Self-Directed Support: Social Workers’ Contribution
Andrew Tyson
on behalf of the Social Work and Care Management Project Group
May, 2009
This paper is one in a series from In Control’s Total Transformation Project 4 on social work, one of ten Total Transformation projects. Together these projects will enable Local Authorities to address outstanding challenges on the path to transformation.
Introduction and Context
This project will provide a set of tools to contextualise, evaluate, prepare and convert care management capacity in a Local Authority for the transformation to Self-Directed Support system.
The purpose of this paper is to assist Authorities in beginning to think about what role, if any social workers might have under a system of Self-Directed Support.
This project has important links and dependencies with projects 8 and 9, on Workforce and Safeguarding.
The project outputs should be seen in the context of the work of other friends and colleagues, particularly those in Local Authority Social Care and Social Services Departments across the country. The project is working in concert with the Department of Health’s Personalisation Team and their social work project, led by Ali Gardener and Brian Cox.
In Control has produced a number of earlier papers on care management, social work and related topics. They are listed in the References section below. This project builds upon this earlier work, and on the learning from Local Authorities in the Total Transformation programme.
Social Work and Care Management
In its 2008 paper, Social Work at its Best, A Statement of Social Work Tasks for the 21st Century, the General Social Care Council sets out a series of core values and principles. It quotes favourably “a widely accepted international definition” of social work:
“The social work profession promotes social change, problem solving in
human relationships and the empowerment and liberation of people to
enhance well-being. Utilising theories of human behaviour and social systems,
social work intervenes at the points where people interact with their
environments. Principles of human rights and social justice are fundamental
to social work”
The Statement goes on to list a series of situations which it says require social work skill and expertise, and the outcomes of social work intervention, the first of which is “more control for people over their own lives and the decisions which affect them.”
In page 153 of his book, Keys To Citizenship (2003), Simon Duffy talks about what he calls the professional gift model, where “care comes as a gift, something you cannot control or reshape, something decided for you by the professionals who have decided what you need.” Under such a regime “the disabled person is left entirely powerless, receiving the kind of help that someone else has decided is right for them.”
Most registered social workers will recognise more than a grain of truth in this; many will say that this state of affairs an unintended consequence of the professionalisation of social work and of social work’s role within an operating system that is now failing. Many will point to their traditional advocacy role on behalf of their clients, and will say that they have in fact acted as the grit in that old operating system, a cog in the machine that has brought individual needs to the fore wherever this is possible. Most will agree however, that care management hasn’t worked well for disabled and older people or for families, and that we now need to move on. What we now need, many social workers say is a new kind of professional social worker, a social worker who is encouraged to recognise and respect a very different power relationship between the citizen and the state, one where “professionals” of whatever discipline are clear that their skills must be made available to cherish, value and empower people, and never to disrespect them or turn them away.
With this in mind, In Control recognises and applauds the GSCC Statement, and welcomes in particular the clearly articulated commitment to promote choice and control.
Our observation is that in reality many Local Authority social workers are still asked to practice in ways very different to this. Since the early 1990s they have been asked to operate as care managers, that is as gate-keepers of the social care system, where their main focus is assessment and apportionment of resources to individuals. These tasks are important but they are not social work as defined above. Many of the gate-keeping tasks are of course also carried out by staff other than social workers. In any event, they are “old system” tasks.
In his 2007 paper on Self-Directed Support and care management, Simon Duffy quotes the 1989 White Paper, Caring for People which defined case management (not care management – but the two terms were used almost interchangeably at the time) as: .…an effective method of targeting resources and planning services to meet specific needs of individual clients. ...To be effective case management systems should include:
¨ Identification of people in need, including systems for referral
¨ Assessment of care needs
¨ Planning and securing the delivery of care
¨ Monitoring the quality of care provided
¨ Review of client needs
This process as it came to be practiced in Social Services in England in the 1990s and 2000s was described in more detail in our earlier paper, Citizenship Through Social Work.
So, to be clear, as we use the terms:
Social work is a profession, based on a particular ethos, education and skill set. The title social worker is now protected and regulated by the General Social Care Council (GSCC);
Care management (or case management) is a function, one set of tasks in the old social care system, and one which can be carried out by a variety of people, social workers and others.
Self-Directed Support
Self-Directed Support is of course the new operating system which In Control pioneered, and which is at the heart of the social care systems on the path to “personalisation.” In Control defines this as:
“Support that you decide and control. You control the money for support – your Budget. You choose what support you want and how to spend your Budget. You can get help to do this if you want.”
As is now well known, there are seven steps involved:
My money - finding out how much. The first step is to complete a person-centred assessment or supported self-assessment so that the person knows whether they are entitled to support from the Local Authority, and if so how much that support is likely to be worth in terms of a Personal Budget.
