LABOUR SOCIAL WORK GROUP MEETING 

WEDNESDAY 13 DECEMBER,

Co-Hosts  
Lord (Mike) Watson  of Invergowrie– was for 7 years Labour Shadow Education Minister in Lords
Emma Lewell-Buck MP has been Labour MP for South Shields since 2013 before which she was a child and family social worker. Shadow Children’s Minister 2016-19
Mike and Emma worked closely with (among others) members of the Together for Children Alliance, and LSWG  to successfully steer Labour amendments to the 2017 Children and Social Work Act through parliament.

Chair:  Dr Anne Cullen RSW is Chair of Labour Social Work Group and Vice Chair Banbury CLP.
Anne has worked in local authority services for both children and adults and in a large teaching hospice as a social work practitioner and manager. She is a past Chair of the Association of Palliative Care Social Workers and is currently a Schwartz Round mentor for The Point of Care Foundation. 

A discussion on a future Labour social work and social care service will be opened by: 

Anna Dixon MBE Anna is Labour Parliamentary Candidate for Shipley. She has over 25 years’ experience in health and social care. Anna’s key roles have included: Director of Strategy and Chief Analyst at the Department of Health, Director of Policy at the King’s Fund and Chief Executive of the Centre for Ageing Better. Anna chaired the Archbishops’ Commission on Reimagining Care (June 2021-Jan 2023) and received an MBE for services to wellbeing in later life in 2021. Anna is the Labour parliamentary candidate for Shipley constituency in West Yorkshire.

Dr Ray Jones is Emeritus Professor of Social Work at Kingston University and St. George’s, University of London, and a registered social worker. He has 50 plus years experience in children’s and adults’ social work and social care as a residential worker, social work practitioner, manager, teacher and researcher. From 1992 to 2006 he was director of social services in Wiltshire; he was the first chief executive of the Social Care Institute for Excellence and has been Chair of BASW. Ray has led inquiries following the deaths of children and adults; was the independent chair of Bristol’s Safeguarding Children Board, and from 2010 until 2016, oversaw children’s services and child protection improvement in five areas of England. In 2013-2014 he was appointed by the Welsh Assembly to advise on the Welsh Social Services and Well-Being Bill. He is the author of eight books including ‘The Story of Baby P: Setting the Record Straight’(2014); ‘In Whose Interest? The Privatisation of Child Protection and Social Work’ (2017) and ‘A History of the Personal Social Services in England’ (2020). In 2022 he was appointed to undertake the Independent Review of Children’s Social Care in Northern Ireland (email laboursocialworkgroup@gmail.com for PowerPoint.

LSWG members will find many similar messages from this Labour Party Afiliated Society with whom we are linking up on areas of shared concern

Labour Social Work Group submission to the National Policy Forum consultation providing more detailed proposals for a Labour Social Work and Social Care programme for government

About Labour Social Work Group and this response

This response to the Labour Policy Forum Consultation is from the Labour Social Work Group- a member-led group recognised by the Labour Party which seeks to contribute to improved wellbeing and life chances of some of the most vulnerable members of society, by strengthening the place of socialist principles within social work policy and practice and within the broader social care and community public and voluntary sector services.

Because social workers provide services across age and needs groups, and work collaboratively across public services and with people who use services, their carers and advocacy groups, we found that what we needed to say did not fit into any section of the consultation. We have submitted responses under Prevention, Early Intervention and Better Public Services for all, Safe and Secure Communities and A future where families come first but are also providing this longer submission to set out a more complete account of our concerns and proposals.

LEVEL AND COMPLEXITY OF NEED

We want to draw attention to the high level of social, emotional mental health needs arising from neglect, trauma, abuse. This applies to adults and children and especially to families where both parents and children have disabilities or have experienced trauma. Because of this we urge that Labour proposals for public services must take in services for all family members and pay particular attention to services for parents with physical, cognitive, and mental health difficulties, and those who are carers for elderly relatives alongside child care responsibilities. For the same reason we argue that Local Authority adult and child and family social work and social care services must be considered alongside each other.

LOCAL AUTHORITY FUNDING

The first step to ensuring that local authorities can fulfil their statutory and human rights duties to provide the range of social care services to appropriately meet differing needs is to arrive at a new funding model. The present funding system is broken: many are left without necessary services or wait so long that their conditions deteriorate. We concur with Clive Betts MP who opened a House of Commons debate on social care services on 8 March:

‘We cannot carry on believing that the existing local government settlement finance system, with occasional top-ups from Government on an ad-hoc basis every year or so, will sustain adult social care for the longer term’.
The arguments (across children’s and adults’ services) are now incontrovertible for bringing one or more additional government funding streams into local government.

The role of social workers

The policy consultation documents omit mention of social work and social work services specifically (not the case with teachers, police, care workers) despite the well documented knowledge of the crisis in recruitment and retention of social workers and the documented harm and distress that this is causing to many of the most vulnerable adults and children.

