Social Care: Who Cares by Warren Belcher

Warren Belcher, a team leader in an adults social services team, who joined into a recent on-line LSWG discussion on Labour’s policies and future direction with respect to adult social services, has agreed for us to put this blog-post on the website.

Social care can often feel frustrating and difficult to understand even for those of us who work within it or experience it as individual citizens along with people’s families, partners and friends by their side.

Social care for a long time (even maybe forever) has been virtually invisible within our wider society apart from the odd TV documentary, a five minute news slot or a sensationalist ear bashing from the increasingly irrelevant press headline. The viewers/readers naturally move on whilst those impacted by any aspect of social care also continue with real life long after the 48 hour outrage has passed or where our news has turned back to what’s happening in America or informing us all in forensic detail who has won Love Island (who knows next year it might even be me!)

Social care is a massive, complex machine which has a profound and important responsibility for people’s wellbeing. At the moment this machine feels a bit clogged up and has almost run out of oil whilst it’s nuts and bolts furiously try to hang on before the wheels come off completely. Social care is long overdue it’s own MOT or SOS depending upon your own experience and point of view. Its probably fair to say though its been in a bit of a state for a while and despite empty words from politicians, little has been done about it. For all the talk of the ‘green’ paper, its still more likely you will see a forlorn David Banner walking down the street going green after eating a dodgy Nandos rather than getting angry over its content, as we still have no clue about what it might actually say.

Social care at the moment reminds me of when I was a kid, where I kept the same trousers with the same holes in the knees. I kept them until they became shorts by default and along with my happy parents we ignored the problem despite the evidence of my cold knees and the need for more sticking plasters. Social care is similar, it has big holes and has to keep adapting into something which sort of resembles itself to survive. Those sticking plasters are rapidly running out as ‘short’ term spending solutions can only get you so far.

Solutions for social care are often talked about but only really in terms of money because as the population gets older, those financial holes will only get bigger. People won’t have as many assets as they do now to self fund and the baby boomers will start complaining and saying that they are not paying for their care even where they can afford to do so. The politicians will listen, knowing they need their votes because THEY always vote. Politically this worries the parties and will cause a reaction to policy where research into poverty has been time and again ignored but protecting individual assets will be taken seriously where people not experiencing poverty will complain. For the time being though politicians still continue to conveniently forget about citizens and social care, especially those under the age of 65 with complex health and social care needs, learning and /or physical disabilities, acquired brain injury, autism and / or mental health need. Just imagine if these people were the majority voters and more visible in society! Where would social care be then Boris? ……..There is only so much ‘spaffing’ up walls available right now I guess!

What’s missing from the social care debate is the failure to consider pride, expertise, citizens gifts and the successes social care has already achieved, despite the challenges it faces. There is indeed much to celebrate and evidence available to justify social care’s own individual investment. If we care to take the time and interest to look into people’s stories (for those who want to tell us them) we can find many successes to build upon and justify why social care is worth such time, effort and investment. I myself have repeatedly called for a defined department of social care with it’s own Secretary of State, along with a fit for purpose shadow minister. This would provide a platform for partnership, rather than the fashionable buzz of integration, which would never provide social care with any equal worth but would slowly dissolve it’s own identity, despite any reassurances this won’t happen.

We all require a social care sector, irrespective of our political persuasion as we may all become consumers of it much like we all went to school and we all see doctors from time to time. I recognise social care can’t be protected from government ideology which is why a government for the few and not the many will always secretly despise the notion of any visible social care system. If it stood out from the crowd it would simply be easier to dissect. Its suited to being buried away in Whitehall like a perverse version of hide and seek. You only start consciously looking for something when you become genuinely worried you can’t find who or what you are looking for!

I’m looking for investment for all citizens with better public scrutiny, better public understanding and in terms of social work a joined up identity for adult and children’s based practitioners. I’m looking for policy which is based upon rich and accepted research with thoughtful expertise rather than disingenuous political reactions in leadership races. Any policy decision must be for the welfare of all society including those of us requiring support and not just the ones who may exercise a vote. A governments first job then must always be the welfare of its individual citizens and our communities.

The Department for Education and the Department of Health &(Social Care) are failing in their ability to respond to the issues of poverty, community capacity and the necessary role social care has to play as one of the worthy experts. These two departments are not well placed to challenge themselves or their masters as the masters should indeed be citizens not the MP’s fighting it out for pure political gain. Perhaps the creation of a ministry for social care though along with its civil servants wouldn’t do much better but any failings and/or ideology would be easier to expose than it is now. To be truly progressive it simply has to happen which is precisely why it doesn’t.

Identity and context influences decision making. I believe the term ‘social services’ offers an opportunity for change. After decades of attempting to move away from the name, it still remains the title which defines aspects of the statutory social care sector. Social services is used by most professionals and is the name the public still associate with statutory social care because they understand it for the good,the bad and indeed the ugly! Social services then should be reclaimed by a profession who have either felt ashamed of it or have lost touch with the public by not seeing it’s relevance within our own office walls.

