Chief Social Worker for Adults' annual report: 2018 to 2019 – social work leadership in changing times

Question 1

Ministerial foreword by Caroline Dinenage MP

Accepted Answer

As Minister for Care at the Department of Health and Social Care, it is great to continue to have Lyn’s advice and steer on a range of issues critical to our country’s health and wellbeing.

As we contemplate the role of modern, progressive social work within the broader context of social care, there has never been a better time for adult social workers to show leadership, professional oversight and cooperation with individuals and families – and the wider health and care sector.

This has been most recently demonstrated with the success of the named social worker pilot schemes, where trusted professional relationships have been built with other health and care services to better support individuals with learning disabilities and their families.

These pilots epitomise the kind of leadership Lyn espouses for the social work profession. This is not leadership in the command and control sense; this is the demonstration of respectful and focused collaboration across services, all the while keeping the person needing support at the heart of decisions about their care.

Social workers will be playing an increasingly important role in the proposed Liberty Protection Safeguards (replacing the not so nicely named Deprivation of Liberty Safeguards). They will be an expert voice of professional challenge to care home managers and other health and care professionals when deciding if restrictions should be placed on individuals who may be a risk to themselves and others.

Through workforce consultations and other engagement activity we’re learning much more about what social workers can – and want – to do. As part of this engagement, last year we launched the ‘Talk Health and Care’ digital platform. It’s an online space where health and social care staff can post ideas, questions and challenges for government.

We also want to promote adult social work – and social care careers generally – as the rewarding career choice they undeniably are. Alongside ongoing recruitment campaigns, I hope the platform will play its part in raising awareness of the rich diversity of roles available and the immense satisfaction that comes from transforming lives.

At a recent social care conference, one delegate recounted her daughter’s experience at school where a teacher told her, in not so many words, ‘if you don’t study hard you’ll end up working in social care’. Well, her daughter did study hard – and still chose a career in social care. And do you know what? Her mum said she loved it. She is not alone either – 96 percent of care professionals feel their work makes a real difference to people’s lives. I’m willing to bet a great many of them are social workers and it’s such a great motivation for others considering joining the profession.

Of course, adult social work isn’t just about the individuals and families directly needing help – it’s about the friends, relatives and loved ones around them too. Last year, Lyn and her colleagues in the Adult Principle Social Worker Networks supported my department, and our partners Carers UK and Carers Trust, in the creation and launch of the Carers Action Plan.

Social workers have long understood the truism that you need to ‘care for the carers’ and are uniquely placed to spot the signs of an approaching crisis in those too busy caring for others to take care of themselves.

Commitments to improve respite care, facilitate carers breaks and encourage employers to offer flexible working arrangements all feature in a comprehensive two-year programme of activity – all informed by the lessons and insights of modern social work.

I believe the plan also serves as a valuable primer for the forthcoming adult social care green paper and its associated consultation which will also benefit from the profession’s contributions.

Meanwhile, a lot of work has gone into the establishment of the new regulator Social Work England. This body will also bang the drum for leadership, high professional standards and the constant renewal, enhancement and expansion of social workers’ knowledge and skills.

2019 will be an exciting year – a year when the social work profession’s voice will be louder and stronger than ever; not speaking from the side-lines but sharing expertise, insights and innovations at the very heart of social care.

Social workers understand better than anyone that care and support must be a collective endeavour. Only together can we protect, sustain and empower a health and care system that delivers great care for all.

Question 2

Reflections from Lyn Romeo, Chief Social Worker for Adults (England)

Accepted Answer

This is my 5th annual report and I ask myself where did the time go? There never seems to be enough time to do all the things we plan for each year, but I am pleased that following consultation, the Knowledge and Skills Statement (KSS) for social work supervisors was published in December 2018. We know that quality supervision, focused on critically-reflective practice is vital, both to improving the quality of decision-making and retaining the social work workforce, through quality assuring practice, supporting career development and improving morale. Ensuring the standards for supervisors are applied consistently and that employers are providing the right support to enable social workers to reach and maintain their capability, will be a priority for me in the year ahead.

The culture and learning environment led by supervisors and Principal Social Workers (PSWs) is the most influential lever to achieving the very best for the people with whom we work. The leadership development programme is now in its third year, supporting PSWs to lead strengths-based practice, co-designed approaches which are led by peopl’s lived experience, helping promote independence and quality of life.

