As a membership body, our view of an issue is a strategic view, informed by our members.
We find a number of ways to get that view across: responding to consultations and calls for evidence; briefings to MSPs; event reports and publications based on our own work.
Ending the need for food banks: consultation on a draft national plan
Social Work Scotland is the professional body for social work leaders, working closely with our partners to shape policy and practice, and improve the quality and experience of social services. We welcome this opportunity to comment on Scottish Government’s draft plan to end the need for foodbanks. We recognise its importance in the delivery of services that are human rights-based, and person-centred, and the critical understanding of the impact of, and correlation between poverty and social inequalities.
As a result of poverty – not a shortage of food – too many people don’t have enough food in Scotland. People in communities across the country have responded incredibly to the growing need, whether by volunteering at a food bank or donating cash and food. Yet there is widespread agreement that food banks should not need to exist – everyone should have enough money to buy food and other essentials. As noted within the consultation document “The primary driver of food insecurity and the need for food banks is insufficient and insecure incomes”.
As social workers, we see poverty within the wider framework of human rights, equality of opportunity and of social, economic and environmental justice; poverty restricts people’s choices and their ability to take part in society.
Social Work Scotland supports the basis of compassion, kindness, respect and the upholding of human rights that has been used by Scottish Government in the development of the plan to end the need for foodbanks as a primary response to food poverty. It is also heartening to see that Scottish Government recognises the innovation, commitment to fairness, partnership approaches, and integrity that has been and continues to be, demonstrated by Social Workers and other public services at the height of the COVID19 pandemic response, and that the learning from this period is the foundation to this response. We are entirely supportive of the Scottish Government’s vision that;
“Everyone has a sufficient and secure income to be able to access food that meets their needs and preferences. Where financial hardship does occur, coordinated local responses prioritise access to emergency financial assistance and money advice alongside access to holistic support services. Where help to access food is needed, this is provided in a way that maximises dignity and reduces future need. Delivering this in practice will take leadership and action at all levels across Scotland”.
The equal focus on prevention and response is much needed and demonstrates an understanding of the requirement to have a multi-tiered approach to address this complex issue. It is important that whilst prevention of food insecurity is the aim, there remains support available to people who require practical support, and that this support is rooted in the values of dignity and respect. The approach also demonstrates the interconnectedness of income, employment opportunities and the cost of living, and their impact on individuals and families.
Whilst there is undoubtedly a huge amount of initiatives both in place and planned, the complexity of associated and contributory factors that have led to the increased use of, and need for, foodbanks over the last five years, make it impossible to say whether these will result in a reduction in their use. That said Social Work Scotland broadly supports most of these initiatives. In particular, the commitments made in the Fair Work Plan, and the work being undertaken via Social Security Scotland to maximise income from social security. These, alongside preventative measure such as those introduced to address the cost of living; the increase in free childcare hours, the introduction of national money advice services, and the commitment to the expansion of eligibility to free school meals for all primary school age children, will undoubtedly have a positive impact.
We would however, urge caution over the use of shopping vouchers in place of food bank referrals as there is the potential that these would further stigmatise individuals and families who are experiencing food insecurity. Their use may be a very good alternative for some; however, this would require careful thought, planning and consultation before being introduced as a policy. Related to this, a further exploration of the concept of prepaid cards such as those used in the “Best Start”scheme, which includes consideration of unintended consequences – such as stigma, would be helpful. A Menu For Change has also done helpful research on the effects of shame on accessing support services around food inequality.
As above, whilst the commitments outlined within the consultation paper are positive, due to the complexity of the issue it is impossible to say what impact they will have on the need for food banks as a primary response to food insecurity.
The commitments outlined demonstrate a, much-needed, broad lens with which to view and address the issue of food insecurity. As noted above, food insecurity sits alongside wider poverty issues and particularly for children, areas such as school uniforms, attainment gap and access to leisure. Therefore, effective tackling of food poverty needs to sit alongside the wider poverty agenda.
The impact measures outlined within the consultation document are robust. It would be helpful, as part of the collation of information from funded activities, as outlined in point 21, if qualitative data was collected, so that lived experience guides any future developments.
(will add text from our introduction here) plus the below
It is important to note that there will likely be an increase in need for food banks in coming months given the current fuel crisis, coupled with the ongoing impact of the UK’s exit from the EU, and the COVID19 pandemic. Social Work Scotland would also like to take this opportunity to note that social work services and charities have always provided food and fuel emergency provision in response to crises, and that crisis need is likely to remain, despite the laudable and right aim to reduce/end use of foodbanks.
A National Care Service for Scotland
SUMMARY OF SUBMISSION FROM SOCIAL WORK SCOTLAND, TO SCOTTISH GOVERNMENT CONSULTATION
Social Work Scotland is the professional body for social work leaders, working closely with partners to shape policy and practice, and improve the quality and experience of social services. We welcome this opportunity to comment on the Scottish Government’s proposals for a National Care Service, and related reforms to social care, scrutiny, improvement, etc.
This paper provides a summary of Social Work Scotland’s consultation response, profiling our position on key sections and issues (as identified by Social Work Scotland’s members). It is organised in the sequence we think issues must be considered, considering the social care system’s critical importance to the health and wellbeing of the nation, its complexity and delicate interdependencies, and the real risks to people if this process of change is not deftly planned, properly resourced and expertly managed.
Please find our full response paper (PDF) here.
Please find our supplementary papers (PDF) here:
Adult Support and Protection code of practice & guidance
Consultation on the Adult Support and Protection (Scotland) Act 2007: updated Code of Practice and Guidance for Adult Protection Committees
SUBMISSION FROM SOCIAL WORK SCOTLAND, TO SCOTTISH GOVERNMENT CONSULTATION
The impact of the COVID-19 pandemic on equalities and human rights
JOINT SUBMISSION FROM SOCIAL WORK SCOTLAND AND SCOTTISH ASSOCIATION OF SOCIAL WORK TO THE SCOTTISH PARLIAMENT’S EQUALITIES AND HUMAN RIGHTS COMMITTEE INQUIRY
13th January 2021
Social Work Scotland is the professional body for social work leaders in Scotland. The Scottish Association of Social Work (SASW) is part of the British Association of Social Workers, an independent membership body for social workers across the UK. Both organisations work closely with partners to shape policy and practice and improve the quality and experience of social services. We are responding to this inquiry together, bringing together the views of frontline social workers and managers who are employed in the public, private and voluntary sectors, as well as those operating as independent practitioners. Our joint membership is diverse, and being located across all parts of Scotland, experiences throughout the pandemic have been highly variable, in line with the differences decisions and approaches taken by local areas. We profile in this submission here the common themes to emerge from their feedback over the past ten months.
QUESTION 1: HOW HAVE GROUPS OF PEOPLE BEEN AFFECTED BY THE VIRUS?
In assessing COVID-19’s impact on equalities and human rights it is helpful to distinguish between the effects related to (a) the virus and disease itself, and (b) the actions taken by public authorities to contain the spread of the virus and protect vulnerable groups, access to emergency services, etc. Social workers have been involved throughout the pandemic in mitigating the impacts seen in both domains (albeit the majority of our activity has focused on the issues created by state efforts to contain the virus, which have affected every member of society in some way).
(A) Impact of the disease
As has now been well documented, the disease COVID-19 does discriminate. It has, to date at least, disproportionately affected older people, those with underlying health conditions, members of our Black, Asian, and other Minority Ethnic communities, and people with low incomes or precarious employment (e.g., zero-hour contracts). The reasons for this prejudice are various, including, in these groups, higher than average numbers of people living together under the same roof (be it a care home or family home), exposure to the virus through public facing roles (e.g., public transport workers, nurses and healthcare assistants, etc.) and above average rates of pre-existing co-morbidities (e.g., diabetes, obesity, hypertension). These factors coalesce together into an increased risk of catching the virus, and then an increased risk of the virus manifesting a serious or fatal response.
The impact of these increased risks has manifested in many ways, with individuals and families affected by some or all of the following:
Stress and anxiety
Loss of income
Loneliness (reduced human contact and self-isolation)
Recovered but with “long covid”
Time in hospital
Decline in mental health
This is not an exhaustive list, but it illustrates that, for those who have caught the virus the potential impact on their human rights cannot be more serious, with loss of mental and physical health, work, and even life. And with the knowledge that the COVID-19 virus does not affect all groups in society equally, but that all groups are interconnected, it is understandable that governments around the world have taken such drastic all-of-society action in their efforts to contain it.
(B) Efforts to contain the virus
The public health measures introduced to slow the spread of the virus only have historical comparators in wartime. Every aspect of life and every individual, family and community has been affected. The scale and severity of restrictions (on the economy, social contact, movement, etc.) has meant that the virus, directly or indirectly, has impacted the rights and wellbeing or every person in the UK. But as with the discriminate impact of the virus, affecting some groups more than others, the impact of efforts to contain it have not fallen evenly on society. As social work practitioners and managers we have had a front-line perspective on this throughout the pandemic; particularly in respect to people who are vulnerable or need additional support, for whom we provide or coordinate services. This includes children, families, parents, carers, adults with disabilities, older people and people involved in the criminal justice system.
Among the many impacts of restrictions over the past year, of particularly note in respect of this inquiry are:
Increased levels of poverty
Digital poverty / inequality
Disruption to referral routes for social work and social care
Disruption to social work, social care and community services
Increased isolation and loneliness, impacting on mental health and wellbeing
Increased pressure within families
As with the impacts of the virus itself, this list is far from exhaustive. What we have tried to illustrate is that the restrictions imposed have surfaced the significant inequalities which existed in society before the pandemic. And, moreover, that the fulfilment of people’s human rights relies on a broad base of civic and public services being accessible. This is particularly true for people and families with fewer socio-economic advantages. Remove the scaffolding from around individuals and communities, and the structure is less resilient to major external and internal stresses.
QUESTION 2: WHICH GROUPS HAVE BEEN DISPROPORTIONATELY AFFECTED BY THE VIRUS AND THE RESPONSE TO IT?
Children, as a cohort, have been particularly affected because of the disruption to education (from early learning and childcare through all stages of school) and the dramatic reduction in opportunities for play, peer and extended family interaction, creativity, learning, travel, etc. These opportunities, complementing formal learning, shape the adults we become. The absence of school and other child/youth activities has also significantly reduced the chance to identify issues early and offer help. That is particularly problematic for young people’s mental and physical health. The long-term legacy of these COVID-19 months is yet to be seen, but it is children and young people whose lives will be most shaped by it. The world of employment will be changed (possibly with fewer of the sort of jobs young people begin with), and public debt built up to underwrite the government’s response will shape public and political debate for decades to come. At an individual level, disruption to schooling and issues with mental health may determine many future choices.
Within the cohort of ‘all children’, specific groups have been affected more than others. For example, those affected by domestic abuse. Levels of domestic abuse in Scotland have been a persistent concern for social work, charities and policy makers for many years, but on the basis of calls to third sector helplines, the pandemic has led to increased prevalence. This is consistent with what we know about domestic abuse, and its relationship to wider stressors within the family. With services reduced or closed, and people encouraged to isolate as much as possible, we have reduced our collective ability to spot and respond to cases at the early stages. This has limited our capacity to protect the rights of children (and others impacted by abuse within the household). Our experience suggests that much greater support is needed for non-abusing parents and children, and that we must engage much more effectively and assiduously with perpetrators. Many local authorities and organisations were building these strengths-based approach (such as the internationally recognised Safe and Together™) at the start of the pandemic, but unfortunately work in some areas has had to be delayed to accommodate other priorities.
The true extent of child sexual abuse and child criminal exploitation through the pandemic has been hard to gauge, but we expect it to have increased. Third sector colleagues and the police draw attention to the significance of interaction between technology-assisted and direct contact abuse, and with the move of children’s lives online, the increased risks. The pandemic has underlined the need for a closer examination of the context of abuse outside the family, and a consideration of how to intervene in both physical locations and online platforms (a theme explored in a recent Social Work Scotland hosted seminar). More generally, ensuring child protection during COVID-19 has been challenging, with the everyday monitoring provided by schools and other universal services reduced or removed. Social work professionals themselves have been restricted in their ability to interact with families, with reductions in home visits, supervised contact, etc. Colleagues report concerns about patterns of Forced Marriage, Female Genital Mutilation and Honour Based Abuse.
There has also been a disproportionate impact for children involved in the Children’s Hearings System and courts. Permanence decisions have been delayed, existing Orders have been rolled forward without expiry date (meaning that families risk being subject to state intervention longer than necessary), and only priority case have been heard by Children’s Hearing panels, potentially limiting access to services from social work and others. Figures provided to the Scottish Government (as part the monitoring of COVID-19’s impact) indicate that since March 2020 there has been a significant reduction in the number of children becoming looked after away from home. At this stage there is not enough data and intelligence to confirm whether this is as a result of system changes or limited access to resources and not necessarily because of reduced need or better practice. This needs to be explored to ensure that children’s rights are not at risk from inaction.
