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.

DateTitleDownload
25/01/2022

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”.

 Consultation Questions

 

  1. Do you think that the approach outlined is consistent with the vision to end poverty and the need for food banks? Is there anything else you think should be included?

Yes

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.

  1. Do you think that the actions underway will help to reduce the need for food banks as a primary response to food insecurity?

Don’t know.

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.

  1. Do you think that the suggestions for what more we plan to do will help to reduce the need for food banks as a primary response to food insecurity?

Don’t know.

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.

  1. Is there anything else that you think should be done with the powers we have at a national or local level to reduce the need for food banks as a primary response to food insecurity? [Open comment]

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.

  1. Do you have any views on how we intend to measure impact, and what would give you confidence that we are moving in the right direction? [Open comment]

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.

  1. Is there anything else that you think should be considered in the development of this plan?

(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.

08/11/2021

 A National Care Service for Scotland

SUMMARY OF SUBMISSION FROM SOCIAL WORK SCOTLAND, TO SCOTTISH GOVERNMENT CONSULTATION 

November 2021 

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:
SWS NCS Supplementary Response – CARERS

SWS NCS Supplementary Response – FINANCE

SWS NCS Supplementary Response – RESIDENTIAL CARE CHARGES


Our overall position 

Over the past decade Social Work Scotland has taken every opportunity available to underline how pressing the need is for investment, paired with reform, across all aspects of social care and social work. The gap between Scotland’s ambitious rhetoric in these areas (often given weight in law) and our collective ability to deliver on it has steadily grown, fuelling disappointment, frustration and cynicism among those seeking publicly-funded support and those employed to deliver it. Ten years on from the Christie Commission, the preventative model of public services that it described also remains, for many, some way off. Closing this ‘implementation gap’ is a shared priority for Ministers and Social Work Scotland’s members.  

The reforms outlined in this consultation present opportunities to close that implementation gap. The COVID-19 pandemic has brought the social care sector to the brink of crisis, and further delay in making necessary changes and improvements is not tenable. We therefore welcome the prospect of co-creating a National Care Service for Scotland, helping to realise its potential and mitigate its risks. The National Care Service’s scope should extend to adult social care and social work, from where the impetus for these specific reforms came, and where the rationale for these proposals is clearest. But defining the boundaries of ‘adult’ social care and social work will be difficult, and we see real value for individuals and communities in maintaining social work as a holistic profession and service, with all its parts connected under a shared professional leadership. For these reasons, as well as our acknowledgement that reform is needed (and has been committed to) in all areas of social care and social work, we recommend that formal discussions, research led and lived-experience informed, are initiated immediately among relevant partners to determine what the best structural and governance arrangements are for justice social work, children and families social work and social care and mental health services. The fundamental questions being always: “will this change make it easier or harder for the people working in the system to achieve positive outcomes alongside people in their communities?” and “will this change progress or impede social justice in Scotland, in terms of poverty and inequality, discrimination and isolation, the environment and human rights?”   

It should be noted that we do not believe organisational structures, in themselves, have a direct impact on the quality of social care and social work, the experiences of people, or the outcomes achieved. Inspections and research have consistently concluded that formal structural arrangements matter much less than the quality of leadership and availability of resources. An approach to change which concentrates primarily on the structures, rather than the people that work within them, is therefore likely to fail in delivering meaningful change on the ground. But this is not said to dismiss structural change as unimportant. Structures can and do have an influence over how resources are allocated and managed, and the nature of leadership. We must get them right, if we are to enable the cultures and practice which the Independent Review of Adult Social Care and the Promise, among others, have called for. Moreover, if structural and policy change is a corollary to unlocking the financial and political investment that social care and social work require, then we must engage with proposals constructively. Social Work Scotland members are eager to share their experience and insight in the process of building a National Care Service that works for all. 

For the leaders of social work in Scotland, the National Care Service consultation has provoked some difficult conversations. We are not all of the same view about what represents the best next step for the profession, or what arrangements work best for the delivery of public services. But we are in complete agreement about the essential and unique contribution social work makes to achieving a socially just, healthier Scotland. Social work sits near the heart of social care, and at its best it can knit together separate components into an experience of assistance and support which feels personal and empowering from the perspective of an individual or family.  We will work tirelessly with any partner committed to helping social work achieve that reality for the diverse communities of Scotland.  


The case for change 

In considering the proposals in this consultation, Social Work Scotland members engaged with an open mind, sharing the view of Ministers that change is needed. There has been disagreement with the reasons for change set out in the consultation document, and with the specific changes proposed, but as an organisation we start from a position of acceptance that the status quo is not, nor should be, an option.  

In part this is because the voices of those with lived experience, whether in the case of the Independent Care Review or Independent Review of Adult Social Care, have made clear that changes must be made. But is also because our own members, and other social work and social care colleagues, have for a long while expressed their dissatisfaction with structures, cultures and policies which are often disabling, rather than enabling, of their personal effort and professional judgement. Eligibility criteria and inadequate workforce numbers which preclude them from taking preventative, empowering actions. Bureaucracy and systemic risk-aversion inhibiting them from developing constructive relationships with those seeking and/or receiving support. Legislation which pushes and pulls in contrary directions, or makes demands which the ‘system’ has no capacity to deliver.  

For social work to fulfil its potential, as a body of relationships through which the lives of individuals, families and communities are improved, we need to see change nationally. But the nature of the change needed is different for every local area. This is why our membership have articulated a variety of opinions in response to the consultation; no disagreement that change is needed, but caution about whether the changes proposed by the consultation are the right ones for their local community, or the group of people they support. In other words, no two parts of Scotland engage with these proposals from exactly the same starting point. This is perhaps best illustrated by the debate around children’s social work and social care, where a multiplicity of different arrangements currently exist, each with its own strengths. The consultation’s proposal to extend the scope of a National Care Service to cover children’s social work and social care has, therefore, been viewed by some as a logical continuation of current arrangements, while for others it represents a profound risk to existing partnerships (particularly with education). On balance, our members have concluded that a case has not yet been made for such radical change (i.e. moving children’s social work and social care into the National Care Service). We have reached a similar conclusion on justice social work. However, we are very aware that this conclusion does not preclude change. For all those local areas where children’s social work and social care are part of Health and Social Care Partnerships, a decision not to include these services in the National Care Service will mean significant change. Which is why the priority must be to initiate a national discussion about what the best next step is, in terms of structural arrangements for specific service areas, maintaining meanwhile as a horizon a strong, unified social work profession.           

Structures of accountability, governance and service delivery are just one part of consultation though, and proposals around eligibility and assessment, workforce development, commissioning, scrutiny, implementation and improvement are, among many others, all welcome. The case for change is strong in these areas, with clear potential to make things work better.        

As social work is so integral to Scotland’s various social care systems (e.g. children, adults, older people, etc.), and our social care, health and education colleagues so critical to achieving social work’s objectives, the focus of our members has always been broad and inclusive. We seek change in the whole system, as it is only when the whole system is working well that people and communities will notice improvement.  

But the consultation rightly makes a number of proposals specifically about social work, which we warmly welcome and endorse. Social work is a national profession without national structures. Despite being a statutory role, with legal responsibilities no other professional can fulfil, there is currently no mechanism for national workforce planning, or for the coordination of ongoing learning and development (or to protect the time of social workers to engage in that learning). The variations between local areas, flagged as a matter of concern by both the Promise and Independent Review of Adult Social Care, is baked into the system by there being, among other reasons, thirty-two distinct approaches to social work resourcing and management. The establishment of the National Social Work Agency, distinct from but in close partnership with the National Care Service, can be a means to address these issues. In addition to offering our strong support for the National Social Work Agency, we also advocate strongly in our response for the reaffirmation, through legislation, of social work professional leadership in the management of public services (through Executive Directors of Social Work on Community Health and Social Care Boards, and equivalents within local authorities). Our work around the implementation of self-directed support legislation continues to provide evidence (to add to much already in place from other sources) that the principles and spirit of the legislation are only achievable when professionals and others have autonomy and agency, able to make decisions and hold risk with confidence. That is only possible in areas where senior leaders make that possible for their teams. The principles of self-directed support, as well as duties around prevention and protection, are core to the social work role; the leadership of the profession can help embed them in all the organisations of which they are part.       

Finance  

As the Minister rights notes in his foreword to the consultation paper, “social care is an investment in our communities and our economy, so that everyone can take their part in society”. The Scottish Government’s commitment to significant investment in social work and social care is to be welcomed and applauded. But we are concerned that the additional funding being proposed alongside the consultation, at “over £800m”, will not be sufficient to realise the scale of change outlined by the proposals.  

The Scottish Government has yet to cost some key proposals highlighted by Derek Feeley as necessary to “strengthen the foundations” of social care, around pay increases for social care workers and increased support for Scotland’s now one million unpaid carers, which in Feeley is wider that the “right to respite” in the consultation paper.  (These and other issues are discussed more fully in our supplementary submission on Finance). We estimate that the delivery of commitments already made by the Scottish Government, combined with the specific consultation proposals and other uncosted Feeley recommendations, would require over £1.5 billion of public spending in 2025-26 to realise. This figure assumes the scope of the National Care Service is adult social work and social care; if the scope is broadened costs will increase further, as all areas require investment to address unmet need.    

We were surprised that the consultation paper continued no questions on finance, apart from charging for residential care. Considering how critical the resourcing is to successful implementation of these proposals, this was perhaps a missed opportunity. But we hope in the stages that follow the consultation there will be forums established for consideration of the finance issues, within which we will be constructive participants, making available the information and knowledge we do have about how much it will cost to make the National Care Service vision a reality.    

Social Work Scotland members did note and welcome the emphasis in the consultation document on early intervention and prevention. These are, like protective interventions, part of the statutory role of social work. When we are properly resourced, social workers can directly improve the experience and wellbeing of individuals and families and communities, nurturing strengths and giving meaning to human rights. Such preventative action also has the bonus of helping to reduce or defer the need for more costly action at a later stage. We are eager to work with the Scottish Government and other partners to ensure the National Care Service, and all other structures from which social work operates from. We are keen to make the preventative part of our statutory role our primary focus, including working with others to address the material poverty, inequalities and deprivation in our communities.  

 

Access & Eligibility 

Reflecting on the substance of the Independent Review of Adult Social Care, and the experiences shared by people working in and receiving support through ‘social care’, this section of the consultation is perhaps the most important. All other sections of the consultation, and all the component pieces of a National Care Service, exist solely to create a safe, enabling context in which to provide care and support for all.  

With that in mind, our response cautions against an overly transactional and consumerist framing to social care and social work, in which all individuals are aware of their needs, are able and willing to articulate them, and eager to receive support. This is not the reality. In some instances individuals with the most acute needs actively avoid and reject the support available to them. Social work and social care are often about navigating the complexities of people’s lives, through a relational approach, to ensure that the needs of an individual are met. The National Care Service’s approach from assessment, eligibility and access through to support must properly reflect this, making possible the principles and standards of self-directed support in every case, not just the few.      

In a similar vein, we are also concerned about the consultation’s reductive narrative on the coordination of support. Care and support can (and is currently) coordinated by many different people, including by individuals themselves. But social work and social care are about more than just ‘care management’. In some cases the social work intervention alone will be all the support necessary, or will link a person into existing networks or in the community. In other cases protective actions may be necessary. The reduction of ‘care and support’ down to a process involving the coordination of various services not only creates risks for the public, it undermines and undervalues social work (and other related professionals) within the system.         

On eligibility criteria, we support a move away from “eligibility criteria in their current form”, but also note that “risk” is not in itself the problem. Risk is a constant and necessary part of our lives, and to engage an individual in determining and managing their own personal risks is the core objective of an empowering social work and social care system. It is important, therefore, that we take this opportunity to fully assess and understand the implications of reforming or abolishing eligibility criteria; we recommend establishing an expert panel to take on the task. It should assess the fiscal consequences of each option, and it should consider the realities of how demand management and rationing works in other services, particularly in the NHS.  


The place of social work within (and beyond) a National Care Service  

Without repeating comments made above, Social Work Scotland supports the establishment of National Care Service, and hopes to see social work at the core of its leadership, planning and delivery, shaping its ethos and culture. Where social work is incorporated into the National Care Service, close attention must be given to how the full breadth of the social work role, encompassing preventative and protective duties, can be realised. We will be eager participants in the coming ‘design stage’, helping to ensure we co-create a context which enables social work to provide the best support and care possible to people and communities. 

However, we seek further discussion and analysis about which specific ‘parts’ of social work should be included in the National Care Service. The commitment of the Scottish Government, supported by most political parties and partners, to establish an National Care Service for adult social care has, to an extent, precluded a discussion about the incorporation of adult social work. Social work and social care are distinct but interrelated things, and we cannot conceive how a National Care Service for adult social care would work without the inclusion of adult social work too. By virtue of the relationships between adult social work / care and drug and alcohol services, and relevant services in prisons, there is a strong case for including these also. But this has presented a profound dilemma for Social Work Scotland’s members. We believe that social work is stronger and more flexible when all its constituent parts (e.g. adult, justice, drug and alcohol, children and families, etc.) are located together within the same structure of leadership and accountability. But on the basis of the case made so far (as set out in the consultation), and mindful of the risks such major reorganisation presents, we have not been able to conclude definitively whether all of social work should be in a National Care Service, or just parts. Our recommendation is that Ministers work with partners, over the next year, to identify and evaluate the risks and benefits of incorporating the various areas noted in the consultation (adults, children and families, justice, mental health services, etc.), as well as others which have not been included but require consideration (e.g. homelessness). We do not reject the idea that inclusion in the National Care Service might facilitate improvement, but more work is needed to ensure that it is, when compared to alternative options, the right next step in the reform of these critical public services. All rely on partnerships between professional groups and services to succeed; reform must strengthen these, not undermine them.   