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We entirely support the proposals to improve the recognition, recruitment, payment, training, and retention of social care workers in community and residential services. However we need to draw attention to the fact that professionally qualified, registered social workers are a distinct professional group within social care and health services, who are essential to the fulfilment of statutory responsibilities for both children and adults. These include, for example, child protection and instigating care proceedings, safeguarding vulnerable adults, making assessments under the provisions of mental health and mental capacity legislation about whether it is appropriate to detain or restrict liberty of vulnerable people. In local authority services for both children and adults social workers undertake essential roles in assessing the needs of people who have complex and multiple needs, working with families in which relationships are complex, multi-generational and conflictual, forming relationships with people whose experiences and personalities make them resistant to engaging with services they urgently need, mobilising partnerships with people from other services to respond to complex needs and supporting people to exercise choice and achieve greater independence by developing their own potential and accessing the support they need.

Social workers fulfil these roles by drawing on a unique professional set of knowledge and skills, including advanced and flexible engagement skills, the ability to develop and sustain relationships of trust, a systemic understanding of family and inter-professional dynamics, analytical skills, a sound working knowledge of relevant legislation; together with a powerful commitment to compassionate care and human rights.

Labour’s policies towards refugees and asylum seekers are also of relevance to social workers since we have important roles in providing and co-ordinating services to these groups- especially unaccompanied asylum-seeking children and to parents and single adults who have no recourse to public funds.

The position of social workers needs urgent attention, as highlighted by recent reports into local authority and Children’s services from government, Labour LGA, Directors of Adults’ and Children’s Services, professional associations, unions, and the regulator, Social Work England. These combine to evidence that there is an acute recruitment and retention shortage of qualified and especially of experienced social workers. This is leading to a lower than acceptable standard of social work and social care services, especially to those in greatest need and distress and in need of protection from serious harm and abuse. Frequent changes of social worker mean that some of those in the greatest distress cannot establish a trusting relationship with a social worker which is essential if their needs are to be sensitively and professionally assessed and they are to receive the practical and emotional services that the evidence with respect to individuals and whole communities shows to be so necessary. The result is that all too often their circumstances deteriorate and that they can no longer receive the assistance they need in their own homes. In short, an effective, ethical, and reliable social work service is essential to meet the Labour aim to emphasise preventive and community services, and to meet the needs of those in greatest distress and at risk of serious harm.

Our specific recommendations for Labour are:

• A Labour government should urgently fund and put in place a high profile national recruitment campaign to encourage people, from diverse ethnic, social and educational backgrounds to apply to train as social workers in locally accessible training programmes. It should do so in partnership with local authority Adults’ and Children’s Services, Health Service Trusts (especially

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mental health services employing social workers),University Schools of Social Work, people who use social work services and their advocates, voluntary sector employers of social workers, the regulator (Social Work England) and the British Association of Social Workers (BASW). This should include an increase in bursaries for student social workers, so that all entering the profession, whether as students or employees/ apprentices are equitably treated and enabled to complete their training without being burdened by financial worries.

• Noting that the social work recruitment problem is compounded by an acute retention problem, much of it caused or made worse by high vacancy rates, and stress caused by dangerously high workloads, a Labour Government should improve the professional support and supervision available and increase post qualifying training and development services across all the areas of social work, for example by supporting locally based Teaching Partnerships in which local Higher Education Institutions (HEIs) and employers work together
• A Labour government should, additionally, take steps to reduce the need for and extent of social workers employed by profit-making agencies, which imposes additional costs but also crucially means that those who need a social work service are faced with multiple changes of social worker and the impossibility to establish a trusting relationship with the professional accountable for making key decisions about the services available to them.
• LSWG supports the recommendations of UNISON and Labour LGA on workforce development and pay and conditions of service for social workers and all those within the broader social care and social/ community services.SOCIAL WORK/ SOCIAL CARE AND COMMUNITY SERVICES FOR CHILDREN AND FAMILIESHelen Hayes MP spoke out forcibly against the Government’s response to the MacAlister Review of children’s social care, saying ‘There is no vision for the direction of children’s social care. There is no ambition for our most vulnerable children. There is no cross-cutting commitment from the top of government to deliver better for every child and every care-experienced person in every part of our country.’ (House of Commons, 3rd February 2023).We welcome that prevention and partnership are at the heart of Labour’s vision but these needs extending so that there is a similar ambition to make appropriate provision for high level and specialist needs. The twin concepts of prevention and partnership informed by research, policy and practice and set in the context of the current legal framework have the potential to offer a coherent approach to transform children’s social care.Primary or structural prevention is about preventing problems before they occur. It includes a set of universal and targeted policies aimed at radically reducing inequalities.Labour Social Work Group members, from across child and family social services delivery, policy, and research, support the principles and broad policy direction set out in the Policy Forum Consultation Documents. We welcome the critique of the years of neglect, mismanagement, and wasteful expenditure of public funds during the Tory years that have been made by Shadow team members and Labour MPs. We welcome plans to reverse the damage done to ‘universal’ services (child care, youth work, social security system, housing and homelessness services) but have yet to hear of detailed plans to replace the Tory government’s ill-thought through, poorly evidenced ‘improvement’ plans in response to their review of children’s social care. Whilst aware that there

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are limits to the detail that can go into the Manifesto, it is now timely for the Labour Shadow team to work on detailed plans to tackle the acknowledged problems that a Labour government will inherit. Plans are needed both for families who need local authority-led social work services in the community and for children in care and care experienced adults.