The challenge of promoting the relationships and wellbeing of children looked after away from home has been accentuated by COVID-19. Social Work Scotland has been central to the development of a framework for decision making about contact, assisting practitioners make extremely difficult decisions. For example, there have been significant challenges around contact, for example between children and birth parents, balancing the benefits with risks, such as spreading the virus to foster or kinship carers (often an older population) or between different parts of the country (which may have different rates of infection and restrictions in place). The limited number of safe physical environments for indoor contact has further restricted options.
Social workers have consistently reported how stretched and affected many kinship and foster carers, and the children in their care, have been, with individuals feeling isolated and disconnected from their normal networks (formal and informal) of support. Local areas have done creative work using virtual support and new models of practical, material help, but for many of these families it has remained a very difficult year. We take heart from the adaptation and resilience the families have shown, and the positive stories emerging of, for instance, effective family group decision making taking place which have kept children out of the care system.
Families with children who have complex physical or learning needs have been particularly impacted by the closure of educational settings, having to assume 24 hour responsibility for care and education. There are specific risks for these families in terms of isolation and burn out without frequent opportunities for support and respite. And for those at or near school leaving age, the crucial transition planning for people with additional support needs (enabling them to make successful moves into further and higher education, or employment) has been disrupted, opportunities restricted.
Adults living in care homes, whether older people or adults with complex needs, have been disproportionately affected by the virus and the response. In the first phase on the pandemic, there were high levels of excess deaths (compared to the weekly 5-year averages for 2015-19, not all of which were recognised on death certificates as COVID-19 related during the period before testing became more widely available.
Some social care workers in residential homes, and also in the community, have also died as a result of contracting COVID-19 through their work, as sadly has been the case for other groups of essential workers.
From a social work perspective, it became increasingly important to ensure that people’s human rights and mental health were being considered alongside (rather than secondary to) clinical excellence and infection control. Issues as varied as discharges from hospitals to care homes, restrictions on visits, limited interaction within homes, mass testing, use of Do Not Attempt Cardiopulmonary Resuscitation forms, have all presented complex and nuanced decision making. And they have proved highly problematic for many care homes, especially those supporting people with cognitive needs. The enhanced oversight of care homes duty, placed on Chief Social Work Officers and other professional leaders, was an attempt to ensure a balanced assessment of risks, rights and needs in shaping local strategies. As we write, the vaccination programme is being rolled out through care homes, and we hope this will enable residents to access their rights to see family and friends, and to ensure they get the full range of services and supports they need.
At the core of the social work role is public protection; assessing risks and benefits in an ecological model, with the aim of securing the best outcomes for an individual, with their needs and wishes met and interests protected. In some instances, social workers are empowered to take actions to protect the interests of an individual, possibly bringing them into conflict with the individual or their carer / family, who wish to take a different course of action. This is a difficult but essential role in a society where not all individuals, whether due to incapacity or circumstances, are in a position to determine their best interests alone. And while families have a undisputed right to inform and lead decision-making in such instances, it is the case that they do not always have access to all the information, or necessarily have the rights, needs and interests of the individual as their primary concern. Over the course of the pandemic, with the social work profession’s ability to perform this role has been restricted, leading to concerns about the welfare of such as for adults with incapacity. Due in reduced reporting channels (fewer agencies and primary care contact with people and families at risk of crisis) and restrictions on movement and interaction, it has been difficult in some cases to ensure the rights and welfare of some individuals’ are being maintained.
Early intervention and community supports are critical to maintaining good mental wellbeing and mental health. Where these are not available, we can expect to see more people reaching mental health crises. This is likely to be compounded where the economic situation is worsened. With people’s mental health needs going unmet, detention – a deprivation of an individual’s liberty – is being considered more frequently than we, as a professional group involved in such decisions, would like to see it. As officers of local authorities within partnership arrangements, Mental Health Officers (specialist social workers with additional qualifications in mental health) are not sufficiently empowered to ensure provision meets assessed need. To ensure the rights of individuals with mental health issues are upheld, MHOs (and other relevant professionals) need access to specialist and community resources, over which people are offered choice and control. We believe that decisions regarding detention should be made after face-to-face assessment of patients, but we are aware that due to staffing constraints, this is not always the case. Whilst the number of people being detained due to their mental health has risen during the pandemic, this is in line with year on year rises. There is evidence, however, from the Mental Welfare Commission that some of the safeguards around detention have been used less frequently than previously. We are concerned about the critical shortage of both MHOs and “Section 22” medical professionals. We note that the Tayside Independent Review report “Trust and Respect” was explicit in finding that a shortage of Registered Medical Officers impacted detrimentally on the patient’s journey.
People who are homeless initially benefitted from the programme to ensure that everyone was off the streets, and the route map for “Everyone Home” has been developed to make asking about homelessness an expectation across public services. However, in order for this success to stand beyond the pandemic, public services must continue to be resourced appropriately to attend to the multiple underlying structural causes of homelessness (including additions, mental health, debt, etc.). Otherwise, we risk returning to pre-pandemic levels of homelessness (or higher, considering the precarious financial situation many people face), with the additional challenge of a diminished voluntary sector, its finances limited after a year of reduced income.
(C) Adults involved in the justice system
Justice Social Work delivers reports to Scottish Courts, provides or commissions community-based programmes as an alternative to prison, and is responsible for a range of expert risk assessment support to the police, prison service and Parole Board. Requirements for physical distancing, and the universal impact on staffing through sickness, isolation and redeployment, have reduced the ability of justice social workers to deliver group programmes and coordinate unpaid work activity. This has a very significant impact, in terms of rights and equalities, on the individuals subject to relevant courts orders, effectively extending sentences and prolonging involvement with the justice system.
Both Social Work Scotland and SASW have articulated concerns to the Scottish Government around the backlog of community order ‘unpaid work’ hours. We believe that without a systematic reduction in the number of outstanding unpaid work hours (through revocation or variation of orders) there is a major risk that Justice Social Work (JSW) will be overwhelmed, with serious consequences for the wider justice system and the rights of both social work professionals and individuals and families, and victims. Whilst some funding has been made available to buy in support from the Third Sector, this will not release the number of hours necessary to meet the backlog in demand.
Before the Coronavirus pandemic there was an increasing focus on expanding early intervention measures such as Diversion from Prosecution and Structured Deferred Sentences which help individuals to avoid unnecessary contact with the criminal justice system and deliver swift interventions which can interrupt a cycle of offending. Many of the strategies now in place to deal with the backlog within the justice system require heavy input from CJSW, but simultaneously the capacity of CJSW has reduced.
People in prison have experienced significant additional curtailments to their rights as visits, time out of cell, meaningful daily activity and access to fresh air have all been reduced. Numbers of people on remand have increased as has the length of time people are remanded impacting on people’s lives, housing, work finances and relationships. Children who have a parent or sibling in prison will experience the removal of the person from their lives in a more extreme way than even prior to the pandemic.
QUESTION 3: HAVE THERE BEEN SPECIFIC EQUALITY OR HUMAN RIGHTS IMPACTS ON GROUPS OF PEOPLE AS A RESPONSE TO THE VIRUS?
The Scottish Human Rights Commission (SHRC) recently published a report into changes to social care provision during COVID-19 and its impact on human rights. It details the experiences of individuals receiving health and social care support, with a focus on the rights of persons with disabilities, older people, carers and children. The testimony of many of those who participated in the research is distressing, highlighting the serious consequences for individuals when support cannot be accessed.
The context around these experiences were the efforts of NHS, local authorities and independent care providers (working together as Health and Social Care Partnerships) to ensure support was available to meet all assessed (and anticipated) need, within safe staffing levels. Plans took into account high rates of staff absence, due to sickness and isolation. The restrictions, and necessary steps to protect staff, meant that many social workers and social care staff would be limited in their ability to work. The focus was on protecting critical services for those most in need. However, the timeframe for how long this would be needed was not clear at the outset, and the working assumption was that measures to reduce care packages for some (to ensure some access for all) would be required for weeks, not months. It is clear now that the impact of these measures varied across Scotland, reflecting different levels and types of pre-pandemic service provision and workforce demographics. But in all areas of Scotland those requiring social care support, and those caring for them, have been disproportionately affected by the pandemic because of the limits the reductions of support place on an individual’s independence (beyond the national restrictions everyone has had to adapt to).
Because many face-to-face support services such as day centres and support groups had their operations significantly reduced as a result of public health requirements, the pressure of continually caring for people during the crisis will also have had an effect on the wellbeing of carers. Carers who support their family members or friends to live independently have experienced isolation and reduced support, with many increasing their caring hours to protect the supported person from additional footfall into their homes and related risks of exposure to the virus.
The SHRC report calls for the social care system to be reimagined as a dynamic interplay within a social infrastructure which supports citizens’ human rights as individuals within families and communities. SASW and Social Work Scotland agree strongly with this vision, but take this opportunity to emphasise that it is only possible when the system is populated by sufficient numbers of skilled people, committed and enabled to deliver the best outcomes for individuals. Such a system, requiring a significantly larger ‘workforce’, is not possible within current funding levels. A return to pre-COVID-19 structures and mechanisms of support, even if funding were increased, would not address the issues flagged by the SHRC report.
It is likely that one of the effects of the pandemic will be to increase the number of people needing health and social work and social care support as a result of:
We take heart from examples highlighted in the Care Inspectorate’s report, ‘Delivering care at home and housing support services during the COVID-19 pandemic’, where local partnerships successfully adapted and flexed their support to meet people’s needs during the pandemic. Teams in local government and the voluntary and private sectors have innovated and adjusted, put people’s needs before contractual hours. The capacity for change and positive reform is in place, and we look forward to the upcoming discussions about how to realise that, in response to the Independent Review of Adult Social Care.
Question 4: What do the Scottish Government and public authorities (e.g. local authorities, health boards etc.) need to change or improve: as a matter of urgency & in the medium to long term?
This question frames a critical debate in an unhelpful way. Locating responsibility for change and improvement solely with Scottish Government and public authorities not only presumes that they have the capacity / resources to effect changes, it encourages us all to see the problem as ‘theirs’ to resolve. The issues we have profiled in this response, such as poverty, structural inequalities and the public-civic infrastructure which give effect to people’s human rights, can only be addressed through both political and societal action. As with climate change, or changes to consumption that limit our impact on biodiversity, public authorities of all kinds are key players. But in democracies like Scotland, they move and act within a space we, the public, give them. Calling for public authorities to effect changes that will require significantly more resources, without our clearly accepting the need to provide those resources (through taxes, government borrowing or reallocation of existing spend), will simply perpetuate the public policy debates we have had for the past ten to fifteen years.
The funding of social care
Social Work Scotland and SASW are particularly concerned about the impacts of the deepening financial crisis in social care, which we have highlighted recently in our respective submissions to the Independent Review of Adult Social Care (IRASC). The crisis also exists in children and families social work services, and criminal justice social work, which are not within the scope of the Independent Review of Adult Social Care.
Adult social care spending per head in Scotland has fallen dramatically for Scotland’s older people, less so in England but more than it has in Wales (see graph in download here).
Spending per head on adults aged 18-64 – mainly people with learning disabilities or physical disabilities, or in need of mental health support — has fared better, but in Scotland is back to the 2010-11 levels whilst the numbers of people living with disabilities, or with mental health problems, have both increased in Scotland, as in the rest of the UK. (The figures in the graph come from the Treasury’s Public Expenditure Statistical Analyses 2020).
Social Work Scotland’s submission to IRASC on Demographic Change and Adult Social Care Expenditure in Scotland is mostly concerned with the Scottish Government’s own H&SC Medium Term Financial Framework (2018), which estimated the increased demands at 3.5% for adult social care as a whole, and 1% for the NHS.
We found that the estimated additional spend on 3.5% per year for adult social care is well supported by research in England by the London School of Economics using sophisticated modelling from survey data not available in Scotland. That also shows that the additional demand for services for younger adults with a learning or physical disability, due largely to improved longevity, is at similar annual percentage increases as demand from older people.
However, our analysis does not support the lower increases for the NHS in the H&SC Medium Term Financial Framework – these are 1% per year for demography, compared to estimates by the Institute for Fiscal Studies of 2.2% per year for England and the UK as a whole (in their major study Securing the future published earlier in 2018).
Our analysis also does not support the annual workforce increases set out in the Scottish Government’s Integrated Health and Social Care Workforce Plan for Scotland published in December 2010, which stated that:
Those figures cannot be found in the MTFF and, we believe, are incorrect. In any event, Scottish Government funding to councils for adult social care has not been increased to the level required to meet demography, yet alone address the unmet need that has accumulated for survivors of the decade of austerity. Increased funding for social care needs to fully recognise the impacts of demographic change, in line with the Scottish Government’s own medium-term planning, and on a corrected basis for the NHS in Scotland.
