Research Policy and Planning: The journal of the Social Services Research Group – Vol 17 (3) 1999
Joined up working: the policy agenda
Margaret Wells, Vice-President, Association of Directors of Social Work in Scotland
The following paper was presented at the SSRG day on inter-agency working in theory and practice on behalf of the Association of Directors of Social Work in Scotland (ADSW). Taking as its central theme co-operation and collaboration in social work services in Scotland, it explores the inter-relationship between the social work, the local government and the broader national policy agendas. The paper concludes with some possible ways of implementing a complex agenda from strategic planning to operational levels.
I am pleased to have the opportunity to address the SSRG conference on behalf of ADSW. Personally 1 have never been able to envisage social work, or any other of the key services and professions with which we work, as having any hope of being effective if we work in isolation. Our challenge is to move beyond traditional liaison and collaboration both in relation to development of integrated policy and strategy, and translating these into the services that we deliver. At the same time we need to recognise the need for specialism and expertise, and get the best value from the different perspectives that different professions bring, while recognising that at times the differences can be marginal and counterproductive. To overcome them, we sometimes need several roles and functions integrated in a single person, for example, intensive home-care.
Scotland – the social context
Over the 30 years since the children’s, probation and health care social work services joined together as the social work service in Scotland, there has been rapid social change including:
- increasingly complex family structures;
- rise in unemployment and family poverty;
- increasing social exclusion;
- increased life expectancy and more older people living alone;
- increasing social division.
These changes and facts of modem life put pressure on individual people, families and their communities. Social work services – whether public, private or voluntary – are now used by most people at some time in their lives.
A society’s strength should be judged not only in economic and material terms but also in the way it supports its vulnerable members and deals with those who break its rules. Amongst other factors, the ways in which care, protection and control are provided will determine the nature of Scottish society in the next century. Social care cannot replace family care but it can and must support it. It is an important part of a just and caring society.
Social work services provide for many people who are socially excluded by poverty, unemployment, ill health, disability, lack of education, addiction and poor housing. The values and principles underpinning social inclusion must, therefore, be applied to the planning of social work services over the next ten years.
The White Paper Aiming for Excellence makes perhaps the most positive public statement to be heard in recent years:
“Social work services – provide a crucial support to people at times of personal or family crisis. [They] can also help to promote social inclusion, by supporting family or friends in ways that help people to remain active members of the community and by helping offenders to become better integrated into a purposeful way of life.”
The social work agenda
The critical issues for social work in Scotland are comprehensively set out in the ADSW in Scotland publication, launched in 1997, Social Work into the Millennium. A further, joint ADSW and CoSLA publication will be launched very soon which will develop the agenda. In the coming years we will be challenged to review social policy, to reconsider our approach to providing social work services at a time of unprecedented social and economic change and to develop new ways to meet needs. The new government has a radical agenda to reform the welfare state.
The future direction of social work in Scotland is being set within the context of the Scottish Parliament. People come first, partnership, consultation, joint planning, joint working, joint commissioning and best value are key themes. No single agency, profession or group will succeed in delivering the social inclusion and care agenda in isolation.
ADSW seeks to promote a just and caring society which fulfils the real needs and aspirations of Scotland’s people. Social inclusion is the overriding aim – “Social work’s core objective is to help empower vulnerable or alienated people and to assist in breaking down barriers to inclusion”. The Social Work (Scotland) Act 1968 defines the central duty of social work as “the promotion of social welfare” this is at the heart of ADSW objectives alongside the promotion of social inclusion. Social work services are an essential part of a healthy, democratic, moral and socially cohesive society.
This vision must now be revived in the context of unitary authorities, community governance and the changing NHS, particularly in relation to Health Boards and Primary Care Trusts. Our vision for the future is for social work to be located within a strengthened local democracy, operating within the nationally agreed framework for services, standards and resources as set out in the White Paper Aiming for Excellence. ADSW is working in partnership with the Scottish Executive, CoSLA, the voluntary and private sectors to develop the arrangements for the Scottish Social Services Council and the Scottish Commission for the Regulation of Care.
The promotion of social welfare and social inclusion requires social work to build stronger partnerships with a range of agencies, service users, their carers and the wider community. The new government has challenged the social work profession in Scotland to build its practice on effective outcomes, on reducing dependency and on streamlining decision making. At the same time the White Paper Aiming for Excellence acknowledges that “social work services are very complex and often face dilemmas that cannot and should not be oversimplified into procedures that simplify accountability while eroding judgement and skill”.