Secondary prevention is about helping children and families when problems first arise – or early help – through developing kinship and community networks and preventative children’s services. A failure to provide these services since 2011 has led to an escalation of family difficulties and increasing numbers of young people coming into care. The evidence base for these is already available (much of it from evaluations of the Sure Start centres and others of Labour’s Every Child Matters policies).

Tertiary prevention is about helping children and young people when the problems they face may continue at home, in the community, or in care. The aim is to ensure children across the age groups, including teenagers, their family members, and carers, receive high quality, rights-based support, and care, to prevent longer-term problems and do all that is possible to help young people fulfil their potential into adulthood. Building on structural and secondary prevention this will contribute to creating ‘safer and secure communities’.

We recommend that:

• The Labour government should set up effective cross-departmental structures (to include Local Authority representatives) so that housing, social security, schools, health services (especially child and adult mental health and addictions services), youth and adult justice safeguarding services work collaboratively.
• Labour should consider setting up a Government Department for the Family (recognising families in all their diversities and across generations).
• We urge the NPF to build on the soundly evidenced recommendations of the Marmot Committee, which closely align with proposals in the Consultation document including reducing poverty by raising universal credit to ensure a living income without dependency on food banks and charity – which will also raise minimum and living wage levels.
• We support the developing plans for an early years education, day care and family support service and urge that policy and detailed plans build on the learning from the Labour government’s Sure Start and Every Child Matters provisions.
• However, these should be more fully developed into a comprehensive network of open access Family Centres for children across the age groups, with an emphasis on support for the diversity of families. including kinship families, foster families, and where needed, adoptive families. These must be ‘open access’ and ‘joined up’ with the wider ‘universal’ early years strategies. They should also work collaboratively with the multi-agency ‘targeted’ services for families with more complex difficulties, to bring together education, social work, child protection, youth offending and advocacy services, including for children and parents with physical and cognitive disabilities and mental health and addiction problems and relationship problems including violence.
• Policies need to ensure there is continuity of relationships with social workers and other professionals across ‘early help’ and child protection and in care services.

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• Labour should put an end to Tory unnecessary use of ‘pilots’. Central government funding for these services should be allocated to each local authority based on an agreed model for assessing needs.
• Labour should end the profiteering in children’s social care by increasing the supply and range of high quality local authority foster families and Children’s Homes as homely environments where the diverse needs of children and young people in care can be met.
• This should be achieved at the local level and with regional planning as appropriate but without the added bureaucracy and the failed market approach underpinning the Government’s plans for ‘regional cooperatives’.
• Labour must end the discrimination against young people living in independent and semiindependent accommodation by enacting their entitlement to ‘care’ up to 18 years of age.
• Labour should enact legislation to require that asylum seeking children and young people are legally ‘looked after’ as ‘children’ by local authorities under the 1989 Act provisions (within DfE government department remit) and not subject to the authority of the Home Office
• Labour should introduce care experience as a ‘protected status’ under the Equalities Act for all qualified young people.
• Labour should implement the robust research findings on promoting the resilience of young people from care to adulthood. Specific measures that should be put in place for all children in care and care leavers:
• provide stable placements, giving love, attachments and continuity, and a positive sense of identity, including an understanding of their culture and heritage.
• help young people to succeed at school or return later to education which leads to young people developing normative social networks, leisure activities and new opportunities.
• Involve young people in individual decisions which shape their lives, and collective decision making to improve policy and practice.
• preparing young people in self-care, practical and inter-personal skills.
• ensuring young people leave care later, including extending care to 21 – ‘staying put’ in fostercare and ‘staying close’ to their Children’s Homes and existing community networks.
• develop informal social networks, including extended family, partner, friendship, andcommunity support.
• ensure access to leaving care services, to help young people with life skills, education,employment and training, housing, finance and wellbeing, and support those who require additional help – those from diverse backgrounds, young parents, those with mental health problems and disabilities, LGBTQ+, and asylum-seeking young people.Working in partnership:Including the participation of children, young people, family members and carers in decision making, underpins making a reality of prevention. Changes in law since the Children Act 1989 and the ratification of the UNCRC have highlighted the importance of upholding children’s rights which have seen expression through participation in individual and collective decision making, advocacy and rights movements. Recommendations

• Labour policy should ensure that children and young people wherever and whenever have access to rights-based services and have access to independent advocacy services, legal advice where needed, Independent Reviewing Officers, and support by care experienced individuals and groups.

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• The Labour government should Invest in models of social work practice and service provision which increase the involvement of adult family members (including kinship carers and family members of children in care) and carers in decisions about their children.

