Next Steps for Social Work30th January 2008

FIRST ROUGH DRAFT - COMMENTS PLEASE

This paper has been written by Simon Duffy. It is a provisional and early attempt to begin setting out a revised model for Social Work as it adapts to the emergence of Self-Directed Support and Local Area Co-ordination.

These thoughts draw heavily upon a detailed exploration of these issues by senior managers from Lancashire County Council and a discussion of in Control’s Yorkshire & Humber Regional Forum.

When thinking about changes within any profession it is important to note that the profession is itself free to revise and develop its own way of working. A profession is not passive. This paper is offered as a map of some of the positive paths that lie ahead. It is for the profession itself to shape its own response to these ideas and identify how best it can make its unique contribution to building a decent society.

in Control Discussion Paper on Next Steps for Social Work Page 1

ContextThe recent government statement Putting People First brings together a number of new approaches to Social Care that have been growing in importance over the last few years. It is now expected that a modern Social Care system will:

• Provide early intervention and reduce dependency on services

• Give people a personal budget and the ability to design and control their own support

• Offer information, advice and brokerage to all, including self-funders

In particular there seem to be two developing and interlocking systems for Social Care which enable local authorities to meet these aspirations and to shift away from the models of care and provision that have dominated public services since the end of World War II. These two systems are:

Self-Directed Support - a system for enabling significant on-going support the ability to tailor and control that support. Building on previous initiatives like Direct Payments this system has been pioneered by in Control and is now being developed in 107 local authorities in England.

Local Area Coordination - a system for enabling people to avoid reliance on services and to improve their lives and reduce risk by connecting to their community more effectively. This model has been pioneered in Western Australia as an essential component of wider reform in social work.

This paper assumes, without argument that these ‘technologies’ are worth further investment. Much more information on both is available form in Control (www.in-control.org.uk). This paper also assumes that the shift these approaches provides a significant opportunity to re-think the current care management system in a way that will be welcomed by many social workers.

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For more information on the impact of Self-Directed

Support on the Care Management system please

read Care Management & Self-Directed Support published in

the Journal of Integrated Care - October 2007

There are currently 70,000 registered social workers. That is an average of 500 per local

authority, c. 1:20 ratio to the social care population, 1:700 ratio of social workers to the

general population. Currently c. £3 billion is spent on care

management.

An emerging patternAlthough there are many roles and functions that are and can be carried out by social workers one primary way of distinguishing their role is to focus on three different groups within the whole population:

1. People who are not eligible but who may become eligible if not adequately supported and who will need Local Area Coordination

2. People eligible for long-term support and who will therefore need Self-Directed Support

3. People who will not be eligible for either level of support but who may be vulnerable to abuse and who will need Safe-Guarding

The assumption is that each role involves a degree of safe-guarding and the minimisation of risk - i.e. it will never be someone else’s problem to worry about risk and vulnerability. However in the case of the first two groups the primary focus of the relationship will be on supporting people to be self-determining, connected to community and in control of their own lives with adequate support.

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Defining the AssumptionsThere are many assumptions that have constrained the development of this model and many of these assumptions are not fully tested - they are informed by experience and intuition but will require further testing by experience:

• There will be one up-front system for adult services which is generic and accessible by the whole population, including self-funders.

• There will be universal systems of advocacy, information and brokerage which will be accessible by the whole population and which should have a significant role for per support and the user-led supports for Independent Living.

• Local Area Co-odination offers a model for shifting attention to people on the edge of eligibility for Self-Directed Support - building better support and community connections for those people will improve outcomes and reduce the demand for Self-Directed Support.

• Some social workers will be well suited to the new emerging roles, although each role will demand distinct skill sets.

• Not all social workers will be suited to all of the emerging roles and some may not be suited to any of the roles and will require re-training.

• Existing social work education may need to change to reflect the new world that is emerging.

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The New InfrastructureCurrently between 30% to 40% of Social Care is spent on infrastructure:

• Care management (16%)

• Service management (c. 15%)

• Back-office costs (?%)

• Existing funding for brokerage, advocacy etc. (?%)

One of the key management challenges will be to develop a new infrastructure for Independent Living and Self-Directed Support. Authorities should aim not just to manage within the existing cost envelope but should aim to shift some of those current infrastructure costs into the hands of disabled people in order that the brokerage and other services can also be framed by people’s experiences.

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From Care Management to Self-Directed SupportCurrently most of the social work resources in adult Social Care is spent on resourcing the Care Management system. If managed well the change to Self-Directed Support will lead to the following changes:

• Less time on ‘front-end’ assessment

• More time on brokerage, but only for c. 20% of case load

• Less time on co-ordination and development

• More time on review and learning

Also, it is possible that a commitment to Self-Directed Support should also enable a renewed investment in Local Area Coordination.

