Social care professionals divided over privatised adult care

(illustration: The Comic Stripper)

As social workers in seven areas prepare to swap council jobs for running their own businesses, Jeremy Dunning finds the sector deeply divided on the merits of social work practices

“Our plans will free up frontline social workers to do what they do best: help people maintain their independence.”That is care services minister Paul Burstow’s verdict on the pilot social work practices for adults he announced last month, backed by £1m in Department of Health funding.

Under the two-year experiment due to start this summer, social workers employed by local authorities will be transferred to new organisations that they will run themselves, to work with service users under contract with those same councils.

The pilots will be in Birmingham, Lambeth, North East Lincolnshire, Shropshire, Stoke-on-Trent, Suffolk and Surrey. Most are likely to be set up as social enterprises – firms with a social purpose that reinvest profits.

Practices are already being trialled in children’s services, where the idea has proved divisive – and the same is already true for the adults’ pilots. Unison has rejected the idea, saying that social workers do not want to be entrepreneurs. Supporters argue that the practices will reduce bureaucracy and allow social workers to take decisions without referring them up a management chain, enabling them to work more rapidly and innovatively with users.

Practices will also improve relationships with service users, says Craig Dearden-Phillips, managing director of the consultancy Stepping Out, an organisation that helps public sector workers set up social enterprises. “People find it more difficult to trust social workers because they are seen as part of the council,” he says. By contrast, being part of a practice is more akin to being an advocacy service.

Service user leaders concur. “At the moment most social workers have to work out of large bureaucratic organisations that make it hard for them to understand where they fit in the system, and even harder for users,” says Sue Bott, chief executive of the National Centre for Independent Living.

“It a good thing for clients, it improves efficiencies and it improves social workers’ morale,” claims Dearden-Phillips.

This view is partially backed by research into the establishment of social enterprises by NHS staff carried out for the King’s Fund think-tank for a paper due out in July.

Senior research fellow Rachel Addicott says she found providers did have less bureaucracy and were able to make quicker decisions because they did not have to deal with the strategic health authority. Their structure also meant there was less hierarchy to deal with and greater staff engagement in decision-making.

However, there were caveats. Staff had to be engaged in the decision to become a social enterprise. Just changing the model did not improve staff morale. Many health social enterprises also had to buy in human resources and legal support, because there was not enough support from the Department of Health to carry out these functions.

But not everyone believes that bureaucracy is reduced. Unison national officer for social work Helga Pile says practices will swap one kind of bureaucracy for another involving contracts with councils as well as things like VAT.

“Social workers don’t want to be entrepreneurs, they want genuine reform, less bureaucracy and more control over decision-making. Why not just get on with delivering this change rather than wasting time and precious funds on experiments in privatisation?” she says.

Pile adds that any savings will come from councils cutting down on costs through contracts, which will be bad for service users.

Ruth Cartwright, joint manager for England of BASW – The College of Social Work, is also concerned that the outsourcing of adult social work is being driven by cost-cutting motives, though she says practices could help free social workers up from the constraints of local authority practice.

There are also concerns that the practices risk fragmenting responsibility for care by taking assessment and care management out of councils, while leaving them with statutory responsibility for care and funding.

“Organisations need to be clear about their care roles and responsibility,” says Wendy Fabbro, strategic director of adult, health and community services for Warwickshire Council. “For me care management is a core function of the local authority service.”

Many of the issues surrounding practices relate to the prospect of their being taken over by private companies and run for profit in future, something to which Pile and Cartwright are vigorously opposed.

Social enterprises are more positively received, while another model is a local authority trading company, an organisation wholly owned by a council that trades commercially. John Baker, executive director at Ernst & Young, who is helping councils develop trading companies for adult care provision, says this would enable authorities to retain responsibility, accountability and influence, while making savings and improving outcomes.

It is still too early to say whether adult social work would be better off outside local government. But Association of Directors of Adult Social Services president Peter Hay – whose council, Birmingham, is one of the pilot areas – says it is worth trying an alternative.

“Do we want to remain in a system that we slag off? No we don’t,” he says, “It’s worth a try. This is a step to try to address some of those longer term issues about a profession that needs to regain confidence.”

Cartwright adds: “Where the authority supports its social workers, then why fix it? But where the authority is not good and does not understand and support its staff, would we be better off outside? I can see that we might be.”

Case study: ‘Exciting to do something with our ideas’

“I’ve only been in the team since September, but I know people who’ve been here for years who had ideas about stuff they would like to do but haven’t had the opportunity to do them. It’s an exciting time to be able to do something with those ideas.” This is social worker Hannah Storey’s perspective on the establishment of a social work practice in Surrey to support deaf and hearing-impaired people.

She is one of 15 people, incorporating social workers, equipment advisers and interpreters, being seconded from Surrey Council to set up the practice.

Although the practice will be headed by a director, team members will be involved in running it, though it is not clear whether they will have an ownership stake.

They are looking forward to the chance to work more creatively to design services that should fit better around clients.

Staff want to offer more services than they can do now in areas such as job support or debt help, where users have reported gaps in provision.

The practice should allow them to capture more people beyond those eligible for support under the Fair Access to Care Services framework.

Equipment adviser Frances Ansell says the enterprise will look for income-generating schemes. “One of the things we’ve seen is that care for people who are sign-language users is very difficult because care agencies don’t have sign-language users on call, so we could look at getting into training.”

The team still have to work up a business plan, though the council has said it will provide business support, and find rented accommodation in Leatherhead outside the council’s offices in the town.

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