If, at the conclusion of this policy development process, social work is to be located across different accountability and leadership structures, further detailed work will be needed to clarify how connections between the various parts of social work will be maintained and enhanced, ensuring holistic assessment and support processes, and seamless and positive transitions for those whose care and support will need to move between (or require the simultaneous involvement of) multiple organisations. Social Work Scotland stands ready to assist in whatever way we can.  


Community Health and Social Care Boards 

We welcome efforts to reduce the variation in structural and governance arrangements in Scotland, identifying it as a barrier to developing and scaling up improvement. However, Social Work Scotland members representing all parts of Scotland, and particularly those based in remote and island communities, have called for some flexibility in the model of integration adopted for the National Care Service, to enable local areas to identify structures which work best for their communities, taking into account demographics, history, geography, local economies and existing partnerships.  

On the question of whether Community Health and Social Care Boards should employ other staff, we concluded early on (when considering these proposals) that it would be difficult to achieve the scale and nature of change required without a more radical approach to the employment of certain professions and other key personnel. The scale of the challenge is daunting, but we recommend that all relevant staff involved in the planning, management and delivery of social care, social work and community health are directly employed by the Community Health and Social Care Board, and together constitute the National Care Service workforce. We are not insensitive to the significance of this recommendation. For social work, as well as other groups, it would represent a seismic shift in working arrangements. But while few of our members actively seek disruption and uncertainty around their employment, every one of them are committed to securing the structures and systems that are most likely to deliver consistently high-quality social work, social care and community health services. Form must follow function, and if the objectives of a National Care Service are to be realised (let alone the more ambitious recommendations of the Independent Review of Adult Social Care) we cannot see how the Community Health and Social Care Board model can progress without direct responsibility for the relevant staff. 


Workforce planning, training and development
 

Moves to extend and enhance national workforce planning in social care and social work are welcome. In our response we highlight the fact that the ‘social care sector’ is considerably more complicated than the ‘health’ sector, and the approach to workforce planning therefore needs to reflect that, in terms of the resources, staff and time allocated to it. There is also detailed work needed to properly assess current and future demand for social care and social work; framed in the context of rights, choice and empowerment, and taking account of demographic and inequalities data. It is not possible to plan for a workforce without a clear projection of the scale and nature of the work.  

On the training and development structures that flow from, and give effect to, robust workforce planning, we are again supportive of steps which will give social care and social work a national infrastructure through which to design and deliver the necessary changes. A good example of this might be exploring how we better reflect the diversity of our communities in the workforce, through education, training and recruitment, and supporting our existing workforce to look outwards at the changing demography, as well as at our own staff. We do not agree that the National Care Service should ‘set’ training and development requirements; that implies a unilateral authority inconsistent with a reality in which relevant professional groups are overseen by independent regulators, and supported by professional bodies or associations. Moreover, depending on the eventual scope of the National Care Service, certain professional groups will span various employment and accountability structures. Training and development requirements should be determined through collaboration among these bodies, and the National Care Service will have a key role in enabling the implementation of those plans.   


National Social Work Agency
 

A National Social Work Agency is no panacea or silver bullet for the challenges facing social work and social care. But for those working in and leading the profession, the establishment of National Social Work Agency is a vital piece in the jigsaw of reform, providing the levers we collectively need to plan, develop and improve social work in Scotland. It should be complimentary to existing bodies, assuming responsibilities that currently no one holds, and bringing greater coordination in areas where various partners have a role but at present no clear lead.  

The current national arrangements for social work are messy and inefficient, with Scottish Government, employers, SSSC, Social Work Scotland, improvement bodies and many others all separately ‘leading’ on aspects of social work’s development. At best the current arrangements serve to hold things together. But if we are to affect the changes in social work systems and practice outlined by the Independent Review of Social Care and the Promise, and which the profession itself has called for, we need to create an enabling context. The National Social Work Agency alone cannot deliver that context, but conversely, the context cannot be created without the kind of functions and leadership a National Social Work Agency will provide. In our response we set out a number of possible benefits a National Social Work Agency might deliver, and we urge Ministers and partners to see the potential and value of this development.    

Please find our full response in the download link (PDF) below.

For further information, please do not hesitate to contact: 

Ben Farrugia
Director, Social Work Scotland
ben.farrugia@socialworkscotland.org 

 

22/10/2021

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
28 September 2021 

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 updated Code of Practice and Guidance for Adult Protection Committees. The reflections within this consultation response are drawn from the experience of our membership of social workers, the lead professionals taking forward duties under the Adult Support and Protection (Scotland) Act 2007 (ASP/the Act) 

Social workers are uniquely placed as a profession to offer insight and contribution to this guidance and to support the effective interaction and joint working of partner professionals in the ASP process. Working within this multi-agency context social work can offer perspective to ensure the protection of adults at risk of harm remains proportionate and in line with a human-rights and person-centred approach. 

It is recognised that Scottish Government have recently consulted on an ASP Guidance for General Practitioners and primary care teams, for which Social Work Scotland has previously provided feedback and recommendations. In addition to this, the current consultation on APC Guidance is also underway. It is recommended that comment and feedback provided in relation to the suite of supportive documents to guide practice take cognisance of amendments made across these documents to ensure continuity of content within the resources. 

Social Work Scotland recommendations reflect the involvement and feedback of the Adult Support and Protection Network. 

A summary of key points for consideration in the ASP Code of Practice are detailed below. 

Summary of key points 

  • A general observation of the Code is that it can be operationally prescriptive at points, not reflective of the principles of the Act in areas, and at times offers one approach where multiple systems of operation exist, making its recommendations less applicable. The attempt to coordinate and lend consistency to practice comes across as confusing at times and does not reflect a full appreciation of operational practice, differing structures in operation, or the role, functions, and duties taken forward by a social worker across other legislative responsibilities.  
  • In Chapter 2, the Code is expanded to outline additional considerations that should be made when determining whether the 3 point test is met. The additions of impact of trauma and coercive control, addictions, and homelessness, are well presented and should be helpful for practitioners. The age of transition, 16 and 17 years, is minimal and our recommendation would be to consider expanding this to ensure appropriate legislation is considered to best support the adult. Local areas may wish to enhance their ASP training to support assessment in these areas. 
  • When the 3 point test is not met, the Code states that local areas “would still be expected to pursue all avenues in order to protect that person from harm”. This should be further explored and expanded upon to assure partnership responsibility within this expectation, as later in the Code there is statement made that the responsibility to determine whether the 3 point test is met lies with social work. In addition, the principles of the Act could be better reflected here to acknowledge an adults right to self-determine, and the potential limitation in scope under legislation for social work to take forward any protective action without the adult’s consent to give fuller recognition of a human-rights based approach to intervention. 
  • Chapters 3 and 4 suggest how referrals, case conferences, and adult participation in ASP audits should be recorded for data reporting purposesThe recommendations made around data collection are welcome and further benefit would be gained from looking at trends emerging from ASP interventions. It would be useful to see this recommendation informing the national discussion ongoing to standardise the annual Scottish Government data return. This would support clarity, and to realise the full impact of this recommendation, it would need to be linked to the national return.  
  • The Information Sharing and effective protection of adults at risk of harm section in Chapter 3 would benefit from acknowledging the principles of the Act, guidance around proportionality, and consideration of an adults right to privacy and confidentiality, whilst recognising the legislative basis to share. There are statements made that confidentiality is not an “absolute right” for people, which could be expressed more sympathetically to support information sharing in line with human-rights. Expanding this section to acknowledge this, as well as the consideration of information sharing at the age of transition (16 and 17 years), would bring a fuller depth to the detail provided. 
  • In Chapter 5, Inquiries, the Code addresses referrals into social work. It states that all referrals coming into social work on an ASP form should be considered under ASP, and that referrals incoming noted as Welfare Concerns (from Police Scotland and SFRS) should be screened for ASP and progressed to ASP where required. It would be useful to highlight that social workers undertake screening activity for all work incoming as part of section 12 Social Work (Scotland) Act 1968 duties. We believe there is a risk that this expectation in the Code functions more as a procedural approach to referrals, rather than one reflective of an understanding of social work duty and function. The Code, as written, could limit the scope of consideration from a wide range of legislative options toward a single focus on the ASP Act. Consideration and acknowledgement of the principles of least restrictive and proportionality could be highlighted here to enforce the importance of giving these effect. Additionally, Police Scotland have a section 5 duty to report harm under the Act. To ensure this is done effectively and to identify any learning needs for officers, the Police have a dedicated Police Hub in place to support quality assurance in referrals. It would perhaps be more appropriate to highlight that social workers may require to upscale harm from any referral if it has not been identified by the referrer. 
  • In Chapter 5, Specific to Welfare Concerns received into social work, the Code raises expectation that social work should contact the referrer of a welfare concern upon conclusion of social work intervention to advise them of the outcome. This expectation would potentially have implications on capacity within teams and is questionable when considering an adults right to confidentiality. In our view, this area would benefit from further consideration: can this recommendation (or should it) be made in an ASP Code of Practice, where actions taken forward would fall under the Social Work (Scotland) Act 1968. 
  • Chapter 6. The Adult Support and Protection (Scotland) Act 2007 places emphasis on the support element of the Act. While a minor linguistic point, we would like the guidance to reflect the support element when moving through the ASP process. For example, in this Chapter the guidance title, Adult Protection Investigations and visits, could be reworded to include Adult Support and Protection Investigations, which would emphasise this important feature of the Act.  
  • In Chapter 8, the Code is operationally prescriptive in how information learned through Inquiry and Investigation should be considered. The Code states that in all cases a risk assessment of information learned through Inquiry and Investigation should be taken forward through a Case Conference, with the expectation that a case conference would be the model to achieve multi-agency assessment of risk. The risk in this scenario is that there could be a loss of consideration for the least restrictive and providing most benefit principles. Where proportionality and person centred approach should guide, these could become lost in a process driven approach. It would be better for the Code to guide on the importance of multi-agency risk analysis and how that should be evidenced and recorded, rather than to insist upon a process that may not be required, or appropriate, in every case. 
  • In Chapter 8, the Code introduces guidance on LSIs with actions proposed to support a unified approach to harm in regulated services. It is acknowledged that LSI is not an identified stage in the ASP process or legislation however the intention to support the process would no doubt be welcome to practitioners. There is some confusion in the way in which the detail is provided that would merit further exploration, as the Code tends to veer toward being operationally prescriptive, which may make it less applicable across the varying structures nationally. The Code suggests that two strands of meetings are held, one for oversight, with Head of Service or above chairing, and another for individual ASP actions and protection plan monitoring. In our view, this approach may have implications on capacity in services to deliver such a model and could be seen as duplicating efforts for similar intentions.  
  • The Code also introduces the expectation that Adult Protection Committees are kept regularly appraised of LSI activities (also in Chapter 8). Social Work Scotland suggests reconsideration of this action for a few reasons: 

The scope of the APC duties within the Act applies to public bodies and their officers, of which many care homes and care agencies (where the majority of LSI activity occurs) are not. The Act does, however, place a duty on APCs to support cooperation and communication. Whether an approach as recommended would support cooperation and collaboration with a private business would be questionable. APCs may not include the agency being discussed through LSI as members, potentially putting cooperation at risk.  

LSI improvements are contingent upon supportive and trusting relationships with agencies feeling able to contribute and be supported to make improvements and future referrals under ASP. The APCs ability to enforce or insist upon any improvements with private businesses would be limited as this recommendation falls out with the scope of their statutory functions. 

A potential solution to support APC involvement in this area could be to recommend that social work services and the Care Inspectorate present themes and trends around harm in regulated settings to APCs to allow any development of public campaigns and offers of multi-agency trainings to be extended to those partners not named within the Act.  

  • Chapter 11, The Protection Orders section has been rearranged in the new Code and is more streamlined and well laid out, this is a useful amendment to the previous Code. 

Code of Practice – Questions 

1a. Chapter 2 seeks to clarify understanding of the previous distinction between people who are unwilling, and those who are unable to protect themselves. How well do you think these objectives are fulfilled? 

Somewhat. 

The Code has been expanded to include areas that will support in the assessment of the individual’s ability to safeguard, and what influences should be considered when determining “unable versus unwilling”. We would suggest a few additions, as detailed below, that this section could incorporate to better support the practitioner in making these determinations. 

The Code refers to the principles of the Act at the start of Chapter 2, and these are clearly stated in the text which will be easily accessible for practitioners. Weaving the principles throughout the Code from this point is not always successfully done. For example, in determining whether someone is “unable or unwilling” the Code details the importance of consideration of past trauma, but does not refer back to the requirement in the Act that the principles be considered and it would be helpful to add this here. 

