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:
- 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
- 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.
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