By Jenny Pitts
There are many reasons to be pessimistic about the future of adult social care and social work services at the moment; is it, as Chris Hatton says, fundamentally broken? Well documented statistics such as the difficulties in recruitment and retention of social work staff, the continual gaping hole of the funding gap etc. don’t need repeating here. We know that doing nothing isn’t an option – something has to change and that change has to be quite radical and deep; we can no longer tinker around the edges while expecting real and sustaining change – waiting lists to reduce, person-centred and community-based solutions to flourish, people’s experience of services to improve, etc. Achieving these things and more is only possible if those leading change work very differently and are prepared to put everything on the table in terms of questioning what needs to change and, importantly, to let the people who know best about what will work drive those changes at a local level.
I talk to many social work teams across the country and all too often hear that they strive to put the person at the heart of practice but that they often feel constrained by the burden of the internal and cross-organisational bureaucracy. With pressure on teams as intense as we have known it, we are using up our greatest asset – the staff – to carry out laborious and often unnecessary process and form filling. The answer doesn’t lie in a new IT care management system but in many areas the system is dictating practice and tying up hard pressed practitioners to spend significantly more time inputting a person’s notes on the system and processing the next steps than they spent talking with the person in question – this is not good for people they support and serves to damage the motivation of practitioners. Systems which have a ‘one size fits all’ approach mean there is no room for proportionality. An assessment has become defined as a document and a stage in the IT system that is needed to unlock other stages, not a rich process that seeks to really understand what’s going on in a person’s life. Changing this is part of the solution but not a solution in itself.
A system that is process-heavy is fundamentally predicated on a culture of mistrust and this works against any desire to be creative and it fuels the urge to cover one’s back in the event of there being any legal challenge, let alone a challenge from panel. Funding panels generally only add to the bureaucratic burden and serve to further damage morale within practitioner teams. Fragile resilience and confidence can be obliterated by the experience of “going to panel”. There are better ways to make decisions about allocating limited resources that don’t ride a coach and horses through the worker’s professional self-esteem and that ultimately better serve the interests of people they’re supporting.
The challenge is complex and if the solutions were easy we would be in a different place. There is no blueprint, no quick fix nor magic bullet but there is a great deal of commitment, knowledge, expertise and learning within social work teams and within the communities they serve. Harnessing this is the key. I would suggest that we already know what we need to do – it’s the doing it that’s the challenge. For decades practitioners have said that we need to reduce bureaucracy so that time is freed up from the ever increasing form filling and process, we need to be more preventative and find ways people can talk to someone before they’re in crisis, we need to reach out and collaborate with all the organisations and community groups who are working to achieve the same end – no organisation has all the resources needed but pooling resources at a community level and people coming together to agree how they can genuinely collaborate as equal partners around a shared vision is powerful.
We’re privileged in the NDTi to work with a host of people within services and across communities who are doing just this and there is a rich body of learning and experience from that preparedness to share. When change starts to happen locally the momentum develops a life of its own and more and more people want to get on board because they see that it works. So we know that it is possible to not have waiting lists, for people to see someone within a week, to have a good conversation that focuses on what matters to them, what they want to achieve and to identify solutions, for practitioners not to be overburdened by paperwork and process and for decision-making to sit at a local level. Morale increases, practitioners feel valued and trusted and empowered to use that thing that has been fragile and wafer thin for too long – their professional judgement. Confidence increases as teams support each other through peer support, reflective practice and shared decision-making. Moving towards a culture of trust and empowerment, within services and across organisations is, in my view, essential but this takes time and it takes bold leadership.
Is this a return to “good old-fashioned community social work”? Maybe. People talk fondly of days when they used to go out with a notepad and pen to conduct their assessment. Did it feel any more risky? Not at all. Did they feel they were using their skills? Yes. Practitioners talk about how they’ve lost sight of the reason they came into the profession – to make a difference in people’s lives, to use their skills in working with people in listening and understanding what matters. This passion and dedication hasn’t gone away but I would suggest that the more we overburden practitioners with process and bureaucracy and rely on IT care management systems that don’t allow them to use their judgement, we run the risk of losing that most precious resource.
Those areas implementing Community Led Support have found that many people benefit from having an appointment with a social care practitioner in a welcoming community venue where they can find out what’s going on locally, what support might be available. These ‘hubs’ often involve community groups and volunteers and can take place in libraries, town halls, community centres, voluntary run cafes, GP surgeries, church rooms and even fire stations, to name but a few. They offer a valuable experience for the person who is offered an appointment usually within two weeks, often days, and mean that with proportionate recording, the practitioner can be far more efficient and have time to follow up any actions. Not everyone needs a home visit but if they do they are therefore able to experience that much more quickly than they would otherwise.
These hubs are one of the ways that services can be far more responsive but are not an end in themselves, they need to be underpinned by skill of the worker to have an effective and strengths based conversation, to have permission to record what matters and to be trusted and supported in that judgement, to have time to connect with the organisations in that community to understand what they offer and work together better. It requires the entire experience of the person to be smooth and joined up – this includes working with customer services teams who so often do a fantastic job in beginning that conversation and understanding what matters and the outcome the person requires. The good conversation, the language that doesn’t confuse or mislead, needs to start as early as possible and be followed through, including that bit of customer service that social care is so poor at – finding out how useful the person found it, did it make a difference, how they can talk to someone again in the future if they need to. Only then we can really understand how effective services are.
There’s a lot of talk about asset-based social work at present but this shouldn’t be some new thing; this is what social work practice should be all about – but we need to allow it to flourish and enable creativity and flexibility and allow people who work in services to do what I believe they do best and what they came into the job to do. If we address that people are more likely to stay and to invest in a career in an underrated but so vitally important a profession.