In outlining the general principles of the Act, where age is referenced, it would be helpful to reference that other protective processes and legislation may apply in relation to the transition ages of 16 and 17 years. 

Particular Circumstances 

Trauma, Addictions, Homelessness, Hoarding

Social Work Scotland welcomes the addition that practitioners should be trauma informed and the inclusion of a link to a trauma website is helpful. Including the principles of the Act into this section to encourage the consideration of these alongside the impact of trauma would be recommended to support a full understanding of the responsibilities of the practitioner when making determinations of whether an individual can safeguard. The workforce in local areas may need to be provided targeted training in this area to support a human-rights based approach to assessment. 

The expansion of the addictions, homelessness, and hoarding section from the previous Code shows, in a concise way, where the intersection of these elements with mental disorder and infirmity, would mean the ASP Act applies. With the addition of the principles of the Act, this will be useful to practitioners. 

Financial Harm

This section introduces the element of coercive control into the factors a practitioner should consider when determining “unable or unwilling” and whether the 3 point test is met. This is welcome and practitioners will likely recognise coercive control within this context. Feedback from practitioners to Social Work Scotland has suggested that local areas may wish to enhance their training in relation to undue pressure and coercive control to support learning around this area as it relates to all types of harm. 

Young People

The transition age of 16 and 17 years reflects additional considerations that social workers should make to ensure appropriate engagement and use of legislation. We believe the section under young people could be enhanced with reference to National Child Protection Guidance, and links to the United Nations Convention on the Rights of the Child (UNCRC) added to support consideration in this area for practitioners. 

While the ASP Act may apply from the age of 16, it would be recommended to reference in this section that there are young people for whom child protection processes may be more appropriate, where they have experienced or been at risk of significant harm. This would need to be thoughtfully considered in addition to when a social worker were determining whether someone was “unable or unwilling” to safeguard. An example of this would be for young adults under 18 years of age where trafficking, sexual exploitation, forced marriage, or FGM is a concern. In these instances, referrals should be made under child protection processes and in general terms, child protection processes should be considered for under 18’s who have experienced or may be at risk of abuse. Taking this approach would ensure protection of rights and considerations by core child protection agencies are integrated into discussions. This approach supports dialogue amongst professionals of the most appropriate process to follow to protect an individual from harm and to protect other children or adults who may be at similar risk in the same environment, or from the same person(s), given the presenting concerns. 

To effectively engage all relevant and appropriate practitioners and agencies in these considerations, an Inter-agency referral discussion would be appropriate and this recommendation aligns with the National Guidance for Child Protection in Scotland recently published. 

1b. Secondly it seeks to provide greater clarity around issues of consent and capacity. How well do you think its objective is fulfilled? 

A little. 

In our view, the reference to the 3 point test and the consideration of capacity should be considered for rewording. The Code suggests that, “Capacity is not, and never should be, a consideration in the three-point test”While it is true that someone who has capacity may nevertheless be unable to protect themselves from harm; it is also true that someone who lacks capacity to make or act on key decisions relating to their welfare or finance will be unable to safeguard themselves in the same key aspects. In taking this into account, denying the relevance of an assessment of capacity to considerations of the first of the 3 points in the three-point test is not helpful. We suggest the alternative wording that, “whilst someone who lacks capacity may be unable to safeguard their own property, rights and other interests, it should never be assumed that an adult who has capacity is able to do so, nor should any decision made regarding whether an adult is an adult at risk ever be delayed for an assessment of capacity to be undertaken”. This supports concerns that retaining capacity excludes someone from meeting the 3 point test in a clearer way, while recognising the fact that those who lack capacity would potentially not meet the first point. 

The Chapter helpfully outlines each of the 3 points in the test to provide further insight into considerations that should be made when assessing against them: 

Unable to Safeguard

The Code introduces the impact of trauma and coercive control on an adult’s ability to make decisions around safeguarding. This section would be enhanced by the addition of the principles of the Act, with a reminder of the responsibility to consider these throughout the ASP process. We welcome this addition to the Code and it reflects the complexity of assessment in this area, with an equally welcome addition that the practitioner should consider the whole of the adult’s circumstances before determining whether they have the ability to safeguard.  The addition of these areas of consideration into the Code may require additional learning and skills development for practitioners to support how such decisions are made in line with human rights based context. 

Risk of Harm

This section includes an update on legislation since the last review of the Code in 2014, with the Health (Tobacco, Nicotine, etc. and Care) (Scotland) Act 2016 and the Counter Terrorism and Security Act 2015. These are useful to include. 

Being More Vulnerable to Harm

The section teases out what is meant by “infirm” in the Act, separating it from a medical diagnosis of disorder or disability. To illustrate the point, the definition of infirmity is provided which should support the consideration of infirmity in its own right, and could be viewed as useful,  “‘weakness (or want of strength), inability or lack of power to do something’. Infirmity does not therefore necessarily rely upon a medical diagnosis in the way that disorder or illness do.”

Use of the 3 point test

In this section there is acknowledgement that the whole of an individual’s circumstances and abilities should be considered and can change, with specific reference made that capacity is not part of the 3 point test, but should be considered at other points of the ASP process, in particular with regard to consenting to medical examination. Comments referenced above with regard to capacity and safeguarding and to the responsibility to consider the principles of the Act would be helpful to reference here. 

Where an adult is at risk of harm, but does not meet all 3 points of the test, there is an addition of a statement that partnerships, “would still be expected to pursue all avenues in order to protect that person from harm”. . We suggest there is an added clarification within this paragraph that the expectation applies to all members of the partnership. This clarity may be required as the preceding paragraph places recognition on the social workers responsibility to consider intervention under other relevant legislation and without clarification here, there may be an assumption that social work hold responsibility for onward actions.  

In addition to this, it would be necessary to include the principles of the Act in this section to support decision making that remains in line with the adult’s right and responsibility to engage in their own risk enablement. This would also support an understanding of an adult’s right to self-determine or to choose not to have involvement of services in their life, which is essential in a human-rights based approach. The Code could be enhanced with the acknowledgement that to truly take forward a human-rights based approach, where an adult does not wish to engage, there may be limited scope under legislation for social work to take protective action. 

2a. Chapter 3 seeks to strengthen the guidance around the duty to refer and the duty to cooperate. How well do you think these objectives are fulfilled? 

Chapter 3 

Somewhat. 

All duties placed upon Councils by the Act are listed as in the previous Code, as well as actions that can be taken by councils. The definition of a Council Officer and the powers placed upon them by the Act are explained and in general the section is clear and should be easy to follow by practitioners. There is an addition at section 9 of the Public Bodies (Joint Working) Scotland Act 2014 which supports updated operational arrangements and this is welcomed. 

The duty to refer and cooperate section clearly outlines the duty to report harm and encourages that when in doubt a referral should be made. It is recommended that the Code expand the section to clearly lay out the duties and responsibilities on public bodies with the suggestion that some services are identified who hold such a duty, for example, opticians, dentists and other NHS employees. 

The Code suggests that all referrals coming into social work identified as ASP should be counted as ASP referrals for data returns. For this recommendation to have useful impact and to allow a national picture to develop there should be a connection to the national Scottish Government data return for ASP. The ability to identify learning for partner agencies regarding the referrals they make into social work could be achieved through this recommendation, however it would be more effective to coordinate such a recommendation through the national data return rather than from the Code of Practice to ensure its consistent application across Scotland. 

There is acknowledgement of the expectation of services not listed in the Act to cooperate with ASP processes, including referrals and engagement with Section 4 duties. This is welcome and should be clearly linked to the effective protection of adults when all partners engage in the public protection process. 

General Practitioner

Reference that “it is ultimately the responsibility of the council or delegated agency to decide whether an adult meets the definition of an adult at risk of harm” from the ASP GP Guidance may be seen as contradictory to the multi-agency approach the Code has set out to achieve. In many local authority areas, GPs and all referrers play an active role in determining whether the 3 point test is met and this should continue to be encouraged and expected. There would also be opportunity to identify in this section that some GPs are NHS employees, and therefore would hold the same duties as other public body workers. This has been fed back to Scottish Government in the consultation response Social Work Scotland provided for the ASP GP Guidance, and would be recommended here as well. 

Scottish Fire and Rescue, Scottish Ambulance, and Scottish Prison Services

Good reference is made to the important contributions of SFRS, SAS, and SPS and the key role they play in supporting adults at risk of harm. This section refers to independent and private institutions such as banks and building societies with regard to the key role they can play in identifying an adult at risk of harm and this acknowledgement is welcome. Specific reference made to Social Work Scotland’s Protocol for Requesting Information under Section 10 of the Act, for use by local partnerships, as a template for their own procedures is welcome. 

2b. Secondly, Chapter 3 seeks to significantly strengthen the guidance in relation to expectations regarding information sharing. How well do you think this objectives is fulfilled? 

A little. 

Information Sharing

The section on Information Sharing could benefit from clarification. The first 3 paragraphs (31, 32, 33) on information sharing vacillate between ‘you must share regardless of consent’, to ‘reflection on the principles of proportionality and necessity’. We would suggest that there would be a benefit of starting the section with the principles of the Act, encouraging the benefit of sharing proportionate information to support an adult at risk, and an acknowledgement of the legislative basis from which to share. This position is clearer as the section progresses, but the initial few areas could be clarified to support that message in the Code. 

In paragraph 31, the statement “The protection of adults at risk of harm is everyone’s responsibility and everyone’s job”, is not legislatively correct given the previous section which outlines the duties placed upon named bodies are for those included in the Act. Stating that, “We all have a responsibility duty, individually and collectively, to protect vulnerable people in our communities” could be better presented. While the sentiment expressed appeals to a sense of moral justification, there should be a qualifier within the statement to indicate that adult protection is important and supporting individuals at risk of harm is best done through collaboration and with a sense of community responsibility. 

Equally, in paragraph 32 stating that,  “Whilst confidentiality is important, it is not an absolute right.”  Can confuse the legal basis under which information is shared. There are criteria for information sharing that would be beneficial to add to this section to support the practitioner around whether and what to share, how and with whom. Relevance and proportionality of information shared should be highlighted here as considerations. The section mentions necessity and lawful basis later in the next paragraph and in paragraph 34, and the Code would benefit from joining these two to have a considered approach to information sharing that sits comfortably between supporting an adult at risk and respecting their right to privacy and confidentiality. We would therefore recommend that appropriate legislative links are embedded into this section to encourage this cross referencing for practitioners. 

The addition of how information is shared at the transition age of 16 and 17 years, with reference to the National Guidance for Child Protection would give wider thought to all of the legislation available when determining appropriate pathways for this age group. 

3a. Chapter 5 seeks to give more detail in relation to the nature of referrals. How well do you think these objectives are fulfilled? 

A little.  

The Code would benefit from acknowledgement of the section 12 duty under the Social Work (Scotland) Act 1968, upon which referrals are considered for progression. This would mitigate any risk that all referrals incoming to social work should be viewed under the Adult Support and Protection Act. The inclusion of the principles of the Act into this section would also be helpful. 

Referrals

Paragraph 5 outlines the two types of referrals a social work service may receive, those under ASP and those determined welfare concerns. Paragraph 7 suggests that both referrals should be considered for ASP, with welfare concerns being upgraded to ASP if required. We would agree that where harm is identified in a referral, that the referral should be considered under the Act. However, the Code does not reference the section 12 duty under the Social Work (Scotland) Act 1968 that applies to the general function of social work and which we believe would clarify the section. There is a risk in the expectation that work could become tracked toward ASP legislation and that the nuance of the social work assessment, made by professional and skilled workers, would be limited by the prescriptive nature of the Code that appears to be driven by the procedures in partner organisations around referrals into social work under Welfare Concerns. We recommend that both the principles of the Act and the duty under the 1968 Act are interwoven into this section in recognition that social work function is guided by both.  

Inquiries

The Code, at paragraph 14, indicates that any referral made under ASP or on ASP paperwork must be taken through the Inquiry process under ASP. There is a risk to implementing this approach as it does not acknowledge the responsibility to consider the principles of the Act or recognise the consideration of other appropriate legislation at point of referral into social work. While an encouragement of referrals into social work where concern for an adult is a positive and supportive aspect of the Code, the direction of professional social workers toward the use of one legislation over another would pose a risk that referrals are tracked. This has the potential to direct responses away from a more appropriate intervention, for example, in the 16 and 17 year old age range, where Child Protection legislation may be more appropriate, or from Mental Health Act where duty to inquire function exists as well. 

The Code promotes collaboration with partners at Inquiry stage which is welcome, however this would have been an opportunity to specify and expand upon the importance that GPs play in the Inquiry process which could perhaps be revisited. The section also states that this stage of the ASP process can be taken forward by those who are not council officers which promotes the wider reach of ability to ensure harm is accurately identified and taken forward. 

The Code is clear in identifying that once there is requirement to visit the adult, either at the point where the 3 point test has been established, or where there is requirement to visit the adult to establish if the 3 point test is met, that actions should be taken forward by a council officer. This clarity will be helpful for services taking forward these duties. 