Funding

There is no doubt that the Labour Policy team will need to come up with proposals to counteract the massive deficits, made considerably worse by the impact of the pandemic and cost of living and housing crisis:

• the draconian cuts to local authorities since 2011, amounting to an estimated £2.2 billion, (including 46% cuts in the ‘early help’ budget and 70% cuts in youth services);
• the Government’s two-year funding plan is totally inadequate and picking off ‘reforms’ is likely to do more harm in both the short and long term to the vulnerable parents and children who need services in the longer term;
• A Labour government must end profiteering with local authorities and vulnerable children being viewed as business opportunities to be competed for;
• the inequity of funding arising from the piloting of family hubs and other governmentdirected ‘innovations’ must end, and funding formula arrived at for family services for all local authorities based on need;
• the dubious ‘assumptions’ informing placement savings (especially in regard to residential care) must be challenged.In summary there is an urgent case for developing a transparent funding model, to ensure equitable resourcing for high quality, needs-led, not-for-profit locally accountable community and out of home child and family social services.SOCIAL CARE/SOCIAL WORK AND COMMUNITY SERVICES FOR OLDER PEOPLE AND ADULTS OF WORKING AGE
  The priority that is having to be given to the NHS’s urgent needs, especially hospital discharge, has unfortunately distracted attention from the fundamental and vital purpose of social care. This includes but goes well beyond the essential role that social care can play in preventing many avoidable admissions to hospitals and costly residential care and nursing homes. As well as the implications for the NHS, these avoidable admissions are actively damaging to the health and wellbeing of the people concerned, bearing in mind that older people rapidly lose physical strength, confidence and self-care skills and become demoralised as a result of even brief hospital admissions, which can compromise their independence and care options on discharge.More than 50% of national expenditure on Social Care and the area of greatest demand and cost pressure on local Councils comes from the needs of adults of working age. This includes people with a wide range of disabling conditions, including the effects of chronic long-term illnesses, physical disabilities, learning disabilities, troubling mental health and other conditions which disadvantage their quality of life and their ‘ordinary life’ opportunities.
  There are huge numbers of people living in their own homes in the community of all ages desperately needing to receive a service, but deemed to be failing to be eligible, or receiving one of insufficient or inadequate quality, often because of the inadequacy of local government funding.

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The current model of social care funding and provision is broken. Social care provision is currently provided in a fragmented and uncoordinated way by many different organisations, mostly from the private sector. Care home businesses have been purchased by private equity companies that have asset stripped them so that they have become unviable, and then withdrawn from the market, creating instability, and undermining the safety and wellbeing of highly vulnerable people. Domiciliary and even more so residential care is currently of variable and too often unacceptably poor quality, although it should be acknowledged that some providers, often smaller organisations, provide care that is exemplary.

We recommend that:

• The future Labour government should urgently provide the funding needed to cover the gap identified by council political leaders of all parties, Directors of Adult Social Services, and NHS leaders, for example to stabilise care providers, to cover the real costs of inflation, more people ageing and living longer with disabling conditions, and to fund the increase in national living wage.
• Labour should prioritise measures that provide meaningful support to relatives and carers and to voluntary organisations working in the community to provide important preventive help.
• Labour policy should give priority to services which enhance the quality of life & independence of people according to their own wishes, as advocated by the #socialcarefuture movement.
• The future Labour government should invest in local councils to enable them to use their detailed and specific knowledge of need in their area, to develop and deliver personalised services to people in their own homes, in partnership with voluntary and community organisations.
• Labour should act urgently to remedy the acute shortage of staff in social care by accepting the recommendations on pay from UNISON and Labour LGA and ensuring that they are provided with appropriate training and career advancement opportunities.
• Labour should review and reform the Benefits system to remove anomalies and injustices such as adults of working age who are reliant on Universal Credit and are unable to work or engage in education due to illness or disability, being charged for essential social care; and adults of working age who are terminally ill being unable to access pensions to which they have contributed until they became too incapacitated to work.AND FINALLY, WE WOULD BE HAPPY TO HELP!The Labour Social Work Group includes practising social workers who have years of experience across the range of service user groups, alongside eminent academic researchers and experienced managers and leaders in the sector. We have links with service user led organisations, professional bodies, Trades Unions, and with other groups who have an interest in social work and social care, and with Labour and Cooperative Party councillors and MPs. We would be happy to contribute further to the development of Labour policy in any way that might be helpful.

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Another chance to read these three powerful letters (published in the Guardian 16 and 24 August 2021) in response to front page article: https://www.theguardian.com/society/2021/aug/11/revealed-englands-pandemic-crisis-of-child-abuse-neglect-and-poverty ). Together they provide a powerful critique of the Government’s Care Review ‘Case for Change‘, from internationally respected social worker/ researcher/ educators who have over the years contributed in UK and overseas to policies and legislative change to strengthen families’, children’s and care leavers’ rights to democratically accountable quality services. See also our Post on a Labour Policy for Child and Family Social Work discussed at a meeting in February 2021 with the Labour Shadow front bench team, and with Labour Local Government leaders.

The acute situation evidenced by Patrick Butler’s article and pointed up in these letters makes it imperative that measures to remedy deficits in services must go beyond this ill-thought-out, Tory-inspired review and beyond the remit of the Department for Education. Secure funding for the child and family social services of all Local Authorities (not just the stop-go ‘innovations’ for the few, given the thumbs up or thumbs down by the What Works Centre’s narrow approach to evaluation) requires a total rethink of Local Government finance. Beyond that, coherent measures to ensure adequate incomes, decent housing, adequately funded public health services and schools, safe environments are essential if the stigma and actual harms of living in poverty and poor neighbourhoods , and the need to unnecessarily come into care, are to be avoided. And that must mean very considerable rises in public spending, and the taxation to pay for it, to make good and go well beyond what was removed during the Tory inflicted years of austerity

Guardian Letters 16 August 2021

Patrick Butler is right that the pandemic has made the crisis in children’s social care

“even more acute” (Crisis in children’s services in England is shocking if not

surprising, 11 August). However, it is difficult to see how the government’s review of

children’s social care will achieve the radical changes needed, for two reasons.

