ADASS chief warns against social work being lost in ‘rush to integration’

Social work’s value is at risk of ‘being lost’ in the drive to integrate services, the president of the Association of Directors of Adult Social Services has warned.

Harold Bodmer, who started his year-long term as ADASS president today, told delegates at the association’s spring seminar one of his five priorities will be to promote social work’s “place in building community assets, and the importance of not losing this in the rush to do something called integration”.

He said: “We risk of course social care but in particular social work becoming lost in local integrated services. Those of us, including me, who have taken mental health social work back from mental health trusts, something that felt entirely counter intuitive, know this well.

“It’s more important now than ever before that we are confident and clear about the work and the role of social workers and the importance that this brings to quality of our delivery of social care. We all need this to enable people living in complex situations to realise full lives, to fully understand interventions that are available in often controversial circumstances.

“The delivery of frontline social work has changed or should have changed as we have developed personalised services and I wonder whether we have paid enough attention to this. And of course frontline staff are often the very people delivering the cuts in social care services. I have a concern that we could easily slip back into an assessment and care management model as the pressure mounts.”

‘Enormous’ financial challenges

Bodmer said the government’s spending review settlement for local authorities presented “enormous challenges” for social care, particularly in the next two years.

As two examples, he pointed to the costs of introducing the national living wage and the costs of complying with the Supreme Court’s landmark ‘Cheshire West’ ruling on deprivation of liberty, which he said many councils were still “struggling to manage”.

The spending review introduced a social care precept which gave local authorities the ability to raise council tax by up to an additional 2% a year for investment in services. The government also committed to investing extra in social care via the Better Care fund from 2017-18 onwards, reaching an extra £1.5bn by 2019-20.

‘An honest debate on savings’

Bodmer acknowledged the settlement had delivered some funding for social care. But he said he’d made “no secret” of his dislike of the Better Care Fund as a means of securing social care investment and said 2019-20 was too late for the extra funds to arrive.

“Our message about money is urgent and real and immediate. There may be more cash coming but even that is not enough and the problems are now,” he said.

“We have made the savings that were comparatively easy to make, if any savings are easy to make. Now what we save will impact on people. Let’s not deceive ourselves about this. The key is how we do it, how we have an honest debate with the public about the resources we have available and what this means.”

Councils faced a “very difficult tightrope” in trying to balance the need to make savings alongside meeting their Care Act duties, said Bodmer. He said councils were likely to face challenges to some of their decisions, a situation his own authority, Norfolk council, had already experienced.

A user-group in Norfolk has raised a complaint with the Care Quality Commission over what it claimed were breaches of statutory duties. The council has denied the claim but has commissioned the Social Care Institute for Excellence to audit its cases.

Concerns over home care provision

Ensuring the next spending review delivers an improved settlement for social care will require building a “social movement” that means politicians view social care funding as an “absolute given”, said Bodmer. Part of that will involve raising public awareness of the fragility of elements of the care system, he added.

“Sustainability of home care is certainly what keeps me awake at night. We have seen new models of outcome based commissioning, examples of innovation and excellence but it is not the mainstream. We will never bring any meaning to integration while the bulk of home care is still based on time and task and on the whole unconnected to the mainstream NHS provider services,” he said.

“We need to up the level of debate about this, increase the volume…A test for me will be when home care staff from a private care agency are really seen as part of a multi-disciplinary team. Are they, for example given access to specialist advice from palliative care nurses as they care for someone at the end of their lives? We have talked about this for many years but now has to be the time to move this forward.”

Bodmer succeeds Ray James as ADASS president and opened his speech by paying tribute to James’ leadership over the past year. He concluded it by reflecting on his own experience of starting his social work career in South Africa in 1976 during the apartheid era.

“From a position of privilege I saw first hand the powerlessness and desperation of people who had, no safety net, no employment, no running water, desperately inadequate healthcare. It was a rapid lesson…and something that has stayed with me for the 39 years of my career.”