The Code recognises the interplay of the needs of the carer or proxy in the ASP inquiry stage with suggestion that their needs be considered as part of the overall assessment of support that may be required which is helpful.  

A clear outline and reminder of the principles of the Act in considerations of intervention after the Inquiry stage would be merited here as they are later referenced in the Investigation section. 

Interagency Referral Discussion

This section acknowledges that some areas use IRDs to share information and it makes specific reference that IRDs should be carried out when there are child protection considerations. Feedback from members has suggested that the section would be enhanced with recommendations of when an IRD should be undertaken, given the differing practices across Scotland. A link is provided in the Code to the AP Committee guidance that does not seem to clarify this point further.  

In addition to providing more clarity on when an IRD should be held, the section would benefit from an acknowledgement of the impact holding IRDs can have on the ability to complete timely ASP inquiries. The gathering of detail from professionals to achieve multi-agency collaboration has been consistently raised by operational teams as a contributing factor for delays in completing a timely Inquiry. An acknowledgement that getting practice right in this way means taking an approach that can be timely, would support a wider understanding of the impact of the actions taken forward under ASP. 

Where an Adult at risk declines to participate

The section clarifies that while all effort should be made to include the adult, the ASP inquiry process should be progressed even where the adult refuses to participate to ensure that appropriate advice support and guidance can be provided to the adult. There is recognition that assessment of capacity and undue pressure should be considered at this stage and it would be recommended that the principles of the Act are referenced here to support decision making in such instances. 

3b. Chapter 5 also seeks to reflect the introduction of welfare concern referrals and IRD processes in some areas of Scotland. How well do you think this objective is fulfilled? 

A little.  

Welfare Concerns

The Code states that “all welfare concern referrals should be screened” for potential ASP concerns. As noted above, the addition of the appropriate legislation under which social work carry out duties, the Social Work (Scotland) Act 1968, section 12, would clarify the basis from which social workers operate upon receiving referrals into social work. This would avoid the potential risk that all work coming into social work would be tracked toward ASP legislation. It would perhaps also be worth adding further detail around the Police section 5 duty under the Act, and the purpose and role that the Police HUB plays in quality assurance of referrals to capture the importance of all key partners making informed referrals.    

The Code could perhaps adopt the following statement; “When a social worker is taking forward duties under section 12 of the 1968 Act, and there is indication that and adult may be at risk of harm, then appropriate actions should be taken under ASP or other relevant protective legislation, such as Child Protection, in cases where an adult is at transition age (16 and 17 years)”. 

Another helpful addition would be to clarify that where an inquiry is made under ASP then contact should be made with the referrer. This would avoid confusion in expectation that referrers are contacted around actions taken forward under section 12 duties from the Social Work (Scotland) Act 1968. There is no obligation under the 1968 Act that all referrals received into social work should have reciprocal contact to the referrer upon completion. Confidentiality of the individual referred into social work would need to be maintained to support ongoing work with and on behalf of the individual that could be compromised by the expectation that all referrers are provided feedback on the interventions and inquiries made by social work.

4. Chapter 6 seeks to clarify the relationship between an inquiry and an investigation. How well do you think these objectives are fulfilled?

Somewhat.  

To maintain the spirit of the legislation it would be recommended that the language of this Chapter reflect the full title of the Act, Adult Support and Protection Investigations, rather than Adult Protection Investigations. 

The statement that, “an Investigation is therefore part of and not subsequent to, a section 4 Inquiry,” has been raised by members as confusing. Members have reported that they would find it helpful to have a clear delineation between Inquiry and Investigation within the Code. Earlier in the Code (paragraph 20 under Inquiries) clarification is made that when the 3 point test cannot be concluded and it is determined that a visit is required to establish if an adult is at risk, that this would initiate the start of an Investigation under section 7. Holding that as a distinct point when the ASP process moves from Inquiry to Investigation is helpful. Stating that Investigation is a continuation of Section 4 could cause confusion as to which part of the process the practitioner is working under and therefore impact on whether they are carrying out the duties required under Investigation. It would be recommended that this is reworded to allow a definitive line on the matter to be drawn to guide practitioners. A removal of this sentence, “An investigation is therefore part of, and not subsequent to, a Section 4 inquiry” and replaced with something suggesting that if you are visiting an adult under ASP you should consider and enact duties under Investigation, would support that. 

What is the purpose of the Visit?

The section outlines the power under section 7 of the Act to allow a council officer to enter any place to make inquiries. The detail is helpful and the expansion to acknowledge that other formats to conduct an interview, via technology, would be an acceptable means to take forward this power will also be useful to practitioners. 

What you should consider prior to the visit?

Consideration of the principles of the Act prior to intervening under the Act is welcomed and we think this will support a proportionate and considered approach to actions taken. Additionally, consideration of the principles of the Act- at the end of the inquiry stage – should also be added, to ensure that intervention in an adult’s life is guided by considerations underpinned by these principles. This section is well laid out and should be easy to follow by practitioners. 

What evidence must a council officer produce?

This section provides clear and concise detail of what evidence the council officer should provide to the adult when taking forward their duties under the Act. This version of the Code removes the requirement for the second officer to provide evidence of their identity and it would be recommended that this be considered for reinstatement for the benefit of the adult to ensure they are fully aware of the identity of each individual attending under ASP. 

 5. Chapter 8 is a new chapter, providing specific guidance in relation to risk assessment, case conferences, protection plans and managing risk. It seeks to offer greater clarity and explanation around these issues. How well do you think these objectives are fulfilled?

Somewhat.  

This section of the Code is new and supports a multi-agency collaboration and approach to managing risk which was welcomed by our members. The section outlines areas that should be covered within local procedures and the list reflects a competent and full consideration of the intersection of areas relevant to managing risk. The approach to analysing risk veered toward an operational approach around case conferences however and an additional reminder that the principles of the Act should underpin any intervention considered at this stage would be helpful as recommendations made later in the Chapter do not appear to take these into consideration. The detail provided around Large Scale Investigation (LSI) would benefit from further consideration, as efforts to provide guidance on practice move toward the procedural which may not be applicable in the differing structures in place nationally. 

Case Conferences

The Code states that in all cases the assessment of information obtained through Inquiry and Investigation should be analysed through interagency case conference. This approach does not support considerations in line with the principles of the Act, that interventions under the Act are proportionate, least restrictive, and will achieve the most benefit for the adult where other less intrusive actions cannot be achieved. Case conferences are a competent way to address complex risk and manage protection plans, but they should not be a blanket approach to analysing information received through the Inquiry and Investigation stages of ASP where it has been determined that a less intrusive action can be taken.  

Where case conferences are taken forward it is agreed that it is helpful that the Code highlights training requirements and engagement of appropriate partners and the adult in the process. This detail is clear and would be easy to follow. 

Large Scale Investigation

This section of the Code is new and introduces a process by which harm, occurring in a regulated service or by a regulated service provider, can be considered. While it is agreed that the Code should offer guidance on approaching institutional or structural harm, the approach taken to address this in the revised Code should be reconsidered. The detail within the LSI section is prescriptive and does not take into account the various structures under which local authorities operate and therefore may be limited in its application. 

Where the guidance is intended to be broad, it becomes specific, for example on page 53 paragraph 16 indicates that decisions should be made to progress with an LSI at a multi-agency meeting chaired by a Head of Service or above. In some partnership areas the position above Head of Service is the Chief Officer of HSC. It would perhaps be better to reflect that the chair of such a meeting should be of sufficient seniority to affect strategic and operational changes which would allow more latitude across current structures to take forward this expectation. 

References made in paragraphs 18 and 19 indicate that an oversight group should be arranged to address the harm identified in the home or regulated service and that in addition to this, individual meetings should be arranged to consider the service users of the regulated service who should all have inquiries and associated protection plans. The impact of this two tier meeting structure and the expectations placed on social work to operate in this way warrant further exploration. Harm identified in care homes or within care at home involve numerous service users and the approach suggested of individual inquiries would likely cause additional workload for teams which may not be required to achieve positive outcomes and reduce harm.   

The intention of an LSI is to address structures and systems that lead to harm for all adults under those structures. It would not be proportionate or productive to support structural and systemic improvement in an LSI by taking forward individual Inquiries and protection plans for every adult. The most appropriate course of action to address structural and system harm is to address that with the care provider and regulatory partners, such as the Care Inspectorate, to ensure the sustainability of the service in the local area and improve outcomes for residents and service users through a proportionate response. 

An addition to the Code from the previous version is the expectations that Adult Protection Committees will be kept regularly updated on LSI activity. It would be useful to consider the impact of this expectation on engagement with care home and care at home services. Structural and systemic harm requires a truly collaborative effort amongst professionals to support reduction of harm and improve outcomes. There should be reflection on the value of discussing LSIs at an APC where the private care provider is likely not to be anonymised or in attendance. Consideration should be given to whether effective collaborative work could be achieved through such a process, the benefit of extending the scope and reach of the APC where they do not hold powers to enforce change, and the potential confusion and blurring of lines between regulatory agencies and the APC in supporting improvements.  

Provision of themes of harm and reassurance that partners are addressing these issues operationally and in collaboration with providers and the Care Inspectorate should be enough detail for the APC to carry forward planning in relation to promoting training, advice, and guidance to those public bodies and office holders in its scope of statutory influence. 

Initial and Significant Case Reviews

This section references the Scottish Government Interim Framework for ICR/SCR which is competent and detailed with reflection on the role of the Care Inspectorate and the processes that have been developed to centralise information and themes found as a result of reviews of significant events. The reference to this in the section will be of help to APCs and practitioners.

6. The chapters on protection orders have been rationalised. Chapter 11 now covers the common elements of protection orders, and the subsequent chapters (12-14) focus on each type of order separately. The intention is to make this section more user-friendly but still provide sufficient guidance and clarity. How well do you think these objectives are fulfilled?

Mostly.  

This section outlines the considerations that must be given when determining whether to progress for a protection order. The section is complete and full and would provide a comprehensive reference to consult for a practitioner. The redesign of the revised Code and the layout of the Protective Orders section makes more sense and is more streamlined. 

Chapter 12, 13, 14, and 15: Assessment, Removal, Banning and Temporary Banning Orders, and Offences 

Full and complete detail of processes taken through use of Orders. In the section on Offences, the offence of obstruction, section 49, in the Act is outlined detail provided on the implications of this.

7. If you would like to provide any comments or suggestions about the changes please do so here:

Preface  

The intention of the guidance is well laid out and promotes inter-agency cooperation, which practitioners will welcome. However, in attempting to address the issue of “regrading” ASP referrals, either upgrading a welfare concern to ASP or downgrading an ASP referral to a welfare concern, the guidance becomes prescriptive, which is not helpful. Social workers hold duties under several pieces of legislation and use professional skill and judgement in determining the appropriate use of these for each referral. These judgements are made on balance with a human-rights based approach and in line with principles of proportionality, least restrictive, and to achieve the most benefit for an individual in their own unique circumstances. The guidance as written could limit a workers considerations on exercising this ability by prescribing approaches to all referrals through an ASP lens. 

Chapter 1 

This Chapter includes welcome reference to several key activities and updates ongoing. The Scottish Mental Health Law Review, with recognition of a person-centred, rights based, approach in line with European Convention on Human Rights (ECHR), is included. There is also an acknowledgement of the Scottish Governments intention to uphold the principles of the United Nations Convention on the Rights of Persons with Disability (UNCRPD), which advocates for the move from substitute to supported decision making.  

We would like to highlight and recommend the addition of the United Nations Convention on the Rights of Children (UNCRC) to the chapter. This would be a useful reference for practitioners as they consider the appropriate use of protective legislation for young adults at transition, within the age range of 16 to 17 years. This would be consistent with the reference made to the UNCRC later in the Code. 

The Chapter highlights that the purpose of the Code will be to provide “guidance about the performance of functions by councils, their officers, and other professionals under the Act. It provides information and guidance on the principles of the Act, and about the measures contained within the Act including when and where it would be appropriate to use such powers”  

The intention of the Code is clear in the above statement, with the Code viewed as a guidance tool reflecting the principles of the Act. This is welcome, however it is noted that at points the attempts to offer guidance become operationally prescriptive, which can then pose a challenge for application across different locality structures. The prescriptive nature of some processes can also come into conflict with the principles of the Act. An example of these would be with regard to Large Scale Investigations, where the Code suggests that the Head of Service or above should chair all oversight meetings, which is operationally prescriptive and may not be appropriate in all existing structures. Another example would be the statement that risk analysis of detail learned through inquiry and investigation must take place at a case conference which is operationally prescriptive and limits the ability to apply the principles of the Act where it may not be of benefit for an adult, who should be in attendance at any meeting held about them. A caveat added to that section to remind practitioners to be mindful of the principles of the Act when determining next steps would be useful. 

Chapter 4 Adult Participation 

The section encourages the inclusion of the adult in the ASP process on the basis of the principles of the Act, highlighting the need to keep the adult informed through use of accessible formats and advocacy. This section will encourage a practitioner to be mindful of the engagement of the adult in the ASP process which is helpful. Accessible communication, including making provision in BSL is welcome. 