Good social work is about a commitment to protecting and promoting people’s human rights, striving for social justice, treating people with respect and valuing their dignity and uniqueness. Alongside this, making sure that social workers and other social care practitioners are valued, supported and have access to supervision and opportunities for continuous professional development is vital if we are to value, retain and support our social work and social care workforce.

Social work practice is about trying to redress the obstacles that can be in the way for people to have the lives they want for themselves, to achieve inclusive lives as full citizens. Strengths based conversations, together with working with people and their carers to ensure that the right care and support options are available, involving people and communities in designing and commissioning support, is part of what social workers should be influencing – either as practitioners working directly with individuals, through involvement in community development projects or as commissioners of services.

Directors of Adult Social Services (DASSs) and PSWs have been leading and supporting this organisational culture change, helping shift the balance to working alongside people, including as part of integrated arrangements across health, social care and housing. This is also helping to shape and evolve practice in the NHS, where significant progress has been made on delivering Personal Health Budgets, which put patients in a shared decision-making relationship with clinicians, alongside the development of integrated social prescribing across primary and social care and job centres. It is inspiring to see socialworkers offering supervision and leadership to other professionals, helping deliver value-based ethical interventions to support the health and wellbeing of an individual and their families through integrated arrangements across the country.

Knowing what works and having a better evidence base remains a priority for me. Following the work during 2017/18 with the James Lind Alliance Priority Setting Partnership to agree the top research questions for adult social work, I hope we can develop a strong evidence base for social work practice and the interventions which work and that the profession will become more involved in developing and contributing to adult social work and social care research more broadly.

Leadership in social work is often consider in the context of senior management or team leadership roles. People in such positions play an important part in creating the right organisational conditions and practice culture where excellent social work practice can thrive. However, social workers’ unique relationship-based work with people, carers and communities is a demonstration of leadership every day, where best practice approaches are supporting people to achieve what matters to them and connecting them with the resources that will enhance and complement their strengths and assets.

This relational way of working requires social workers to have both an intellectual and emotional connectedness to their practice and to think, understand and do the things that can have a positive impact on people’s lives. Using their knowledge and understanding of their role, their ability to connect knowledge and to use it to inform practice, is professional leadership in action.

The unique combination of social work values, knowledge, critical thinking and practical application make social work the distinctive profession that it is. I hope the publication of the Strengths Approach: Practice Framework and Practice Handbook will help support social workers to deepen and consolidate their professional practice and to influence approaches in health and social care partnerships.

Recognition of the key role that social workers play in mental health services meant that they played a key part in the Mental Health Act (MHA) review and I would like to thank mental health social workers for their contribution to this important work.

The development of the new social work regulator, Social Work England (SWE) has also involved significant contributions for practicing social workers and social work academics, again demonstrating social work leadership in action.

The development of capabilities for social work with people with learning disabilities and for people with autism, will also support the strengthening of good quality social work in these important areas. Isabelle Trowler, the Chief Social Worker for Children and Families and I will be contributing to the review of the Autism Strategy during 2019 and recommending improved practice approaches to working with children, adults and their families.

Safeguarding adults continues to be a key area for development and there is considerable learning from Safeguarding Adults Reviews both locally and nationally. We know from these reviews that there are some areas that need further attention and one such area is ‘Transitional Safeguarding’. This refers to the safeguarding of adolescents and young adults, and some of the organisational difficulties that arise once young people turn 18, or problems that were not effectively addressed pre-18, which manifest in adulthood. These vulnerable young people aged 18-25 are often not then eligible for adult social care but can still benefit from the support of social workers and other professionals. By working together with colleagues in children’s social care, we can find ways of supporting adolescents and young adults to play a role in promoting their own safety, whilst not holding them responsible for the harm they face. (See Research in Practice/for Adults Report: Mind the Gap)

The world around us continues to change and the last year has underlined more than ever, that nothing is certain. Supporting people through change and uncertainty and working with complexity and conflict are core components of social work practice. In times of greater constraint, social work’s enablement approach in responding to the impact of such conditions remains key. People’s socio-economic circumstances should be a key consideration in every social work assessment, support plan and review.

Social workers have always had to take appropriate action to ensure people can access the support and resources they need – this means being even more in touch with what’s going on in communities and connecting people to opportunities and strengthening the focus on what matters and what’s possible in their lives.

