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’.
Where next
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
Helen (@SocialWorkHelen)
August 24, 2012
I read this with interest. Assessment is so much more than assessing for eligibility and services. I am bound to ‘fly the flag’ for social workers but I agree that I have worked with excellent and not so good, both qualified and unqualified workers. Assessments by those who are trained and perceptive uncover so much more than eligibility and need for services. As in the article, people don’t always know their rights and also self-exclude by simply not using the right language or not wishing to aknowledge their own limitations. Assessments force people to think about what they cannot do in an era when social work students are being told about the benefits of the strengths perspective.
Assessment can alert you to the carer who is exhausted and becoming less able to cope without support. It enables you to break through the cheerful exterior that so many wear for the hour that they might be interacting with another. By sitting down with the person and building a trusting relationship quickly, giving the time and space for that person to breathe and think about what is happening, can bring up an array of issues that form filling will not. We can pick up on body language, verbal cues, see when the person is wanting us to open the door on a difficult conversation. We can think about future care planning for the person who has a life limiting illness, we might be the first person who has given permission for them to talk in this way. We can consider the family as whole, and think about how the person might want their life to be. Yes – this has been standard good social work practice way before the ‘personalisation’ agenda began stating the obvious.
We DO need a stronger professional voice. We need to try to find words for a role that can be so delicate and subtle that it leaves others wondering what it’s all about. We are notoriously bad at selling ourselves. Humilty is a trait found in so many good social workers and for this reason we find it excruciating to talk about what we do well. People know they feel better when they have a social worker supporting them. I would be rich beyond words if I had a pound for every time someone told me they wished they just had a named social worker they could call when they needed them.
Assessment is our first encounter and first opportunity to build a relationship that can be therapeutic, supportive and enabling. Sadly, assessment is often also the last time we might see that person face to face in the new era of time limited care management. Even so, good assessment skills can uncover the tip of an iceberg which, if left unexplored, can lead to crisis, carer burnout, safeguarding, unhappiness and an increased dependence on already stretched services.
Carol Duncan
August 24, 2012
I’m a social work student half way through a Masters course absolutely passionate about the importance of assessments and applying the theory we are learning and to bring that into people’s lives who deserve far more than a form-filling routine. Relationship and building trust with service-users is everything and they rightly expect a high quality service. I am so disillusioned with the way the whole social work industry has caved in to the Personalisation myth that no one needs professionals anymore. I agree with above blog; this profession needs to fight for itself and we need managers in voluntary and public sector to employ professionals where needed. Social Work has particular relevance for advocacy, mental health, mental capacity and understanding human development and attachments, things I knew nothing about before training despite working as a social work assistant for four years. A NQSW salary is very affordable and amazing value for a newly trained keen employee with up to date skills but they are like hen’s teeth to get. It would be extremely hard to maintain enthusiasm and skills unless we can work in the position we are trained to do and if we can not get work then all this knowledge and experience is lost and the NHS bursary to fund us is also wasted.
Bristol Michael
August 24, 2012
Form-filling is one thing but going on and on is another. You won’t have much impact if people’s eyes start to glaze over. The other day, I took a social worker totally out of his comfort zone by insisting he stopped using the vile construction “issues around” three times a sentence, thought what he actually meant and expressed it in English. He was unable to do so.
ermintrude2
August 25, 2012
Thanks Carol and Helen
Michael, I can completely understand – there are good and bad social workers just like all people but it doesn’t mean none of us know how to communicate and what we do has no value
Bristol Michael
August 26, 2012
Quite so! There are shocking nurses too – I can think of a couple Z had to bar from Mental Nurse for behaving crassly and refusing to apologise or mend their ways. Indeed, I can think of one yur in Bristle who behaved in exactly the same way.
Zarathustra
August 28, 2012
Indeed. Given the increasingly-detailed guidance on social networking coming out of the NMC, I think if something like that happened in future I would have to ban them a lot quicker. Partly to appease the NMC, but also to save myself a lot of headache conducting a battle of wits with the unarmed.
Bristol Michael
August 29, 2012
Let alone an armed battle with the witless…I notice somebody got himself banned from E-Goat “for being a complete bell-end”. M
The Small Places (@TheSmallPlaces)
August 29, 2012
Thanks for this post Ermintrude, I wouldn’t have read the report otherwise! I agree that this report has some rather ominous elements. It strikes me that it is actively advocating the kind of signposting away from assessment that the CSCI heavily criticised in their research on FACS. It also advocates ‘reducing the number of assessments that do not lead to a service’, which from a legal perspective is really problematic. LA’s have a duty to assess whenever it appears to them that a person *may* qualify for a service they *could* provide. This basically means an LA has a duty to assess anybody who (in the arcane and horrible language of the National Assistance Act 1948) is ‘blind, deaf or dumb, or who suffer from mental disorder of any description and other persons aged eighteen or over who are substantially and permanently handicapped by illness, injury, or congenital deformity or such other disabilities as may be prescribed by the Minister.’ The fact that in reality the person wouldn’t be eligible in terms of FACS or because they’ve got their own financial resources they could use is no reason not to assess. The duty to assess must be discharged regardless of whether or not a person would receive a service, just as long as they fall into the category described above. It’s troubling the Audit Commission are advocating an approach which may mean people’s needs are missed, and that is in such tension with community care law.