Change agents, not gatekeepers - a timely reminder of social work's value

Published by Professional Social Work magazine, 4 October, 2021

With so much media and political attention on social care there is a danger that social work, which is a very undervalued resource, may be further marginalised. But in reality, it’s vital social work and social workers are valued as a “mending” rather than a “minding” service.

In the late 1960s and early 1970s social work was regarded as a valuable resource in its own right and social workers seen as ‘agents of change’. Since then, they have been increasingly regarded as ‘gatekeepers’ assessing the eligibility for practical help and rationing of services.

The Seebohm Report which led to the establishment of Social Service Departments in 1971 recognised the value of social work and saw social workers as the key resource. It did not, however, create the “one door to knock on”, it promised, as a multi-disciplinary/inter-agency response is often required in differing combinations depending upon the desired outcome.

This was subsequently recognised with the establishment of Area Child Protection Committees and Child Protection Procedures (post Maria Caldwell), Mental Health procedures, the creation of Community Mental Handicap Teams (now Learning Disability), Youth Justice Teams and others.

The undoing of much of the public sector was down to the philosophy of the Thatcher years and more particularly, in respect of health and social services, to Sir Roy Griffiths and his mistaken belief that people were motivated by and could be controlled by money.

This led to the introduction of the contract culture and the internal market with the purchaser/provider split which Sir Roy thought would create a level playing field to facilitate a mixed economy of care thereby forcing quality up and prices down. It has subsequently been proven to have had the opposite effect and led to over-prescription taking away the ability of carers to react in situ to changing need. It also led to greater fragmentation with different components of a ‘package of care’ bought from different providers.

Unlike Freddie Seebolm, Sir Roy Griffiths appeared to have little understanding of the nature of social work. A consequence of which was that social workers were deployed on the ‘purchasing side’, assessing the need for specific services (often responding to ‘presenting problems’ rather than the ‘underlying problem’) which led to several social services departments providing ‘minding’ rather than ‘mending’ services, with an ever-increasing workload of dependent people.  

Brought up in the days of Florence Hollis, who described social work as a “psycho- social process”, I have always considered social work to be about the use of relationship, and various therapeutic techniques, to bring about change. Social workers need to begin where the client is (I personally dislike the term ‘user’) and convey empathy with their client’s perceived problem. Taking a social history, itself a form of catharsis, and identifying the underlying problems before providing help in:

• Decision taking and problem solving – asking open-ended questions to get the client to list and consider the options. Trying to avoid jumping in to fill silence. Prompting, if necessary, by repeating the question and waiting
• Dealing with ambivalence, denial or depression – asking open-ended questions to weight options, give insight or trace previous turning points in the client’s life – again making a good use of silence
• Coming to terms with reality – looking at what their client can do and how he/she can compensate for what they can no longer do
• Removing the emotional blocks to recovery – by lowering anxiety through a better understanding of the total picture
• lowering or increasing anxiety to improve functioning – this was key to my work as a social worker, manager and agent of change. Too high a level of anxiety or too low a level of anxiety will impede functioning. In the 1960s the NSPCC would usually increase the level of anxiety, through threat of consequence, believing it would improve functioning. Family Service Units took the opposite view and provided support to reduce the level of anxiety to increase functioning. Neither were able to measure where the level of anxiety was to start with. I would consider this at depth both when working with clients, supervising staff and managing organisations. Anxiety is an intrinsic part of culture and one needs to optimise the anxiety level, not too high and not too low, of an organisation for it to work both effectively and efficiently
• Improving motivation – open-ended questions to consider what the client does well, agreeing achievable targets and giving praise when they are achieved – without appearing patronising
• Understanding and bringing about change in behaviour – open-ended questions about their past during social history taking. Open-ended questions about their behaviour, what they hope to achieve by it, how they think other people might see them, and why other people react as they do. Further open-ended questions as to how they want other people to react and how they might do things differently to achieve this
• Budgeting and negotiation with creditors – asking the client (or clients) to write down and prioritise their expenditure against income. Look at ways of increasing income or reducing expenditure and prioritisation. Negotiating re-payment by instalment with creditors. As a social worker I always found that people were far more willing to pay instalments via me than direct to a rent collector, for example
• Improving inter-personal relationships – discussion with each party as to how they see the relationship, how they feel about the other, and what they would like the relationship to be, if they wish to continue. Seeing both parties together to help them repeat the positives of what they had said individually. Open-ended questions as to what they each (themselves – not the other) might do differently to improve matters. Follow up interviews as required
• Involving friends and relatives in physical care – gaining acceptance of the need for help, asking who might be able to help, permission to approach them and discuss difficulties, see response and what they might do, test this is genuine and not just as a result of the visit - do they really have the time etc? Agree who is to do what and when with all concerned
• Changing external factors in the environment - this can involve a whole range of things from care proceedings in respect of children, to the provision of aids, adaptations or rehousing, to negotiating with creditors, employers, the police or local authority. Or helping to find work or sheltered placement
• Arranging practical help and support – both voluntary and paid

