Hot on the heels of a story which extols the virtues of a ‘new’ social enterprise set up by social workers in Lambeth, comes a report from the Audit Commission, published yesterday, which urges councils to reduce spending on qualified social workers in order to save money on assessments in adult social care.
In some ways, it’s very easy to see these two apparently separate news items discretely but it’s also too tempting to run them together to see a pattern of where adult social work is heading.
Audit Commission Report
I briefly read through the Audit Commission report this morning – it is intended for ‘managers and senior managers in adult social care’ and the scope is to look at how local authorities can save money through the assessment processes in this sector in order to have more money to spend on care services.
Interestingly, it pulls out the ‘personalisation’ card in terms of identifying the different ways that assessments are being conducted (more self-assessments – for example) – and that’s true but I hope I would have always put the individual at the centre of every assessment I did – even before ‘personalisation’.
An assessment is a key to eligibility in adult social care and with self-assessments being introduced, it is basically allowing people to self-exclude earlier in the process without having as much professional involvement – which actually, isn’t a problem for those who are below the criteria but what the report misses is how much the process of assessment by a skilled person (whether qualified or not) can scratch the surface of the forms that are completed – particularly when the forms are tailored towards people with physical disabilities and physical health problems – and uncover needs that would meet the eligibility criteria.
The report pushes the somewhat dangerous opinion (in my view) that delivering personalised services will necessarily create lower costs. That’s a stumbling block which has led to poor implementation in my view. I actually don’t have any problem with support planning/brokerage and assessment being pushed to different organisations – but it still has to be done well. It’s interesting that while the Topaz team in Lambeth are looking at working with people who fall below the eligibility criteria, local authorities are looking at people who are eligible having more support from less qualified people – to save money. Lets not forget that’s what it’s about.
But I don’t want to get too fixated on the qualified/unqualified dichotomy because qualified doesn’t always mean better. But it doesn’t mean worse, either.
A paragraph in the report refers to savings being made in ‘back office’ roles – well, honestly, there is a greater need for administration and ‘bureaucracy’ in personalised care packages because we want to be able to offer people different options to manage their own care – either direct payments, individual service funds, trust funds or managed budgets. Of course we don’t have all those options available for all (yet) but imagining that costs can be cut by reducing ‘back office’ roles is honestly, facile. Cuts to ‘back office’ roles has and does put much more pressure on ‘frontline’ jobs. False economies in the extreme.
The report talks about improving online information and.. oh.. leaflets to provide information and to (they hope) deter people from requesting an assessment in the first place. I can see that being useful – and I’m glad they didn’t get ‘online overboard’ and some of the sites produced by local authorities to signpost people are appalling so it’s good advice, it’s just sad to think a report has to be compiled to give that advice. It is a bit depressing that call centres are seen as a solution in any part of social care though particularly when the role of the call centre is to ‘reduce the need for formal assessments’ – in other words it is to filter people out of the system at an earlier stage – so much for preventative work.
The headline of the report though – is that it recommends ‘changing’ the skill mix in adult social care to ‘reflect’ personalisation by shifting from social workers to social work assistants and that’s where some of my main concerns and thoughts lie.
Does a ‘professional’ need to Assess?
Having worked in adult social care teams, I know that there are some awful qualified members of staff and some fantastic non-qualified members of staff. Experience levels vary and I don’t have a problem with a mix of staff. I have no problem with some assessments moving away to third sector organisations and user-led organisations in particular (I will not give a wholehearted ‘bye’ to social enterprises though as I believe ‘social enterprise’ is a VERY broad term that can have a lot of different meanings). Some assessments are basic, many assessments are best completed without the need of any input but some, and this is the key, really do need expert input. Sometimes it’s the conversation that arises in an assessment (which, by the way, is not merely a ‘form-filling’ process) that can lead to further information being garnered. The more lax the assessment process, the more likely that opportunities to provide ‘early intervention’ or identify harder to define needs may be lost.
I mentioned above that all the assessment processes I’ve seen from adult social care are very biased towards physical health needs – it can take a more skilled assessment to draw out mental health needs or more complex family dynamics between the person being assessed and their families. I worry that bypassing the importance of assessment and the skill needed, we may lose carers’ needs which need to be identified much earlier.
So while I don’t think a ‘professional’ needs to assess in every case, what is very important (and missing from the Audit Commission report’) is an appreciation of the importance that professional training, experience, understanding and working with social work theories relating to assessments and an understanding of current research and a commitment to reflection and sensitive communication is and can be to assessments and safeguarding process.
What is social work?
In many ways, this is the key question for adult services and one that has been asked for years – since the move to the ‘care management’ models after the NHS and Community Care Act (1990) was enacted and it became clear that care management was not a social work exclusive role.
The question is more easily answered, I think, in children services and in mental health services where the social work roles are, I think, better defined. Perhaps the separation and specialisation into different ‘fields’ has damaged adult social work more than the others as it has become harder to define.
In adult social work there’s a need for a much stronger professional voice to explain and expound the importance that social work training has in delivering effective outcomes all round. Assessment is a skill and skills can be trained but it need to be linked with knowledge, understanding and reflection to create a picture in more complex (and sometimes the step between simple and complex can be one question, one statement, one gesture) situations.
As a society we undervalue the social work training and role at our cost but increasingly, I can see the role for social work being pushed back to safeguarding functions and ‘complex’ work – that’s easily said and I’m sure it appeals to the Audit Commission but it’s important for us, our professional bodies such as the College and Adult Social Care departments and academics to push that we often find the ‘safeguarding’ and ‘complex’ work by doing some of the things that could be done by ‘someone else’.
Community Care has responses from BASW and the College which say similar things. I think it’s important that as social workers in adult services, we also prove our own worth internally. We talk about research we have read in team meetings, in our supervision, we explain why we did what we did in terms of the theories we know and use. We talk professionally, we respond professionally and we become what we want our profession to be.
We need to all take responsibility to prove our own worth.
picture by KatherineKenny at Flickr