The role and status of social work
Social work is one of the few ‘key worker’ professions which is, when able to operate as conceived, proactive and person-led. It exists (and in legislation is empowered) to take action in defence or support of people made vulnerable by their circumstances. Those we work with may be less likely to be heard, and may struggle to stay afloat when the scaffolding of support is stripped away (as it has been during COVID-19). Social work sees people in their own individual context, recognising that an individual’s relationships, strengths, interests, etc. constitute the person, and that to give meaning to their human rights is to reinforce and promote those assets. But we must also balance individual rights with those of others, and consider the risks of certain actions to the individual themselves, their families and wider society. Our role must be to enable those people to have a voice, and to provide protective support or intervention where that becomes necessary.
As illustrated above, before COVID-19 social work (and the wider social care system it underpins) was already facing significant financial constraint; demand and aspiration not matched by available budgets. The 2019/20 COSLA report Investing in Essential Services, highlighted the challenges local authorities face to meet the outcomes and targets identified in the national performance framework within existing resources, referencing specifically child poverty and vulnerable adults. The strain that the social care system is under, and the conditions in which care professionals must practice, has been well documented in a range of reports from academics and institutions. The latest such report from the University of the West of Scotland (UWS) (Decent work in Scotland’s Care Homes) highlights a sector facing ‘systemic issues, a lack of respect and in need of cultural change’.
Within the current landscape, social work professionals – trained to respect and uphold human rights and work alongside individuals and communities (balancing and holding needs, risks and interests) – find themselves working in systems which can force them to be ‘assessors’ of risk and gatekeepers to over-rationedrvices. This not only means we fail to realise the human rights and outcomes potential of social work, but we slowly erode the enthusiasm and commitment of the professionals themselves.
While there has been positive innovation, acceleration of developments and much useful learning from the past year, the pandemic has made it harder to work alongside people and families at the challenging points and transitions in their lives. This has posed a unique challenge to social work, which is support based within and upon relationships. Feedback from our members has highlighted a number of further issues for the profession, limiting our ability to provide support and services and significantly affecting the working conditions and wellbeing of social workers. We would welcome any opportunity to discuss this further with the Committee.
Social Work Scotland’s Chief Social Work Officer (CSWO) committee has reported that the pandemic’s impact on the social work profession has been to compound pre-existing issues. These include dealing with real term reductions in budgets (which in turn increases workload on individuals), difficulties in recruitment, lacking visibility and authority in key decision-making forums, the disparity in social work and social care’s pay and conditions between health and social care partnerships. The split professional leadership across adults, justice and children and families is also seen, by some, to weaken oversight and coordination.
In July 2020 the Social Workers’ Union reported that one third of social workers are considering leaving the profession as a direct result of the pandemic. The union released an action plan calling for increased mental health support, a social work recruitment drive and a pledge not to re-introduce austerity measures post-pandemic.
As we move through and, hopefully, out of the pandemic, we would like to see and contribute to a re-imagining of the role and functions of public services. People are not simply ‘rights holders’ and professionals (such as social workers) are not simply ‘duty bearers’; we are all people, facing the challenges presented by the context, trying to deliver the optimum outcomes for individual and society, while having to balance competing interests, rights, demands and priorities. Similarly, public services must embrace greater creativity in how they support people to give meaning to their human rights and find genuine wellbeing. That will require a workforce who feel equipped and empowered to do what they were trained to do. The Human Rights Taskforce due to report in March 2021 will, no doubt, be considering a range of ways that public services and others can achieve this, and the Independent Review of Adult Social Care and The Promise are re-imagining support services for key groups.
For further information, please do not hesitate to contact:
Social Work Scotland
 See World Health Organisation website: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it
 See Social Work Scotland supplementary submissions to the Independent Review of Adult Social Care: https://socialworkscotland.org/wp-content/uploads/2020/11/SWS-Supp-Sub-1-DEMOGRAPHIC-CHANGE-AND-ADULT-SOCIAL-CARE-EXPENDITURE-IN-SCOTLAND.pdf; and https://socialworkscotland.org/wp-content/uploads/2020/11/SWS-Supp-Sub-2-ASC-EXPENDITURE-IN-THE-DECADE-OF-AUSTERITY.pdf.
 Coronavirus (COVID-19): children, young people and families – evidence and intelligence reports (various)
 The IRISS summary of a University of Edinburgh/City of Edinburgh Knowledge exchange project illustrates the value of this rights based approach in the most urgent of circumstances https://www.iriss.org.uk/sites/default/files/2020-06/recognition_matters_briefing_june_2020.pdf
 National Records of Scotland: https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital-events/general-publications/weekly-and-monthly-data-on-births-and-deaths/deaths-involving-coronavirus-covid-19-in-scotland (Week 53)
Independent Review of Adult Social Care: main and supplementary submissions
INDEPENDENT REVIEW OF ADULT SOCIAL CARE: submissions from Social Work Scotland to Derek Feeley, Chair of the Independent Review of Adult Social Care
6 November 2020
Social Work Scotland is the professional body for social work leaders, working closely with our partners to share policy and practice, and improve the quality and experience of social services. We are a key partner in the national Adult Social Care Reform Programme, creating an operational framework for Self-directed Support across Scotland, which through the practice of relationship-based social work, supports the consistent delivery of social care that is personalised, rights-based and which supports active citizenship. Another of our current projects is aligned to a Scottish Government programme (Health and Justice Collaboration Board) to test and implement frameworks for the delivery of integrated adult social services in Scottish prisons.
We welcome the focus of the Independent Review of Adult Social Care on sustainable improvement to adult social care in Scotland within a human-right frame of reference, and we have been delighted to welcome Derek Feeley, chair of the Review in meeting with Chief Social Work Officers and members of the Social Work Scotland Adult Social Care committee. At that meeting, Social Work Scotland presented Mr Feeley with a summary report of key messages for the Review from social work leaders. Our formal submissions to the Review expand on those key messages, and we look forward to ongoing engagement with the Review.
Social Work Scotland’s response comprises:
Summary of Social Work Scotland main submission
The Independent Review of Adult Social Care is an important opportunity for Social Work Scotland to articulate positions in respect of the scope, nature, delivery, management, governance, regulation, funding and future direction of adult social care in Scotland. Within this, engagement with the Review (both written and in person) provide a chance to emphasise the unique role and contribution of social work, as a distinct but core component of social care.
Social Work Scotland have responded to previous inquiries and consultations looking at similar questions (See Appendix A). Building on these responses, and following structured discussions within (a) Chief Social Work Officer and Adult Social Care Standing Committees and (b) members of the Board and partners (including Chief Officers and COSLA), Social Work Scotland has identified a number of key messages / positions to be fed into the Review. Effort has been made to ensure these messages / positions are consistent with a vision for adult social care that is ambitious but deliverable. The key points are:
Rationale supporting our key messages / positions
A priority in our discussion with the Independent Review is building a common understanding of what is being referred to by the term ‘adult social care’.
We believe a distinction should be drawn between social care, a concept that implies the delivery of a service to an individual, and social work, whose function is specified under the Social Work (Scotland) Act 1968 as undertaking holistic assessments and determining the level of support required to meet eligible needs. Moreover, social work is a proactive service, rather than simply a reactive one; it exists and is empowered to take action with people made vulnerable by their circumstances, balancing their rights with those of others, and the risks of their actions to themselves, their families and wider society.
The role of social work is therefore dynamic and complex, working alongside people and families at often challenging moment and transitions. In helping to protect people social workers must sometimes use statutory measures, bringing them into conflict with the individual and families. It is a difficult but essential role in a society (and social care system), where not every individual is in a position to determine their best interests alone, or the best interests of those they have responsibility for.
The position of social work as a profession within social care
Social work is currently the gateway through which most individuals access social care support funded by the state. In order for that social care provision to be delivered to the right people in the right way, social work practice needs to be independent and robust (i.e. true to its statutory and ethical underpinnings), with the knowledge and expertise to navigate a variety of settings, including home, hospital, residential care homes, homelessness and prison. It needs to be equipped to work with people of any age, in a way which situates the individual within a web of relationships and interactions. Responding to an older person affected by domestic abuse may necessarily involve family, friends and other professionals.
Among the regulated professions, Social Work is unique occupying the liminal spaces between universal services – education, health, justice, housing, welfare. Where there is contraction of universal service provision (usually followed by a heightening of thresholds) or a conflict between a universal service and an individual/family, social work responds, and in our response, we consider the person holistically. We have seen several examples of this in recent years:
Due to a number of factors, some going back decades, the role of social work within the social care system has been pushed towards transactional care management and adherence to bureaucratic processes and procedures. In practice, this means that social work acts as both gateway to and gatekeeper of social care. Frontline social work effectively acts as a control for finite local authority budgets, and this causes us a professional dilemma. Resource allocation processes often impact on our ability to enhance human rights and on the quality of the relationship with families. It is more straightforward to develop a care and support plan for a service or a budget; it is much more time consuming to get alongside the person, consider their life complexities and the potential contribution of their community and natural support to them living a full and rich life, then work collaboratively with them on how to go forward. This approach benefits personal outcomes, but comes with a long term financial cost.
Cost-cutting and overreliance on a care management approach has resulted in proportionately fewer qualified social workers available who are able to engage in this way to support the growing population of adults with complex needs. Shifting to a more intense practice model will require additional financial and other resources, but in the end relational, therapeutic support would much better support people’s human rights, and should itself be a right. This is demonstrated where local authorities have shifted towards this approach.
Social work’s specific statutory duties centred on the delicate balance of rights and risks – both individual and societal – demands well trained autonomous professionals supported in their duties by their authority’s Chief Social Work Officer. The CSWO remit is wide ranging with safeguarding responsibility for individuals at risk, for proper deployment and support of the social work and social care workforce, for ensuring robust and effective systems and processes, care governance, and continuous improvement across the whole range of social work and social care services. The CSWO is directly responsible for some statutory functions which restrict personal liberty, and has specific duties in relation to safeguarding.
The widening of regulation and inspection into the social care workforce and services has, to an extent, diverted focus from social work as a distinct profession. This becomes problematic when social work enters into partnership arrangements across adults, children and families and justice, where the unique contribution of social work is lost to view. Social workers can become demoralised and disenfranchised as professionals.
Social Work Scotland believes that there is much to be gained by the proper integration of health, social work and social care. However, this needs to be on the basis of a differentiated understanding of the principles and values of all the professions involved, retaining each profession’s unique contribution and impact within local integration arrangements. To facilitate this, we are supportive of measures which would consolidate social work as a genuinely national profession, recognised and supported nationally, underpinned by common terms and conditions and a strategy for its development.
A national profession, perhaps supported by a national agency, would also provide greater opportunities for professionals to progress professionally, without having to take on management responsibilities, and encourage greater professional autonomy in the carrying out of assessment and support planning. In parallel, similar steps for our colleagues in social care roles would potentially give their essential work proper value and status.
Resources and implementation of complex change
The social care model in Scotland was not designed or funded to meet the current expectation of provision or demand. An increase in complexity of people’s circumstances has been well documented, as has the disastrous impact of UK welfare reform on the impoverishment of many people and their families. These factors serve to increase the demand on social work and social care services.
Social Work Scotland members increasingly experience the effect that real-term spending reductions is having on their ability to sustain levels of service, maintain quality and provide non-statutory early help to prevent escalation into crisis. Social services (social work and social care) as a whole system within the integration environment with health must be sufficiently funded to meet its statutory duties and have clear, fair and well-functioning mechanisms for resource allocation within the overall available funding. Despite an overwhelming commitment from social work and social care services, the fragility of the wider social care system has become all the more apparent during the Covid-19 pandemic.
Social Work Scotland believes that the system could be reimagined to be a much more dynamic interplay of social infrastructure supporting citizens’ human rights as individuals and within families and communities, with a combined workforce operating at community level.
Whilst there is much widespread agreement across national and local, public and independent sector, and national partnership organisations, as to what good social services look like (enshrined in the Social Care (Self-directed Support) (Scotland) Act 2013), the question is what will it take to design and implement the changes necessary to meet these aims for everyone in all areas of Scotland?
It is critical that we come to a collective understanding of the essential elements that contribute to successful implementation of whole-system change, including the roles and remits of regulatory bodies, improvement agencies, and vehicles of service delivery. This is what has been missing in the implementation of recent ambitious and transformative social policy in Scotland.
Our view has been shaped by our experience progressing implementation of self-directed support in Scotland. Approaching this through the structure and insight offered by implementation science, we have made progress in identifying the essential, non-negotiable components which need to be in place for a publicly funded social care system to enable a person and/or their families to be in control of their life, regardless of their disability (visible or hidden) or life circumstances. Among those core components are established practices, which when reliably delivered by a well-trained and supported workforce, consistently deliver desired results. We also know what infrastructure needs to look like (including upstream community assets, accessible housing, case management IT systems, technology, administrative support, commissioning and procurement, eligibility policy, finance and budgeting systems), and what leadership needs to look like (and have as skills) in what are highly adaptive environments.
