Care Bill [Lords]

The College of Social Work (CB 09)

Stage Briefing

The College of Social Work (TCSW) is the centre of excellence for social work and provides resources to its members to uphold and strengthen standards of professional practice. It holds the professional standards for social work, supports the professional development of social workers, and campaigns on issues relating to social work policy and practice. An independent membership organisation, The College provides quality assurance for initial and post-qualifying education through its training and education endorsement scheme.

The College is led by and accountable to its members, and as such this response was produced in conjunction with members of its Adults Faculty and policy champions volunteers.

Like colleges for other professions, our role is to:

· Hold the standards for the profession and support and enable our members to meet those standards.

· Be the voice of the profession to policy makers and the media, ensuring that our members speak up for the profession.

· Be led by and accountable to our members – the profession. We do this in order to improve the outcomes for the people served by our profession.

Wellbeing and Prevention and the future of social work

Late last year TCSW published a discussion paper, the Business Case for Social Work with Adults [1] , which sought to demonstrate the unique contribution social workers made to the lives of service users. We argued that in order to meet the agenda put forward by the Government, social work with adults, carers and families would have to reinvent itself and not rely upon the old verities of care management. TCSW made clear that local authority styles of social work must evolve from a paternalistic relationship with a caseload of ‘clients’ into a partnership with service users who aspire to be ‘active citizens.’

Over the past few years social workers have learnt to work on the basis of co-production, blending professional understanding with the knowledge of an individual’s own situation, preferences, networks and neighbourhood. The incorporation of personalisation and diversity into policy and practice better encompasses the highly complex circumstances many individuals are faced with, a point that is reflected in the Care Bill’s wide ranging approach to wellbeing.

This desire for change has been seized upon by the sector both on the frontline and at the strategic level. The President of ADASS Sandie Keene, writing in the report, The New Social Care: Strength Based Approaches, stated that "old-style social care saw people with problems. Today, we see people with potential, hopes and aspirations," before adding that the "the days of local authorities being paternal and risk averse are gone." [2]

While we agree that this person-centred approach is being steadily disseminated in policy and practice across the sector, it would be premature to declare that the risk averse, paternal approach to social care is over. Current systems are still strongly influenced and dominated by task orientated approaches, with care assessments viewed as a means of gathering evidence to inform what services an individual might require.

It therefore remains the case, particularly where resources are tight, for social work practice to focus upon case activities that are centred on essential tasks. This emphasis, which can be seen as a consequence of local authorities reverting to their statutory duties in the face of budgetary pressures, does raise questions as to how well poised councils are to implement the proposals outlined in the wellbeing and prevention clauses. Huge systemic challenges lie separate the Government’s aspirations from reality. TCSW is concerned that local authorities are not resourced to deliver a well-being and preventative agenda.

The current financial climate may be a considerable obstacle to successful system change. Local authority social care budgets have shrunk by £2.68bn over the last three years, while the Chancellor has outlined a further overall 10 per cent to be cut from budgets in 2015/16. London Councils have warned that the costs of implementing the new funding proposals under the care cap could leave the capital’s borough with costs of up to £1.14bn – equivalent to half the current annual cost of London’s adult social care. The rapidly rising cost of social care has also been documented by the LGA, with the body estimating that spending on care will pass 45 per cent of council budgets by 2019/20. [3] Significant shifts are already occurring. Last year the spend on social care made up around a third of the total council budget. This has risen to 41 per cent in 2013/14

At the same time, the average current spend on prevention of £588m in 2013/14 only makes up 4.2 per cent of the total social care budget. However, as the LGA warned in their adult social care spending round submission, reducing spending on prevention and early intervention is one of the only places left to look for further savings. [4] A ComRes poll of councillors for the British Red Cross revealed that local authority cuts to preventative care are leaving elderly and vulnerable people at risk, with nearly two thirds of elected members admitting that their local authority had cut or frozen funding for preventative and lower-level social care since the last local election. Cuts to preventative services are averaging around 16 per cent. Sixty-nine per cent of councillors who’ve experienced cuts said that people in need will not receive the care they need. [5]

Wellbeing and prevention and the national eligibility threshold

Underpinned by the wellbeing principle, the Bill proposes a complete makeover of the car e system. The language used by the Government suggests that services will no longer be barred to all but the most vulnerable and desperate, and rightly discredits the current model in favour of one which mobilises the resources of communities to support people well before they reach crisis point. The Government has indicated that it wants to build a system that promotes independence and reduces dependency.

TCSW was therefore disappointed when in June the Chancellor George Osborne announced that the national minimum eligibility threshold would be set at a level equivalent to ‘substantial’ under the current guidance framework. TCSW had argued that ‘moderate’ would allow for local authorities to better respond to the needs and wants of individuals seeking care and support. TCSW would argue that setting the threshold at the substantial band could fatally undermine this intent. While we acknowledge that the resources required to support the individuals with support needs at this level form the bulk of social care spending, it is only allocated to those whose needs are greatest, and who represent only a relatively small subset of people with care needs. TCSW contends that such an offer is unlikely to reduce dependency and promote independence.

However, it became apparent when gathering responses from social workers in anticipation of this response that even arguing for a ‘moderate’ national threshold would not go far enough. There is a view among a significant number of social workers, many of whom will have already experienced several major reforms of social services during their careers, that the care system is fundamentally flawed. While there is widespread support for a Bill that looks to put into legislation the principles of wellbeing and prevention, there are serious reservations regarding the capacity of a system that is intrinsically built around managing deficits to meet these aims.

This in turn raises a bigger question regarding the course the Government should take. While TCSW acknowledges that the regulations set out in the discussion document should be understood in the context of the wider Care Bill, we are concerned that they offer more of the same in terms of focussing on care activities that are centred on essential tasks. Past evidence would suggest that this approach will never be able to fully address the full circumstances of a person’s life.

While social work assessments are supposed to focus on needs, the reality is that need is usually interpreted in the light of available resources. While in principle the two are distinct, practice can be very different. Strategic decisions can have a huge impact on the services available to individuals.

Social work assessments, coupled with people’s own self-assessments, should determine the nature and extent of the care packages that people receive. In reality, though, the principal determinant is too often the availability of resources. These resource allocations are often based on historical costs of meeting a certain group of needs. As explained below, this fails to acknowledge that:

· The growth of personalisation has resulted in more varied approaches to meeting need altered the associated costs;

· There is no straightforward correlation between a given level of need and the cost of meeting it, at least if the varied nature of people’s needs and choices are properly taken into account;

· That the cost and availability of services varies from one area to another only compounds this issue further. Resources that may be appropriate to respond to the needs of an individual in one area may be insufficient in another. As such two individuals with identical needs living in two different parts of the country may be receiving profoundly different services. The Government’s proposals do little to alter this fact.

What the Government needs to consider

TCSW is urging the Government to radically consider the scope and purpose of this consultation. As we have demonstrated, local authorities facing severe financial pressures are likely to cut services that matter most to delivering the care and support agenda outlined in the Care Bill. We have seen instances in the past where progressive agendas have been submerged by financial realities. TCSW is fearful that the situation here will be no different.

We would argue that the Government:

· strongly reconsider the merits of a national minimum eligibility threshold that continues to focus on deficits;

· consider an approach to prioritising needs to enable consistency of response across the country without compromising the uniqueness of each person;

· consider how assessment and resource allocation can be properly separated, leading to care and support planning that meets all needs as necessary to deliver independence and wellbeing.

January 2014