The section on Advocacy outlines the importance of offering advocacy after the Inquiry stage to support an adult in the ASP process and this is welcome and will assist practitioners. The recognition that the duty to provide advocacy where an adult has a mental disorder is acknowledged, with a reference to the principles of the Act, that intervention should be of the most benefit to the adult and to ensure this is achieved, advocacy should be considered for involvement. 

The role of the Appropriate Adult is detailed within the Code. The Code would be enhanced here with a statement that where an Appropriate Adult has concern an adult is at risk of harm, they should make a report of harm to social work. Appropriate Adult legislation places responsibility for delivering Appropriate Adult services on the local authority, and as such a section 5 duty would apply. In this instance, reference in the Code to the duty to report harm and cooperate with an Inquiry and Investigation would be helpful. 

Meetings of agencies with the adult at risk

This section highlights the importance and right of the adult to attend any meetings held about them and the detail provided should support the engagement of an adult in their case conference or any other meeting held about them. The potential impact on the adult, and carers, of the ASP process is reflected, and it is recommended that this be acknowledged as part of considerations made regarding application of the principles of the Act. The detail provided around Self-Directed Support, is helpful to include in the Code to enable its consideration as to how to best support an adult at risk of harm. The associated links to legislation are useful and should support cross-referencing to important legislation and guidance. 

Audit of Adult Participation

This section lays out expectations that any audit of ASP needs to ensure there is contribution from adults and feedback in their own words. This is a welcome expectation, and one which would benefit in being made within the APC Guidance currently out for consultation. The additional expectation that APCs should be tracking the number of meetings held and the number of these meetings where the adult attends would be an area to expand upon in the national ASP data collection. This recommendation would be additional data collection activity at the national level that should be considered as part of the Scottish Government return if it is to be fully realised from this recommendation in the Code. 

Chapter 7: Interviews conducted as part of an adult protection investigation 

The recommendation in this section is around the consideration of wording and use of language in the title. The language used in the title of this Chapter should be reconsidered to follow the Act, therefore, “Interviews conducted as part of an adult support and protection investigation”, would be proposed. 

This section outlines the components of the Section 8 power under the Act which allows the council officer to conduct an interview. It clearly describes what an interview is, where an interview can take place, and the right of an adult to not answer questions within the interview. It is well laid out and would be easy to follow for the practitioner. Reference to support and advocacy is made and would be helpful as a reminder for the worker taking forward this power. Reference to Section 35(6) of the Act indicating that a council officer or a medical practitioner cannot override the adults wish not to participate is useful and highlights the human rights approach and considerations that should be made when supporting an adult at risk. 

Capacity

The importance of obtaining consent during the interview process and to assessing the adult’s ability to understand the process and contribute to it is detailed within this section. The detail around capacity and the ways in which it can vary across areas is important and will be of value to practitioners. Further detail has been provided on consideration of capacity in relation to the ability to safeguard under the section Use of the 3 point test. 

Participation

Consideration of supporting an adult to contribute as fully as possible to the ASP process is detailed in this section, with reference to consideration being given to undue pressure. Facilitating interaction through appropriate communication aids and interpreters is detailed and will be helpful to the practitioner. The consideration of the requirement for an Assessment order is introduced.  

The section considers communication support requirements, such as sensory impairment and those who do not use English as a first language. It later provides the recommendation that a sign language interpreter be utilised to support non-verbal communication and with regard to the BSL Act recognising BSL as a language. It would be recommended that the use of a sign language interpreter be moved from the sentence around non-verbal communication and Makaton, to the following bullet point where an interpreter is recommended for other languages. This would be in line with the recognition of BSL as a language rather than a communication difficulty. 

Chapter 9 Medical Examinations 

This section is complete and easy to understand and it refers to the Sexual Assault Referral Centres, which is a welcome addition. It would be recommended that links to relevant legislation are included here for completeness. The Forensic Medical Services (Victims of Sexual Offences) Scotland Bill, the Clinical Pathway Guidance for both Adults and Children who disclose sexual assault, and in addition, reference to the National Child Protection Guidance with its reference to medical examinations for young people in transition age of 16 and 17 years.  

Chapter 10: Examination of Records 

This section outlines the duties under Section 10 of the Act and outlines these in a clear and competent manner. The reference to the Protocol for Accessing Records circulated by SWS is a welcome reference. There is good proportionality of information sharing and access to records within this section with a clear reflection of the rights of the adult and obtaining consent where possible. 

Legislation Links 

A list of legislation is included in the Code and it would be recommended that there is the inclusion of the recently published National Child Protection Guidance, and the Domestic Abuse (Scotland) Act, for completeness. 

For further information, please do not hesitate to contact: 

Jennifer Rezendes 

Head of Policy and Workforce, Social Work Scotland 

Jennifer.Rezendes@socialworkscotland.org  

 

 

13/01/2021

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.

KEY POINTS

  1. While acknowledging that COVID-19 has manifested some new equality and human rights issues, overwhelmingly its impact has been to exacerbate existing inequalities and lay bare the fragility of the systems (services, people) who protect and give meaning to human rights. This is particularly the case for those individuals whose rights were more vulnerable prior to the pandemic, due to age, disability, gender, sexuality, socio-economic status, race and ethnicity, housing security, mental health, etc. Well-resourced public services (such as social work and social care) as well as an active civic society (including charities, voluntary organisations, etc) are essential to the realisation of Scotland’s vision of a rights-based, equal society. Instead, the funding of the social care system has fallen in real terms over the decade of austerity – in the opposite direction to increasing need due to demographic and other changes.
  2. The many different dimensions of social inequalities create overlapping layers of disadvantage, which are multiple for many people; these have been tracked by the disproportionate impacts of the pandemic. In managing our ongoing response to COVID-19, and in our “rebuilding better” after, careful attention must be paid to the views and needs of these specific groups, ensuring plans take account of their vulnerability to the virus itself and/or its wider socio-economic and mental health effects, and deal with root causes.
  3. Social work is a critical component in many public service systems. In children, adult and justice services, social workers mediate access to a wide range of support (e.g., child and adult social care), deliver specific interventions and protect the interests of those unable to do so independently. COVID-19 has restricted social work’s ability to perform these functions, due to staff absence, work-from-home restrictions, limited PPE (in the early stages of the pandemic) and prioritisation of other urgent issues. As a result of social work being less present and accessible, the rights of some individuals will have been affected. Social workers, with colleagues across social services, have worked tirelessly to minimise this impact, but there are limits to what can be achieved through remote working or with depleted teams. Vaccination holds out the promise of a return to face-to-face interaction and relational work on a much wider scale than is currently possible. However, the impact of COVID-19 on the profession, and the organisations which employ them, is likely to stretch over a number of years. Any plan to re-address the inequities and rights impact of the pandemic must have within it a commitment to address issues impeding the delivery of effective social work practice.
  4. The pandemic has revealed the limitations of a ‘rights bearer’ and ‘duty holder’ framing of human rights. Corporate bodies, such as local authorities, may hold duties to uphold rights, but those corporate bodies are in reality just organised groups of people, all with their own needs, vulnerabilities and rights. The response to COVID-19 has, universally, forced employers to consider the welfare of their staff, and the urgency and risk of the work they are involved in. Within the NHS, that has led to the cancellation of operations and delayed treatment for thousands of people. For social work and social care, it has meant, in some cases, reductions in the level of support which can be made available. A realistic appraisal of the impact of the pandemic on rights and equality should highlight the responsibilities of employers to keep their people safe, and the enormous challenges they faced in the early stages, seeking to securing solutions which would enable professionals and others (such as social workers, social care staff and carers) to resume their work.
  5. Just as people rely on other people to give meaning to their human rights, the rights of different individuals can sometimes be in tension, or even conflict, with each other. In some cases, an individual’s exercise of their right to put themselves and/or others into potential harm. It is the unique role of social work to assess an individual’s needs, understand their wishes, and to promote their interests and wellbeing within the framework of their human rights and the current service / resource context. Sometimes this involves taking decisions in an individual’s interests which are at odds with their (or a family or friend’s) wishes. Such situations demand a high degree of sensitivity and skill to manage, and are, by their nature, often contentious and emotive. We make this point to underline the importance of taking a broad and nuanced perspective in any evaluation of how human rights have been impacted in the pandemic. Every individual’s story is complex and multifaceted, and understanding comes from a breadth of perspectives.
  6. The virus, its impact on people’s health, and the impact of the measures we have taken to contain its spread, have most affected least advantaged in our society (on all dimensions: income and wealth, housing, digital, social, etc). 2020 and 2021 will have served to exacerbate our existing inequalities. Our hope is that, in having these inequalities more clearly surfaced, and a wider proportion of the population made aware, through their own experiences, of the challenges brought about by low incomes, isolation and family stress bring, the public’s appetite for addressing the underlying structural factors will be strengthened.

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[1], 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

  • Worry for self and family, about illness and/or social and financial impacts
  • Worry about transmission of the virus to loved ones, known contacts, professionals and carers, colleagues, other residents in home or accommodation, unknown members of the public, etc.
  • Worry about putting pressure on the health service, reducing its capacity for others.

Loss of income

  • Actual reductions in income because not able to work

Loneliness (reduced human contact and self-isolation)

  • Reduced in person contact with family, carers and professionals.

Recovered but with “long covid”

  • Development of chronic health conditions, impacting on long-term ability to work, participate in education, society, etc.

Time in hospital

  • Range of experiences including near-death and trauma, as well as the joy of survival
  • Consumption of scare resources including deferment of services required by people with other medical conditions leading to ‘survivor guilt’.

Decline in mental health

  • Various psychological impacts, exacerbating existing conditions and provoking new ones.

Death

  • Loss of future lives
  • Bereavements and long-term loss to loved ones, families, friends
  • Financial loss to families and wider society (multipliers, taxation, etc)
  • Loss of contributions to society, and local communities

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

  • Poverty, much of which existed prior to the pandemic, is a key underlying factor for the escalation of crisis in many households[2].
  • Financial pressures resulting from insecure or total loss of employment and/or insufficient government support (for example where individuals must self-isolate) has contributed significantly to financial insecurity. The Government’s commitment to free school meals and increased levels of financial support have ameliorated this to some extent, but the medium to long-term impact of increased anxiety within families (and to individuals within those families) may be serious.
  • Increase in food poverty (with its concomitant impact on education, health, etc.).[3]
  • Increases in applications for welfare and crisis support[4]. Accordingly, social work has faced increased demand for practical support around income maximisation and housing.

Digital poverty / inequality

  • Some individuals / families have been able to continue to participate effectively in school, healthcare, routine assessment, etc. thanks to digital connectivity. Indeed for some people the move of many services online has been beneficial, removing the need and cost of travel, etc., and changing the terms of their interaction with professionals. However, for others the move online has meant marginalisation, and the loss of support / a service. The pre-existing ‘digital divide’ – reflecting inequality of access to knowledge, hardware, software, data and support – has been exaggerated, with those most likely to lose out being those already most disadvantaged. Digital connectivity is no longer a “nice to have” when essential services move online.
  • The move online has also encouraged new types of financial fraud, increased exposure to on-line sexual grooming and the potential for other forms of exploitation of vulnerable people[5].

Disruption to referral routes for social work and social care

  • Because engagement with schools, GPs, hospitals, etc. has significantly reduced, along with home visits by nurses, voluntary organisations, etc., referrals to social work or police for vulnerable children and adults have been disrupted, leading to delays in issues being identified. Early notification of concern is critical to prevent situations deteriorating further, leading to more serious problems.

Disruption to social work, social care and community services

  • Social work and social care services entered the pandemic with insufficient capacity to meet demand related to population aging, widening inequalities and growing social care needs[6]. As the pandemic took hold, sickness, self-isolation and re-deployment reduced capacity further. Limitations on PPE, national guidance on home visiting and other factors also impacted on social work’s ability to reach people vulnerable or in need.
  • Voluntary sector and community organisations / services forced to close (e.g. day services, etc.), restricting the opportunities available to certain groups, such as those with disabilities, to leave their homes, maintain relationships, etc.
  • Public sector and independent (voluntary or private sector) providers of care and support forced to reduce the care packages they can service.

Increased isolation and loneliness, impacting on mental health and wellbeing

  • Isolation and loneliness have increased across all sections of the population, with significant impact on mental wellbeing and mental health. However, for individuals and families who were already isolated (as too many older people, adults with disabilities and parents were) the closing of services and reduction of interaction / visits from family, carers, support workers, etc. has exaggerated this further.

Increased pressure within families

  • Poverty (be it financial, food, digital, housing) creates stress within families. The government’s efforts to contain the COVID-19 pandemic have increased those pressures within many families.
  • Further pressure has been built through individuals spending extended periods of time exclusively together at home, the demands of home schooling, disruption to exams, young people’s lack of access to friends, the general social anxiety about the future, etc.

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 and Families:

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™[7]) 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[8], 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[9]). 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.[10] 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[11], 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.[12]

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.

(B) Adults

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[13].

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[14], 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[15] 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”[16] 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[17] have articulated concerns to the Scottish Government around the backlog of community order ‘unpaid work’ hours[18]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[19].

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[20].  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:

  • The immediate impact of illness, loss and grief and trauma
  • The economic impact which may mean more individuals and families experience derivation and poverty which is a key factor in bringing people to social services
  • The longer-term impact of long-covid, the reduction in planned health treatment and the need for physical distancing reducing opportunities for preventative and early intervention means that more people will have higher levels of chronic physical, mental health and social needs.