Over the past decade, support to build community capacity, in the shape of community learning and development services, community workers, and grants to community groups, has been critically reduced across Scotland.
Investment is required to ensure that communities are ready and resourced to engage in strategic planning and commissioning processes. Independent support organisations, such as those funded by Support in the Right Direction (SiRD), are vital in ensuring the voice of people who use services and carers are invited and heard.
Engagement should lie at the heart of decision-making and is the key to people having meaningful choice and control in their own support. Engagement supports the principles of personalisation underpinning Scotland’s Self-directed Support (SDS) legislation. Practically, good engagement that personalises social care means that care arrangements are more likely to meet needs and less likely to go wrong.
The wide range of asset-based approaches and resources already available are used in a piecemeal way across Scotland, but can be abandoned or distorted when budgets are tight. In order to implement these approaches, which often conflict with the traditional ‘way we do things’, attention needs to be given to workforce training and coaching, supportive systems and devolved leadership.
We feel very strongly that there needs to be consideration of the range of people’s lived experience when designing and constructing social work and social care services. Often the focus of public discussion around social care is older people with personal care needs. Other individual experiences, such as adults with complex learning disabilities or mental health, are not so well profiled, or held in mind. Those experiencing alcohol and drug addiction, domestic abuse and the justice system tend to come from communities experiencing the greatest health and social deprivation. An adult social care system is as much about these experiences as any other; these voices must come to the fore.
Eligibility criteria reform and human rights
Current eligibility criteria are deficit-based assessment of levels of risk to an individual if care is not provided. They run contrary to the principles of personalisation, as they drive time-and-task service provision. They are applied differently across Scotland and result in unnecessary variation in outcomes for individuals. The current approach to eligibility is impacting too severely on vulnerable people and those at the edge of social care, and we strongly recommend that the National Eligibility Criteria are reformed.
Social work and social care financing needs to be sufficient to support the quantity and types/models of care necessary to support our population. Services in many areas of Scotland are currently constrained such that they are only able to address critical risks (as defined in the National Eligibility Criteria) by the provision of personal care only, leading vulnerable people to struggle when their needs change or when their needs are social in nature rather than physical. Our work in the implementation framework for SDS shows us that the current national eligibility criteria are not fit for purpose, and indeed run counter to the values and principles of Self-directed Support. We recognise that a framework is required to ensure fair distribution of resources which should support strengths-based social work, community social work and ensures early help is provided for people with lower levels of need.
The provision of only critical level services presumes that intervention for anything less can be picked up by family or local community, and that the person has the capacity to organise and manage sometimes complex support arrangements. In some settings (for example prison) people do not have this level of family or community support and are not able to follow signposting to where third sector support might be available. Lack of early help precipitates crises which are costly in outcomes for the person and financially for the local authority.
There should be consideration given also to the variation in charging and contributions policies across local authority areas and their disproportionate impact on individuals with similar needs in different areas of Scotland
While supportive, we recognise the challenge inherent in determining how social care needs (as articulated in social work law) are incorporated into a human-rights-based frame in a meaningful and measurable way. Underpinning principles should cover the range of activities necessary for ‘active citizenship’, including reducing isolation, supporting people to make and maintain friendships, promoting vocational skills, supporting people to develop and enhance life skills, promoting physical and mental well-being, and mitigating health inequalities.
This would involve supporting people with complex needs in personalised ways, supporting carers, promoting SDS and personalisation within partnerships, working with people at the earliest opportunity to maintain, improve or maximise independence, building capacity in the community and with sustainable services, ensuring best value and effective partnership working, reducing dependence on high-tariff services, and creating services that are aware and confident about using and utilising technology.
This ideal approach will require considerable additional resource, particularly as applied to a growing older population. The population shift will impact disproportionately on women, who provide most of the care to family members. Consideration must also be given to how to properly resource the Carers (Scotland) Act 2016, giving real affect to the principles of that legislation.
Commissioning for personalisation
We note that the majority of pre-Covid local Commissioning Plans are weighted towards health-related matters and make little or no reference to personalised care and support. A perspective that embraces the holistic person with the right to choice and control should be central to framing more personalised commissioning practices.
SDS legislation calls for innovative solutions to allow people to hold individual service funds, necessitating a shift in commissioning practice from block funding to personal commissioning, to enable more freedom of choice and greater control.
We acknowledge that there is some financial risk in departing from traditional service models to new models that might initially be underused. We would support more discussion on how risk might be shared.
Many services commissioned and arranged by the local authority (Option 3) are delivered on the basis of ‘time-and-task’, and this is runs counter to a human rights-based approach to delivering care and support, because people’s needs and choices naturally change on a day-to-day basis. Introducing more of a personal approach to is essential to assist people receiving supports in a way that meets their personal outcomes. We believe that quantifying ‘time’ rather than ‘task’ would allow greater choice and control by individuals, whilst allowing for a budget to be allocated to meet personal outcomes.
Embedding Self-directed Support as good social work and social care
Scotland is a country with significant geographically and economically variation, with a diverse and vibrant citizenship with whom we should be aiming to personalise care and support and to offer people choice and control of how they want to manage their lives.
We recommend that the review considers what implementation science might offer in our national attempts to implement SDS consistently across Scotland. We believe that this approach is the most suited to undertaking the sort of complex, adaptive change required to meet Scotland’s ambitious progressive policies.
With national partners and local authorities, we are asking what it will take to embed SDS in a sustainable manner across the geographies of Scotland and across all care groups equally. In accordance with best international implementation practice, this includes examining practices and tools for their effectiveness and fidelity, and understanding and promoting the system drivers necessary for adaptive change.
Going forward, we strongly support a shift from traditional ‘care management’ approach in adult social work to more relationship-based practice with the supported people at the centre of decision making. Systems and processes would need to flow from that guiding principle.
This approach would see LAs/HSCPs move away from care management to a more traditional form of social work, working relationally and enhancing the natural supports of family, friends and neighbour’s contribution through such models as Family Group Decision Making and Community-Led Support. A radical shift of focus of integration authorities to support people to self-manage, on personalising care and support at home and on effective early intervention and prevention would involve working collaboratively with a wider range of partners including education, housing and community representatives using shared decision-making processes and sharing both risk and responsibility.
Whilst housing statements are required to be considered by Integration Authorities, better arrangements are needed to influence housing providers when they’re planning adaptations to existing housing stock. We would want to see housing developers required to contribute toward the provision of community health and social services. We could require a certain proportion of new build houses to be ready for use by someone with a high level of support needs.
Technology needs to be at the heart of the future of care preserving independence and supporting social interdependency. It should not substitute for human contact. The National Digital Platform should incorporate as great a focus on technology to deliver social care as on health, and should be given highest priority as a core enabler.
Data and other systems require to be better aligned to the principles of SDS. Much time and effort is spent on managing outdated information systems that do not link well around the person. There is no national requirement to capture outcomes achieved for adults.
Data that is useful to improve frontline operations currently has less priority than aggregated performance management data, which we argue from an implementation perspective is not sufficient as little can be learned from it.
We have also found differences in resource allocation across client groups that does not comply with a rights-based approach. Algorithms underpinning local resource allocation systems favour younger adults over older adults, leading to some outcomes being unfunded or underfunded. In many cases, only critical personal care needs are resourced.
A key driver of any adaptive system change is workforce; selection, training and coaching. In order to attract a competent and committed workforce, remuneration should reflect the complexity and responsibility of roles across a varied employment landscape. Innovation is required in how we support people to employ their own personal assistants (employed with an Option 1 Direct Payment). We need an inward migration system that can attract skilled workers into social work and social care. We need to focus on attracting workers to urban, rural and island areas and keeping them engaged and motivated. We require a gendered analysis of the workforce if we are to understand how to attract men into the social work and social care workforce and how to best support women in the workforce.
With budget cuts over the past decade, local authority social work learning and development teams have all but disappeared, impacting greatly on the ongoing training of social work and social care staff. This highlights the lack of parity of social work and social care with other professions such as teaching and nursing. If adaptive change is to be implemented effectively, then the workforce requires not only high standard skill-based training but ongoing intensive coaching and supervision, and to expect pay rises in line with those offered to nurses and teachers.
National Care Service
While we believe that social work and social care needs to be delivered locally, Social Work Scotland is supportive of the development of a national adults practice model (similar to GIRFEC) which support consistency of approach across Scotland whilst allowing for variation only where this is reasonable in the context of local geography, demography and cost of living.
However, we are unclear how the principles of choice and control central to Self-directed Support can be realised by the creation of a National Care Service if it is to be responsible for delivery of social care. It may be that a National Care Service can have most effect as a layer between national government and local delivery, driving greater consistency, improvement in the workforce, equitable distribution of resources, etc.
While the concept of a National Care Service may be attractive in some regard (e.g. a driver for consistency), we have practical concern about the design of such a service and how it might be implemented as intended within Scotland’s governance landscape.
 In reference to implementation of the Promise.
 For example, the Drugs Deaths Taskforce
 For example, the Review of Mental Health Law in Scotland and Forensic mental health services: independent review
 In reference to development of the Community Justice agenda.
 “Social care means all forms of personal and practical support for children, young people and adults who need extra support. It describes services and other types of help, including care homes and supporting unpaid carers to help them continue in their caring role.” Scottish Government. A Social Work Scotland definition would expand this to include care and support provided at home.
 “Social work is a practice-based profession and an academic discipline that promotes social change and development, social cohesion, and the empowerment and liberation of people. Principles of social justice, human rights, collective responsibility and respect for diversities are central to social work. Underpinned by theories of social work, social sciences, humanities and indigenous knowledge, social work engages people and structures to address life challenges and enhance wellbeing.” IFSW, July 2014
 Thematic review of self-directed support in Scotland – June 2019, Care Inspectorate
INDEPENDENT REVIEW OF MENTAL HEALTH LAW IN SCOTLAND
Submission from Social Work Scotland to John Scott QC
29 May 2020
Social Work Scotland is the professional body for social work leaders, working closely with our partners to shape policy and practice, and improve the quality and experience of social services.
Social Work Scotland appreciated the time taken by the Secretariat for the review to meet with the Social Work Scotland Mental Health group in February 2020, and offers this response to the discussion questions set out in Part B of the consultation paper.
PART B Organisations or individuals who work with the law
The Review would like you to draw on your experience of working with Mental Health law and consider the following questions. You do not need to answer all of the questions, and please feel free to provide as much or as little evidence for your answers as you wish.
Reciprocity and resourcing
Social Work Scotland’s experience is that while the Mental Health (Care and Treatment)(Scotland) Act 2003 is progressive in its approach regarding reciprocity, it is not in any way sufficiently funded for this to be realised in practice. We find that the principle of compulsion remains as the dominant culture, centred on clinical care planning such as medication and nursing care. The wider interests and ambitions of active citizens are largely absent from care plans.
The Review should consider general trends in the use of legislation, particularly measures of last resort. We are concerned about an increase use of emergency and short term detentions.
While short-term detentions are the preferred method of detaining a person in hospital, the increase in their use strongly indicates that the level of support available in the community is not sufficient, and we wonder if partnerships are fully cognisant of their duties with regards to community provision.
Seeing an increased use of legislative measures, we are concerned that austerity is impacting on how the act is used, particularly in relation to thresholds of risk. We are pleased that the Review is incorporating an economic perspective as we believe that this is central to understanding how the current Act is being used and the impact on people subject to legislation. Given our concerns regarding adequacy of resources to meet needs, we hope that the Review can also seek to instigate a review of mental health support services.
There is much in the current Act that is facilitative and reciprocal, e.g. duties under section 25 – 27, but these are rarely central to the provision of support. These duties require local authorities to minimise the effect of mental illness by the provision of community-based support services. The most well used provision in this duty is the provision of advocacy, but the Act allows for a much greater range of provision. However, mounting budget constraints have resulted in only critical services being provided. We also note the limited use of Self-directed Support options for people experiencing mental illness.
We draw the review’s attention to our response to the recent Social Care Inquiry which argues for early supports for people with fragile mental health, including the use of asset-based approaches, such as CPA, and a rethink of the current system of eligibility criteria.
Despite being a duty in the Act, a lack of person-focussed assessment and well executed discharge planning results in people whose mental health has been stabilised being discharged into circumstances unconducive to their continued mental wellbeing, such as poor living conditions where there is no heating and no furniture, and an absence of social supports. Consequently, other legislative duties are not met, for example the involvement of carers in discharge planning under the Carers (Scotland) Act 2016. Whilst we accept that MHOs need to exert challenge, there is too widespread a disregard of section 25 – 27 duties by partnerships and local authorities to argue effectively.
We note that there is improvement in the use and standard of Advanced Statements, but members also find resistance to their use on some areas. Often discharges are made without the MHO being contacted by the hospital. The reality is that there is often poor collaborative partnership working, especially when resources are constrained.
We welcome the Review’s systemic approach. Seventeen years on, the 2003 Act requires to be reviewed against a range of system-wide factors including the extent to which integration of health and social care has fulfilled its intended outcomes. One recent review cites wide-ranging systemic failures resulting in poor outcomes for people.