Underpinning this work is a thorough knowledge of “human growth and behaviour”, the importance of the first five years and Freudian Theory of the ID (animal instincts), Super Ego (developed conscience) and the Ego (arbitrator), the conscious, sub-conscious and unconscious, and the maturation process. Social workers also have a grounding in psychology and sociology and an understanding of prejudice. Social workers also use “transactional analysis”, make use of “transference” and use such techniques as “a systems approach to family therapy”.

These are the generic (not to be confused with generalist) skills of social workers. They then need the specialist knowledge of their areas of work whether it be working with people with specific disabilities or illnesses, mental illness, older people, youth justice, domestic abuse and marital counselling, parenting skills and child protection, fostering and adoption, registration and inspection, homelessness or work with adult offenders. And a detailed knowledge of the legislative framework in which they work, the law and resources available on which they can draw.

It is then important that social workers are engaged on the work which interests and motivates them, as social work is a vocation.  

In recent times it has concerned me that in child protection the emphasis appears to have been increasingly on “safeguarding” rather than understanding and bringing about lasting change. Doctors can indicate whether or not they consider an injury to be non-accidental, the police can bring a prosecution or temporarily remove the perpetrator, but it is for the social worker to determine what caused the incident, the likelihood of it recurring, and if it might what might be done to ensure that it doesn’t.

All too often case conferences are held to decide whether a child should be returned home when none of those present are able to say what they have done to bring about change in the situation, to warrant even consideration of a return home, and the discussion solely around the additional safeguarding measures required to reduce risk.

Despite the success during the 1970s and 1980s of policies of diversion and alternatives to custardy, which saw crime rates falling, residential care and custardy is still being used for young people who offend. We know the solution lies in minimising adverse peer group influence and fully occupying the young person throughout their waking day on activities which interest them. And that such establishments reinforce offending and establish a pattern of offending for life, creating criminals.

Very rarely can social workers work in isolation and a multi-disciplinary approach is often required. Therefore, there is a need to construct multi-disciplinary, inter-agency, whole task, right-sized teams aligned behind outcome with access to all the resources required to achieve their goals. Communication is best within groups and worst between groups. Therefore, these teams need to operate out of a shared base at the focal point of the community of interest which they serve.

This does not mean the dreaded open plan offices (employers have found during the pandemic that they have got greater output from their employees who are home working free from the distraction and interruptions of open plan offices). These teams need to be able to “plan, do and evaluate” their own work which completes the “learning cycle” of “constant improvement” and enables them to gain the satisfaction derived from seeing the outcome of their interventions.

Social workers need to be given the time and resources to do the job for which they were trained. A room to themselves in which to carry out diagnostic thought, write their reports and letters, make telephone calls and receive their clients in order to make a differential use of office and home-based interviews is essential.

The client should not be kept at arms-length in impersonal interview rooms but invited into the heart of the business into a room which reflects the personality of the social worker. When I was director of social services in South Glamorgan these teams were based in resource centres (providing day care etc), family centres or integrated family centres and schools to bring professionals into day-to-day contact with those with whom they were working.

There was a communal staff room where all involved might off-load when returning from a stressful situation by just involving those there for similar reasons and not disrupting everyone else. This also acted as a catalyst to team building and the mutual understanding of each other’s role towards common shared goals. All too often professionals are inadvertently working against each other.

There is so much which could be done to improve the effectiveness and efficiency of health and social care. A complete change of culture is required to liberate the dedicated, conscientious staff, who struggle to do a good job despite the system, rather than the organisation supporting them in their work.

This requires organisational, structural and leadership change.

Chris Perry is a former director of Social Services for South Glamorgan County Council, a former non-executive director of Winchester and Eastleigh NHS Trust and a former director of Age Concern Hampshire.

Read a previous article written by Chris on health and social care reform here