It also never fails to escape me that those working in social care where the impact on the ground matters most (let’s face it that’s why it exists in the first place) can still be treated overwhelmingly and exceptionally badly both in terms of real investment and valuing the frontline role. Its financially where real lack of worth is so easily exposed as are the consequences regarding retention and quality of consistent care. You only have to compare wages and salary increments within some of the same organisations to see where the injustice are and for too long real wage growth remains painfully stagnant. I’m not sure what the level of profiteering is made off the back of social care commissioning wise, but it’s nothing short of a murky world where no one can be blamed directly and god forbid anyone attempts to ask.

The challenge of decent pay for care and support workers is however complicated and compounded by the high numbers of people employed at that level. Paying a few leaders will always be less of a challenge than paying for the vast majority of direct carers or social workers. Its the same in any industry that those who turn the wheels still only get the crumbs. However the private markets and contract arrangements in social care are still worth investigating, given that vast sums of money don’t trickle down to where the investment is required the most ie paying for the real expertise on the ground delivering direct care and support.

Citizens with support requirements can’t afford not to have consistent care and support workers, yet we don’t price this investment as much as we do for other indirect roles in social care, some of which pay eye watering amounts of money for less impact or possibly no real impact at all. It exposes an industry flawed by a risk of over professionalism over actual impactual care delivery.

The role of day to day social work practice itself within the juggernaut of increasingly corporate organisations is also at risk of increased irrelevance where there is any talk of outsourcing services. Social work must not allow itself to sleepwalk into a exclusive reactionary role as this will be at the expense of relationships and any nuance of grounded practice. The value of such direct practice would be at risk of diminishing to the point it would only be viewed as a stepping ladder to progress further away from direct work where experience and retention is still so desperately required. Social work does not react well to targets and key performance indicators in the same way a salesman measures his/her sales.

Frontline practice is tough, it’s instantly accountable to the people it supports, its on your shoulders when it counts and delegation is not so easy with continuous and shifting expectations when actually trying to see through day to day tasks. Social work is of course necessary at strategic levels but would benefit from moderately recent frontline experience about what works and what doesn’t. It is vital leaders are in touch with the realistic challenges taking place caused by the shear volume of citizens requiring social care support as increasingly reactionary solutions with little growth in employing enough experienced social care staff to meet demand is required or it affects the entire systems they work in.

The Care Act (2014) and Mental Capacity Act (2005) have significantly impacted on such social care systems and delivery. As an example, to make adult safeguarding truly personal requires time and expertise. Arranging a truly fit for purpose capacity assessment, preparing the citizen, supporting their family, establishing a meeting for the assessment, undertaking the assessment, writing up the assessment, organising a best interest decision (where appropriate) and repeating above steps for best interests is a lot of tasks. At the same time the social worker has to establish a protection plan, possibly make several internal and external referrals including to the Police, CQC, CCG and IMCA. They also manage immediate complaints, possible defensiveness and hostility as well as keeping the referer up to date, recording the case notes, recording the strategy discussions and recording decision making tools for managers to make decisions. This all sounds like good practice but multiply that by countless new referrals everyday and you get the picture that the strategic verses the operational can clash. It only takes one missed phone call and one email request for further information not to come though or a cancelled visit for a delay to send a social worker into a spiral of anxiety with a back log created, especially when simultaneously managing commissioning, crisis work, further allocations, covering sick leave for colleagues, expectations of training, attending other meetings and being asked to find solutions for many other things which could constitute full time jobs in there own right. It’s a tough gig day in day out trying to keep on top of all that and many good folk do indeed cope with it.

Social care undoubtedly sits within a big industry focussing on individuals and communities who require support and information in terms of risk, aspiration, safeguarding, daily living, relationships and care support. The individual social worker working within it requires ‘continuous professional development’ with rules, regulations, standards, action learning sets, training and requirements for self reflection and the dreaded critical analysis. We however must not forget the systems these individuals sit within as they must be fit for purpose. If Local Authorities are to remain at the heart of delivering services they must be confident to challenge government visibly and with determination by being honest with the public and the politicians. Most of us are familiar with terms such as ‘lessons will be learned’ at times of reported and very visible significant tragedies. The worry is other micro tragedies are happening before our very eyes every single day. The practice conferences and speakers at them must talk about the challenges of welfare and the impacts for social care which is not free at the point of access. This day to day remains the single biggest area which causes citizens receiving care to feel over overwhelmingly stressed or miserable.

For all the talk of good practice/relationship based practice and the increasingly used rhetoric concerning social justice, our collective challenge must be to reflect and think about actual impact. Despite organisation changes, implemented standards, good practice expectations, legislation requirements and training, have people’s lives in the community really changed for the better in the last 20 years based upon how the organisation of social care has provided its ‘offer’? The resounding thing to think about before answering is to consider the voice of the citizen like Anna to help us provide not just an answer but a better response to the question…….

“Got email to say time for my #socialcare review. Feel terrified. Having PAs allows me to live independently, but I always feel like I’m begging not to have my hours cut. I’ve spoken at national conferences about social care but this makes me feel sick & powerless. Silly but true.” (AnnaSeverwright 08.08.2019)

So do you care?