Writing from the experience of a Northern Ireland integrated Health and Social Services Board one Director of Social Services (John Richards, BASW, January 1998) writes that other professions believe that they can do what social work does, often at less cost (assessment, care planning, therapeutic intervention, etc). What they fail to consider are the statutory duties placed on social workers, the underlying values and principles, its holistic approach and its need to take account of the social consequences of the condition or behaviour that warrants intervention. Social work, for example, has a great deal to add and to bring alongside the medical model of care and treatment.
Good practice requires the partnership of a range of professionals in designing integrated services to meet the assessed needs of individual people, as well as partnership with the people who use the services themselves and their carers. Our work must focus tightly on achieving the best outcome for each person within a reasonable timescale and within this social work must be much more open and explicit about what it can do.
The local authority agenda
In terms of the local context, it is now more than three and a half years since local government re-organisation and the establishment of unitary authorities. Themes actively being developed are:
- decentralisation of services and decision-making;
- increased local accountability and community involvement;
- corporate working across services within unitary authorities – social work, housing, education, environmental health, leisure and recreation, roads and transport, planning and economic development.
All of these services are now geographically and increasingly, structurally co-terminous. ‘Department’ is becoming a word of the past. Cross-service solutions are the way forward, breaking away from single service responses to need, narrow perspectives, multiple assessments and wasteful duplication.
Importantly, there is the developing relationship between Local Authorities and the Scottish Parliament and the need for the latter to join up the policy agenda both within an across services. In doing so our focus, policies and plan will be integrated in ways which reflect and sensibly address the realities of life for the individuals, families and communities to whom we provide services now and in the future.
The policy agenda
We live and work in an ever more complex context of national policies and initiatives, local accountability and aspirations and, quite properly, increasing public expectations in terms of what we do and how we do it. There is also a wide range of specialisms, areas of expertise, professions and agencies which must combine to provide services demonstrating that we are indeed focused on people.
In the foreword to the social inclusion strategy Dona Dewer, the First Minister, writes that:
“the government is committed to promoting social inclusion and equality of opportunity in Scotland. The vision aspires to prosperity for all and sees the opportunities afforded through work and education as crucial for everyone. Where people experience difficulties the emphasis is on helping them back onto their feet rather than creating dependency and helping people to break out of the spiral of exclusion”.
Partnership working is the key to social inclusion. The Government’s approach has set out a vision for a Scotland in which:
- every child, whatever his or her social or economic background, has the best possible start in life;
- there are opportunities to work for all those who are able to do so;
- those who are unable to work or are beyond the normal working age have a decent quality of life;
- everyone is enabled to participate to the maximum of their potential.
Promoting social inclusion is the responsibility of many services. To be successful and effective, social work, health, housing, education and others must work in partnership. Chief Social Work Officers have to plan and shape their services alongside NHS Executives and Consultants, other Local Authority Chief Officers and Executive Directors of private and voluntary organisations.
To these partnerships, social work brings a broad view which takes account not just of someone’s social care needs, but of all aspects of their life and of the often wide-ranging and varied needs of different members within a single family. These include: individual experience and wishes; personal characteristics; relationships within families and the wider community, at school, at work, at leisure; the effects of health and disability and the impact of poverty and environment on someone’s day to day life. There are always opportunities available but people often need help to overcome barriers to achieve their potential. Social work staff have a crucial role to play – they are trained to respect those who are excluded, to enable them to tackle the difficulties and inequalities that they face as individuals and as families, to advocate on their behalf when necessary and to promote social inclusion for all.
It is this context which shapes the national and local policies, strategies and working arrangements to which we address ourselves. The integration of the national policy agenda is in itself complex and there are issues about how we ensure that it compliments and informs the local agenda without turning local government and its services into local administration. Local needs should be identified and addressed in flexible ways that meet the range of needs in communities in ways that may well be varied.
In many respects the Social Inclusion Strategy is overarching and provides a context for an exciting but problematic number of other initiatives including the New Community Schools, the Early Years Strategy and the National Childcare Strategy.
The social work White Paper Aiming for Excellence makes some very positive (and warmly welcomed) statements about the importance of social work services and their status, in respect of which the establishment of the Scottish Social Services Council is an important development. Joint working with education and health are stressed as important and there are details about how these agendas should join up. Each structural solution, however, brings its own challenges.