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’[21], 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 [22]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:

The Scottish Government’s Medium Term Financial Framework (MTFF) estimates that to address the effects of demand, we will require 1.3% per annum more NHS employees and 1.7% per annum more social care employees in the period to 2023/24”.

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[23]. 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’[24].

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.[25]  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[26] 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:

Flora Aldridge

Social Work Scotland

Flora.aldridge@socialworkscotland.org

 

Emily Galloway

SASW

Emily.galloway@basw.co.uk

[1] 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

[2] https://www.basw.co.uk/media/news/2020/oct/port-storm-poverty-aware-social-work-pandemic

[3] https://www.trusselltrust.org/2020/09/14/new-report-reveals-how-coronavirus-has-affected-food-bank-use/

[4]https://scotland.shelter.org.uk/__data/assets/pdf_file/0008/1934099/Shelter_Scotland_briefing_LGCC_Homelessness_and_Covid_140820.pdf/_nocache

[5] IBID page 91

[6] 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.

[7] ABOUT THE MODEL – Safe & Together Institute (safeandtogetherinstitute.com)

[8] https://www.scra.gov.uk/2020/10/sexual-exploitation-of-children-new-research-report/

[9] https://socialworkscotland.org/contextual-safeguarding-event-2020/

[10] Coronavirus (COVID-19): children, young people and families – evidence and intelligence reports (various)

[11] https://socialworkscotland.org/publication/connections-for-wellbeing/

[12] 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

[13] 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)

[14] OLDER PEOPLE BEING PRESSURISED INTO SIGNING DO NOT ATTEMPT CPR FORMS – JOINT STATEMENT FROM AGE SECTOR ORGANISATIONS | Media | Age UK

[15] Detentions for mental health care during the pandemic – new report | Mental Welfare Commission for Scotland (mwcscot.org.uk)

[16] route-map-4.pdf (everyonehome.scot)

[17] Letter for Humza Yousaf, MSP, Cabinet Secretary for Justice from SASW | www.basw.co.uk

[18] https://socialworkscotland.org/briefings/reducing-the-backlog-of-unpaid-work-hours-coronavirus-scotland-act-2020/

[19] https://socialworkscotland.org/consultation/pre-budget-scrutiny-2021-22-justice-committee-call-for-views/

[20] https://www.scottishhumanrights.com/media/2102/covid-19-social-care-monitoring-report-vfinal.pdf, Chapter 3, page 15

[21] https://hub.careinspectorate.com/media/4171/delivering-cah-and-hss-during-the-covid-19-pandemic.pdf

[22] https://socialworkscotland.org/wp-content/uploads/2020/11/SWS-Supp-Sub-1-DEMOGRAPHIC-CHANGE-AND-ADULT-SOCIAL-CARE-EXPENDITURE-IN-SCOTLAND.pdf

[23] https://www.cosla.gov.uk/__data/assets/pdf_file/0021/14808/cosla-investinessentialservices.pdf

[24] https://dwsc-research.org/wp-content/uploads/2020/12/Decent-Work-in-Scottish-Care-Homes-Report-Final.pdf

[25] https://www.sehd.scot.nhs.uk/publications/DC20011129CCD8single.pdf

[26] SWU: Social Work’s Six-Point Urgent Action Plan | www.basw.co.uk

06/11/2020

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:

  1. Main submission – read the full text below or download a copy of this document  (PDF)
  2. A supplementary submission which provides a brief analysis of the impact of demographic change on the need to spend on adult social care in Scotland. In particular, it reviews the most recent work by the Scottish Government on this issue, in the Health and Social Care Medium Term Financial Framework (HSCMTFF) published in October 2018, and also used subsequently in the Scottish Government’s Integrated Health and Social Care Workforce Plan for Scotland published in December 2019.  Read the full analysis here. (PDF)
  3. A further supplement, which looks at adult social care expenditure in the decade of austerity – comparing Scotland with the rest of the United Kingdom. Specifically, this document underpins the others by analysing the most recent local authority expenditure data for Adult Social Care in Scotland, from the published financial returns; and looks at whether Scottish social care expenditure has fared better or worse than in England or in Wales over the period of austerity, using available data from the Public Expenditure Statistical Analyses (PESA) for “personal social services” published annually by HM Treasury. The financial data is augmented where relevant by available service and activity statistics to help paint a fuller picture. Read the full analysis here. (PDF)

Summary of Social Work Scotland main submission

The Independent Review of Adult Social Care[1] 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:

  • Choice, control and personalisation should be the foundations of our social care systems, enabling an asset-based approach to assessment and support, rather than a medicalised model based on deficits and eligibility criteria. However, it is the availability and flexibility of resources in the system (money fundamentally, but principally people) which significantly determines the degree to which an individual or family experience the system as positive and enabling, or detached, bureaucratic and impersonal. The need to manage insufficient and finite budgets requires local authorities and Health and Social Care Partnerships to impose eligibility criteria that render the concepts of choice and control meaningless to a great extent.
  • Only the person living their experience, and those who are close to them, can speak to that experience, describing the good and bad, their hopes and concerns. The design of social care, from the level of an individual plan to the nation-wide system itself, must be led by people’s own experience and insight. Commitment to such an approach demands more, however, than providing opportunities for people to speak. Those listening must be motivated and equipped to understand what is being said, and take appropriate individualised or systemic action in response.
  • An effective social care system enables people to build on their own strengths, with support from others where necessary, to achieve positive, personal outcomes. Policies, structures and processes should be designed on the basis of subsidiarity, pushing power down the system, into the hands of those requiring support, and those who support them. Social workers, operating with the necessary skill, autonomy and authority, have an essential role in such a system, surfacing people’s personal choices, and balancing rights and interests with society’s duty to protect people from harm (in its many forms, including financial and emotional).
  • Social care – indeed all social services – should not just respect human rights, but proactively work to give human rights meaning and effect. That is only possible when people working in the social care system (and in particular social workers, who have statutory responsibilities to balance rights and risks in complex circumstances) feel empowered and incentivised to act in the defence or promotion of an individual’s human rights.
  • People’s circumstances are too unique, and Scotland’s physical and human geography too complex, to guarantee consistency of experience within our social care system. But we can aim to deliver consistency of practice (enabling people to determine what package of support, and level of control, would be best for them) and greater consistency of offer (the support options available to a person) in every community.
  • Social Work is a discrete but essential component of the Social Care system. Reform of adult social care, as with reform of children’s social care[2], drug and alcohol services[3], mental health[4] and justice[5], must attend specifically to the unique role and requirements of the social work profession, which holds statutory responsibilities to safeguard, to assess need and to ensure provision of care and support. In other words, reform must answer the question “what does social work require in order to fulfil its statutory and ethical functions?”
  • Reform of adult social care must be considered in the context of parallel ‘whole-system-change’ agendas, including the Promise (children’s social care) and justice. Individually, each is a positive opportunity to implement the type of public service reform identified by the Christie Commission. However, they also risk fragmenting the social work profession into separate silos, at a time when the profession’s coherence and interconnections are critical to the realisation of holistic, ecological and person-led support. People do not fall neatly into silos, and social work as a generic profession is uniquely well situated to support an individual and their family and support network to navigate the boundaries of our public services and wider societal inequities.
  • Health and Social Care integration has delivered many benefits, and while it does present challenges, we are too early in our national change journey to expect all issues to have been resolved, or to risk unpicking the progress made to date. Reform of adult social care should be focused on addressing the deficiencies of the current governance and delivery structures.
  • Social care is just shorthand for a structure within which people work with people. Real change will only come if proper attention is given to people (workforce and leaders) within those structures, utilising what we now know (in particular from research into implementation) about how to shift behaviours, practice and outcomes. A desire to change is not sufficient. Nor is an increase in resources or changes in law. Systematic work must be undertaken, over a number of years, which enables and supports the frontline workforce to change their approach. At Social Work Scotland we are attempting to incorporate the insights offered by implementation science, and encourage the Review to consider what that body of evidence tells us about effecting sustainable change.
  • The national improvement ‘offer’ for social work and social care needs to change. The recent introduction of National Health and Care Outcomes is a welcome development, but an effective national infrastructure is not in place to support sustained improvement across the sector. The conflation of scrutiny and improvement functions within the Care Inspectorate and within the Scottish Social Services Council has impacted on these organisations’ efficacy in those capacities. Decisions must be taken about the siting of scrutiny and improvement support functions so that there is maximum benefit for service delivery.
  • In attending to the unique role and requirements of social work over the long term, as well as improving consistency of practice, providing subsidiarity within the system, and offsetting the potential fragmentation of the profession, Scotland should establish a national social work agency, differentiated from a national care service. With responsibility for supporting quality and facilitating improvement, it would sit alongside equivalents already in place for education and health. This body would not have responsibility for the regulation of the workforce (which would remain with the Scottish Social Services Council) or delivery of services (which should happen at a local level), but it would lead on learning and development, implementation of new models of practice, attending to issues of professional parity, etc.
  • The delivery of social work (safeguarding, assessment, monitoring, support, advice, review) and social care (practical actions to support people meet their personal outcomes) must be local, embedded in and responsive to communities. People’s contexts, needs and environments are varied, and our social care system must reflect that; particularly if our objective is for social care to be personalised, with people having control and However, social care could be improved through the establishment of national structures which validate its central role in society, acknowledge the contribution and requirements of those who work within it, and which assist with improvement and implementation (e.g. adoption of new technologies). A National Care Service, under this formulation, would not be involved in delivery of care, but rather the management of resources within the system.
  • Social Work Scotland acknowledges improvements made to the statistical information available about adult social care in Scotland, and the ongoing effort to link this data to that available for the NHS, so that a more holistic picture can be formed about health and social care as a whole.  However, the staff resources needed to support and maintain information systems locally have been severely cut back in recent years.  As a result, the national adult social care statistics published in Insights in Social Care: Statistics for Scotland. Support provided or funded by health and social care partnerships in Scotland have many gaps which have to be estimated, where possible, making some of the data difficult to use.  Key data time-series, such as on social work assessments, are no longer published, and we are concerned that the social care expenditure information collected by the Scottish Government is being severely cut.  We agree with the recent review by the Office of National Statistics that the evidence base for adult social care is under-resourced compared to that for the NHS.
  • Above all there is insufficient funding in the social care system to deliver the improvements the Independent Review seeks in terms of the outcomes achieved by and with people who use services, their carers and families, and the experience of people who work in adult social care. Despite the best efforts of local authorities to protect social care from the effects of funding reductions over the last eight to nine years of austerity, adult social care expenditure has fallen per head in real terms, especially for older people, and the demographic challenges posed by the ageing population have largely not been met. We confidently believe significant additional investment will be needed, in the short, medium and long-term and we urge the Review group to be bold in its recommendations to deliver the investment needed to achieve the national care system its people need and want.

 

Rationale supporting our key messages / positions

Definitions

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[6], a concept that implies the delivery of a service to an individual, and social work[7], 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:

  • Where affordable and/or appropriate housing is unavailable, social work is tasked to coordinate the necessary support for people to live safely in their own homes.
  • Where NHS capacity restricts (leading to longer waiting times or removal of service) social work is responsible for identifying or developing service models which can support people with very complex needs to live in their community.
  • Where clinical assessments for autism or other learning disabilities (which can appear very inconsistent between areas) limit the NHS funded options for an individual or family, social work must engage to find alternatives.
  • Where pastoral and pupil support posts are lost from schools, social work is challenged to manage the needs of vulnerable children within their families; many of whom will have complex needs of their own.

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[8].

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.

Community-based support

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.

Workforce

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.

Supplementary submissions:

APPENDIX A: SOCIAL WORK SCOTLAND RESPONSES TO RELEVANT INQUIRES AND CONSULTATIONS

Submission from Social Work Scotland to Health and Sport Committee, Scottish Parliament, 20 February 2020

Housing to 2040: Consultation on Policy Options – Submission from Social Work Scotland, to the Scottish Government Consultation, 27 February 2020

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

How well is the Care Inspectorate fulfilling its statutory role? – Submission from Social Work Scotland to Scottish Parliament call for views, 10 August 2020

Independent Review of Mental Health Law in Scotland: Submission from Social Work Scotland to John Scott QC, 29 May 2020

Submission from Social Work Scotland to IJB Chairs and Vice Chairs Executive Group, 17 July 2020

Social Work Scotland response to the Scottish Government Review of Local Authority Financial Returns – Social Work Services (LFR03), 23 August 2020

[1] https://www.gov.scot/publications/independent-review-of-adult-social-care-terms-of-reference/

[2] In reference to implementation of the Promise.

[3] For example, the Drugs Deaths Taskforce

[4] For example, the Review of Mental Health Law in Scotland and Forensic mental health services: independent review

[5] In reference to development of the Community Justice agenda.

[6] “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.

[7] “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

[8] Thematic review of self-directed support in Scotland – June 2019, Care Inspectorate

Ends

03/09/2020

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.

