SUMMARY OF SUBMISSION FROM SOCIAL WORK SCOTLAND, TO SCOTTISH GOVERNMENT CONSULTATION
Social Work Scotland is the professional body for social work leaders, working closely with partners to shape policy and practice, and improve the quality and experience of social services. We welcome this opportunity to comment on the Scottish Government’s proposals for a National Care Service, and related reforms to social care, scrutiny, improvement, etc.
This paper provides a summary of Social Work Scotland’s consultation response, profiling our position on key sections and issues (as identified by Social Work Scotland’s members). It is organised in the sequence we think issues must be considered, considering the social care system’s critical importance to the health and wellbeing of the nation, its complexity and delicate interdependencies, and the real risks to people if this process of change is not deftly planned, properly resourced and expertly managed.
Please find our full response paper (PDF) here.
Please find our supplementary papers (PDF) here:
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 preclude them from taking preventative, empowering actions. Bureaucracy and systemic risk-aversion inhibit them from developing constructive relationships with those seeking and/or receiving support. Legislation that pushes and pulls in contrary directions, or makes demands that 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 members 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. This 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.
As the Minister’s 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 needs.
We were surprised that the consultation paper continued no questions on finance, apart from charging for residential care. Considering how critical resourcing is to the 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. 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 are 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 a 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, but it also 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 the comments made above, Social Work Scotland supports the establishment of the 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 that enables social workers 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 a 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 the 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 that 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 the 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 is 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 that 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 the 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 complementary 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 the 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)(find in left sidebar of page)
For further information, please do not hesitate to contact:
Director, Social Work Scotland