It is not always clear to which part of the integrated system is delegated the local authority duties under sections 25 – 27 of the Act. We are concerned that integration authorities are not sufficiently sighted on this aspect of the Act, instead focusing largely on the provision of clinical services.
Considerable variation exists across Scotland in how mental health and social care services are delivered to people and their carers. We are interested in understanding the degree to which this variation is warranted by local circumstances and need, and to determine how unacceptable variation can be diminished in a way that respects local democracy.
We greatly welcome the Review’s focus on human rights, and believe that this is the touchstone through which we can determine efficacy of approach.
Pressures on key professional groups
Social Work Scotland published a paper in 2017 on the capacity, challenges, opportunities and achievements of Mental Health Officers. Whilst now three-years old, the experiences and findings of the research remain relevant in 2020.
With cumulative work pressure on MHOs, priority is given to the preparation of Community Treatment Orders, and use of Social Circumstance Reports (section 231) has largely been overlooked.
With people’s needs, other than critical need, being unmet, detention is considered more frequently than it should. As officers of local authorities within partnership arrangements, MHOs are not sufficiently empowered to bring to bear their powers over the provision of assessed need. MHOs need access to community resources and good quality social supports, where people are offered choice and control.
We are concerned about the critical shortage of section 22 medical professionals, knowing that there are fewer medical trainees in the system than are required. We believe that medical decision should be made after face to face assessment of patients, but aware that due to staffing constraints, this is not always the case. We note that the Tayside Independent Review report was explicit in finding that a shortage of Registered Medical Officers impacted detrimentally on the patient’s journey.
Best practice in planning hospital admission fails because there is limited inpatient bed capacity. Threshold for admission is high, with people at crisis before they are admitted.
The practice of ‘boarding out’ results in some people refusing to be admitted voluntarily. Consequently, people may be detained and admitted to hospitals some distance away from their families and communities. When guardianship is pending, compulsion can be used to place the person in a nursing home. In this context we question how supported decision making is being used or how the best interests and human rights of people can be respected.
We are concerned about the use of Emergency Detention Certificates without MHO consents. In general hospitals the Act can be used to stop people absconding, with EDCs made before MHOs are contacted.
We find that inpatient services remain clinical in focus and are not set up to support the whole person. Use of the Care Programme Approach has been pulled back in many areas.
As noted above, partnership focus on inpatient bed pressures results in a lack of attention to early intervention and prevention at a community level.
There is a problem accessing some specialist resources, i.e learning disability in some areas of Scotland. Social Work Scotland members have noted waiting list for detentions in learning disability services, and for people who need specialist learning disability mental health services. Wards and beds are being shut, putting additional pressures on Community Mental Health Teams and MHOs. We have been told that some MHOs have been required to use Adult Support and Protection measures to force decisions about detention.
Tribunals and legal supports
Challenges from MHOs do not always land well with medical colleagues or with tribunal members, and we think this is indicative of a wider issue regarding relative weight of professional knowledge in decision making, with a higher status being afforded to medical views. It is standard practice in tribunals to excuse medical colleagues due to pressure of work in a way that others are not.
We find that tribunals are less likely to take radical decisions that support the spirit of the legislation. Proactively, tribunals could more rigorously examine deficits in the system that might have prevented unwanted outcomes. To this end, the Review might consider allowing tribunals a wider range of interrogative powers.
Tribunals might better take the perspective of the person and their carers from an early stage in proceedings (rather than at the end of the proceeding as is currently the case), and from this standpoint, inquire into all aspects of the treatment and care plans. This would ward against pathologising the person, and marry up better with supported decision making.
We wonder if a representative other than a curator ad litem would be better able to reflect a wider overview of the person’s circumstances and views.
The place of the legal profession is confusing under current arrangements. Where a legal professional is appointed as curator, that professional can also act as the person’s solicitor. This could give rise to conflicts of interest, and we recommend tightening of tribunal authority.
In general, we think that tribunal regulations need to be broadened with respect to compelling professionals and organisations to act in the best interests of the person.
There are several populations whose needs are not well served by the Act as it stands.
These include people who have recurring mental illness and in some instances people with multiple conditions, like learning disability and mental health. Welfare reform has had a notable adverse effect on mental health, with those in poverty experiencing a worsening of their mental health.
Services are not well geared to cope with the needs of people with different ethnic backgrounds, e.g. South Asian, Eastern European. The system lacks cultural awareness, with lack of timely translation of information materials/documents. Frequently, family members are called on to translate at meetings, and may project their own meaning on what is being communicated. Where translation services are commissioned, in some cases, their quality is questionable. We consider there should be a national minimum standard set for such services.
Children and young people are not well served by existing legislation and systems. There is an inconsistency of approach across CAMHS services and legislation is not always used when appropriate despite young people being significantly unwell. There may be an argument that use of legislation does not align with a therapeutic relationship, but legislation could be used more effectively in some cases.
There needs to be a recognition that CAMHS facilities are not sufficient to allow short periods of inpatient treatment that can improve prognosis. There are insufficient beds available for young people, and inpatient provision is not geared to cope with young people with behavioural challenge. There are at times inappropriate placement made of young people in adult wards. A much greater awareness and use of trauma informed approaches is required for all age groups, but especially crucial for children and young people.
Social Work Scotland is involved in the development of the national secure adolescent inpatient service in Ayrshire scheduled to start build in 2021. This resource will support a national network of clinicians providing more streamlined care pathways and management of some CAMHS referrals. However, this development will not address neurodevelopment disorders, learning disability and autism.
The current legislation does not work well for people with fluctuating capacity who fall between the various pieces of legislation. The person may be neglecting themselves, or displaying antisocial community behaviours, and could be using alcohol or substances. Obtaining medical evidence for lack of capacity is a problem if the person has capacity on their ‘good days’. We find that very few guardianship orders are tailored appropriately, tending to a shopping list of actions.
Of the five legal tests, there is no test for significantly impaired decision making (SIDM), which relies on the judgement of the clinician and MHO.
It is hard to argue against necessity when there is no community alternative available due to under-resourcing. This leads to detention that cause significant trauma for the person when a community alternative could ameliorate trauma.
As there are limited drug treatments for people with personality disorder, treatment protocol involves consistent care management plan for all professionals (including A&E) and family, with no deviation (so as to avoid use of manipulation by the person). Such protocols are very staff intensive and require highly effective and timely information sharing, and our experience is that they can break down readily due to lack of resourcing.
Some of regulation around specified persons has not kept pace of rapid expansion of digital platforms and social media. The legislation as it stands does not give the legal protection that should be afforded to restricting access to digital technologies.
The Act requires a local authority to provide services for people with a mental disorder who are not in hospital, which should be designed to minimise the effect of mental disorder on people and enable them to live as full a life as possible (sections 25 and 26 of the Act).
We do not consider that this requirement is met, and would argue for a greater focus on recovery. Medical provision in communities is overstretched and there are not enough students entering medical training.
Appointment scheduling is not supportive of community treatment for those on a CTO who are not taking depo medications. Section 112 (6 hour detention) can be used to support compliance and to assess and treat. We believe that this section is not being used effectively by community consultants. There is a tendency to wait too long, the person then goes into crisis, then a longer period of detention is required. This is not timely and not proportionate.
We hold that legislation should have a greater focus on human rights, linked to the well-intentioned principle of reciprocity. As we noted earlier in our response, it proves difficult if not impossible for frontline staff to exert influence on authorities due to budget constraints and competing demands of stakeholders. We would want to see greater understanding and focus on the well-established social determinants of health model, which takes a public health perspective on inequalities and human needs.
We agree that the law could and should support the rights and dignity of people with mental health needs. There has been a lack of progress in implementing short term fixes to Adults With Incapacity legislation, which we find disrespect of people’s rights.
Social Work Scotland supports the use of a short-term placement order, allowing the person to be removed to a place of safety until an urgent guardianship application could be progressed.
Lack of progress has led to unnecessary deprivation of liberty and unnecessary use of mental health legislation as only viable solution to what is a social issue. For example, a person with dementia may leave their home unaware of their safety, leaving their front door open. Adults With Incapacity legislation has no emergency provision for intervention in this case. Adult Support and Protection legislation may apply, but measures may not be appropriate, leaving the only available solution to have the person detained/admitted to hospital.
The three pieces of current legislation stand alone, lack effective overlap and do not align. It is not uncommon for people subject to mental health legislation also to be subject to adults with incapacity and adult support and protection legislation. We recommend that the Review considers streamlining and consolidating legislation.
Whilst we look with interest to the implementation of the Northern Irish approach to fused legislation, Social Work Scotland would support the development of pieces of discrete but well-aligned legislation.
The Adult Support and Protection (Scotland) Act (ASPA) is the safety net between adults with incapacity and mental health legislation but it does not give local authorities the power to protect particularly vulnerable people from the actions of others, for example when the person lives alone and is preyed upon by others.
ASPA does not interface effectively with other legislation. It is much wider in its scope that the MHA, and can be used as a triage mechanism for mental health legislation. We believe that if ASPA were better resourced, there would be a reduced requirement for Adults with Incapacity legislation and mental health legislation. ASPA provides the basis for effective risk management and a route to collective decision making. ASP inspections were largely positive in terms of informal partnership working.
AWI timescales currently allow for extensive periods of delay for private applicants to get powers in place, with no limit to how long private solicitors take. Legal Aid is an added issue. Although it is an entitlement, it can impact on the priority given by private solicitors.
There requires to be robust quality assurance in place for private guardianships. We see poor quality guardianships, consisting of copy and paste paragraphs, which are not personalised. Consideration could be given as to how support other agencies (third sector) to facilitate process.
Whilst we agree that powers for life should not be adopted for people whose condition is likely to change, but believe that courts could make indefinite orders in some case where the person is in later life with a lifelong condition.
In many instances, the problem is not in the fundamental legislation, but the way it is currently being used.
Social Work Scotland welcomes the move by the Scottish Government to make Powers of Attorney more straightforward.
The existing MHO contingent across Scotland is very committed and well-trained. However, as noted earlier in this response, the current funded complement of MHOs is not sufficient to work proactively in the mental health system. Scottish Government is currently providing funding to train up more MHOs where the shortages are most acute across Scotland, and we await progress with this initiative. There should be consideration of the model of MHO delivery across Scotland to ensure that MHOs are used to their best ability in statutory work, and there is a linked requirement to improve the availability of community resources to ensure that people do not reach crisis unnecessarily.
We have noted the shortage of trained medical professionals, but we also note that there are challenges in the demands on carers and on advocacy services. We consider that the lack of suitably trained professionals across the whole system is likely to impact on the success of more progressive mental health legislation, as will the lack of community resources. We feel strongly that the Review should look to implementation science to determine what it would take to deliver systemic progressive mental health policy across Scotland.
Social Work Scotland welcomes the human rights-based approach to the Review, but consideration must be given as to how this can be implemented in practice within a resource framework. Considerations should include: a strengthened duty on professionals to adhere to codes of practice for tribunals; consideration of means by which consistency of good practice can be met by solicitors acting in private applications for guardianships; consideration of a more defined test for incapacity; consideration to widening the professional groups who can attest to capacity to include psychologists, MHOs and social workers.
Social Work Scotland’s response to the learning disability and autism review supports the view that learning disability and mental health legislation should diverge. Consistency of approach is needed if the Review is considering merging legislation.
We suggest that consideration could be given to a singularlised suite of human-rights-based legislation in linked subsections, dealt with by one legal entity, incorporating the wider duties in relation to social support. The benefits of this approach would need to be measured against the disruption of extensive legislation change and consideration of its practical implementation and application.
Submission to IJB Chairs and Vice Chairs Executive Group
Submission from Social Work Scotland to IJB Chairs and Vice Chairs Executive Group
17 July 2020
Social Work Scotland is the professional body for social work leaders, working closely with our partners to shape policy and practice, and improve the quality and experience of social services. We are a key partner in the national Adult Social Care Reform Programme, creating an operational framework for Self-directed Support across Scotland supporting consistent delivery of social care that is personalised,
Social Work Scotland welcomes the invitation of the IJB Chairs and Vice Chairs Executive Group to respond to consultation around the strategic changes needed to sustain and take forward the care sector in the light of the experience to date of the Covid-19 pandemic.