  • The Mental Health (Care and Treatment) (Scotland) Act 2003 (“the Act”) came into force in 2005 – how well does it work at the moment? In answering this it would be helpful to us if you could consider the following:
  • how well the Act helps people to get the right care, treatment and support
  • how well the Act protects people’s human rights (Please see the start of the paper for the human rights we think are most relevant here)
  • how well the Act maximises a person’s ability to make their own decisions and give effect to them
  • how things have changed since the Act came into force in 2005
  • Are there certain things that hinder the Act from working effectively? What would improve things?

 

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[1].

We draw the review’s attention to our response to the recent Social Care Inquiry[2] 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.

 

Integration context

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[3] 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[4] 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[5] was explicit in finding that a shortage of Registered Medical Officers impacted detrimentally on the patient’s journey.

 

Inpatient resources

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.

 

Specialist resources

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.

 

  • Are there groups of people whose particular needs are not well served by the current legislation? What would improve things?

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.

 

  • The Act has a set of legal tests to justify making someone subject to compulsion. Would you suggest any changes to these? In answering this, you may wish to think about how practical the tests are to apply and how fair they are to different groups, including people with different diagnoses.

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).

  • Do you think this requirement is currently met? Does more need to be done to help people recover from mental disorder? You may wish to provide an example or examples.

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.

 

  • Does the law need to have more of a focus on promoting people’s social, economic and cultural rights, such as rights relating to housing, education, work and standards of living and health? If so, how?

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.

 

  • Do you think the law could do more to raise awareness of and encourage respect for the rights and dignity of people with mental health needs? The Review is also looking at the way people with a mental disorder are affected by the Adults with Incapacity (Scotland) Act 2003, and the Adult Support and Protection (Scotland) Act 2007.

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.

 

  • Based on your experience, are there any difficulties with the way the 3 pieces of legislation work separately or the way they work together? What improvements might be made to overcome those difficulties?

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[6] 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.

 

  • Is there anything else you wish to tell the Review? Please fill in the box below with your contribution. There is no restriction to the length of your statement. You may submit additional pages by post or use the text box below, or submit written submissions by email.

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[7] 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[8] 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.

 

[1] https://www.audit-scotland.gov.uk/report/self-directed-support-2017-progress-report

[2] https://socialworkscotland.org/consultation/social-care-inquiry/

[3] https://independentinquiry.org/wp-content/uploads/2020/02/Final-Report-of-the-Independent-Inquiry-into-Mental-Health-Services-in-Tayside.pdf

[4] https://socialworkscotland.org/wp-content/uploads/2018/05/TheMentalHealthOfficer_capacitychallengesopportunitiesandachievements.pdf

[5]  https://independentinquiry.org/wp-content/uploads/2020/02/Final-Report-of-the-Independent-Inquiry-into-Mental-Health-Services-in-Tayside.pdf

[6] https://www.careinspectorate.com/images/documents/4453/Review%20of%20adult%20support%20and%20protection%20report%20(April%202018).pdf

[7] https://www.celcis.org/knowledge-bank/search-bank/active-implementation-hub/

[8] https://socialworkscotland.org/consultation/independent-review-of-learning-disability-and-autism-in-the-mental-health-act/

12/08/2020

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,
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.

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
work services and criminal justice social work services, which have also been affected by Covid-19 related issues.

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
they had before. ARC Scotland have reported that some supported people would not be keen to return to these traditional models of care and support [1].

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:
 Inclusion of community-led services and supports, including local micro providers, on the future commissioning framework.
 Continued investment in local relationships which have been developed between HSCPs and providers during Covid-19
 Investment in home-based rehabilitation/ interim care for older people.
 Review of local interpretation of eligibility criteria and charging policies.
 Flexibility to be embedded more fully and permanently in standard procedures.
 Support from national regulators for flexible innovation.

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
maintaining person-facing care and support.

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.
 Encouragement to use SDS creatively and differently. Better focus on getting the right support to those who need it as soon possible.
 More joined-up work with the third sector that has been truly collaborative.

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?
(i) Structure
(ii) Funding
(iii) Regulation

We understand that further national consideration is to be given to social care reform in the light of Covid-19, and Social Work Scotland looks forward to working collectively with Health and Social Care Scotland amongst other national partners.

While understanding why care home provision has been singled out, we also think that the IJB Chairs and Vice Chairs Executive Group’s submission should support the recommendations in the recent report by the independent Advisory Group on Economic Recovery, Towards a robust, resilient wellbeing economy for Scotland.

This report reminded readers that:

Scotland’s social care sector employs 200,000 people […] and has a financial value to the Scottish economy of over £3 billion. But care is not only a vital contributor and support to the economy: much more than that, good quality, safe, supportive and effective care is essential to our society. (p51)

Before the crisis, the sector was confronted by major challenges in relation to procurement of services from public authorities; to the recruitment, retention and pay of its workforce; and to the longer-terms sustainability of its funding, and indeed its entire business model. The crisis has only sharpened the nature of these challenges: but it has brought home to us how precious a function the care sector provides for us all. Care homes in particular have truly been at the front line in the crisis; we must make sure that, as we come out of the immediate emergency, Scotland takes action to strengthen the capacity and sustainability of the care sector as a whole. (p51).

Adequate funding is the first requirement. Ten year of public sector austerity has severely reduced funding for local government in Scotland, and, while Councils have sought to protect social care, expenditure has fallen in real terms at the same time as the increasing numbers of older people, especially those aged 85 years and over, has increased the need for social work and social care services by 2.9% per year, according to figures in the Scottish Government’s 2018 Health & Social Care Medium Term Financial Framework (MTFF), which also gives a figure of 4% per year including pay and price inflation. Given the increasing care being provided by family members and other “unpaid carers”, it is vital that the Scottish Government adequately fund the Carers Act (Scotland) Act, especially in relation
to replacement (respite) care. (Social Work Scotland can provide a briefing note on this, if required).

The immediate need is to fund the on-going measures necessary to protect people and families who use services, and the staff providing services, from Covid-19 infection. That means sufficient PPE, regular live virus testing, and an effective test-trace-isolate system to prevent the spread of infection. The contract tracing human resources needed are significant and it is not always clear that the test-trace-isolate system is being delivered across Scotland at sufficient scale. Some follow-up on isolation advice is also needed so we know whether the advice is followed.

Scotland does not have ongoing random sampling for live virus in a Covid Infection Survey (similar to that being run in England from May 2020 in a joint project between ONS and Oxford University), but the recent Public Health Scotland of a pilot study of blood samples collected by regional laboratories for other clinical reasons might in future provide the firmer epidemiology necessary for current and
future planning at national and regional level.

The other key early task is to stabilise the social care workforce numbers, currently 7.7% of Scotland’s workforce, given that current levels of recruitment from abroad will soon become impossible under the UK Government’s proposed post Brexit immigration policies. Since the mid-1990s, the largely female
workforce has been increasing privatised, low-paid and often with poor pension and other conditions of service. Staff turnover and vacancies levels are high. According to the Fair Work Convention, nearly 20% of social care workers are not on permanent contracts.

Public recognition of this important work has grown very significantly during the Covid-19 crisis, and the time is right to increase wages and salaries. Clearly that will require significant levels of funding, and also legislation or regulation to intervene in the market – for example, it might be necessary to consider a Scottish Social Care minimum wage at a level above the current Scottish Living Wage.

All the above points about social care services as a whole, also apply particularly to care at home and to care homes. Many of the issues affecting care homes also affect sheltered housing schemes and housing with care schemes where there is a staff team working in shifts to provide care and support to frail older adults, and to other group living arrangements for supported adults who depend on external care
workers for support. Such establishments should be included in ongoing pandemic and winter planning.

We need to understand how the very high Covid-19 deaths came to occur in care homes – 46.5% of all registered deaths in Scotland identified as involving Covid-19 by 5 July (weeks 15-27). Certainly, residents in care homes are by definition vulnerable populations with age-related (and in some areas, poverty-related) conditions that are associated with higher death rates from Covid-19. However, the
viral infection has to get into care homes for these factors to apply.

The care home sector is highly regulated but this did not protect care home residents during Covid-19.

Apart from the well-publicised shortage of PPE and testing, lessons need to be learnt from discharging patients with untested live virus from hospital to care homes because they were considered medically fit for discharge, where they passed on the virus to other residents and staff. The overriding focus on preparing acute hospital care for the expected large numbers of Covid-19 admissions without proper regard to the health and social care system as a whole has in England been partly blamed on the lack of integration of between the NHS and social care. In Scotland we consider ourselves further forward with integrating health and social care, yet the high death rate in care homes here does not indicate an
integrated system. It also raises questions about governance, if, as seems to have been the case, these decisions did not come through to IJBs.

Lessons also need to be learnt in all parts of the UK from the cessation of normal NHS services to increase 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.

We think that it should be possible to vary registration requirements more quickly and responsively across the social care sector in order to support local need and personalised care arrangements.

Throughout lockdown, several local partnerships have offered a service for a critical few who have been assessed as needing respite during lockdown, using building bases and staffing models which have been fully risk assessed, and which maintain physical distancing and other infection control measures. These critical arrangements have been provided due to the high risk posed to specific individuals and their carers during lockdown. In some cases, these local arrangements have required variations to been made in the registration of building-based services. If these alternative, bespoke arrangements have been well received by people and carers, it is reasonable to imagine that they could continue beyond the pandemic.

More generally, there needs to be a shift of perspective around care home provision. Care homes should be viewed as a valued part of community provision helping to meet national wellbeing outcomes, in a spectrum of services supporting prevention, maintaining communities and increasing personalisation.

Care homes are often seen as a final destination when in fact they can be utilised very well as a form of step-down or rehabilitation provision.

There should be a wider focus on the whole system of care and support, with greater focus on early intervention and prevention such as intense care at home/rehabilitation services for people leaving hospital who might otherwise go into a care home.

Q4. It can be reasonably anticipated that there will be more care required in home or homely settings. The Third sector play a crucial part in IJBs achieving effective care in the community. How can IJBs ensure greater resilience of and contribution from the Third sector?

The third sector plays an important role, accounting for around 27% of Scotland’s social care workforce, according to the Scottish Centre for Employment Research (2018). However, a bigger role is currently played by the for-profit private sector. In a mixed economy, the balance between the public, voluntary, independent and private sectors need not be left to the market, but is a proper subject for public debate and democratic decision-making.

We know of positive examples of partnership working with the Third Sector throughout the pandemic, affording independent sector partners the ability to step up and step down support in a flexible way, which has increased trust, confidence and flexibility in how these partnerships work. We would support further learning through analysis of how this was achieved, the funding needed to deliver
partnership collaboration, cost effectiveness for support delivery and opportunities for continuing these partnerships.

Much has rested on the goodwill of communities being willing and able to support people in need, and we should aim to support this as we emerge from Covid-19. While checks and balances need to be robust there should be consideration of how we can reduce bureaucracy and make best use of available funding. Involving local communities in the process is a good starting point but supporting them to lead the process may be even better.

Social Work Scotland has learned that some local authorities have taken a community-led support approach, involving the contribution of third sector organisations, to supporting individuals with early intervention and prevention activity. These include Edinburgh’s Three Conversations Model and Health
Improvement Scotland’s Community Hubs in 9 test sites across Scotland.

By allowing people advice, information at the lowest level from third sector organisations and partners before establishing higher level needs, this has resulted in some issues being resolved quickly without lengthy waits for assessments or even the need for higher level care and or supports. Only those where it is established need higher level care and or supports are then referred into the normal SDS routes for social care.

In a community-led model, workers stick with people until an outcome is achieved. This prevents a person having to tell their story repeatedly to multiple organisations, and outcomes are tracked more easily.

Commissioning frameworks could be much less restrictive and more supportive of third sector/independent/ social enterprise inclusion. We would support clearer strategic links within Community Planning Partnerships and with Public Health Scotland, and closer involvement of TSIs within integration arrangements.

We would support greater use of Individual Service Funds (ISFs), so that the supported person is the commissioner of services, in particular care at home. In this way, the person can chose how, when, where and in what way their support is delivered.

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.

Q5. Engagement with local communities is a vital part of identifying how the powers vested in IJBs by the Public Bodies (Joint Working) (Scotland) Act 2014 can be tailored to support local need. What can IJBs do to better engage with the groups you represent?

Social Work Scotland would urge IJBs to engage with supported people and their carers to understand how people’s views have been shaped by their experiences of receiving care during the pandemic. In the aforementioned Social Work Scotland response to the Scottish Parliament on the Social Care Inquiry, we noted the strength of feeling across our membership:

“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”.

This is all the more important as supported people’s experiences and views will have been shaped by their experiences of care during the pandemic.

Engagement with local communities is critical to help shape a broad sense of what types and qualities of care and support are required for a local population. However, engagement should not be tokenistic, and requires reciprocity. Too often third sector organisations feel they are used for all their knowledge, skills and ideas but with little return for them.

Generic engagement is not sufficient. Services need to be tailored to individual people not general populations, and requests made by individuals in their assessment and care planning should inform wider strategic developments.

East Ayrshire’s Thinking Differently approach has evolved a very open and transparent model where people with lived experience of social care actively involved in decision-making forums to drive improvement practice and contribute to decisions about budget spend. This approach goes beyond engagement to real involvement and empowerment of people accessing care and support services.