Whilst the Kilbrandon Report recognised the importance of integrated social work services to families and achieved much in this respect, difficult questions still remain. For example, how do we improve joint working with education and health and, at the same time, work to ensure that broad social work services to families are themselves sufficiently integrated? On top of this how do we make sure that our corporate working with other local authority and agency services is as good as it needs to be to address people’s wide ranging needs – such as transport for older people; addressing the health agenda for children and their families and meeting the employment and leisure needs o people with mental illness essential to overcoming their isolation and other difficulties? Here links need to be made with primary health care (which must also connect with community care in respect of the wide ranging needs that fall within the remit of the developing LHM) and with the employment and leisure services. In this complex scenario we are part of a wide network of important providers and voices – including the voluntary and private sectors, people who use services and carers, all of whom must be heard and involved in shaping policy and practice.
The Health White Paper Designed to Care sets out proposals for the NHS re-structuring: aiming to offer people the treatment they need where and when they wan it. The partnership approach again features strongly, in particular through Local Authorities’ social work and housing functions. In removing the internal market it has brought primary care, GPs in particular and for the first time, within the organisation. This is a major change which is still taking shape and which complicates thE development of a joint working agenda.
The Education White Paper Targeting Excellence is described as a radical programme to improve the education system and its achievements, aiming to offer wide ranging opportunities to young people regardless of their background.
The Green Paper on Housing, Investing in Modernisation identifies housing as a basic need and sets out a stronger strategic role for local authorities. It highlights community ownership and issues around securing new forms of investment to ensure appropriate and adequate provision. Housing partnerships and stock transfer are also key areas, creating new bodies with whom we have to work not just in terms of bricks and mortar but also in relation to policies and practice dealing with, for example, people who misuse drugs, children and families, anti-social behaviour.
The Health Green Paper, Working Together for a Healthier Scotland, will also have implications for local authorities, as will Tough Options, a proposed new initiative in which a smaller number of inter-authority groups will provide criminal justice services.
The national agenda is clearly complex and needs some simplification. A rationalisation of social work planning has been asked for. The Social Work Information Group has been set up jointly by ADSW, CoSLA, the Scottish Executive and Accounts Commission to do this.
Traditionally social work has not delivered holistic services. People have fitted into provision rather than services being designed to meet the assessed needs of individuals. In our attempts to join up what we already do, key questions are: how far are we moving towards the delivery of services in ways that the key policy objectives intend? And do we listen sufficiently to what people say they need and how they would like it to be provided?
Health and social work services have to integrate at different levels from strategic planning through to operational levels. At a national level there is a need to:
- avoid contradictory policy and objectives; provide a framework to shape and support local agreements and the respective responsibilities of the Health Service and Local Government in integrating policy with national priorities, at the same time allowing for local flexibility;
- provide adequate resources, for example, implement the recommendations of The Royal Commission for the long-term care of the elderly, and work jointly for this.
- establish a consistent and transparent framework for resource transfer.
Strategic planning at local level would need:
- a partnership approach to the assessment of population needs, whether between Health Boards and Local Authorities or between Education and Social Work, and the development of joint plans, for example, Community Plans, Joint Community Care Plans, Children’s Services Plans, I-UP’s, Population Needs Assessments, Local Partnerships and Action Programmes, Housing Plans.
Options might include: joint committees; places for Health and Trust Board representatives on key Local Authority Committees; structurally guaranteed places for Local Authority representatives on Health and Trust Boards, particularly Primary Care Trusts and user representation at these levels.
At a locality planning and service delivery level, for example in childcare services there needs to be:
- A joint board dealing with criminal justice (see CoSLA paper);
- dialogue between local health care co-operatives including all the professionals involved – doctors, nurses and professions allied to medicine – as well as social work and wider local authority locality planning groups;
- a commitment to co-terminosity at local level to facilitate sensible joint planning and commissioning arrangements and integrated service delivery;
- agreement on mechanisms to consult and involve service users and carers in shaping both plans and service delivery;
- joint resource and service management between, for example, LHCC’s, social work, housing and education services at LHCC and/or local level in defined areas;
- a commitment to new models of service – reducing need for multiple assessments, with multi-skilled staff where appropriate and imaginative models of management;
- scope for local variation within agreed standards and objectives in developing arrangements for joint working and for delivery of integrated care;
- joint commissioning, including linked budgets.
Some options here include shared accommodation and linked working or between health and social care teams and/or individuals.
Integrated service provision is perhaps most highly developed in health and social care and has been shown to work. There are many examples of success for us to build on. We need to value the staff in all sectors – clinicians, social workers, professionals allied to medicine and their managers – who develop and deliver services within the parameters set for them. The policy agenda is clearly complex and with increasing emphasis on evidence based practice we need to shape the research agenda and develop ways of evaluating the benefits that we anticipate will follow from our efforts to join up our policies an practice.