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Are social work values under threat?By: Linda Steele
Despite reassurances from health minister John Hutton that he wants social care staff to form a 'genuine partnership of equals' with NHS workers, many fear the profession's values are under threat. Linda Steele investigates Thus John Hutton sought to reassure his audience at a recent Guardian/National Institute for Social Work conference. It's a message he's repeated up and down the country. If the health minister is to be believed, why has the social care sector got the jitters? Why do many social workers feel that the values espoused by their profession are under threat? It's not just the old problem of social workers' poor public image (although that doesn't help). At times, the government's modernising agenda doesn't seem to leave much room for the social work contribution. A coalition of local government organisations and charities has been fighting a rearguard action against care trusts, which will provide health and social care services for adults, once the health and social care bill becomes law. While local health and social services are free to enter into partnerships, those that don't could find themselves forced into setting up a care trust. Leaving aside the question of whether forcing recalcitrant or underperforming authorities into "one size fits all" agencies will realise ministers' dreams of high quality, "joined-up" services, the fact that care trusts are NHS bodies has provoked concerns. Most important of these is "a significant risk that the broadly based community and social care model will lose out to a medical/clinical approach", according to the opposition. "People may have a range of health and social care needs but they have other needs - they might go to adult education classes or the library and may need support [with] those. Good social workers will know about other services, and can look at providing a package of support which recognises older or disabled people as active citizens who aren't just patients on the receiving end of medical services." And there's the argument in a nutshell. Social work values, so the theory goes, reflect a world view in which all individuals are treated as citizens within society, with rights, and worthy of equal respect. They also promote a vision of the individual as part of a social nexus in which the effects of one's environment - including family, friends, income and housing - are crucially important to one's health and ability to have a normal everyday life. Moreover, it's not the place of the social worker to be judgmental. "In intervening in people's lives to achieve change, social workers must recognise the interrelationships of structural and individual factors in the social context in which services operate, and the need to address their impact on the lives of children and adults." Pie in the sky? Some service users might think so. And no one could pretend that all social workers abide by these golden rules. But, while not every doctor or nurse sees only a walking disease to be cured as opposed to a whole person, differences in organisational structures, training and a body of knowledge and professional ethos can and do affect the way that service users are treated. Mental health is one key area. Government proposals could mean that the agreement of an approved social worker (ASW) to someone being detained under the Mental Health Act in England and Wales will no longer be required. The argument against such a move is that requiring both a psychiatrist and an ASW (rather than a mental health professional such as a nurse) to "section" someone means that a patient's social and cultural circumstances will be taken into consideration as well as their symptoms of ill health. Ray Rowden, visiting professor of nursing and clinical leadership at York University, says that: "[ASWs'] independence of the health hierarchy means they can ask difficult questions. If you allow others to fulfil that role, you get a much more overt medical model and you weaken the safeguard, where you look through another prism. A psychiatrist will see signs and symptoms, whereas an ASW will look at this woman as a mother who has a job. Sectioning may become too easy, a little less challenged." And the dilution of the ASW role is seen in many quarters as an attack on social work values. "It's very worrying. It's the result of a power struggle, [in which] health is the more powerful interest," says Ian Johnston, director of the British Association of Social Workers. "Health has been invaded by social care, for example through community care developments. We're increasingly becoming in charge of mental health, learning disabilities services and this is the backlash." Or, as one senior mental health expert - who didn't wish to be named - puts it: "It's another nail in the coffin of social work." But the same concerns don't appear to be surfacing in Scotland. One commentator argues that this is because there's a "reforming zeal" in Scottish social care which social work's representative bodies elsewhere in Britain have yet to unite behind. Carole Wilkinson, vice-president of the Association of Directors of Social Work, who moved to Scotland from England five years ago, thinks there are a number of factors at work. The first is a popular and political commitment to local authorities providing public services, which was lost in England during the period of contracting-out and privatisation under the last government. High quality services, brought about through education and training, are also important, she says. "There's also a strong emphasis not just on qualifying but post-qualifying training up here. It improves the confidence of workers, clearly improves their practice and says something about the way the Scottish executive and parliament value education and training in social work." While few will speak openly, some believe there's no parallel interest in social work and its values at the political centre in the south. It's thought that the health minister with responsibility for social care, John Hutton, has learned to appreciate the value of a social work dimension - if perhaps being as exasperated as everyone else at the scandals which hit the headlines from time to time. But some doubt that health secretary Alan Milburn, and others, such as Paul Boateng, the minister for youth in the Home Office, really have any time for social workers. Senior politicians, so this line of thought goes, see social workers as outmoded and incompetent. Some see it as a broader problem. The government simply doesn't trust local authorities, according to this argument. And yet there's also a view abroad which says that, far from attacking or ignoring social work values, the government has incorporated them into its thinking. The big anti-poverty, social inclusion and neighbourhood renewal programmes are all informed by them. One proponent of this view is Dorothy Statham, director of the National Institute for Social Work. "If you look at the government's modernising agenda, theirs is a rights and social justice approach, thinking holistically, looking at users' views. We used to be called woolly minded liberals for that kind of thinking." And the argument that social work values have not been lost - but social work may have lost its way - is made by Joyce Moseley, Youth Justice Board member and chief executive of children's charity, RPS Rainer. "Social work values are about communities and family networks … but, in the 1980s and 1990s, social services became increasingly prescriptive and individualistic," she said. While squeezed resources and a hostile Tory government had a large part to play in that, with a few exceptions, "social services haven't yet grabbed the agenda". That "modernising" agenda - set by government - is not all bad. Along with exhortations to work in partnership, it includes a strategy to drive up quality, including the move to a new, degree-level social work qualification and backing for a social care institute for excellence to promote what works best in social care. And then there will be the new agency to regulate the social care workforce in England, the general social care council, which opens for business this October. This, believe some, could be crunch time. "The crucial thing is that regulatory body will be far more eclectic than health care bodies, [and will include] social workers, clients and unions, which will have seats as of rights. It's very important that the profession thinks about who sits on that," says Mr Rowden. The GSSC will have a duty to promote high standards of conduct in social work training and practice. Could it prove to be the champion of a revitalised social work profession? Certainly, that's the official Department of Health line. "Social care has a unique contribution to make to the public services. And, says a spokesperson: "The tradition of social work and social care is a distinct one, and the social work ethic is not something that can be duplicated or replaced by clinical models." This recognition is genuine, believes Jennifer Bernard, CCETSW chief executive. "When the government came into power, there was a mistrust of social work and other public professionals." But, she says, the government's own analysis of social problems shows that "there's a need for social work in modern welfare services". And if ministers have come to realise that if there weren't social workers, someone would have to invent them, perhaps that - and a drive for improved training and service standards - will be enough to ensure the continuation of social work values as put into practice by a distinct group of professionals. Perhaps. |