Consideration should be given to widespread use of remuneration and expenses for supported people and carer representatives where this does not routinely happen.

More focus should be put to achieving the intentions of the Community Empowerment (Scotland) Act 2015. Involvement of local community engagement teams and NHS, investment in TSIs and enterprise support organisations, involvement of local authority economic development, collaboration with funding
bodies are all features supportive of achieving the requirements of the Act. Local elected members are influential in this regard. Good communication with elected members on the benefits and opportunities of community empowerment and building trusting relations could enable a power shift to community led approaches.

As mentioned previously, there has been an upsurge in volunteer activity at community level. We think it should be possible to attract volunteers into the social care workforce, and would support consideration of continuing post-Covid the national campaign, ‘There’s more to care than caring’.

Partnerships can engage and support the work of professional organisations that support their frontline and leadership workforces, such as the Scottish Association of Social Workers and Social Work Scotland. Professional organisations offer corporate memberships and opportunities to promote good practice and share communications. HSCS can ensure social work and social care professional associations are included as stakeholders with significant expertise which can help to improve consistency and quality of strategic planning.

Q6. Integration of Health and Social Care (HSC) staff is a key component of the successful deployment of the IJBs strategic aims. Do you have examples of where further levels of HSC staff integration would help you achieve your organisations aims and ambitions?

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 each profession, and consideration of retaining each profession’s unique contribution and impact within local integration arrangements.

Local partnerships should aim to work in ways that promote good relationships between specialists. People do not fit well into our traditional service silos. People have mental health issues also need support with their children, may be carers themselves and could have a physical disability or sensory impairment.

In some rural areas, NHS staff, local authority staff and third sector staff work as one team. The community nurse may carry out a social care task like giving the person a meal. A personal assistant is given instruction on how to apply a dressing by the nurse so that the nurse can attend to other patients in greater need of medical intervention. Volunteers provide older people with foot care support trained and monitored by the NHS podiatry services and delivered in a church hall once a week, allowing the podiatrist to attend to more serious cases. This type of blended approach requires flexibility to be built in to commissioning processes.

We see many instances where innovative service design is bolted on to more traditional bureaucratic systems and processes, which hinder the overall aim. We believe that the key ingredients to effecting sustained change are adaptive leadership, trusting relationships, confidence and putting the person at the centre of process and service design.

During the pandemic, arrangements were put in place and communicated very quickly but at times were very confusing. We can learn from this how communication can be improved between partners and key contacts identified to ensure routes to information, decisions and actions are clearer. Delegated
responsibilities were not always clear and this led to delays in decisions or progressing actions.

True partnership working encompasses whole system responsibilities. While SDS is the primary responsibility of social work, in reality SDS is about ensuring that those who need support get the right support at the right time in order to meet their identified needs. This should be a key priority for all and will be better achieved with real partnership working.

Q7. Data and information which help identify how best to deploy HSC resources are critical to direct these resources. Are there more effective ways in which information you hold could help IJBs monitor improvements in services delivered by HSC which support your organisation.

Currently there is no national requirement to capture outcomes achieved for adults and older people. There are however some local authorities who track outcomes achieved, not achieved and partially achieved for people and the success or failures behind each is used to inform staff learning and the improvement of services and targeting resources. An outcome approach can provide rich information to help target resources more effectively and more personalised to what matters to people. Following an outcomes approach allows clarification of what ‘good’ looks like.

There is a difference in resource allocation across client groups that does not comply with a rights-based approach. Algorithms underpinning 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.

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.

Much time and effort is spent on managing outdated information systems that do not link well around the person. It would be helpful to learn how well local data systems withstood the collation of information that was asked for during the pandemic, and how public and independent sector fared with this. We know, for example, that data requested from care homes during the pandemic put an extraordinary burden on managers at a critical time. To understand the purpose of and the use to which the collected data was put, whether there was a good shared understanding of what was required and whether the data gathered measured impact effectively; and to consider whether early data requests are feasible during an exceptional event like the pandemic and how accurate can they be.

For further information, please do not hesitate to contact:
Dr Jane Kellock
Head of Strategy, Social Work Scotland
jane.kellock@socialworkscotland.org

[1 ]ARC Scotland Provider Forums COVID-19 meeting summary: March – May 2020

12/08/2020

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

 

  • Do you agree with how we propose to develop new assumptions and the evidence base? Do you have any alternative or additional suggestions that we should consider?

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.

 

  • What should we do about our existing Integrated Workforce Plan and workforce commitments?

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:

 

  1. Does exposure to the virus create immunity, and if so, for how long?

 

  1. Will an effective vaccine to Covid19 be found soon, and be produced at scale and reasonable cost to governments, so that it can be used world-wide?

 

  1. Will the virus mutate, either to a new equally virulent form, or, like the common cold, to a much less harmful form?

 

  1. Can PPE be produced, purchased and distributed in larger volumes to meet all needs for protection?

 

  1. Can the testing for live virus be massively increased, with associated contact tracing, so that people infected can be isolated, and transmission stopped? Health and Care staff, and the people using their services need such testing frequently. The contract tracing human resources needed are significant and in need of planning.

 

  1. Can the random sampling for live virus, which has only recently started in England (in a joint project between ONS and Oxford University), be increased to show the variation around the average prevalence (currently 1 in 400) between different areas of the UK, and urban versus rural areas, in order to provide the firmer epidemiology necessary for current and future planning?

 

  1. Can this random testing be combined with antibody testing to provide evidence of re-infection rates and possible “herd immunity”, also needed to provide the firmer epidemiology necessary for planning renewal?

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.

  • How do we best manage workforce planning as a whole-system endeavour, across the integrated health and social care landscape?

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.

  • What kind of workforce plan do you think will be required to cope with rapidly changing circumstances throughout the pandemic and after?

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).~

  • Are there any assumptions you would add?

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:

  1. The numbers of combined health and social care are given on page 8 of the Plan as “over 368,000 headcount” and “291,000 Whole Time Equivalent”. These are said to be the most up to date available data, but no weblinks are given. The “as at” dates are not given for these baseline staffing numbers; the counts are not given separately for NHS and Social Care, as they need to be; and it is not clear whether  any categories of NHS or social care staff been excluded from any of these counts (eg staff at the State Hospital).

 

  1. Page 8 of the Plan states that “The Scottish Government’s Medium Term Financial Framework (MTFF) estimates that to address the effects of demand, we will require 1.3% per annum more NHS employees and 1.7% per annum more social care employees in the period to 2023/24”. We could not find that information in the Health and Social Care MTFF published in October 2018,  which refers to annual growth rates of 3.5% in demand for health services and 4% for social care (H&SC MTFF pages 10 and 11). However, these are the total expenditure growth rates required to 2023/4, and include pay and price rises and other non-demographic factors.  If we strip those out using the data in Figure 8 of the H&SC MTFF, then the average annual growth required in activity year on year becomes 2.9% for social care and 2.4% for health.  That is still a lot higher than the 1.7% and 1.3% figures. Could we please be provided with a table showing how these staffing increases in the Workforce Plan relate to the H&SC MTFF financial projections?

 

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.

 

  1. Page 9 of the Plan includes a chart showing how “assumed demand” will increase total WTE staffing from the baseline of 291,287 WTE, to 310,758 WTE by 2023-24, before “mitigations” bring this down to 301,808. No figures are given for the elements of increased demand, or for the individual mitigations, which also should be separated between NHS and Social Care – otherwise there is no clarity.

  • How would you prefer to be updated on progress with this 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.

28/02/2020

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

OVERARCHING THEMES

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[1] (as distinct from social care[2]) 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”[3]  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:

  • “a shared agreement on the purpose of adult social care support, with a focus on human rights
  • social care support that is centred on a person, how they want to live their life, and what is important to them – including the freedom to move to a different area of Scotland
  • changing attitudes towards social care support, so that it is seen as an investment in Scotland’s people, society and economy
  • investment in social care support, and how it is paid for in the future
  • a valued and skilled workforce
  • strengthening the quality and consistency of co-production at local and national level with people with lived experience and the wider community
  • equity of experience and expectations across Scotland
  • evaluation, data and learning”

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.

  1. How should the public be involved in planning their own and their community’s social care services?

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[4] (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”[5]. Supported Decision Making[6] can help some people’s views and choices to be expressed.  The Care Programme Approach[7] is designed to provide a wider structure of care and support to people with mental health problems.  The Good Conversations approach[8] 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.

  1. How should integration authorities commission and procure social care to ensure it is person-centred

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[9]) 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[10] 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[11] 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.

 

  1. Looking ahead, what are the essential elements in an ideal model of social care (e.g. workforce, technology, housing etc.)?

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)[12], University of Strathclyde. Social Work Scotland is commissioning CELCIS to support its project work, including the national SDS and Social Care in Prisons projects.

Self-directed Support

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.

Building assets

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[13] approach and Community-Led Support[14]. There have been attempts made to revitalise a Community Social Work[15] 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.

Housing

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[16], 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[17].  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.

Community spaces

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[18]  and on redesigning town centres to provide opportunities for more intergenerational and inclusive living.

Technology

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[19] 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.

Workforce

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.

 

  1. What needs to happen to ensure the equitable provision of social care across the country?

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.

Figure 1.

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:
Dr Jane Kellock
Head of Strategy, Social Work Scotland
jane.kellock@socialworkscotland.org

[1] “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

[2] “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/

[3] https://www.gov.scot/policies/social-care/reforming-adult-social-care/

[4] https://www.gov.scot/publications/evaluation-participatory-budgeting-activity-scotland-2016-2018-2/pages/3/

[5] https://arcscotland.org.uk/involvement/charter-for-involvement/

[6] https://www.mwcscot.org.uk/sites/default/files/2019-06/mwc_sdm_draft_gp_guide_10__post_board__jw_final.pdf

[7] https://www.rethink.org/advice-and-information/living-with-mental-illness/treatment-and-support/care-programme-approach-cpa/

[8] https://personaloutcomespartnership.wordpress.com/courses/making-it-personal/good-conversations/

[9] https://www.gov.scot/binaries/content/documents/govscot/publications/advice-and-guidance/2015/01/personal-and-nursing-care-of-older-people–national-standard-criteria-and-waiting-times-guidance/documents/personal-and-nursing-care-of-older-people—national-standard-criteria-and-waiting-times-guidance/personal-and-nursing-care-of-older-people—national-standard-criteria-and-waiting-times-guidance/govscot%3Adocument/National%2BStandard%2BCriteria%2Band%2BWaiting%2BTimes%2Bfor%2Bthe%2BPersonal%2Band%2BNursing%2BCare%2Bof%2BOlder%2BPeople%2BGuidance%2B.pdf

[10] https://www.audit-scotland.gov.uk/report/self-directed-support-2017-progress-report

[11] https://www.careinspectorate.com/images/documents/5139/Thematic%20review%20of%20self%20directed%20support%20in%20Scotland.pdf

[12] https://www.celcis.org/training-and-events/active-implementation-training-celcis/

[13] https://ihub.scot/improvement-programmes/living-well-in-communities/our-programmes/neighbourhood-care/

[14] https://www.ndti.org.uk/our-work/our-projects/community-led-support/cls-in-scotland

[15] https://www.iriss.org.uk/resources/reports/community-social-work-scotland

[16] https://www.sfha.co.uk/news/news-category/sfha-news/news-article/why-are-an-increasing-number-of-people-in-housing-talking-about-tech

[17] https://www.gov.scot/publications/housing-to-2040/

[18] https://www.ads.org.uk/age-friendly-places/

[19] https://nds.nes.digital/about/

27/02/2020

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[1] 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[2]. 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’[3], 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.’[4]

 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[5]. 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[6], 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[7]. 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[8].  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[9]  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[10] 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’[11] 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).’ [12]

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[13] 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?

N/A

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)?

N/A

 

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? 

N/A

Q6. Do you have any proposals that would improve the quality, standards and state of repair of existing and new housing?

N/A

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[14], 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?

N/A

 

For further information, please do not hesitate to contact:

 Flora Aldridge
Communication & Events Manager, Social Work Scotland
flora.aldridge@socialworkscotland.org

[1] https://www.gov.scot/publications/housing-to-2040/

[2] https://housingevidence.ac.uk/wp-content/uploads/2019/12/191205-housing-visions-2040-DC.pdf

[3] 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

[4] The Promise: https://www.carereview.scot/destination/independent-care-review-reports/

[5] https://www.iriss.org.uk/resources/insights/rural-social-work-scotland

[6] https://socialworkscotland.org/statement-on-resources/

[7]The Promise: https://www.carereview.scot/destination/independent-care-review-reports/

[8] https://www.gov.scot/policies/social-care/reforming-adult-social-care/

[9] https://www.ads.org.uk/age-friendly-places/

[10] https://futurecities.catapult.org.uk/2019/05/14/blog-systems-thinking-and-housing/

[11]  https://www.equalityhumanrights.com/sites/default/files/housing-and-disabled-people-scotland-hidden-crisis-long-summary.pdf

[12] IBID

[13] https://www.housinglin.org.uk/_assets/Resources/Housing/OtherOrganisation/HousingAndAgeingReport.pdf

[14] https://www.ads.org.uk/age-friendly-places/