Adult social care in Britain has been at the centre of much media and public attention in recent years. Revelations of horrific abuse in learning disability settings, the collapse of major private care home providers, abject failures of inspection and regulation, and uncertainty over how long-term care of older people should be funded have all given rise to serious public concern. In this short form book, part of the Critical and Radical Debates in Social Work series, Iain Ferguson and Michael Lavalette give an historical overview of adult social care. The roots of the current crisis are located in the under-valuing of older people and adults with disabilities and in the marketisation of social care over the past two decades. The authors critically examine recent developments in social work with adults, including the personalisation agenda, and the prospects for adult social care and social work in a context of seemingly never-ending austerity.
Two stories dominated the British news media in the early summer of 2011. The first concerned Winterbourne View, a private hospital for adults with learning disabilities near Bristol. Undercover filming for the BBC Panorama programme in late May 2011 showed staff there involved in appalling abuse of vulnerable residents, some of it verging on torture. Residents were seen being pinned down by staff members, slapped, dragged out of bed and, in one case, doused in water and left outside in cold weather. The programme caused public outrage and some weeks later, the home, owned by the private care company Castlebeck, was closed by the Department of Health and a group of eleven carers subsequently charged with some 45 counts alleging illtreatment against or neglect of five victims.
Hard on the heels of the Winterbourne scandal came the announcement of the closure of Southern Cross, with 37,000 residents in over 750 care homes, the biggest provider of residential care for older people in the UK. The announcement caused huge anxiety among the residents of its care homes, their relatives and Southern Cross workers, 3, 000 of whom lost their jobs. In echoes of the banking crisis of 2008, the state was forced to step in, with the Conservative– Liberal Democrat Coalition Government announcing that no resident would be turned out onto the street. In the event, many of the homes were subsequently bought out by Four Seasons, the second largest care provider (the financial stability of which was also the subject of considerable speculation in the financial press during 2011: Bowers, 2012; Scourfield, 2012).
There is an important semantic distinction between social work and social care: the former implies taking action to bring about change or build on strengths; the latter implies the (ongoing) provision of services to meet the needs of those who are seen as unable to take charge of their lives for themselves. While we need to acknowledge that, at certain points through their journeys, people experiencing mental distress may require the care of others, the language of social care has been allowed to become dominant in defining the everyday practices of much of mental health social work. This has led to services being driven by an overwhelming concern with the ‘deficit’ aspects of people’s lives in terms of illness, risk and incapacity, and an inability to recognise and develop people’s assets and capabilities – which can be essential if we are to enable people to turn their lives around and recover from debilitating experiences of mental distress.
Currently, the immediate agendas that dominate social work practice are short-term and reactive – principally those of safeguarding and resource rationing. However, a policy response of recourse to ever-tighter eligibility criteria is likely to be counterproductive in relation to mental health. Instead of resources being made available to work with people when this may be most productive in terms of building capability and promoting recovery, involvement only becomes allowed at times when people are so distressed that social interventions may be of limited utility. In this way, people may easily become trapped into long-term dependency on potentially very expensive services if the support is not there at the right time for them to reclaim control over their lives with the support of those family and friends who may be important to them.
Whenever UNISON members working in adult social care gather to talk about personalisation some key themes crop up:
window-dressing for cuts;
reduced social work involvement;
loss of local services and jobs; and
increase in safeguarding concerns.
Day centres being closed, meals on wheels services being cut, management pressure to trim care packages – all these are being done in personalisation’s name.
Councils are focusing their efforts on hitting the crude target of everyone on a personal budget, while facing growing need with shrinking resources. The direct consequence is the strangling of the principles of empowerment and control in a tangle of bureaucracy. Resource allocation systems, in all their complexity, make rights more difficult to keep in focus, and rationing easier to disguise.
As Peter Beresford has pointed out, personalisation is a policy that has been sold by anecdote. But it is proving much harder to get an airing for the anecdotes that practitioners are telling us, for example:
The elderly parents and carers of a learning-disabled man who used to attend a day centre five days a week. Now the centre is closed, he has a direct payment that is only enough to pay for a support worker to take him out a few hours a week. The rest of the week, he is at home, bored and his parents are finding it hard to cope.
The disabled woman who has a direct payment that pays for a team of personal assistants (PAs). Things are getting very difficult as one of the PAs (a UNISON member) has been injured at work but the woman does not believe that it is her responsibility to have employers’ liability insurance, and the council is not helping to resolve the issue.
England and the Republic of Ireland are bound together historically and in a contemporary sense. Both are currently governed by coalition administrations intent on pursing broadly neoliberal policies. In terms of social work practice, in the Republic, the main legislation relating to social work with children was, until the enactment of the Children Act 2001, the Children Act 1908 placed on the statute book by the former British colonial administration. Today, social work in both England and Ireland is mostly work undertaken by women workers. In the latter jurisdiction, 83.2% of social work posts are filled by women (NSWQB, 2006, p 23). Nevertheless, not surprisingly, there are certain national defining characteristics. That is to say, the difficulties and dilemmas confronting practitioners, social work academics and the users of services are not the same in England and the Republic of Ireland.
This relatively short contribution to the ‘Radical and Critical Perspectives’ series can only begin to identify some of the main emerging issues and themes relating to social work with children and families.1 In this context, readers need to be alert to the fact that it is, I feel, misguided to simply view social work – with children and families or any other group – as an entirely benign and emancipatory activity. Social work should not be sentimentalised and its function and purpose misunderstood. When discussing social work, we need to keep the state in vision: by and large, social workers are employed by the state and this is a social formation that does not simply act as a ‘good-enough parent’, seeking to intervene in the lives of children because of the need to ensure that their welfare is ‘paramount’.
Recent years have witnessed a number of 'child protection' scandals where children, often from the poorest and most marginalised communities, have been on the receiving end of violence, abuse and social harm. In this short form book, part of the Critical and Radical Debates in Social Work series, Paul Michael Garrett looks at the impact of marketisation of social work services in both Ireland and England. He argues that marketisation has had a negative impact on policy regimes, working conditions, social work practices and on the services for vulnerable children and young people. Leading researchers from across the globe contribute to the debate and provide additional evidence from a range of policy regimes that catalogue the negative impact neoliberalism has had on children's services.