You asked for our summary of the main points we think relevant as to how IJBs would revise or replace existing strategies or approaches to local delivery, and also to use your attached short questionnaire. You ask respondents to separate their views between:
a) The immediate focus of the Mobilisation Recovery Group (MRG), established by the Cabinet Secretary for Health and Sport and including representation from the IJB Chairs and Vice Chairs group, “to generate system wide input into decisions around resuming paused services” and
b) “Supporting continuing services for which activity has been intense, such as care homes and care at home services for older people throughout the pandemic”
Our first point concerns the scope of the intended IJB Chairs and Vice Chairs Executive Group submission. We believe this should also include NHS services, not only those subject to IJB direction, but also acute hospital inpatient services, such as intensive care, for which Covid-19 activity has also been intense. We also note that while all adult social care services are subject to direction by all IJBs, there are a number of H&SC partnership agreements that also include some children’s social
Secondly, it is widely accepted that IJBs must work with other agencies to be effective, and this is stated in your covering note which mentions IJB “central responsibilities to work in partnership as we commission, finance and monitor services as we move through and beyond this crisis”. However, while the questionnaire rightly mentions the Third Sector, there is no mention of local government, only “engagement with local communities”. Local government services – including housing, education, welfare services and rights advice, and other community services – all have an important role in promoting and sustaining health and wellbeing, and need to be taken into account and involved in IJB plans and proposals for changing “existing strategies or approaches to local delivery”. Our other main points are as follows:
Q1. Many innovative changes have resulted from a response to the COVID19 crisis. Within the IJBs scope of delegated responsibilities what consolidation of innovations would you want to see through the commissioning of services by IJBs?
In the Social Work Scotland response to the Scottish Parliament on the Social Care Inquiry in February this year, we put forward a strong position for sufficient funding to be made available to deliver models of care required to support population need, noting that increased budget constraints have led to tightening of eligibility criteria for social care support. Post-Covid, it will be crucial to model robustly what it will take to deliver national and local aspirations, and to manage expectations transparently.
Taking a human rights approach to care, commissioning should focus on the range of activity necessary for active citizenship: “including reducing isolation, supporting people to make and maintain friendships, promoting vocational skills, supporting people to develop and enhance life skills, promoting physical and mental wellbeing, and mitigating health inequalities”.
Personalisation and flexibility
Personalisation is at the heart of good social work, and is the guiding principle of Self-directed Support (SDS) policy and legislation. Under SDS, people can choose from four options designed for maximum flexibility.
During the pandemic, we saw a reduction in bureaucracy of assessment, care planning and budget allocation processes in some areas, which allowed for a more flexible and quicker response. Going forward, we would like to see a shift from traditional ‘care management’ approach in adult social work to more relationship-based practice with the supported people at the centre of decision making. Systems and processes would need to flow from that guiding principle.
Before the pandemic, we saw that many local policies and procedures were quite rigid around what could and could not be commissioned through a personal SDS budget. In some, but not all, local partnerships we have seen innovative flexible responses to need during the pandemic which are in line with both the letter and the spirit of SDS. In many cases, supported people have been allowed to use their personal budgets more creatively, for example, to employ family members, to purchase items of kit to enable physical activity at home, and to cover costs related to the pandemic.
People with lived experience of social care who are members of the SDS Collective have stated in their call to action that they are happier with a more flexible approach. In some cases the alternatives that people have chosen have proved to be less costly than the traditional models of respite and day care that
We note that the majority of pre-Covid local Commissioning Plans are weighted towards health-related matters and make little or no reference to personalised care and support. Social Work Scotland would support that the holistic person with the right to choice and control should be central to framing more personalised commissioning practices.
Specific asks are for:
Impact of Covid-19 on provider sustainability
We note a range of factors that impinged on providers during the pandemic. Availability of sustainability funding, testing regimes, availability of PPE, data reporting arrangements and oversight arrangements contributed to real strain on providers at a time when they were experiencing significant challenges in
Commissioning arrangement should explicitly set out issues/expectations related to infection control, recognising the continued presence of Covid-19. The mixed economy that residential and care at home operates led to there being differences in who could access essential kit, and payment of kit, training and advice was variable.
Q2. The ongoing criticism of IJBs is that transformation hasn’t been fast enough or innovative enough to date. How have IJBs been able to change, adapt and flex at a fast pace in response to the pandemic and how can this ability to design and implement change at pace can be continued? What has been different about how we have worked in the past 3 months that we can keep?
During the early stages of the pandemic, there was a clearly defined mandate, critical priorities and a common purpose shared by all partners. This imperative transcended many of the differences and challenges between partners for a period.
Research tells us that SDS can only be fully implemented if Chief Officers and other key leaders view it as a priority. During the crisis, examples of good leadership emerge and creative, solution-focused thinking was encouraged. We noted the following features:
Fast tracking of packages of care (POC) and commissioning the use of previously unused support services not on approved providers lists in order to meet needs and outcomes.
The crisis meant more dynamic appraisal of options and creation/acceptance of doing things differently, and a shift to more outcome focused approaches.
The usual patterns of care and support were temporarily altered with increased flexibility, increased personalisation, trust in communities to meet their own needs as people opted out of services and others asked for care to be reduced, and new models of community support emerged.
Issues around systems, processes and IT remained as barriers during the pandemic. Partners, whilst in integration arrangements, in the main still operate as separate organisations, with different digital infrastructure.
Through the pandemic, we have learned much about communicating in different ways, using a variety of digital platforms. We have seen good use of digital technology to connect with supported people, their families and other professionals. This has resulted in meetings being more accessible and time efficient, while often creating less intimidating and intruding spaces.
We have heard that many supported people prefer using technology to communicate where communication can be paced better for the supported person, be lighter touch and more frequent, rather than formal meetings. We are also aware of distinct benefits to children’s social work contacts where relationships have improved through use of digital platforms rather than face to face meetings.
Digital inclusion needs to be accelerated to ensure that people have access to technology and support to use it. Connecting with services, family and friends through technology has been critical during COVID. Use of web based information has been key but people have to be able to access this.
Q3. The advisory group on economic recovery has identified structure, funding and regulation as the main focus of a review of adult social care. What specific aspects of these areas would you wish IJBs to consider in relation to Care Home provision?
Covid-19 Workforce Plan Discussion Paper
COVID-19 WORKFORCE PLANNING FOR THE HEALTH AND SOCIAL CARE WORKFORCE IN SCOTLAND – MAY 2020
SUBMISSION FROM SOCIAL WORK SCOTLAND TO SCOTTISH GOVERNMENT
26 May 2020
We agree that workforce planning in the light of Covid19 must separately consider the immediate, medium term, and long term contexts and objectives. (para 7i). In Annex A, these are described as Respond, Recover, Renew.
Scotland and the rest of the UK is not yet at the end of the Respond period. While there is evidence that social distancing and lockdown has reduced the virus transmission rate, there are still new cases and fatalities especially in care homes and the community. A cautious and phased approach to lockdown remains essential but, despite improvements, this will be hampered by the insufficient supply of PPE for all who need it, by the current limitations on the volume of “test-trace-isolate” initiatives in the health and social care sectors.
Providing adequate support to NHS, care homes, home care, mental health, domestic abuse, financial support, food banks, volunteer coordination, and other essential services must remain the top priority of the Government, the public sector, and society.
It is not obvious how changing the Workforce Plan at national level can assist that work at local level. Rather we all need to learn from what has been done well and what hasn’t in the response so far to the virus.
Apart from the shortage of PPE and testing, lessons need to be learnt from discharging untested patients from hospital to care homes because they were considered “medically fit for discharge”, and its contribution to the high rate of death from Covid-19 in care homes. Lessons also need to be learnt from the failure of the NHS to meet normal demand while freeing bed capacity for Covid-19. Some of the excess mortality in this period will be due to cancelled diagnosis and treatment for people with cancer, heart disease or other life-threatening conditions. In both these cases, the lesson is that too narrow an understanding of “Protect the NHS” costs lives as well as saving others.
Health and social care integration requires both parts to be considered equally. While the current Integrated Health and Social Care Work Plan is a significant step forward, it is noteworthy that there are far fewer specific commitments relating to social care than health, despite the fact that their workforces are of broadly similar size.
We consider that additional resource is most likely to be required across mental health services for all ages, and across social care. The independent sector will require to adjust to the impact of Covid-19, and this will impact on capacity at local level and the support required from councils and partnerships.
We think it is too early to make significant changes to the Workforce Plan for the longer term, as the “Renew” landscape will be not yet clear. There is growing support in Scotland for a fundamental review of social care, including funding and care models, and that is something Social Work Scotland welcomes and will support.
There are some critical key questions whose answer will form the main parameters of the next phase:
The current Workforce Plan commitments were based on meeting identified needs, which have not gone away. The question now is whether there are more important Covid19-related priorities for the resources allocated to these commitments; if so, then the commitments should be deferred. We are sure that all stakeholders, especially Integration Authorities, Councils, and the NHS will already be acting pragmatically. Covid-related priorities must include restoring essential health and social care services for people on waiting lists whose diagnostic tests, assessments, treatments or support have been deferred, and for people who have not been referred not come forward because of current Covid19 priorities.
See the points made about information under questions (4) and (6).
Urgent consideration needs to be given to increasing the flexibility of the workforce to operate across health and social care sectors, and public and independent sectors, understanding that this will require regard to terms and conditions, training and professional registration.
The voice of people who use services should underpin assumptions about workforce demand across the system. The usual pattern of care delivery has been temporarily altered to a significant extent, as some partnerships have sought to reduce their volume of service delivery, some have restricted flexibility and some have increased personalisation. Some people have opted of their own accord to temporarily reduce their reliance on directly funded social care, due to risk of contracting Covid-19, others have been approached by partnerships requesting to reduce their POC, others have changed their Self-directed Support option in order to find the model of support that best suits them at this time. Preferences In short, their experiences are significantly different to what they were prior to the pandemic.
The experience and needs of the Personal Assistant workforce should be drawn out, as they are a small but crucial sector in the delivery of personalised social care.
Local governance arrangements require to be strengthened and closely aligned with national workforce priorities. The statutory role of social work needs to be accommodated in national and local workforce planning.
Lessons learned from the pandemic about effective use of flexible working, home and remote working, and the use of digital meeting platforms should be incorporated.
The role of the Scottish Government here is to support, with information, guidance, and resources, the relevant public bodies at local level. Many aspects of the current Workforce Plan will remain: we need to continue all the actions that ensure we have a well-trained, educated, and supported workforce at sufficient volumes to provide the services society requires.
We envisage the need for short-, medium-, and longer-term plans based on current knowledge and insight. As new service models emerge, based on changed requirements, and ideally evidence of “what works”, then the Plan can change accordingly. The possibility of further lockdown needs to be incorporated into planning assumptions.
New models of community supports need to be sustained to ameliorate the requirement for directly provided care, for example renewed consideration could be given to a Buurtzorg model of community support, and from the early adoption of Community-led Hubs (Health Improvement Scotland).~
One specific commitment needs some attention in any event. The first bullet in para 5 of the Discussion Document states you will “As a baseline, look again at the modelling and financial assumptions set out in the integrated workforce plan published at the end of 2019”.
This is welcome as there is some lack of clarity in the statistical information underpinning the current Integrated Workforce Plan:
Underpinning question 2. Is our concern that the staffing growth implied by the Scottish Government’s 2018 Medium Term Financial Framework has not been correctly stated in the 2019 Health and Social Care Workforce Plan, perhaps due to a statistical calculation error. For example, taking the Workforce Plan to the next stage would mean discussion of what kinds of health and social care staff are needed in the future, but if the national financial parameters are wrong, then that will impact negatively on that work.
The Integrated Workforce Plan would benefit from a dedicated page on the Scottish Government website. This should include key documents, any toolkits, useful contacts, links to other sites, etc. It should also include and Excel Workbook holding the relevant staffing statistical time series starting with the Plan baseline dates, by type of staff and setting, and updated regularly by NES and SSC, with a summary page for Scotland, and in time separate pages for each Partnership area. That would provide transparency about the actual direction of travel and enable more rapid monitoring of the Plan delivery.
Ideally, members of networks and stakeholder groups would be able to sign up on the website for email alerts to updates. Meanwhile communications can continue via email.
Social Care Inquiry
SUBMISSION FROM SOCIAL WORK SCOTLAND TO HEALTH AND SPORT COMMITTEE, SCOTTISH PARLIAMENT
20 February 2020
Social Work Scotland is the professional body for social work leaders, working closely with our partners to shape policy and practice, and improve the quality and experience of social services. We are a key partner in the national Adult Social Care Reform Programme, creating an operational framework for Self-directed Support across Scotland supporting consistent delivery of social care that is personalised, rights-based and which supports active citizenship. Another of our current projects is aligned to a Scottish Government programme (Health and Justice Collaboration Board) to test and implement frameworks for the delivery of integrated adult social services in Scottish prisons.
Notwithstanding ongoing progress in the national reform programme, the Health and Sport Committee’s inquiry into the future needs and delivery requirements for social care for adults is a welcome focus on the sustainability of models of social care and the investment required to support the wellbeing of Scotland’s citizens.
THE FUTURE DELIVERY OF SOCIAL CARE IN SCOTLAND
Social care is a concept that implies the delivery of a service to an individual to meet professionally defined social and health deficits. In recent years, social care has become professionalised to such an extent that it can feel institutional in nature to those receiving social care and those delivering it.