As Self-Directed Support and ideas like Local Area Coordination begin to be extended across social care and beyond there will be new and exciting possibilities for social workers.

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From Specialist to GenericIn many local authorities, like Lancashire, the current structure of social care is defined by the different client groups:

• Older people

• People with learning difficulties

• People with mental health problems

• People with physical disabilities and sensory impairments

It seems likely that the use of such client group distinctions will lessen as Self-Directed Support becomes more dominant. People will seek services that make sense to them and will not be restricted by professionally defined distinctions. Specialist skills will still be relevant but they will need to be ‘re-marketed’ and offered to people on the basis of their benefits rather than any organisational assumption that ‘certain kinds of people need certain kinds of services’.

There will also be an increasing emphasis on services for people with long-term health conditions who will increasingly seek Self-Directed Support rather than medically defined services.

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Emerging Role No. 1 - Local Area Co-ordinationThe role of the Local Area Coordinator has clearly defined by empirical research within Western Australia and by its recent introduction to Scotland and Northern Ireland. However there many questions of definition that will need at least some further exploration in the different context within England. In outline the role involves:

• Linked to a specific local community - so named - you’ve got to know and be embedded within the community

• Available to everyone in the local area - however there is an eligibility process for more intensive support

• Helps people to problem-solve

• Instigate new projects for community (e.g. Small Sparks) and works alongside other agents of community development

• Facilitate local community skills bank

• Linking and networking

• Marketing, newsletter: can you, did you know

• Sign-posting

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Emerging Role No. 2 - Self-Directed Support CoordinationAt this point, reflecting upon the successes and failures of the care management function it is possible to distinguish three different roles within the broader role of SDS Coordination, namely: (a) an assessment role (b) a brokerage/planning role and (c) a review role. However at this stage it may be too early to artificially distinguish these roles and it may distract people from the larger issues. So it maybe better, at least for now, to note that SDS Coordination will:

• Determine need, risk and vulnerability and assess level of support needed

• Applying support decision-making principles and Mental Capacity Act

• Offer advice and information and sign-posting to Infrastructure for Independent Living

• Help with support planning - where necessary - not to 100% of population

• Link to other services and agencies - especially re-ablement services

• Offer a regular ‘health-check’ to see that people are getting good value for money, offering advice and linking to others

• Supporting the development of the wider framework of services available

• Publicise problems and successes

It is important to note the importance of re-ablement within this model. Lancashire’s figures suggest that approximately 50% of those using the re-ablement service will not need to go on to require long-term support and hence will not require a personal budget.

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Emerging Role No. 3 - Safeguarding RoleThe third role is as a general guardian of public safety - helping people who are being abused or helping people who may be putting themselves or others at risk. This role is defined by a number of statutory interventions. In general it is assumed that this role will serve those people who are not eligible for support from the other two roles - although there may be occasions where there is some overlap. The role involves

• Make difficult decisions

• Gain trust of public

• Be aware of abuse

• Support challenging people

• Provide consultancy, advice, information

• Support prosecutions

• Understand mental health law

One of the biggest challenges in this role is its policing impact. It can feel somewhat ‘negative’ and there is at least anecdotal evidence of burn-out associated with it. It will be very important to think about how such a service is managed, supported and framed. However the importance of the role and the culture that seems to inevitably develop around the role does not seem helpful to mix with the LAC and SDSC roles.

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ChallengesIn discussion various challenges or thoughts arose that will need to be reflected in more developed versions of this paper and in real efforts to put these ideas into practice:

• It is vital that we do not build services around professional definitions of role - services must be based upon the real needs of individuals and communities - professional roles must respond to those needs.

• Some of the roles require great skill and it will be important that pay reflects the relevant skills - e.g. the LAC role may require some of the most skill and hence, arguably, reward.

• Keep it simple - it is clear that change is necessary but that there will be many uncertainties - keeping an overall narrative that is clear and easy to explain will be important.

• There is the potential for resistance, yet there are many positives for existing social work staff and it will be important to identify role models and champions for the new ways of working.

• More work needs to be done to define Job Titles and Job Roles and Required Skills - this should set the framework for the management of change. The question of the need for qualifications should only follow this prior analysis.

• Senior managers will need to work progressively to shift resources away from the old models of operation and into the new models - while being careful not to increase overall level of infrastructure in the system.

• It will be important to work closely with the NHS as these models will have a profound and potentially very positive impact on health outcomes - but will also require change within the NHS.

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