A National Care Service must focus on “reducing crisis and strengthening communities”

Social workers, service users, carers and other stakeholders support a National Care Service, the Scottish Association of Social Workers (SASW) has said.

18/11/21

A National Care Service must focus on “reducing crisis and strengthening communities”

In its response to the Social Care Review in Scotland, SASW said that in future, the focus for social workers must be in early intervention and prevention. This will improve outcomes, effect a return to balanced caseloads, and ensure that social work and social care are attractive, sought-after career choices.

“Social care support is an investment enabling rights and capabilities and supporting independent living. People must experience it as preventative and anticipatory, consistent and fair. Care and support can only be truly effective if it is relationship-based and collaborative with people, their families and communities.”

Social workers said that a national service would also be an opportunity for the profession to have a stronger voice, for consistency, and a better and more equitable distribution of resources.

Alison Bavidge, National Director of SASW, said: “People who use services tell us the current system isn’t working. Social workers are not doing the work they came into the profession to do. We are at a stage where the social contract between the profession and those it serves is at best strained. Government now needs to decide whether we continue this trajectory, or whether we redirect.”

SASW’s report was compiled following an extensive consultation, including a detailed survey and meetings with members, and covering service improvements, the scope of a National Care Service, commissioning, regulation, and the social care workforce.

Sixty-two per cent of SASW survey respondents said the National Care Service should include adults and children’s social work and social care services. Bringing children’s services into the NCS would ensure a continuum of care and support from pre-birth through to adults’ services, and into older age.

SASW opts for a single model of governance for the future: “Our current landscape is cluttered with different arrangements which makes clarity of responsibility and accountability complex.”

The report says that SASW members recognise the need for significant cultural change to take on the new model.

“Structural change alone will not deliver the aspiration of integration and experience of seamless services. Careful transitional arrangements will also be necessary to ensure continuity of delivery.”

There was overwhelming support for a single model of integration, through Community Health and Social Care Boards aligned to local authority areas.

“While the single model of integration is supported, the need for local flexibility to meet local need remains highlighted as well as a desire for opportunity to learn from good practice in the independent sector.”

The reforms should lead to improvements in working conditions for the profession: “Social workers often work many hours over their contracted hours, rarely for additional payment,” the report says, adding that flexible working conditions will be vital in enabling healthy working lives.

“Whilst many of our social workers note an aspiration for national terms and conditions for social work and social care staff, similar to that in either health, teaching, the police and other public services, it is important that this does not reduce existing terms and conditions nor inhibit the flexibility our work often requires. The workforce is looking for national agreement about salary scales and a clear route for national engagement and representation by the profession’s range of unions.”

“It is clear from the consultation that there are options to be explored for staff currently employed in community health, social work and social care. SASW supports the involvement of staff in decisions about the future of social work and social care and about their future employer.”

Integration could be improved by employing health, social work and social care staff in the same organisation. It could also address current problems of protectionism around budgets and resources.

“There is frustration in the sector that managers are unable to carry out formal management functions across the integrated organisational boundaries. This results in them operating two sets of policies and not having the authority to deploy staff to respond to operational delivery pressures. The aspiration here is that having staff employed within a single organisation such as the NCS and hosted within CHSCBs would resolve these issues.”

There was widespread criticism of current position of social work. Key parts of the social workers’ professional role had been lost. Since the 1990s, the task-oriented, deficit-based assessment methodology emphasised fixing the individual. This came at the expense of more creative options which considered people’s own wishes, experiences, work and social environments. More positively, the ‘mixed economy’ of care had brought innovations and opportunities through working in communities.

SASW’s report says that cuts to local government spending have meant that local authorities found they could no longer afford some crucial preventative and early intervention supports. Budget restrictions meant that eligibility criteria and thresholds for social work support were informed by decisions about not only whom to support, but even whom to assess.

In effect, “social workers became involved later and later in supporting people having problematic times. This later engagement affects our relationship with the people we support which becomes more strained as social workers become involved in lives often only at that point of statutory intervention.”

Social workers have become not only gatekeepers of resource but may then be perceived as the punishers of people for whom prevention and early intervention were not available or did not work. In addition, social workers are then held to account for this by the media and public.

Despite its generally positive response, SASW highlighted widespread concern about the Scottish Government’s proposals.

“It was clear from our engagement that everyone found the consultation questions difficult to answer even when framed as views on Government ‘vision and direction of travel’ due to the current lack of detail.

“The diversity of views reflected to the Association demonstrate not only anxiety about lack of detail, but also professional and personal conflict around:
- a very significant structural change following not long after health and social care integration, which has resulted in diverse governance arrangements and separation of the specialisms in social work
- whether this level of structural change will deliver the outcomes we all want
- the underlying problem which is lack of resource for public services.”

“We recognise that, whatever the decisions by Government, change will bring opportunities but also the potential for fracture and disruption to existing support services and partnerships across the sector; a sector which has just emerged from the experience of the pandemic, as well as a significant restructure only five years ago. SASW is committed to working in partnership with key stakeholders and to engaging positively with the Government programme set to follow in the new year.”

Read the proposals in full: A National Care Service for Scotland: consultationhttps://www.gov.scot/publications/national-care-service-scotland-consultation/
Scottish Association of Social Work response: https://www.basw.co.uk/system/files/resources/sasw_response_to_the_national_care_service_consultation.pdf

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