Social Work Scotland sees the role of social work downplayed in recent decades with a focus on transactional care management and adherence to bureaucratic processes and procedures. The role of social work (as distinct from social care) is by its nature dynamic and complex as it follows people and families through often chaotic life challenges and transitions, helping people to find the right way forward for them, enabling them to take risks, with all the attendant conflicts that this implies, and when necessary and proportionate, using statutory measures to intervene to protect people. In order for social care to be delivered to the right people in the right way, social work practice needs to be strong and delivered across the range of settings including home, hospital, residential home, care home, homelessness and prison for all vulnerable people at any age.
The social care model in Scotland was not designed or funded to meet the current expectation of provision or demand. Social Work Scotland members increasingly experience the effect that real-term spending reductions is having on their ability to sustain levels of service, maintain quality and provide non-statutory early help to prevent escalation into crisis. Social services (social work and social care) as a whole system within the integration environment with health must be sufficiently funded to meet its statutory duties.
Social Work Scotland believes that the system could be reimagined to be a much more dynamic interplay of social infrastructure supporting citizens as individuals and within families and communities, with a combined workforce operating at community level.
The Adult Social Care Reform programme, of which Social Work Scotland is an enthusiastic national partner, states that “social care support is about supporting people to live independently, be active citizens, participate and contribute to our society, and maintain their dignity and human rights” Whilst there is widespread agreement with this aim, the question remains: what will it take to implement the change necessary to meet these aims for everyone in all areas of Scotland?
The reform programme takes us back to the drawing board to consider these priorities:
It is critical that we understand the essential elements that contribute to successful implementation of whole-system change: the person’s life journey both within and outwith the system, what matters to the person and their families and what they need to be fully in control of their life, regardless of their disability (visible or hidden) or health condition, which social work and social care policies and practices are useful and how we can ensure that they are reliably delivered by a well-trained and supported workforce, what the infrastructure needs to look like (including community assets, accessible housing, case management IT systems, technology, administrative support, commissioning and procurement, eligibility policy, finance and budgeting systems), and the qualities, skills and behaviours of adaptive systems leadership.
Adult social work and social care contributes to the wider system of integrated social and health care and support, which in turn, we believe, should be better embedded within local community planning processes.
Social Work Scotland supports the approach of active citizenship, where people are involved at all levels of decision-making and throughout strategic and individual planning and commissioning processes. We recognise that community engagement requires considerable time and workforce resource to be done well.
Through representation on their Integration Joint Board, many communities may have already expressed their views of local social care needs but this does not necessarily reflect in the services commissioned by Health and Social Care Partnerships.
Participatory budgeting and the allocation of small community investment funds have helped develop some good preventative community-based social care activities across Scotland (such as dementia cafés and Men’s Sheds) but are generally funded only for one year and heavily rely on volunteers. While helping to address identified community social care needs, such initiatives are often not sustainable.
We welcome the development of new community engagement guidance for integration authorities under the Integration Review. However, over the past decade, support to build community capacity, in the shape of community learning and development services, community workers, and grants to community groups, has been critically reduced across Scotland. Investment is required to ensure that communities are ready and resourced to engage in strategic planning and commissioning processes. Independent support organisations, such as those funded by Support in the Right Direction (SiRD), are vital in ensuring the voice of people who use services and carers are invited and heard.
True engagement needs to start where people are at, so local partnerships need to be imaginative and creative about seeking views from people, in ongoing and multiple ways. Engagement should lie at the heart of decision-making and is the key to people having meaningful choice and control in their own support. Engagement therefore supports the principles of personalisation underpinning Scotland’s Self-directed Support (SDS) legislation. Practically, good engagement that personalises social care means that care arrangements are more likely to meet needs and less likely to go wrong.
There already exists a range of asset-based resources and approaches to support people to engage. The National Involvement Network’s (2015) Charter for Involvement “sets out in their own words how supported people want to be involved, in the support that they get, in the organisations that provide their services, in the wider community”. Supported Decision Making can help some people’s views and choices to be expressed. The Care Programme Approach is designed to provide a wider structure of care and support to people with mental health problems. The Good Conversations approach engages with people about their personal outcomes.
However, these resources are used in a piecemeal way across Scotland, and are largely abandoned when budgets are tight. In order to implement these approaches, which often conflict with the traditional ‘way we do things’, attention needs to be given to workforce training and coaching, supportive systems and devolved leadership.
We feel very strongly that there needs to be consideration of the range of people’s lived experience when designing and constructing social work and social care services. Often the focus of social care is older people with personal care needs due to frailty or long-term conditions and people with physical disabilities, with other experiences not well supported including mental illness, learning disabilities, alcohol and drug addiction, domestic abuse, families at the edge of care, care-experienced children and young people, people vulnerable to abuse and those in our justice system, who tend to come from communities experiencing the greatest health and social deprivation. It would be helpful if the Health and Sport Committee could take cognisance of the review of mental health legislation in Scotland where Social Work Scotland will be making similar points regarding the need for early intervention, better resourcing of community supports, and greater choice and control.
As SDS helps move choice and control to the individual and as communities take on more social care support though community empowerment, we wonder if some of the obligations of regulation need also to move to the individual or community, and the role of regulatory and inspection bodies reconsidered.
Social work and social care financing needs to be sufficient to support the quantity and types/models of care necessary to support our population. Services in many areas of Scotland are currently constrained such that they are only able to address substantial and critical risks (as defined in the National Eligibility Criteria) by the provision of personal care only, leading vulnerable people to struggle when their needs change or when their needs are social in nature rather than physical.
Scotland should embrace a human rights based approach to care. Underpinning principles should cover the range of activities necessary for active citizenship, including reducing isolation, supporting people to make and maintain friendships, promoting vocational skills, supporting people to develop and enhance life skills, promoting physical and mental well-being, and mitigating health inequalities.
This would involve supporting people with complex needs in personalised ways, supporting carers, promoting SDS and personalisation within partnerships, working with people at the earliest opportunity to maintain, improve or maximise independence, building capacity in the community and with sustainable services, ensuring best value and effective partnership working, reducing dependence on high-tariff services, and creating services that are aware and confident about using and utilising technology.
Social Work Scotland recognises the progress being made by integration authorities in strategic commissioning, though it is notable that current commissioning practices are not well placed to support personalised options. Audit Scotland found that SDS Option 2 in particular is not fully developed.
SDS legislation calls for innovative solutions to allow people to hold individual service funds, necessitating a shift in commissioning practice from block funding to personal commissioning, to enable more freedom of choice and greater control. The Care Inspectorate did find that local authority finance teams were becoming more knowledgeable, less risk-averse and more open to creative use of personal budgets, though this is by no means wide-spread.
Most services commissioned and arranged by the local authority (Option 3) are delivered on the basis of ‘time-and-task’, and this is runs counter to a human rights-based approach to delivering care and support, because people’s needs and choices naturally change on a day-to-day basis. Introducing more of a personal approach to is essential to assist people receiving supports in a way that meets their personal outcomes. We believe that quantifying ‘time’ rather than ‘task’ would allow greater choice and control by individuals, whilst allowing for a budget to be allocated.
We echo COSLA’s view that the lack of variety in the social care market is contributing to rigidity and lack of choice, and think that addressing this should be a priority. Social Work Scotland is aware of innovation in commissioning such as alliance contracting, which could be explored.
In future, integration should give rise to the pooling of health and social care budgets to form personalised care packages controlled by the person.
We shouldn’t be thinking about an ideal model of social care; an ideal is neither possible nor desirable. Scotland is a country with significant geographically and economically variation, with a diverse and vibrant citizenship with whom we should be aiming to personalise care and support and to offer people choice and control of how they want to manage their lives.
The promise of integration has not yet been realised, though a major shift in professional structures and organisational dynamics could not feasibly happen in a few short years. In some settings where social care and support is required, other partners need to be more fully involved such as the Scottish Prison Service in regards to prisons and local authority housing departments who are key enablers in providing environments to meet the needs of their populations.
We do think that there are essential elements that can support a revitalised and redesigned system of social work and social care but we fear that implementing integration and reforming adult social care by attempting ambitious systemic change without methodological rigour will fail.
We recommend that the committee considers what implementation science might offer in our national attempts to implement complex social policies consistently across Scotland. We believe that this approach is the most suited to undertaking the sort of complex, adaptive change required to meet Scotland’s ambitious progressive policies. Scotland hosts national expertise in the form of the Active Implementation approach supported by the Centre for Excellence for Looked After Children in Scotland (CELCIS), University of Strathclyde. Social Work Scotland is commissioning CELCIS to support its project work, including the national SDS and Social Care in Prisons projects.
As noted in the introduction, Social Work Scotland is hosting the national Self-directed Support project on behalf of the Scottish Government and COSLA. Learning from past experience, we are committed to understanding what it will take to embed SDS in a sustainable manner across the geographies of Scotland and across all care groups equally. In accordance with best international implementation practice, this includes examining practices and tools for their effectiveness and fidelity, and understanding and promoting the system drivers necessary for adaptive change.
This project is in its early stages, but essential components will include community infrastructure and assets, help to galvanise natural family and community supports, personalised assessment and support planning, resource release models, and review processes.
The underpinning questions is what are the essential elements for a good life as an active citizen in all environments. This includes respecting human rights, having loving relationships, a decent income, the opportunity to learn, work and contribute, to be part of a community, to have a home that can adapt to your needs, support to maintain health and wellbeing and when you need support to be able to have a say in how, when and what that support looks like.
This entails a well-trained and adequately paid workforce, access to transport and technology and to feel safe where you live. Personalisation and Self-directed Support are at the heart of good social work and good social care, and should be the key driver in local planning processes.
Current application of the National Eligibility Criteria presumes that intervention for anything less than critical and substantial risk can be picked up by family or local community and that the person has the capacity to organise and manage sometimes complex arrangements. In some settings (for example prison) people do not have this level of family or community support and are not able to follow signposting to where third sector support might be available. Lack of early help precipitates crises which are costly in outcomes for the person and financially for the local authority.
A radical shift of focus of integration authorities to support people to self-manage, on personalising care and support at home and on effective early intervention and prevention would involve working collaboratively with a wider range of partners including education, housing and community representatives using shared decision-making processes and sharing both risk and responsibility. The current approach to eligibility is impacting too severely on vulnerable people and those at the edge of social care, and we recommend that the National Eligibility Criteria are reformed.
An early intervention approach would see social workers move away from care management to working relationally and enhancing the natural supports of family, friends and neighbour’s contribution through such models as Family Group Decision Making. However, as the working age population is set to shrink while the older population will increase as the baby-boomer generations reach older age, this population shift will impact disproportionately on women, who provide most of the – care to family members. Consideration must be given as to how Scotland can best support carers.
Where localities are well-resourced and organised, consideration could be given to devolving budgets to enable integrated teams to develop local services and supports. Health and Social Care Partnerships approach to locality working could have, as the norm, integrated teams (community social work and community nursing) who hold their own budget and involve community representatives and local providers in regular place-based conversations. Alternative models already being tested in Scotland include Buurtzorg in the form of Neighbourhood Care approach and Community-Led Support. There have been attempts made to revitalise a Community Social Work approach in some areas.
Under existing SDS legislation individual budgets can be provided to people to procure their own service and support where they are comfortable and supported to do so, although this happens infrequently.
It is critical importance to develop a strong Third Sector with investments from Government to ensure partnership and sustainability. There should be consideration to supporting local partnerships to commission more specialist services (those that are high cost and risk, but low volume) on a regional or national basis.
Houses should be designed for people to live in through life into older age and for those with increased dependency. This would include the ability to retrofit hoists and large equipment, and should have technology built in. Such housing should be affordable and be sited at the heart of the community.
There are tensions and barriers to more productive working with housing developers, largely due to the planning system and financial pressures on housing associations which prevent ambitions around accessible housing – for older people and housing for life – to be built. The best practice guidance issued by Scottish Government for more accessible housing is not a requirement and has proved challenging to comply with, and we think there is merit in examining industry standards for accessibility to consider whether they are fit for purpose. There are some very positive examples of best practice driven by the Scottish Federation of Housing Associations such as technological solutions in housing, but these are limited in spread.
Whilst housing statements are required to be considered by Integration Authorities, better relationships could be built with the SFHA/Scottish Housing Regulator to raise awareness and understanding of how social work can work alongside housing professionals, and to influence housing associations nationally when they’re planning adaptations made to existing housing stock to allow for transitions from family life to house people with mobility issues, frailty and living alone as well as dementia. In addition, we should require housing developers to contribute toward the provision of community health and social services. We could require a certain proportion of houses to be ready for use by someone with a high level of support needs.
There should be closer alignment of local authority housing services with health and social care partnerships to ensure that there is effective local housing planning to support population needs.
