Personalisation: Is the social worker role being eroded?

It has been a year since the Putting People First programme to personalise care and support for adults in England came into effect.

Councils were told they had three years to engineer a “system-wide transformation”, to give users more choice and control, shift provision from crisis intervention to prevention and provide universal information and advice on services to all users and carers, backed by £520m in funding.

Our recent survey of more than 400 council social workers and managers, conducted with the Department of Health and Social Care Institute for Excellence, showed progress was variable, with a quarter of authorities having a transformation strategy in place and one-fifth still at an early stage of developing one.

Social work role unclear

And a third of the way through the transformation programme, social workers’ role in it is far from clear.

The government and adult care directors have long cast personalisation as an opportunity to revive “real social work” by swapping the rationing and gatekeeping of care management for a role in empowering service users to shape their lives.

However, last month British Association of Social Workers official Ruth Cartwright (right) warned some councils were cutting back on social workers because they saw them as “too expensive” for the personalisation era.

BASW’s letter to Phil Hope

And last week, outgoing BASW chief executive, Ian Johnston, wrote to care services minister Phil Hope calling for explicit guidance from the DH on the “unique contribution” of social workers in delivering personalisation.

Johnston said in some areas social workers felt excluded from personalisation because councils were “narrowly focusing” on increasing direct payment and personal budget rates “rather than on the principles of Putting People First”.

He wrote: “We are concerned that an erosion of the social worker role with adults will see service users missing out on the positive, enabling approach that social workers bring.”

Survey backs up concerns

Our survey with the DH and Scie, conducted in February, backs up some of BASW’s concerns. Forty-six per cent of respondents said their personalisation training needs had not been met by their employer and 56% said that there was not enough published guidance.

There is emerging evidence that the implementation of personalisation is seeing a shift in care management work for people with lower-level needs from social workers to non-qualified staff. Social workers have been left managing more complex cases, often in integrated teams with health, and those involving safeguarding concerns.

Wirral cuts

But apart from in the Wirral, which announced plans last year to cut social work posts by 26 and increase non-social work posts by 29 in adult services, there are no confirmed instances of job cuts for social workers. Nevertheless, a Community Care survey of 600 adult social workers published last October found 58% thought fewer of them would be in post by 2011.

Peter Beresford (right), professor of social work at Brunel University and chair of service user organisation Shaping Our Lives, recently published research on what service users wanted out of the transformation of adult social care. It found what they wanted from social workers was advocacy and long-term work that builds relationships with users, rather than short-term interventions and gatekeeping.

However, Beresford warns: “I’m seriously worried because there is some evidence in a range of local authorities that social workers are being sidelined and other roles are being taken on. We’re seeing people being recruited often who will just be basically form-fillers. They will be people without the skills and the good orientation that service users truly value about social workers.”

Doubts lost amid enthusiasm

Beresford warns that doubts voiced by practitioners, service users and carers a year ago were lost amid the “terrific enthusiasm” of policy-makers and adult directors for personalisation. He continues: “What worries me is that one year in to a three-year programme of transformation, only now are we getting that kind of anxiety coming to the fore, when I would have hoped we’d have been dealing with that right at the start.”

Jeremy Cooper, adult social care transformation lead for consultants Impower, says there is a logic to shifting care management tasks to non-qualified staff.

Care management role

“We would argue that a significant proportion of what care managers in many parts of the country currently spend their time doing does not require a professional social worker. In fact, we’d go so far as to say that people with a different skill set would do a better job of some parts of that.”

Cooper disagrees with BASW’s analysis that personalisation has precipitated a decline in the number of adult social workers and that there should be more guidance handed out. “Because people are doing things differently, any guidance would have to be lowest common denominator, I don’t think that would be particularly helpful,” he says, warning that doing so could “restrict innovation”.

Extra tasks for social workers

However, he adds councils have not done enough in looking at what extra tasks social workers should be taking on, rather than concentrating only on the ones they should not be doing.

“I don’t think that a lot of councils have worked through where they might need more activity, such as more proactive and enabling care reviews,” he says. “If you look at how often cases are reviewed, it’s shocking. There are a lot of people who are left for years without really being properly assessed what their needs are and what they want to achieve in life.”

Longstanding debate

National director for social care transformation Jeff Jerome (right), who has been charged with leading the implementation of personalisation in a DH-funded role, says the debate about the role of social workers in care management predates the personalisation agenda.

“You need both qualified and unqualified staff and there is huge variation between local authorities on that,” he says. “Some employ much higher proportion of qualified staff to do social work roles or care management roles than others. There’s been a debate on that for some time.”

Expansion in workforce

Jerome says that the number of people working in care and support will expand over the next ten years but stresses that the nature of their employment and professional background is to be determined.

He says councils will have to consider how many staff they need in a range of roles, including allocating resources to service users, providing brokerage and support in accessing services, commissioning or community development.

No consistent social work role

He adds: “I would be surprised if anybody could come up with something that is called a social work role – there are a series of principles and functions that have come in and out of that role over many years.”

However, as our research indicates and BASW’s intervention indicates, there is an appetite for that role to be defined.

The Department of Health’s long-awaited adult social care workforce strategy, due this spring, is expected to provide some answers.

Social Work Taskforce

After that practitioners will have to wait for the Social Work Taskforce’s verdict, due in October.

At a time when the future of children’s social work is a source of considerable debate, it may be that determining the future shape of adult social work proves to be the taskforce’s toughest task.

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