BRITISH ASSOCIATION OF SOCIAL WORKERS (BASW) ENGLAND – WRITTEN EVIDENCE (ASC0087)

1. The British Association of Social Workers are the professional membership association for social workers in the UK. Social workers have frontline experience of social care and support many people who are in receipt of social care services.  

Introduction

2. BASW England’s response comes after engagement with our members through the BASW England adult social work group, who focus their work on policy areas impacting upon social work and social workers supporting adults. This group comprises of members of BASW as well as people with lived experience of care services.
3. A subsequent member engagement event which was open to all BASW England members took place on 24th May where four key questions listed on the consultation were selected for discussion in the meeting which was attended by 18 members.
4. The response is in two parts. The first half focuses on questions explored by our adult social work group. The second includes responses to questions explored at the member engagement event.
5. The points are often brief and summarised based on the discussions that were had.

PART 1

The invisibility of adult social care and its consequences

Q1. One of the fundamental challenges facing adult social care is that it is ‘invisible’. Do you agree? What do you think explains this?

6. The group noted the importance for social workers to have parity with health professionals and having the acknowledgement of their role and contribution which is key to the issue of invisibility and is something that must be addressed in line with the integration agenda.
7. Whilst it could be argued that social care is becoming increasingly more visible, it does not mean that the government or the public generally fully appreciate the complexity and risk involved in social care and this was very evident in the way that the sector was initially treated in the Pandemic which has contributed to the invisibility of social care and social work alongside it.

Q2. What are the key changes that need to be made to reduce the invisibility of adult social care?

8. Whilst acknowledging the need to promote integration, social care is often overshadowed by health due to its position within the Department of Health and Social Care and the group would like to see a greater prominence for the Minister for Social Care.
9. Resourcing was highlighted and it was made clear that social workers need the tools and resources to do their job. Austerity and chronic underfunding of the social care system is impacting this.
10.                     There needs to be greater promotion and uplifting in general of the social care system.
11.                     Another view shared is that the Government, user-led organisations and other relevant bodies should meet together to plan a campaign including high profile events to raise the profile of social care and the contribution of social work supported by the Government.

Q4. How would you define the purpose of adult social care? How does the invisibility of adult social care get in the way of achieving this purpose?

12.                     The purpose of adult social care is to help people who have needs because of difficulty with either activities of daily living, maintaining independence or social interaction that derive from impairment or illness, where this has a negative impact on their wellbeing. Adult social care also helps the carers of people who have these difficulties. Local Authorities have duties to help people to make arrangements to meet their social care needs by organising a needs-assessment (and a carer’s assessment if applicable) and also coordinating a plan of how needs are to be met.
13.                     A social worker will often take the lead role in both activities, involving adults with social care needs and carers as much as possible, and also liaising with other professionals to coordinate their contribution to the process.
14.                     The lack of public knowledge about the importance of a needs-assessment contributes to invisibility. Many people believe that it is simply a matter of arranging services, and this is often reinforced by statements from Government and other public bodies. The role of social workers should be seen as like that of a GP, where an assessment would be seen as being comparable with diagnosis.

Better support for unpaid carers

Q3: What are the key priorities for carers in terms of their own support, wellbeing and resilience? How and where can these best be provided?

15.                     The current model of procurement in relation to carers support is both rigid and overly prescriptive. A more flexible model and funding mechanism which would lead to community social work that can work with different communities of carers in a more flexible way.
16.                     Statutory social work is not the only way in which qualified social workers can work in society. If there was a different funding mechanism and community social workers could work with different communities of carers in a much more flexible way than currently this would be beneficial.

An example of a different approach which focuses on peer support is provided in the response to question 7 below.

17.                     Organisations need to remove barriers and provide alternatives to, or support for, carers less confident about using the internet, so that information and systems are accessible. 
18.                     Recognise the unique difficulties faced by young carers, parent carers, carers of people with mental health issues, Black Asian Minority Ethnic (BAME) carers or carers who are disabled people may face.

Q7. Why is the current care system so difficult to access for carers? What needs to be put in place so that carers can simply understand what is available to them as a right and discretion, and the person they support? Do you know of good practice examples? How can these examples be expanded more widely across the system?

