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Social Work and the National Care Service

SASW's National Director, Alison Bavidge, reflects on the unprecedented opportunity offered by Scotland's proposals for a National Care Service...

The Scottish Government consultation on a National Care Service (NCS) is open with an extended deadline to 2 November.  This is an unprecedented (in my career span) time that offers the social work profession significant opportunity to demonstrate how we work, to assert the expertise we bring that generates options and autonomy for the people we work with, and to show our skills in creating supportive and trusting relationships. 

But this opportunity comes with high stakes for the profession.  If we get this right, we can look forward to a social work profession that is a universal service, accessible and trusted. If we get this wrong, social work will be practiced only in situations of crisis and high risk, where relationships and trust are strained and where the constant stress exacerbates burn-out and reduces the attractiveness of social work as a career.

My reading of the consultation on the national care service is that the social work profession has a problem of definition: the profession and our government hold fundamentally different positions about what social work is and what social workers (should) do.  

Here’s what the consultation document says about social work: “Where individuals have critical and substantial needs, and high levels of risk or public protection issues arise, this requires a social worker to carry out a risk management assessment and develop a care plan”.  This is closely followed by a question that asks whether people think they should have a ”light-touch conversation if (they) need a little bit of support; or a more detailed conversation with a qualified social worker if (their) support needs are more complex”.  The intimation here is that social workers are not for everyday use.  It sounds as though we do only high risk and complex work and perhaps are not skilled in tailoring our assessments or support to the needs of the person who has asked for a conversation about the help they might need.

To be fair, later in the consultation the descriptors are broader and reflect the roots of the profession in human rights, our role in assessment of need, planning, commissioning, coordination, delivery and review of social work and social care services.  There is one reference to direct support by social workers, but this is ambiguous.  More positively, the consultation notes that a more cohesive social work service for people in prison would optimise opportunities for care and rehabilitation within prison and increase the potential for community services to support people on their release, reducing the likelihood of repeating crisis and re-engagement in the justice system. 

Prevention and early intervention are referenced throughout the report but not in connection with social work.  Nurses are, in contrast, noted for their role in early intervention. 

In short, there seems to be an articulation of social work in the consultation expressing the profession only in terms of its statutory powers for intervention.  Given the government is our funder and effectively our main employer through local authorities, this is of grave concern. 

What is clear to those practising social work is that, in the last 30 years, social work has lost significant slices of what we consider our role.

Care Management in the 1990s elevated a task-oriented deficit-based assessment methodology that intensified the focus on fixing the individual rather than involving them in articulating their desires and life experiences, exploring their work and social environments to generate creative options.

The mixed economy of care that was generated around the same time brought opportunities to work with independent partners within communities, innovate and evolve the public sector offering.  However, cuts to social work budgets and austerity meant that it became cheaper to buy in services by staff not qualified in social work where the service could be disassociated from “statutory”, ie, uninvited and often unwelcome interventions.   The cuts to local government spending have meant that some really important preventative and early intervention supports, that local authorities found they could no longer afford, were picked up by Health Services or the Third Sector, for example social prescribing and distress brief intervention. 

Eligibility criteria followed as decisions about not only who to support, but even whom to assess, became necessary due to budget reductions. This meant that in effect social workers became involved later and later in supporting people having problematic times.  This later engagement affects our relationship with the people we support which becomes more strained as social workers become involved in cases often only at that point of statutory intervention. Social workers have become the punishers of people for whom prevention and early intervention has not worked and are held to account for this by the media and public.  The social contract between the profession and those it serves is at best strained if not severed.

Social workers study for four years or, following a first degree and appropriate experience, take a two-year postgraduate course (usually as a Masters degree).  They are trained to observe, explore, have good conversations and to support with minimal intervention and a high regard for human rights.   We expect to have to negotiate competing rights in families and communities and work in the messy grey areas of life.  Social workers gain huge experience of generating solutions with people and so can bring that experience into future work to help give greater information and choice to people who (we hope) experience most of their challenging times only once.  We are regulated and work to codes of practice but constantly have our professional autonomy severed by institutional requirements around process and budget in a way that does not happen for GPs or nurses assessing patient need.

The National Care Service Consultation shows us that we have work to do to ensure our profession is not defined by others who may not completely understand who we are and how we could work so much more effectively.  Working alongside people who need our services, SASW looks forward to co-creating a new vision of the future of social work with Social Work Scotland and supporting the Office of the Chief Social Work Adviser in Scottish Government to articulate an ambitious, skilled and respected social work profession universally accessible and with a new social contract based on relationships and trust.

Read the consultation, here.