You would be forgiven for thinking that squaring the circle of rising demographic pressures and shrinking budgets defined adult social work in 2013. Research out only this month showed 382,000 fewer people were receiving council-arranged care in England in 2012-13 than would have been the case had eligibility remained at 2009-10 levels. But it wasn’t all about the cuts as this digest of the year shows.
A new leader and more practitioners in England
Social work stamped its mark on government in England with the appointment of the first chief social worker for adults: Lyn Romeo, formerly assistant director of adults’ services at Camden Council in London. Romeo’s role is to use her position in the Department of Health to ensure policy is shaped by the views and values of social workers, and to work with social workers to promote improvements in practice in line with policy.
Since taking up her post in the autumn, Romeo has spent her time getting out and about meeting teams around England, becoming increasingly visible on Twitter and forging links with sector organisations, particularly The College of Social Work. The college’s network of principal adult social workers will provide Romeo with key intelligence from frontline practice to take to government.
Challenges for Romeo in 2014 include influencing the Care Bill, which is currently going through Parliament and is designed to overhaul the law on adult care. Her role will be particularly significant in ensuring that regulations and guidance published under the bill highlight and promote the role of social work.
Despite the cuts and reductions in the number of council-employed staff in English adults’ services departments, councils increased their employment of social workers from September 2011 to September 2012, according to official figures released in February.
A business case for social work?
Does this suggest that local authority senior managers see social workers as a part of the solution to their current financial predicament? It’s possible. A narrative has developed during the year that employing social workers in community development roles, supporting people to make the most of their strengths and skills and develop social networks, can promote independence and well-being for people and thereby protect councils’ bottom lines.
This is certainly an idea that attracts The College of Social Work, which has been continuing to develop a business case for adult social work during the year. But it also informs the Care Bill, which will require practitioners to take into account how community resources, rather than care services, can help a person meet their aspirations and needs, and provide people with information and advice on reducing or delaying their need for care if they are found ineligible.
This approach is already evident in services such as People2People, the social work practice based in Shropshire that we featured in September, with its emphasis on seeking solutions for people with eligible needs without recourse to paid support.
It also comes through in the development of family group conferencing in supporting vulnerable adults facing abuse and neglect from family members, to improve their lives by bringing together people from their local network to develop solutions that reduce risks to them. Authorities using this approach, such as Greenwich and Central Bedfordshire, who we featured in June, have found that it can delay or prevent the need for increased services, including admissions to a care home.
However, all was not so rosy in the adult social work garden in 2013, not just because of the cuts but because of challenges in practice. A particular concern was around people who may lack capacity to make decisions about their accommodation or care being moved into care homes, particularly from hospital, against their expressed wishes and those of their family.
While this is often justified on safeguarding grounds, it can often run contrary to the Mental Capacity Act 2005, particularly the principle of having regard for the “least restrictive option” when making decisions about a person’s care and support. This point was made forcefully by consultant social worker Elmari Bishop, The College of Social Work’s spokesperson on the Mental Capacity Act (MCA), in July:
It may take a bit more work to plan, co-ordinate, implement and monitor care packages at home and it may carry more risk, but when it comes to making best interests decisions, the MCA doesn’t state that you have to go for the “safest” option; in fact – the MCA places a legal requirement on us to consider the “least restrictive” option. Risk and safety are of course relevant factors to consider, but it shouldn’t drive your best interests decision.”
This issue has been picked up by the House of Lords select committee reviewing the MCA and should feature in their report, due early in 2014. Social workers’ “legal literacy” in relation to their powers to safeguard vulnerable adults was also questioned in guidance for directors of adults’ services published by the Association of Directors of Adult Social Services and Local Government Association in March. Author and ex-director Mike Briggs said:
“We have found that many of these [powers] are underused and practitioners are not as aware of them as they ought to be. Directors should therefore make sure your staff are legally literate, that is they know what these powers are and how to use them in the best interest of the person at risk of harm.”
Practitioners themselves reported ongoing challenges in making personal budgets work given the bureaucracy that has grown up around them, in the results of our annual personalisation survey. This is despite the second National Personal Budgets Survey – based on the views of 3,400 service users and carers – finding that personal budgets were most effective when there were less constraints on how service users can use them and practitioners faced less restrictions on supporting them.
This message seems to be getting through in some areas, including Portsmouth, Essex, Southend, Norfolk and Camden, whose experience of reducing bureaucracy in personalisation we featured during the year.
Integration, integration, integration
The necessity for social workers to work ever more closely with their health colleagues in addressing the needs of frail older people, disabled people and those with long-term conditions was another dominant theme of 2013.
In Scotland, the government published legislation in May to fully integrate the commissioning of adult social care and health. In the same month, we featured the experience from the Highlands of how the legislation might work: there, 1,400 adult social care staff from the council transferred to NHS Highland in 2012. Social workers are now working alongside district nurses and others in integrated community teams, a move replicated in Staffordshire, where the local NHS partnership trust is now responsible for adult social care.
While the government in Westminster is not mandating structural integration of health and adult care, it did set an ambition this year for the services to be “fully integrated” by 2018. To support this, it has announced 14 pioneer areas to different new ways of integrating provision. Multi-disciplinary teams, social workers working alongside GPs in planning care and joint care planning all feature among these sites.
These themes will no doubt recur in 2014. But as financial pressures deepen, the challenge for social workers of maintaining good standards of practice is likely to get steeper.