First, it will require a commitment to more progressive taxation and increases in the

minimum wage and universal credit to combat major inequalities, including those

associated with the rising demand for children’s and youth services: childhood

poverty, social deprivation, homelessness, poor health, ethnicity and disability.

Second, it will require the introduction of needs-led funding of local authority

services; the end of exploitative privatised provision, including the use of poor-

quality unregulated accommodation; and the reversal of draconian cuts in local

services from 2010, which against rising demands have prevented children

remaining with their families and communities, or receiving quality care to fulfil

their potential into adulthood.

Prof Mike Stein

University of York

 Your report on children’s social services paints an accurate picture of help and care

for children collapsing and in crisis. The report focused on more demand during the

pandemic, but there has been a longer trajectory of decay, disinvestment and

disregard.

Since 2010, Conservativeled governments have targeted austerity at poor

communities and at public services. Privatisation has been promoted, and well

over £200m each year is now gushing out of children’s services as profits for

international venture capitalists. Poorer services at a higher cost.

The pandemic has not caused today’s difficulties. Instead, it is the virus of an

ideology and intention promoting a privatised marketplace amid cuts that riddle

children’s social services and leave children and families stranded and neglected. It is

a virus that needs to be tackled with urgency.

Ray Jones

Emeritus professor of social work, Chepstow, Monmouthshire

Guardian letters  24 August 2021

In stating “above all, poverty must be reduced”, your editorial is setting the public policy bar very low.

What is required is a much wider societal vision – the implementation of progressive income tax, wealth reform, and public policies to combat major inequalities and injustices, including responding to the accumulated evidence of their impact on health, education, wellbeing and local communities, so young people can remain within their families. See, for example, Kate Pickett and Richard Wilkinson’s interview in the Guardian (‘Inequality strikes at our health and happiness’, 18 September 2018).

A vision of equality and a commitment to the needs-led funding of public services should be the essential foundation stones for any recommendations arising from the government’s review of children’s social care.

Prof Mike Stein
York University

Dr. Robert J. MurphyBA (Hons), MSc, PhD, Dip Soc Admin, CQSW,

  Dip Stress Management Training

Rob is LSWG co-ordinator on Social Work and social services for adults and children with mental health difficulties

Date:               20.7.2020

Labour Party website – ‘mental health a national priority’

Information/issues:

            800,000 children living with mental health disorders according to the Children’s Commissioner

            100,000 children denied mental health treatment each year

            4,500 fewer mental health nurses, chronic shortage of consultant psychiatrists

Proposals:

            Enhanced training bursary for nurses

            Bed cuts force children to go to non-local beds sometimes hundreds of miles from home

            Early intervention is the key to prevent or intervene in cases of abuse, neglect, trauma – i.e. Adverse Childhood Experiences (ACE)

            Extend school counselling services – to help better integrate mental health services with education and give young people somewhere to turn

            Poor mental health arises not just in schools but also in our communities, families, and online

            Poverty leads to injustices such that you are 3x more likely to develop mental health problems, and have higher rates of suicide, addictions and deaths from overdoses. Poverty results in health inequalities.

            Plan for happiness and wellbeing? – Future Generations Wellbeing Act which determines that ‘health in all policies’, ‘health equality audits of all government decisions’

The website cites LSE research which estimates the annual cost of mental ill-health at £105 billion

The website also states that research has shown that half of adults with mental health difficulties had symptoms at aged 14 yrs and yet only 8% of mental health budget is allocated for the treatment of young people.

The Labour Party is committed to tackling the issue of staff shortage crisis, through guaranteeing the rights of EU nationals working in the UK, reintroducing nurses’ bursaries, and lifting the NHS pay freeze

Review of the MHA Sir Simon Wessely DHSC 2018

A few significant conclusions:

            Increasing rate of detentions under the MHA

            Patients’ voice lost or ignored

            Services bureaucratic, uncaring, and coercive

            Over-representation of BAME people detained under MHA

            Questioning how people with learning disabilities and autism are examined/assessed

            Questioning the application of international standards of human rights

The Review noted that:

            49551 detentions under the MHA were recorded in 2017/18

            There was a 40% increase in detention from 2005/06 to 2015/16

            Black people were 4x more likely than White people to be detained under the MHA

            More Black patients, especially young Black men, were subject to Community Treatment Orders (CTO)

            Black people are 8x more likely to be subject to CTOs than White people

            For Black people as service users they experience coercion, stigma, racism, and discrimination amounting to institutionalised racism according to research carried out by Frank Keating and published in 2002 and quoted in this Review

The Review’s recommendations:

            There is a poor standard of care and support in mental health services

            The services ought to be more rights-based and reflect the 4 key principles and values of dignity, respect for persons, mutuality, and reciprocity

The Review concludes that the lack of dignity and trust inspires fear of getting worse and not better when compulsorily admitted to hospital

The new underpinning principles ought to reflect choice and autonomy such as:

            Shared decisions in care plans and treatment

            Statutory advance choice documents (ACD)

            Medication – service users’ wishes taken into account

            Patients entitled to challenge treatments

            Patients can request a second opinion (SOAD)

            Allow a patient to consent in advance to admission ie agree to become a voluntary patient at a future point which then removes the need to use the MHA

The role of the Nearest Relative is also highlighted with a recommendation that this is changed to a Nominated Person (NR)

A number of other issues are raised such as the use of police cells as a place of safety and whether the NHS ought to commission health services in police custody.