The Scottish Government has developed a draft vision for housing for 2040. Whilst this document references a number of key challenges such as the ageing population, increasing health and social care needs, child poverty, homelessness and welfare reform, it does not go far enough to acknowledge some critical issues such as the housing needs of people with dementia, flexible care and support services for people who are older inclusive and intergenerational communities. Crucially, ‘places of care’ should not necessarily be envisaged as care homes. Consideration should be given to how we commission services that allow people to stay in their own homes and communities, supporting their relationships and identity, rather than moving people into residential settings.
We should focus on building sustainable communities. Statutory social work, social care and health services are not the answer in isolation.
Spaces in communities should be fit for purpose for meeting the needs of more vulnerable adults. Whist soft play is ubiquitous for young children, we should have similar sensory spaces for other groups such as people with autism, or people who needs a quite communal space. Architecture and Design Scotland have conducted good work on age friendly places and on redesigning town centres to provide opportunities for more intergenerational and inclusive living.
Technology needs to be at the heart of the future of care preserving independence and supporting social inter-dependency. It should not substitute for human contact. The National Digital Platform should incorporate as great a focus on technology to deliver social care as on health, and should be given highest priority as a core enabler.
Technology that allows people to monitor their own wellbeing and the use of algorithms to trigger service response when needed should be standard. It should deliver platforms to make it easier to find and refer to organisations that offer support. Technology Enhanced Care should not focus solely on established applications, like community alarms, tracking devices and sensors, but should include emerging uses such as apps and widgets on Smartphones, and the use of artificial intelligence virtual assistants, which are widely available.
IT to support Self-directed Support would include systems for booking care and short breaks, and how to make use of individual service funds.
A key driver of any adaptive system change is workforce; selection, training and coaching. In order to attract a competent and committed workforce, remuneration should reflect the complexity and responsibility of roles across a varied employment landscape. Innovation is required in how we support people to employ their own personal assistants (employed with an Option 1 Direct Payment). We need an inward migration system that can attract skilled workers into the social care field, and note with dismay the likelihood of too high salary thresholds for European immigrants post-Brexit. We need to focus on attracting workers to urban, rural and island areas and keeping them engaged and motivated. We require a gendered analysis of the workforce if we are to understand how to attract men into the social care workforce and how to best support women in the workforce.
An integrated workforce must be drawn from across disciplines and be multi-skilled across both health and social care. This will require developments in foundational training and changes in workforce regulation.
With budget cuts over the past decade, local authority social work learning and development teams have all but disappeared, impacting greatly on the ongoing training of social work and social care staff. Staff on the whole make do with what they source themselves on an ad hoc basis, and there is limited if any dedicated time-to-learn. This highlights the lack of parity of social work and social care with other professions such as teaching and nursing. If adaptive change is to be implemented effectively, then the workforce requires not only high standard skill-based training but ongoing intensive coaching and supervision, and to expect pay rises in line with those offered to nurses and teachers.
The fundamental driver of equity is to ensure that investment in social work and social care is sufficient to meet population needs and choice from early help though to crisis intervention. For too long we have heard the rhetoric of ‘record investment in the NHS’ compared to ‘the soaring cost of social care’. We need to reconsider the value of social work and social care, and promote public awareness of the interrelationship, and crucial role that social work and social care play in supporting our communities.
Social Work Scotland is supportive of the development of national practice models which support consistency of approach across Scotland whilst allowing for variation onlwhere this is reasonable in the context of local geography, demography and cost of living. We believe that there are opportunities that need to be seized within the current reviews of Integration and Adult Social Care to reimagine partnerships within local and national government, social work and health (including Public Health Scotland) and across community planning.
Our Adult Social Care Standing Committee is looking at the development of a common practice model for adults similar to the national practice model for children (Getting It Right For Every Child) based on work already undertaken by Highland Council (Figure 1) and by Dundee HSCP.
Having a common practice framework across integration authorities would support a coherent performance framework for social work and social care service delivery and for integration across social work, social care and health, and would orientate the systemic adaptive change necessary to embed the progressive policies of personalisation and integration.
The benefits include a common shared language and shared pathways, with single integrated health and care plans for people. A common practice framework would help align data and IT systems across councils and health. Integrated teams have been supplanted on top of pre-existing professional teams in some areas, so there is duplication. However, there is a need to test out new ways of doing things safely, while protecting current systems, however imperfect, and this requires implementation funding.
Taking a similar approach, Social Work Scotland is developing a national framework for Self-directed Support as the key deliverable of the SDS project. This will take cognisance of the person’s life journey and the service systems required to support personalisation.
As noted on p8, Social Work Scotland holds that the existing eligibility criteria should be reviewed. Current eligibility criteria are deficit-based assessment of levels of risk to an individual if care is not provided. They run contrary to the principles of personalisation, as they drive time-and-task service provision. They are applied differently across Scotland and result in unnecessary variation in outcomes for individuals. There should be consideration given also to the variation in charging and contributions policies across local authority areas and their disproportionate impact on individuals with similar needs in different areas of Scotland.
Currently the rules of ‘Ordinary Residence’ mean that people receiving care at home who move across local authority boundaries are subject to reassessment under different (and non-transparent) local policies and systems, and can see their care provision significantly altered as a result. This has become particularly obvious in our prison work as people’s rights to ask the Parole Board for release are impacted by disputes round ordinary residence and what appears to be reluctance to fund care packages and accommodation for people with more complex needs. We would like to see a rights-based review of ‘Ordinary Residence’ undertaken with the aim of improving portability of care across local boundaries as well as the processes around transitions between settings.
For further information, please do not hesitate to contact:
 “Social work is a practice-based profession and an academic discipline that promotes social change and development, social cohesion, and the empowerment and liberation of people. Principles of social justice, human rights, collective responsibility and respect for diversities are central to social work. Underpinned by theories of social work, social sciences, humanities and indigenous knowledge, social work engages people and structures to address life challenges and enhance wellbeing.” IFSW, July 2014
 “Social care means all forms of personal and practical support for children, young people and adults who need extra support. It describes services and other types of help, including care homes and supporting unpaid carers to help them continue in their caring role.” Scottish Government https://www.gov.scot/policies/social-care/
Housing to 2040
Housing to 2040: Consultation on Policy Options
SUBMISSION FROM SOCIAL WORK SCOTLAND, TO THE SCOTTISH GOVERNMENT CONSULTATION
27 February 2020
Social Work Scotland is the professional body for social work leaders, working closely with our partners to shape policy and practice, and improve the quality and experience of social services. We welcome this opportunity to comment on the draft housing vision for 2040 and the underpinning principles for future housing policy.
Q1. Earlier this year we published our draft vision and principles. Do you have any comments on the draft vision and principles? Please be specific and identify what you would change and why
Social Work Scotland agrees that a whole systems approach to housing is crucial, focused on ensuring holistic, rights-based support is available for individuals, children and families when they need it. Only in this way will Scotland enable people to live healthy, secure and productive lives, characterised by good relationships and sense of purpose.
We also strongly support the assertion that good housing has a substantial role to play in meeting the Scottish Government’s National Outcomes, including child poverty and homelessness. Indeed we believe good housing also supports priorities specified in the Adult Social Care Reform programme, specifically ‘places of care’ being encouraged as independent living in community settings.
We agree with the reflections made by Professor Clapham of the University of Glasgow, in his assessment of the principles as being vague and open to interpretation. In order to strengthen a whole systems approach to housing, we believe it is critical to give greater emphasis to the care and support priorities (tending towards prevention) rather than health (tending towards late stage interventions). Research into housing has long argued for ‘a social work approach to housing’, in recognition of the fundamental role that housing has on individual and community wellbeing. This was highlighted recently by the Independent Care Review, which had:
[…] ‘consistently heard that financial and housing support were some of the greatest concerns from children and families… when the economy hurts children and adults, and housing and social security systems fail to provide the protection from harm needed to compensate, increased pressures on family life can increase the odds of interacting with the care system.’
In addition to ‘rural proofing’ the vision and principles of Housing to 2040, we suggest that the care and support needs of ageing rural communities, isolated individuals and families (particularly in the Highlands and Islands) are considered in more detail. Social work and care will be central to supporting people to stay independent and well in suitable housing, so regardless of the built environment, infrastructure to offer social care services and support to individuals and families may be limited, or provided in alternative ways. Solutions which work in more urban areas or communities may not be appropriate in other areas, and the vision and principle (while striving for equality for individuals) should not dampen innovation and local adaptation (indeed it should encourage it)
Alongside ‘health’ we would like to see sustainable care and support identified as a specific driver for Housing to 2040. Social Work Scotland has been working with partners and the Scottish Government to look at key resourcing challenges facing social work and social care, and which are affecting both practice and future recruitment across the workforce. Our collective capacity to address poverty and child protection concerns (for which housing is also a key factor) was also raised in the Independent Care Review. Alongside the drivers identified for population and health, it is clear Scotland will continue to face rising demand for professional, skilled care and support, and without the sustainability of this provision, the success of this vision and its principles are unlikely to be met.
The principles 5, 13 & 14 have clear overlaps with the aims set out in the Scottish Government’s Adult Social Care reform programme. That programme states that [social care support] “is about supporting people to live independently, be active citizens, participate and contribute to our society, and maintain their dignity and human rights. Housing which meets the needs of our ageing population by location and accessibility, and which acknowledges the increase in single person households, is absolutely central to this. However, we feel that Housing to 2040 could be both more explicit and nuanced about the centrality of adequate housing in meeting the care needs (maybe even human rights) of people with dementia, complex physical disabilities, flexible care and support needs, and intergenerational families. Crucially, the ‘places of care’ identified in the Adult Social Care Reform programme should not necessarily be envisaged as care homes. Housing to 2040 is the place in which Scotland should articulate how it will enable people to stay in their own homes and communities for as long as it is in their best interests to do so, maintaining their relationships and identity, enhancing their wellbeing.
For reference, Architecture and Design Scotland have conducted extensive work on age friendly places and on redesigning town centres to provide opportunities for more intergenerational and inclusive living. Developing closer links between housing provision and social care, as identified in 1.5, may support this, and the vision overall should focus on building sustainable communities through an integrated, Whole System approach.
Finally, we would like to see the complexity of these issues better acknowledged in the constraints and principle section. Taking a Whole Systems approach is the right thing to do, but to be successful Housing to 2040 must surface and address the complexity head on, attending to the many interconnected and interdependent systems – health and social care (and within that, social work) being just one. Presenting the context as simpler than it really is will only increase the risk of failure.
Q2. Do you have any comments on the scenarios and resilience of the route map or constraints? These are set out in sections 3 and 4 of Annex C.
We note the financial constraints section of Annex C, and believe that it illustrates an inherent tension between the vision and reality. We would like to see more robust and data driven assessment to support some of the market-shaping principles particularly.
Under Constraints 4.3, we suggest that, rather than separating out ‘accessible and age appropriate’ homes, this specification be included into all future housing requirements, to reduce or remove the ‘bottleneck’ in access to appropriate housing, experienced by many people, and which has profound impacts on other parts of the system – health, education, social work and social care, criminal justice. Given the population projections for Scotland, housing accessibility will become a pressing concern before 2040.
A 2018 study undertaken by the Equality and Human Rights Commission found that ‘The need for accessible housing will increase as the population continues to age. In Scotland, the number of people aged 75 and over is projected to increase by 23 per cent between 2010 and 2020, and by 82 per cent between 2010 and 2035 (Scottish Government, 2011). The demand for wheelchair-accessible housing is expected to increase significantly: a projected 80 per cent increased in the population of wheelchair users by 2024, with an increase in unmet needs from 17,226 to 31,007 households (Horizon Housing, 2018).’ 
As colleagues from Inclusion Scotland often note, with increases in life expectancy and demographic trends, nearly everyone will be a disabled person for part of their life. To accommodate that future population, a focus on intergenerational and lifetime homes that are adaptable, flexible, inclusive and affordable must not just be part of the vision of Housing to 2040. It must be at its centre. Evidence from the University of Stirling’s 2018 Housing and Ageing report supports this approach and outlines some of the challenges in creating stronger links between health and social care and housing to support people more holistically.
Q3. Do you have any proposals that would increase the affordability of housing in the future?
Q4. Do you have any proposals that would increase the accessibility and/or functionality of existing and new housing (for example, for older and disabled people)?
Q5. Do you have any proposals that would help us respond to the global climate emergency by increasing the energy efficiency and warmth and lowering the carbon emissions of existing and new housing?
Q6. Do you have any proposals that would improve the quality, standards and state of repair of existing and new housing?
Q7. Do you have any proposals that would improve the space around our homes and promote connected places and vibrant communities?
We support the further development and incorporation of learning from Age Friendly Places, as published by Architecture and Design Scotland, and, as stated above, believe that a more holistic approach to community, incorporating accessibility and flexibility more unilaterally into the built and planned environment, will provide Scotland with a more equitable housing system in future.
Q8. Any other comments?
For further information, please do not hesitate to contact:
 STEWART, G., & STEWART, J. (1992). Social Work with Homeless Families. The British Journal of Social Work, 22(3), 271-289. Retrieved February 20, 2020, from www.jstor.org/stable/23709313