19.                     One of the barriers to people accessing services or accessing social work itself is down to the bureaucracy in systems.
20.                     Steering people towards paid services as opposed to voluntary groups. Voluntary services are often not valued as some of the things they offer are commissioned by councils and are therefore seen as competition.
21.                     The current system is designed to give people as little as possible. Statutory services persuade people they don’t need social care. It is not being viewed in the same way as access to health care which is a right.
22.                     'Prevention, reduction and delay' in the Care Act is often interpreted as - keep people supported in any way possible that isn't within a commissioned service for as long as possible.
23.                     Bureaucracy is an issue with the current system. Systems are often inherently designed to be 'tricky' to work around.
24.                     Here is a good practice example: In Derby, a Carers' Retreat (called 'Haven House') was set up by a social enterprise run by local family carers. In partnership with Voluntary Action Derby, the social enterprise (known as 'Creative Carers) won a council contract to deliver 'Universal', preventative services, under the Care Act 2014. A wide range of wellbeing and peer support activities were provided both at Haven House and across the city within diverse communities, including in different languages. Examples include dance, drumming, art, photography, drama, cooking, and darts sessions, facilitated, wherever possible, by qualified/trained carers and regular themed 'open events' where carers could meet a range of health and social care professionals in 'their own' space, breaking down power dynamics. Active participation from carers, through the use of Community Social Work skills, meant that carers were passionate about a project that was truly theirs. A close partnership was developed with the relevant Social Work team where information and advice events were co-produced, and a regular drop-in was held at Haven House by the Social Work team. The short-term contract lasted from 2014-2018 when, at that point, it could not be lawfully extended, and the commissioning cycle did not seamlessly continue. A small project, built on ethical peer support principles, was unable to maintain sustainability between the tendering rounds within the commissioning cycle (delayed on technicalities under Procurement Regulations) and had no alternative but to close the resource. A more flexible funding system would have allowed this innovative, partnership-building project to survive.  To find out more about the project contact its founder Vita Snowden (via BASW England: england@basw.co.uk )

Putting co-production at the heart of care

Q2. It is often difficult for people who draw on care and support and carers to exercise choice and control if they do not know what good support looks like or what kinds of care and support might be available. What information and support could be helpful to address this and how could it be made available more easily?

25.                     In looking at the way the Care Act is applied, there are currently different views about what can be done to meet needs.
26.                     The Local Authority is responsible for making decisions about how needs will be best met and making the arrangements to do so (where applicable), but they rely on the professional judgements of social workers in making these decisions.
27.                     BASW England believes that there should be greater recognition of the professional judgments that social workers make in Government guidance to local authorities. Such judgements are recognised in legal case law but are not referenced in existing policies and statutory guidance. This recognition is particularly important in circumstances where eligible needs are not being adequately met, as highlighted by the Ombudsman and ADASS. There has always been a tension between professional judgements that incur expenditure and ensuring that the local authority keeps within its budget, but it is not always openly acknowledged. We think that the distinction between social work professional judgement and a local authority’s duty to take cost factors into account should be more transparent, and that adults and carers should have a right to know how this distinction has been applied to their circumstances.
28.                     We believe that social workers should be empowered to clearly state their professional judgements when contributing to the local authority decision about how individual needs will be met, and to identify where there is under-met need and potential unmet need. This should be supported by employers and built into the routine of the way that assessment and care and support planning is undertaken, recognised within local complaints procedures and investigations by the Ombudsman.

Q3. We recognise that people with long-term conditions require different support at different points in their lives and that transitions, such as a change in health needs, moving from children to adult services, leaving education, starting a job or moving home, can be particularly challenging. Can you describe the key moments of transition from your experience? How have the formal processes worked during these periods of transition? What could or should have been in place to make these transition moments easier?

29.                     Below we have shared a summary of someone’s poor experiences of transition to adult social care.

Poor experience of Transition to adult social care:

30.                     My son who is autistic and has learning disabilities has been receiving support from children’s social care as a child in need in the form of a direct payment for over 8 years, reviewed annually. Personal Assistants were employed and the arrangements worked well with changes made over the years to meet his needs.  
31.                     11 months before my Son’s 18th birthday a thorough referral developed in partnership with my Son was made to the preparation for adulthood team at social care to advise them of the support in place and to initiate the process of transferring across to the new team as funding for support would then need to come from adult social care.
32.                     Communication was poor, we heard nothing until 2 weeks before my son turned 18. There was no handover, despite contact with the relevant team There was no commitment to honour ongoing funding of the direct payment. This meant that 2 weeks after turning 18 Personal Assistant’s contracts had to be terminated and caring responsibilities then fell to me in the absence of any other support. Because of the uncertainty about whether funding for support would be agreed it wasn’t possible to put anything in place.
33.                     The changes and the lack of preparation has had a huge impact on my son who struggles to cope with change. He has had the change from school to college, the loss of personal assistants with whom he had established relationships, leading to a loss of independence. Wider implications in terms of additional caring responsibilities meaning less time for other children in our family.
34.                     The uncertainty - left feeling in limbo , feeling isolated, incredibly stressful. Battling with the requirements of different systems and processes across education, health and social care with no idea when things will change or improve.

