Are social care functions safe in a health body?

Leading social care figures ponder the pros and cons of the transfer of GSCC functions to the Health Professions Council

The coalition’s decision to abolish the General Social Care Council and transfer its functions to the Health Professions Council is the latest in a series of moves to give health bodies responsibility for social care functions.

Last month’s health White Paper also extended the remit of the National Institute for Health and Clinical Excellence to producing quality standards for social care. It will take over functions from the Social Care Institute for Excellence. In addition, Monitor, which regulates foundation trusts, will become an “economic regulator” for health and social care.

Past examples of social care functions being absorbed into other bodies may give cause for concern.

Lord Laming, in his 2009 report on child protection, said expertise in inspecting ­safeguarding was lost when Ofsted took responsibility for assessing children’s social care from the Commission for Social Care Inspection in 2007.

A similar concern was raised by outgoing CSCI chair Denise Platt when the Care Quality Commission took responsibility for regulating health and social care in 2009, because many CSCI managers did not transfer to the new body.

Community Care asked leading figures from across social care whether the sector has anything to fear from the latest plans.

 Madeleine Moon, Labour MP for Bridgend and former south Wales social worker

Social work has never been valued as a professional orientation in its own right. The problem is that healthcare works on a medical model where the priority is the needs of the hospital and the doctor, rather than the needs of the client or the patient.

The social work profession always operates on the basis of the best interests of the individual.

My worry is that, without careful management, we will lose that focus on the individual social welfare needs of the client.

They should have protected the focus on social work in regulation, especially at a time when social work is under such attack and it needs to develop a more stable and confident workforce. You’re not going to get that when social work is seen as a handmaiden to health.

 David N Jones, a former Ofsted inspector (2007-10) and previous general secretary of the British Association of Social Workers

There has to be a clear demonstration that the new workforce regulator will cover the whole of social work.

Some social workers are in healthcare settings, others are in, say, criminal justice and children’s services, so there has to be a huge change in the healthcare body to engage with the whole spectrum.

Social work is crucial to supporting health and education but, because social work is a small profession, has fewer people involved and only deals with some of the most difficult cases that come before universal services, there’s a risk that it becomes dominated by the other professions.

The other issue is that structural change in regulation and services can increase the risk to children. Maria Colwell died in 1973 during the implementation of the Seebohm reforms which created social services departments, for example.

 Des Kelly, executive director, National Care Forum

Greater alignment of health and social care is clearly desirable for people receiving services. Therefore, bringing together bodies that exist to support the delivery of service may seem logical. But health and social care are not joined up.

There is a real risk that merging improvement bodies will lose the distinctive contribution of social care. Social care provision, although still largely a publicly-funded service, is different from the NHS, with more than 40,000 employers and with even greater diversity as personalisation develops new services and employers.

The drive to reduce the budget deficit is being used as a justification and the only surprise is how easy it all seems to have been. But there will be significant consequences, including the risk that resources are wasted in rearranging structures and dismissing the benefits existing ones can deliver.

 Marion Davis, president, Association of Directors of Children’s Services

There is no doubt that the transfer of responsibility for inspecting children’s social care was logistically and professionally challenging for Ofsted.

The challenge lay in developing an inspection framework that took into account social work values and practice, rather than assessing compliance with processes. To assist in this, each profession should have a strong and coherent organisation, such as the proposed national college, to develop clear professional standards.

Regulators and inspectors should then use these standards to hold organisations and individuals to account.

 Jill Manthorpe, director of the social care workforce research unit, King’s College London

Not surprisingly, there is anxiety among some in social work about the cost-benefit equation of moves into health bodies. Less fear has been expressed in the wider social care community. The question perhaps is not so much whether social care ­functions are safe but whether interests, values and priorities can survive.

Social care functions may be better serviced by the resource bank of healthcare regulators. Look, for example, at the comparative funding of the professional regulators in health and in social care; and how funding does seem to help the health system.

Think how the NHS locally supports the involvement of clinicians in the running of their royal colleges.

Further, we may be able to learn from health about how professionals can influence their workload and safety levels.

Lastly, the government is also planning to transfer health ­functions – public health specifically – to local government. Social care and social work have much to offer here, on prevention, protection and personalisation. What a seismic change this might be.

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

Health and social care’s separate development means they have become more like chalk and cheese than sympathetic buddies.

While health is still too often narrowly medically based, seeing the root of most problems in individual illness and pathology, social care has benefited from a much broader social approach that takes account of the individual in her or his environment, community and social context.

The over-medicalised nature of mental health policy and provision is a warning of the problems to expect when medical models predominate.

Worse is the David and Goliath problem, with health bodies granted more funding, credibility and respect, reinforcing social care’s inferior status. Social care must have its own bodies to safeguard its own distinct role and contribution – otherwise these will be at risk.

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