In relation to the criminal justice system the role of Magistrates’ Courts is questioned in relation to the remand for assessment of a person under Section 35 of the MHA and for treatment under Section 36 of the MHA

I raised issues which I consider important in the email and papers I circulated previously, including:

The commodification of children’s mental health which is resulting in the increased labelling of children at school has to be a priority. I can agree with the need for a counselling service in each school, but the role of learning mentors is a preventive step which is prior to counselling and a role which is of tremendous benefit for the child, their family, the teachers and the school’s academic targets. 

No one is born with ADHD, OCD, PTSD, bi-polar disorder, schizophrenia or any other psychiatric diagnosis or psychological disorder or condition. These ascriptions are applied by professional experts when a child or adult is deemed to be eligible for these relatively expensive services. Once the child or adult has crossed the threshold into the diagnostic system the door of ‘normality’ typically closes behind them, and they take on the symptomatic identity attributed to them.

I think it is ironic that the Review of the MHA should highlight the need for the implementation to reflect international standards of human rights when the 1983 MHA was itself primarily concerned with trying to establish a balance between civil liberties and compulsory treatments. Social workers as ASWs had a crucial role to play in the preservation of a person’s civil rights and liberties and prevent unwarranted detentions. The irony is that the increasing emphasis on finite and ‘available’ resources, driven by economic goals and unburdening the state and the taxpayers, has resulted in eligibility criteria which preclude, for example, the use of voluntary admission to hospital.

This Review is ironically very familiar because it repeats the dilemmas faced by those who wrote the 1983 Act and demonstrate that the fundamental issues have not changed in relation to legislating for madness in society!

So I think the Labour Party can usefully focus on the requirement for all schools to establish the role of learning mentors as a preventive mental health measure and to supplement this with a school counsellor, recognising a clear distinction in role which will be reflected in remuneration. This is one of the best means of allocating resources which will be of great benefit as a preventative mental health measure.

I also think that the Party needs to develop a strategy for tackling the evident institutional racism within the mental health system in all its features. This must include reducing the number of compulsory detentions and treatments of BAME people, as well as addressing the specific discrimination of young Black men in relation to the use of CTOs, the use of coercion, and the use of antipsychotic medication as a form of restraint and treatment.

The Party must also develop policies which focus on service users’ rights to contribute and even determine the type and quality and features of services and resources which are designed to meet their mental health needs.

I think the use of statutory Advance Choice Documents is fraught with legal, moral and professional pitfalls.

I also think the use of CTOs needs a fundamental review to establish who is using it and in what circumstances.

I also have question marks about the use of personalised budgets in mental health and I wonder how social workers are using them.

I also have fundamental questions about how the Mental Capacity Act is being used in the mental health system but also in relation to older people and people diagnosed with dementia and Alzheimers Disease.

I also think the use of the Nearest Relative has always been controversial, and I am concerned about the implications of changing this role to a Nominated Person role.   

The role of the police in the use of mental health legislation has always been fraught and more has to be done about ensuring that anyone who has to be involved in a potential suicide, domestic violence, and use of compulsory admissions to hospital for treatment or assessments of people in the community and the use of police cells as a place of safety have to be evaluated and effective and constructive policies developed.

I would like to see more evaluation of the use of antipsychotic medication especially in relation to its long-term use, because it has damaging effects on major organs particularly the liver, heart and brain.

I would like to see ECT banned as a method of psychiatric treatment.

I think we need to develop a clear mental health role for social workers.

I think that the Approved Mental Health Social Work role is fundamental to upholding the civil rights of people who are being assessed under the MHA, but I think this is a role that ought to have more credibility and extend more positively into a broader role in relation to children and families.

Food for thought! Where do we go from here?

Sent to Labour Shadow lead on mental health services Dr Rosena Allin-Khan May 2021

This briefing focuses on social work with adults and is a companion paper to that which focused on social work with children and families. Both are from the Labour Social Work Group and are addressed to Labour MPs, councillors, and policy makers. They share similar aims and principles.

Keir Starmer, in his 2020 Conference speech set out a narrative for a Labour government, linking it with Labour’s past achievements and emphasising the centrality of family and community. Labour created the rights-based welfare state including publicly funded and provided social services.