Making my plan. The second step is to work with others to create a support plan to set out what is needed to get a good life. Importantly, this process includes determining how the Personal Budget is used – alongside “free support” from family friends or community, and any other resources the person brings.
Getting my plan agreed. A manager from the Local Authority then signs off the plan. They will be looking at whether it moves towards meeting the person’s aspirations, and whether it is realistic and affordable.
Organising my money. The fourth step is to work out who is best placed to receive and take care of the Personal Budget. In Control suggests that there are six options: the person him or herself, their representative, friends and family, an independent organisation, a service provider or a professional.
Organising my support. The person then –with whatever help is necessary- identifies and organises their support in a way that makes sense to them. Increasingly, technical solutions such as Shop4Support will help with this. People may also need assistance with insurance, management and employment issues.
Living life. The sixth step is to get on with life, spending money, receiving support – and making a contribution in whatever way. The essence is to use funding and supports in ways that are flexible and which respond to life’s challenges and opportunities.
Seeing how it worked. Finally, things are reviewed. This is a process of reflection, learning, and feedback. The plan for the period ahead needs to change as life moves on.
(this definition is adapted from the one given on the In Control website)
This, then is the new operating system, which is at the heart of transformed Local Authorities’ social care services. Currently these Authorities employ a workforce which includes significant numbers of professionally trained and accredited social workers. A key set of questions for transformed systems is:
· Does the new systems need social workers?
· If so, what might be their contribution, and how does it fit with that of others?
· What is needed to equip social workers for new roles and responsibilities?
An important contextual point, stressed by the GSCC and made by a number of people in the course of our work: social work is, at its heart about human relationships and capacities. It is, in particular about relationships which support people at times of difficulty and stress in making and enacting realistic plans for the future, plans which keep them connected and keep them safe. Professional social work is not now and can never simply be about “seven steps to Self-Directed Support”: it is about individuals of all ages and from all cultures in relationships, families, institutions and communities, and about their hopes, dreams and aspirations, and the resources they have at their disposal to make these real.
This of course is also the wider context for Self-Directed Support (and for personalisation). An awareness of this wider context needs to inform the way Local Authorities proceed with their change programme.
Social Work and Self-Directed Support
With this in mind, the table in the following section seeks to set out the tasks and skills required to complete the seven steps. It tries to define where social workers might sit to help with a particular task. It attempts to define the distinctive role of the social worker in this. We are not asserting that there is any task in the list that can be done only or always by social workers: but we are suggesting that in many instances, in practice social workers are often best-placed to undertake a given task. The education and experience of professional social workers should be seen as a valuable resource for many Local Authorities, and as those Local Authorities plan the route to transformation this resource is one they will need to consider.
More than this, though: as we continue to refine and test the new operating system, now in scores of Local Authorities in England, where more than ten thousand citizens are getting control of their lives through Personal Budgets, we are faced with a number of new challenges. These challenges include:
¨ a deep economic recession, with its impact on local economies and on public sector finances;
¨ what Professor Luke Clements calls the “industrialisation” of the new operating system – moving beyond a few small pilots, with dedicated resources and innovative trail-blazing staff;
¨ a growing realisation that personalisation simply cannot be effective if it is restricted to one area of work (“adult social care”) and not take root in others – children’s services and health in particular.
Professional social workers offer much in precisely these three areas: a focus on economic disadvantage; familiarity with the vagaries of Local Authority systems and procedures; and skills in thinking and working with whole systems.
It is perhaps this last –the absolute necessity of a focus beyond the individual which we have recognised as now needing most attention: Nic Cosby and Pippa Murray have developed and promoted the concept of real wealth (this is described in the paper by Duffy and Gillespie on Community Capacity and Social Care and by Crosby and Duffy on the whole life approach)- strengths, connections, understanding and assets – a mix of gifts and attributes which we all have to varying degrees, and which all citizens using Self-Directed Support bring to the table. The ethos and focus of professional social workers, as the GSCC sets it out should mean that the profession is almost perfectly poised to work with people in just this way: to amplify strengths, make connections, foster understanding and capitalise on assets. Whether the profession can do this in reality is highly dependent upon the culture of each Local Authority, and upon their explicit and implicit expectations of the social work workforce.
The table below was developed by discussion with the eleven Total Transformation Local Authorities who are members of the social work project group; it was informed by a workshop at In Control’s Big Event in March, 2009; and by a second workshop with In Control authorities in London and the South East in May, 2009; and by work by John Waters in discussion with social workers in several Local Authorities around the country. The table is prefaced by an overview statement about the role and tasks of social work in a transformed system.