We need to speak up about the staffing crisis in adults’ social work

By Paula McFadden, social work researcher, Queen’s University Belfast

Between 1985 and 2010, the proportion of the UK population aged over 85 doubled. It is projected that by 2035, the number of people living beyond 85 years will be 5% of the total population and those over 65 will make up over 23%.

Demographic changes have led to a dramatic increase in referrals to social services and considerable pressure on adults’ social workers trying to deliver the best service to those most in need, with increasingly reduced resources to do so.

Older people’s services need a voice

NICE have produced guidance on safe staffing levels in accident and emergency wards, which makes headline news. Whilst this is vital, social work needs an equally loud voice to argue for a safe service for community social work for older people. We need more media attention on the risks and range of concerns in this area.

This article is part of Community Care’s Stand up for Social Work campaign. We’re standing up for social work by being honest, offering support and providing inspiration.

In the past, adult services were often seen as the ‘easier’ option for social workers in comparison to child protection work. In many respects, the pendulum has swung and it is now those social workers working with older people who feel increasingly disadvantaged and are at risk of burnout.

Caseloads and capacity

Firstly we need to look at caseload size and caseload weighting. Whilst it has long been acknowledged that caseload size has a significant bearing on safety of vulnerable children, it has only recently been recognised as matter of concern in adult social work.

Caseloads have incrementally grown with the demographic shifts, without a parallel growth in the workforce. This often has resulted in caseloads of older adults reaching unmanageable proportions. It is not unknown for adult social workers to have caseloads over 80.

Working beyond capacity has implications for the three factors identified in the Maslach Burnout Inventory, the key scientific measure used for assessing vulnerability to burnout in caring professions. These are emotional exhaustion, depersonalisation and a sense of personal accomplishment.

Burnout risks

Social work always involves ethical and procedural complexity to minimise risk and enhance wellbeing of people who have experienced emotional trauma or adverse life events. Dealing with people’s anger, fear, despair and embarrassment is intrinsic to the work and can be overwhelming if workers do not have good supervision or other ways of coping with the emotional impact.

At the same time, strict procedures designed to streamline work and allow practitioners to manage more cases can lead to depersonalised relationships with service users, conflicting with the initial motivations for doing the job and contrasting with social work values.

In addition, because solutions to service users’ problems may not be straightforward or are dictated by factors outside of the worker’s control, the ‘job satisfaction’ of having helped someone can be frustrated. Increasing workloads mean practitioners cannot spend quality time on every case, and some may never feel that they are doing a ‘good enough’ job.

Complex legislation

The second issue is the complex and patchy legislation that guides adult social work practice in the UK. For example in Northern Ireland, community care legislation, human rights, mental health, disability and personal social services law, plus carers and direct payment legislation all feed into a structure for managing assessment and service provision, but there isn’t safeguarding legislation as exists for children.

The Care Act has recently been introduced in England bringing wide-ranging changes which mean, in the short term at term at least, social workers face uncertainty and must find time to learn and understand the changes while still managing busy workloads.

Social workers therefore rely on best practice principles and supervision to ensure the decisions they make are sound and based on ‘best interests’ and critical thinking that can be defended.

However, due to the pressures of large caseloads, practitioners are not confident this is always achievable. There is a fear of being blamed for failures if complaints arise. Plus, the potential for error increases if individuals are working beyond capacity and this contextual aspect to error or ‘failures’ needs to be recognised.

Who manages adults’ social workers?

The third major issue is a lack of direct social work line management. This is in comparison to children’s social work, where line management is by social workers from the front line and up the chain, sometimes even to director level.

The integration agenda means adults’ social workers are often managed by someone with a nursing or occupational therapy background; their expertise is not in social work which impacts on decision-making and social workers’ confidence in their professional identity in multidisciplinary teams.

A strategic response is needed

Social work helps the most disadvantaged and marginalised groups in society and will remain at the coalface to support those most in need. Increasingly this will be older adults.

We are facing a new era for the profession and need to have hard discussions about how to ‘stand up’ for social workers as individuals and the profession as a whole. It is time for strategic responses at a policy level to redistribute wealth to meet growing areas of need and finding structures that support society’s carers to enable them to continue in this critical role.

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