A “mending” not a “minding” service

With so much media and political attention on social care there is a danger that social work, which is a very undervalued resource, may be further marginalised. This article attempts to demonstrate that social work and social workers are vital to a “mending” rather than a “minding” service.

In the late 1960s and early 1970s social work was regarded as a valuable resource and social workers seen as “agents of change”. Since then, social workers have been increasingly regarded as “gate keepers” assessing the eligibility for practical help and rationing of services.

The Seebohm Report which led to the establishment of Social Service Departments in 1971 recognised the value of social work. It did not, however, create the “one door to knock on”, it promised, as a multi-disciplinary / inter-agency response is often required. This was subsequently recognised with the establishment of Area Child Protection Committees (post Maria Caldwell), Mental Health procedures, “Community Mental Handicap Teams”, and Youth Justice Teams etc.

The undoing of much of the public sector was down to the Thatcher years and more particularly, in respect of Health and Social Services, to Sir Roy Griffiths and his mistaken belief that people were motivated by and could be controlled by money. This led to the introduction of the contract culture with the purchaser / provider split which Sir Roy thought would create a level playing field to facilitate a mixed economy of care thereby forcing quality up and prices down. It has subsequently been proven to have had the opposite effect and led to over-prescription taking away the ability of carers to react in situ to changing need. It led to greater fragmentation with different components of a “package of care” bought from different providers.

Social Workers were deployed on the “purchasing side”, assessing the need for specific services (often responding to “presenting problems” rather than the “underlying problem”) which led to several social services departments providing “minding” rather than “mending” services with an ever-increasing workload of dependent people.

Brought up in the days of Florence Hollis, who described social work as a “psycho- social process”, I have always considered social work to be about the use of relationship, and various therapeutic techniques, to bring about change. Social Workers need to begin where the client is (I personally dislike the term “user”) and convey empathy with their client’s perceived problem. Taking a social history, itself a form of catharsis, and identifying the underlying problems before providing help in:

  • decision taking and problem solving
  • dealing with ambivalence, denial or depression
  • coming to terms with reality
  • removing the emotional blocks to recovery
  • lowering or increasing anxiety to improve functioning
  • improving motivation
  • understanding and bringing about change in behaviour
  • budgeting and negotiation with creditors
  • improving inter-personal relationships
  • involving friends and relatives in physical care
  • changing external factors in the environment
  • arranging practical help and support

Underpinning this work is a thorough knowledge of “human growth and behaviour”, the importance of the first five years and Freudian Theory of the ID (instincts), Super Ego (developed conscience) and the Ego (arbitrator), the conscious, sub-conscious and unconscious, and the maturation process. Social Workers have a grounding in psychology and sociology and an understanding of prejudice. They also use “transactional analysis”, make use of “transference” and use such techniques as “a systems approach to family therapy”.

These are the “generic” (not to be confused with “generalist”) skills of social workers. They then need the specialist knowledge of their areas of work whether it be working with people with specific disabilities or illnesses, mental illness, older people, youth justice, domestic abuse and marital counselling, parenting skills and child protection, fostering and adoption, registration and inspection, homelessness or work with adult offenders. And a detailed knowledge of the legislative framework in which they work, the law and resources available on which they can draw. They should be engaged on the work which interests and motivates them as social work is a vocation.

In child protection Doctors can indicate if an injury is non-accidental, the police can bring a prosecution and remove the perpetrator, but it is for the social worker to determine what caused the incident, the likelihood of it recurring, and if it might what might be done to ensure that it doesn’t.

Very rarely can social workers work in isolation and a multi-disciplinary approach is often required. There is a need to construct multi-disciplinary, inter-agency, whole task, right-sized teams aligned behind outcome with access to all the resources required to achieve their goals. These teams need to operate out of a shared base at the focal point of the community of interest which they serve.

This does not mean an open plan office. (Employers have found during the pandemic that they have got greater output from their employees who are home working free from distraction and interruptions). Social Workers need a room to themselves in which to carry out diagnostic thought, write their reports and receive their clients in-order to make a differential use of office and home-based interviews. The client should not be kept at arms-length in impersonal interview rooms but invited into the heart of the business into a room which reflects the personality of the social worker. There needs to be a communal staff room where all involved might off load when returning from a stressful situation by just involving those there for similar reasons and not disrupting everyone else. This also acts as a catalyst to team building and the mutual understanding of each other’s role.

These teams need to be able to “plan, do and evaluate” their own work which completes the “learning cycle” of “constant improvement” and enables them to gain the satisfaction derived from seeing the outcome of their interventions.

Health and social care need radical reform, based upon a whole systems review, designed to reduce demand, resolve problems when ever possible and provide high quality continuing care for those who need it.  Social Work is key in that it can turn lives around and is cost effective in reducing long term dependence.

 

* Chris Perry is a former Director of Social Services of South Glamorgan County Council, a former Non-Executive Director of Winchester & Eastleigh Healthcare NHS Trust and a former Director of Age Concern Hampshire.

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4 Comments

  • As a former elected Convenor of Social Care (married to a former Director of Social Care), I regard this as one of the most important articles ever to appear on LDV. I congratulate, Chris and would urge him to get in touch with the Lib Dem leadership at Westminster to ensure they are properly briefed and informed. They need to hear and respond to what he has said.

    I also urge Chris to advocate a root and branch reform of the prevailing ‘market culture’ which permeaets the outsourcing of social work in contracts to for-profit organisations with a consequent race to cheapness (rather than quality) in provision. Growing old or having special needs has become something to fear…… when, instead, how it is responded to should be a marker of how civilised a society we are.

    If Liberal Democrats are to stand for anything meaningful in the future this should be it. Back in the 1960’s days of Liberal revival, the slogans, ‘People Count’ and ‘People Matter’ meant something. It’s time for them to mean something again if the modern party is to make any serious attempt to regain it’s soul.

  • Barry Lofty 28th Oct '21 - 2:48pm

    I by know means have the experience or knowledge about the care system in our country as Chris Perry or David Raw and his wife have, but one does not need to be an expert to realise that a country that sees itself as being a leader and a respected member of the so called free world, falls a long way short in its care for the more vulnerable members of our society, we could and should be doing an awful lot better and need to remedy this situation. As David said there should a great deal more scrutiny and openness as to who and why the social care contracts are outsourced just for a start.

  • @ Barry Lofty Thank you, Barry. It’s not rocket science. If social care contracts are issued based on the lowest possible market price (rather than quality) it follows the work force employed will be on the lowest possible wages. The outcome ? Staff shortages, hurried appointments, low quality care.

    The outcomes are what happened to vulnerable people after the cuts in local government spending post 2010 as referred to by Katharine and Michael in their article elsewhere today on LDV.

    It is also why some of us who were active in politics and local government as Liberal/Lib Dem Party representatives since the 1960’s are still very angry. Until this boil is lanced nothing can or will change. It is not about whether the party gets 1% in a parliamentary by-election in Scotland (though that’s another outcome), it’s about the real lives of ordinary people (often the most vulnerable) and the suffering that has ensued.

  • In the current system care packages aren’t even chosen by the lead social worker, the package, once signed off, is sent to the social work brokerage team who put the care package on their website and invite bids from various registered, usually private, care providers. The lead social worker is then informed of the successful care provider, It really is a market based system more so than many people may realise.

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