In contrast, there is every indication that the Tories will continue the direction of travel outlined in this paper, specifically: 

• Fail to meaningfully explore ways to adequately fund local authorities
• Continue, against all the evidence, to maintain the stance ‘public sector bad private sector good’ by continuing to replace local authority services for adults with lower quality and (often) more expensive for-profit providers
• Further reduce access to publicly funded social services for adults with care and support needs
• Expect (even) more of family carers
• Fail to provide vital funding of independent living support for people with disabilities
• Continue to ‘lose’ (minimise and under-fund) the social work service within the catch all umbrella of ‘social care’
• Manipulate the character of the social work profession so that social workers are – effectively – reserved for ‘investigative roles’ such as ‘safeguarding’. Opportunities to engage supportively and therapeutically with adults and their carers are already very limited and the well-established preventive aims of social work seriously reduced. This, coupled with the neo-liberal narrative, undermines social workers’ historical public service ethic, political awareness, therapeutic knowledge and skills; commitment to advocacy, promotion ofrights, personal choice and social justice; and capacity to challenge discrimination. Their role working in, and with, communities has all but disappeared.  
• Fail to recognise that effective social work with adults:
  • Means understanding complex relationships, establishing trust, judging risk, managing conflict and facilitating individual and community capacities. These are not ‘jobs’ anyone can do.
  • Requires the ability to work with a diverse range of needs, wishes and ages. A coherent new policy approach to adult social care must complement and interrelate with this aim.   

This briefing focusing on adult social work aims to:

1. Make suggestions on immediate action Labour should be taking to protect social work services for adults & their families and prepare the ground for a more sustainable social work workforce & a more comprehensive coherent service for adults  
2. Summarises the context of social work with adults after 10 years of Tory cuts and neo-liberal assaults on democratically accountable services.

What Labour could be saying and doing now

Labour national and local politicians, policy makers and social workers must take every opportunity to change the narrative about social work with adults and work towards bringing adult and children’s social workers together within re-unified Local Government Social Services functions. Links with measures to combat poverty and engage with social and health inequalities are as necessary now as they ever were. Whilst greater integration with the NHS is critical for adults’ wellbeing, it will only be effectively achieved if parity of funding and esteem is accorded comprehensive social care services. 

The essential components of an integrated approach and a new narrative are:

• Reject the Tory government-imposed fragmentation of political accountability for vulnerable people who need social services assistance & appoint a Shadow Minister and team for Adults and Children’s social services, working closely with the Shadow Housing, Communities & Local Government, Health, Home Office, Social Security, & Equalities teams.
• Challenge the relentless privatisation of care services. Privatisation often costs more and yet provides a lower quality service for users & family carers (care homes are a good example). There is also little accountability for poor quality care.  
• Challenge the stigmatising narrative that adults who are eligible for support from their local authority have somehow ‘failed’ to be ‘independent’ and are unable to manage their own lives and affairs.
• Challenge the terminology of ‘risk’ and ‘eligibility’that permeates social work with adults through the prioritisation of processes and procedures e.g. ‘safeguarding’ and ‘interventions’. Social work is a much broader activity than this and is handcuffed by a narrow statutorily determined role.
• Continue to challenge the now widely criticised model of care management and place emphasis on strengths based approaches but acknowledge that these require proper funding of public services to be effective (local authorities, social care services, housing, universal services such as libraries, primary care, and social security benefits) 
• Engage meaningfully with individuals and organisations who give voice to the experiences of service users and carers. Ensure users and carers can effectively influence policy changes and resourcing decisions & encourage local authorities to embed the practices of co-production & co-design into their structures and operations.   
• Re-engage with social work as a therapeutic profession. Social workers could and should be a source of help, support, understanding and advice rather than ‘the last resort’ for those who are desperate or are abused/neglected.
• Recover social work as a profession that promotes citizen’s rights and entitlements, challenges discrimination, and addresses health and social inequalities: inequalities have widened significantly over the last decade shortening lives, deepening disadvantage & eroding well-being. These inequalities have been amplified by the Covid pandemic.    
• Re-engage with social work as a profession that is accessible to the public and can work preventively – embedding social workers in communities where they are recognised as a resource, where they get to know local people, services and networks, and build trusting working relationships with others such as GPs, housing officers, & the neighbourhood police. Social workers have traditionally been drivers of integrated, coordinated responses to community development & advocates for community groups & citizen led initiatives.
• Commit tothe provision of a well-trained, stable, research minded & experienced workforce: as promoted by Croisdale-Appleby in his report, Re-visioning social work education, 2014). This requires moving away from shorter specialised (in Children and Families and mental health only) pre-qualifying social work programmes and developing systemic incentives to enhance retention of adults’ social workers, offer opportunities for specialisation e.g. in dementia care, learning disabilities, mental health and post-qualifying development.
• Commit to the provision of high-quality specialist roles required in law: Approved Mental Health Professionals (over 90% are social workers) and Best Interests Assessors/Approved Mental Capacity Professionals
• Ensure that family carers are proactively offered an assessment of need and that this assessment is done by a social worker. Increasingly local authorities are outsourcing carers assessments to third sector carers agencies with limiting contract requirements (charities usually). Whilst many do a good job, the agency has no responsibility for the cared for person; this practice contributes to greater system fragmentation, corrodes sustainability & corrupts the independence of charities.
• Ensure that local authority eligibility criteria are based on need and not budget caps and that adults who meet the criteria to receive support (who by definition have complex needs) are offered a social work service. Skill is needed to explore issues of rights, choice, need & wish.
• Commit to engaging with health partners structurally in relationship to improvements to health and social care systems. Although most adults’ social workers work closely with health partners their perspectives & distinctive contribution to multidisciplinary working and patient outcomes are rarely visible in strategic planning or in ‘new’ models of care e.g. Vanguards. Social work tends to be lost under the catch all umbrella of ‘social care’.   
• Acknowledge that means testing of access to publicly funded social care is ineffective & inefficient as well as discriminatory & commit to taking steps towards developing universal social services to which citizens have a right when they need them.
• Commit to a coherent offer in terms of support services across the country. The social care system is very complicated & is a challenge to navigate. Providers vary in terms of quality, provider type (private/charity), costs and availability & there is widespread confusion about what is provided/funded by the NHS, the LA, and what users need to pay for. This commitment should include reengagement with local authorities as – sometimes – more appropriate providers of community and residential care services for working age & older adults with care and support needs (currently, LAs provide very few services directly).