Q4. What does truly co-produced care look like for younger and for older people with differing challenges and needs? Have you got any good examples to share?

35.                     The 'Tick Boxes and Tokenism' report produced by Shaping Our Lives (2022) presented findings from a survey which looked at what might help people to take part in involvement activities.[1]
36.                     The report explored engagement prior to, during and after and the key themes that came out which investigated what may aid co-produced care. The group highlighted this as a good example to look into.

Q5. How can we design care and support arrangements which work both for the person drawing on care and support and for those who care for them?

37.                     There needs to be a range of ways for people to participate in the production and development of services and support.
38.                     Co-production and community social work skills are intrinsically linked. Enabling meaningful participation with people, families and carers requires a skilled approach otherwise this runs the risk of being tokenistic.
39.                     Very often engaging with people, families and communities is badged as a task of commissioning and not seen as an activity that requires skilled approaches to enable people to develop their skills and confidence.
40.                     Carer participation in this work and in local community life (e.g. a peer support group) is not 'free' (without a financial cost); resources and the right kind of skills need to be available to allow for successful, meaningful participation.

PART 2

Member engagement event responses – these are questions asked in the background of the call for the evidence.

41.                    How can we raise the profile of adult social care and increase everyone’s understanding of the important contribution which care makes to society and people’s lives?
42.                     A key theme from this discussion was that public awareness of the important role that social work and social care plays is incredibly important. Whilst BASW has a role in this, its crucial that government champions the workforce and the critical role they play in supporting lives of people up and down the country.
43.                     The Department of Health and Social Care has a clear role in telling the stories and making social work visible using its platforms.
44.                     People do not view their own cares needs through the lens of either health or social care, so its important that the government’s integration reforms ensure parity and that the voice of social care and social work is not lost.
45.                     The integration agenda provides an opportunity to push back against the ‘us vs them’ attitude that is often felt by social workers working in or with health settings. 
46.                     Voices from Local Authorities and social care must be at the table of Integrated care systems and included in future planning regarding NHS and care services going forward.

47.                    How can we stop people who draw on care and support and carers from being marginalised and taken for granted?
48.                     There was consensus among our members that carers are often exploited by the state to go above and beyond what is expected of them.
49.                     This is reflected in a perceived defunding of social care which not only impacts those who draw on care and support, but often the friends and family who are then expected to step up due to an over-reliance on carers.
50.                     It is important to recognise that carers themselves are often elderly or frail and may even have care needs themselves. The dynamic of relationships can also be affected, disregarding that a carer may need space and time away from the person they are caring for.
51.                     The role of social workers in helping to the make the system more humane and the advocacy of people’s rights should be acknowledged and valued, particularly in hospital settings.
52.                     The fragmentation of services and how opaque it is to challenge decisions and hold services to account was also raised. The difficulty in navigating processes to obtain benefits was also mentioned in the discussion.

53.                    How can people exercise genuine choice and control over their own care and support if society makes assumptions about who is available to provide care and what kinds of relationships families should have with each other?
54.                     New legislation was disproportionately skewed towards health and that the government’s favouring of providing resources to the NHS has meant social work has been squeezed so much that there are limited offerings to help families.
55.                     Funding doesn’t enable and promote relationships. As alluded to in the previous answer there are too many instances where a couple will have their own health and care needs which often leads to women having to care for their partners despite having their own needs, which also highlights gendered assumptions within care.
56.                     The outsourcing of services has discouraged joined up working, with choice and control being a myth in an age of marketisation within the current system.
57.                     Self-funders were raised as they are often having to pay more than they should because providers are compensating for Local Authority price caps. Privatisation and marketisation were mentioned again as reasons for this.

58.                    How can the social care system continue to support people who need it in the future if it does not acknowledge some of the assumptions that it is built upon, such as around the availability of carers, are becoming out-of-date?
59.                     A major criticism of assumptions made by government was that the community can bear the burden of many caring responsibilities.
60.                     It was agreed that this assumption was something that needs to be challenged. This is because it was seen that reliance on community is ‘cost free’ despite the pressure that already exists on many people. Even though most people will need to draw on care within their lives it is problematic that it is becoming accepted that the community can step up where funded services do not or cannot.
61.                     Acknowledging the scale of this problem is critical. The group agreed that government needs to raise awareness of disability, old age and the challenges faced by people which need to be promoted as part of public health planning.

27 May 2022