouse, The Role of the Social Worker in the 21st Century, Scottish executive, 2005
● P Beresford, “Thinking about ‘mental health’: Towards a social model”, Journal of Mental Health, 11 (6), pp581-584, 2002
● P Gilbert, The Value of Everything: Social Work and its Importance in the Field of Mental Health, Russell House Publishing, 2003

What are your experiences of working in health settings? Is the gap narrowing or do we need to be more active in standing up for ourselves? Have your say on our Discussion Forum

This article appeared in the 29 March issue under the headline “An injection of social care”