Last year, I suddenly found myself as a social worker employed by the NHS and managing a health team that was entirely separated from the local authority.
A series of events had led me to this point. In 2010, the arrangements for integrated health and social care between Avon and Wiltshire NHS Partnership Trust and the six local authorities we worked with had started to break down, partly due to some councils feeling that the NHS didn’t sufficiently understand or prioritise social care and social work agendas.
And so it was that Bristol City Council officially severed its integration arrangement with the trust in 2012. In the ensuing redesign of services, I found myself as a social worker managing a health team in the medically-dominated world of the NHS and cut off from the local authority, so often the ‘natural environment’ for statutory social work.
Social workers felt almost invisible in the trust
At that time I felt an absence of professional support for social work within our NHS trust. I wondered if other social work colleagues felt the same. We held a meeting and it quickly became clear the concerns were widely shared.
Social workers said they felt almost invisible within the trust. They had no career pathway, professional development or supervision. There was no encouragement to provide placements for students and no social work representation within the organisation. We hadn’t had a social work conference for nine years. Our head of social work post had long been deleted.
On the positive side, we also had healthy debates about the distinctiveness of social work’s contribution in mental health and the benefits for service users if our skills could be better employed. There was also enthusiasm for future meetings. A grassroots movement to establish social work’s role in our trust had taken its first tentative steps.
Gradually a momentum developed, aided by key allies we found in the trust such as the director of nursing and chair of the professionals’ council. We began to hold regular social work forums. We were helped by support from other NHS Trust departments and the links we had made with local networks of council social care leads and Approved Mental Health Professionals (AMHPs).
When the trust appointed a new chief executive, Iain Tulley, in November 2012 he was sympathetic to our situation and recognised the need to improve the trust’s social care delivery. Crucially, the trust’s board formally recognised that it had not paid sufficient attention to social work and social care. It was decided that a dedicated strategy for social work’s role in the trust was needed.
Work on the strategy began in February of this year focused on three key questions: what would be different in a ‘post-strategy’ world? What does social work have to offer? And what do social workers need from the organisation?
We gathered feedback at our March social work conference – the first social work conference the trust had held for nine years. Service user and carer groups, local authorities, academics, The College of Social Work and BASW all took part in a debate about our strategy alongside over 90 social workers and social work students. We held a formal consultation with service users.
A strategy for social work
The findings were distilled into our final social work strategy. The strategy – which can be read here – includes 10 aspects of social work’s distinctive contribution to mental health, five strategic goals for social work in the trust, and measures to assess whether they are being met.
The trust has formally adopted the strategy and committed to appointing a permanent head of social care to oversee its implementation.
We have a long way to go but the process of developing the strategy has already raised social work and social care’s profile in the trust.
Professional support for social work is increasing and AMHP training for health employed staff rising up the agenda. Social work students are returning and the assessed and supported year in employment scheme is tentatively being implemented. Social care is increasingly being discussed in mainstream trust meetings. The strategy is about to be launched at a local partnership event in each of the six local authority areas with the aim of breathing life into its 16 sides of A4.
There is optimism about the potential for the strategy to inspire change at the highest levels of our organisation too. Here’s what our chief executive had to say about the strategy:
“The strategy has involved a broad and thorough consultation and it has been a pleasure to witness the commitment of those involved. Our hope is that the strategy will support the development of social work professionalism and social care expertise within Avon and Wiltshire Partnership and will make us an organisation that social care agencies welcome as partners. These improved partnerships can only be of benefit to service users.”
A cynical view might be that traditional perspectives exert a strong gravitational pull on NHS organisations, leading them to drift back towards seeing the world through a ‘health’ lens. However, we are optimistic that having a social work strategy will enable our trust to maintain a ‘wide angle’ focus on both health and social care.
Phil Wilshire is social work lead at Avon and Wiltshire Partnership NHS Trust