Social work with adults: the context

The 2014 Care Act provides the legal framework for adult social care. Whilst it is regarded – broadly – as a positive and timely piece of legislation, its capacity to deliver on its aims have been severely undermined as it was introduced during a period of austerity. The Tory administration wants to (continue to) reduce public spending whilst simultaneously improving outcomes for users and carers.

We are still waiting for the long promised Green (or White) Paper on the future of adult social care. There have been more than 10 well researched, evidence-based, financially mindful, politically informed, strategic & comprehensive proposals for sustainable adult social care services over the last decade. One of the (still) most relevant is the Kings Fund/Barker Independent Commission on the Future of Health and Social Care in England published in 2014.

Adults’ social workers work with older people with (often chronic) health conditions, people with learning or physical disabilities, mental health problems, dementia, addiction or substance misuse issues and ‘other adults’ with care and support needs. They also work with the family members and others who provide unpaid care. As a consequence of tight eligibility criteria adults’ social workers tend to only see people with complex needs, often at a crisis point, who have few resources. This ‘late in the day’ model means that opportunities to act preventively, and in a way that offers a sustainable cost-effective response, are (often) lost. 52% of publicly funded adult social care services is provided to older people; 48% is for ‘other groups’ of adults. About 8% of users receive a personal budget. It is important to recognise that there is a cross-over between adults’ social work and child and family social services. A significant proportion of parents seen by a social worker have chronic physical and/or mental health problems, a learning disability or a substance misuse problem.

There are estimated to be 8.8m adult carers in the UK, a figure that is increasing due to the growing number of older people with care and support needs living in the community. The carer population is diverse; it incorporates increasing numbers of older people who may have their own health problems, younger adults, and mid-life carers who are often obliged to give up paid work to care.  

More adults (10.9m in 2019) who have care and support needs now self-fund ie they (or their family) pay for privately organised support services. There is a growing group of adults who cannot afford to self-fund but who do not meet local authority eligibility criteria for publicly funded support. Self-funders receive little, or no, assistance in making care related choices despite the complexity of decisions and the, often considerable, costs involved.

Since 2010 central government grants to local authorities have reduced by 40%. The current level of expenditure on adults’ social care services is below the 2010/11 level, despite increasing demand. Key impacts include:  

• The number of adults in England receiving state-funded social care fell from around 1.3m in 2012/13 to 841,000 in 2018/19; of these two thirds are older people.
• In 2017, Age UK reported that 1.4m people aged 65 years & over did not receive the help they needed with ‘essential daily living activities’ such as bathing; a significant proportion received no help at all. Older people on low incomes are most affected.
• If services to adults with care and support needs are reduced, carers are obliged to ‘pick up the care tab’; services for carers are also reduced:

• The number of carers receiving any local authority funded services fell from 308,160 in 2017/18 to 297,300 in 2018/19
• Only about 10% of carers receive an assessment of need (mandated in the Care Act)
• More than 90% of all local authorities respond only to needs that are ‘critical’ or ‘substantial’; in 2018/19 only a quarter of people who approached their local authority for help received (some level of) a social care service.
• It is routinely reported in the British Medical Journal, and evidenced in research, how damaging cuts to local authority budgets have been to the health and wellbeing of adults, how costly lack of social care is to the NHS (e.g. increased admissions to hospital), and how inefficient a lack of joined up planning and working is for all parties. This is linked to calls for a national social care service.
  • A number of trusted organisations have described ‘adequate funding’ for social services as ‘not prohibitive’ (eg: LGA, Kings Fund, Centre for Welfare Reform); they also argue that it would help contain escalating NHS costs.

It is noteworthy that five times more older people are living in poverty in the UK now than was the case in 1986; the highest rate in Western Europe. In 2017/18 in England 2m older people lived in poverty; of these 1m lived in severe poverty. Also, 6m older people lived in fuel poverty.

What next?

In the context of a widely acknowledged crisis in social care – and heightened public awareness due to the Covid crisis of the large number of people who rely on social care – the time is ripe for the Labour Party to engage with a radical review of the sector and, as a key part of this, reimagine the critical role social work with adults and their families could, and should, play. Some would even suggest that what is called for is the present-day equivalent of the 1969 Seebohm Report which laid the foundation stones of generic local authority social services departments and a universal model of care and support.   

Sent in March 2021 to Labour Shadow team at Health and Social Care (Jon Ashworth, Liz Kendall, Rosena Allin-Khan) and to Steve Reed Shadow Local Government Minister