My priorities for 2019/20

Delivering better outcomes for people through improving leadership in the profession at all levels will remain at the heart of my priorities for 2019/20:

Embed strengths based social work practice:
- Publishing and promoting SBA practice framework and handbook
- Advising on recommendations from SCIE’s Adult Social Care Innovation Network
Support the quality of social work practice and leadership:
- Sustaining the leadership development programme for Principal Social Workers
- Supporting developing of standards and capabilities for practice supervisors
- Implementing capabilities and development pathway for social work with older people, people with learning disabilities and for people with autism
- With the Chief Social Worker for Children and Families, improving practice for children with autism preparing for adulthood
Improve knowledge and application of what works and what is the right approach to supporting people to have better lives:
- Promoting the Top 10 questions for social work research for development and funding
- Supporting the growth and development of early career researchers through conference support and raise awareness of funding sources for social work research, with continued oversight through my Research Advisory Group
- Working with the Social Work Teaching Partnerships to deliver improvements to: practice placement quality and quality; research/practitioner activity
Promote the value and contribution that social work and social workers bring to the health and social care system:
- Strengthening social work in integrated mental health services, community and hospital health care and specialist mental health and mental capacity roles
- Ensuring social work’s role is reflected in the Social Care and Prevention Green Papers; the review of the Autism Strategy and in disaster/emergency response planning

Question 3

Adult social work in an integrated health and care system

Accepted Answer

In this section I have set out the activities and policies that the Department of Health and Social Care, government and the sector are developing to improve the social care environment, best practice and professional development.

In my last report, I talked about the first steps made towards building Social Work England (SWE) and its pioneering journey to becoming the single bespoke regulator for the whole social work profession.

I am especially grateful to the hundreds of social workers and people with lived experience who have shared their views and expertise to help get this vital organisation off the ground. I know many of you across the country have spoken to the SWE team at face-to-face events, via online engagement, consultation activity or through their identity survey (which attracted close to 900 responses). This gives me confidence that when SWE is ready to regulate, it will be informed by genuine insight into our profession, in all its complexity.

As Chief Executive Colum Conway sets out:

Our vision for SWE is that it will be a modern, innovative, and open professional regulator, with the promotion of high-quality standards in social work at the heart of everything we do. We want to create a regulator that first and foremost safeguards and protects our service users and the public – so listening to their voices is fundamental. We want SWE to be an intelligence-led regulator that bases its work on evidence and data. We want to understand where there are problems developing in the sector, the risks to professionals, service users and the public, and to see if we can prevent some of them before they escalate.

We want to move to an engagement led model of regulation with all the key stakeholders in the sector. All this means transparency around our work and ensuring ongoing communication and engagement, particularly around actively sharing good practices.

I believe Social Work England has the potential to make a real difference, raising standards to improve the status of the profession and ultimately ensure people get the right support whenever they might need it in life.

As people, including those with disabilities, are living longer than ever before we need to ensure that they can make the most of these extra years. There is nothing theoretical about this challenge, in fact for those working in the sector providing high quality services to growing numbers of service users is part of their daily lives. The Green Paper will shine a light on the challenges faced by the social care sector and set out proposals for a fairer more sustainable social care system. The Green Paper will be published shortly and it is important we take the time to make sure we get the big decisions right so we can build a social care system fit for the future.

Everyone should know that, when they need it, they will receive high quality care which supports them to maintain their independence and wellbeing. If we are to deliver this we need to: ensure our services are joined up around the individual so they can transition seamlessly between different services; deliver, develop, and expand modern high-quality models of care that best meet the requirements of service users; and address examples of poor quality where they exist. Underlying this drive to deliver the best quality care possible should be a strengths-based approach to Social Work. By focusing on what a person’s abilities and aspirations are we can find new ways to enrich people’s lives.

It is also important to recognise the hard working and caring people who provide care. Unpaid carers play an invaluable role in improving the lives of people living with disabilities so it’s important that we ensure carers are appreciated for the difference they make and supported them to balance their wider lives and their caring responsibilities. Those working in the sector should also be valued for the critically important work they do, and we need to ensure that a career in social care is an attractive and rewarding option for those people with the right skills and values.

The publication of the Green Paper will be the start of a consultation. The Government wants to hear from members of the public, people with lived experience, and people working in the sector, about the changes they’d like to see to improve the Adult Social Care system and I would like to encourage everyone in the sector to consider and respond.

Improving the lives of carers

Every year, more and more people take on a caring role. Their enormous contribution makes a difference not only to the people they support, but is an integral part of our health and social care system. They often have extensive contact with the system and they regularly highlight the importance of having their expertise recognised by the people they interact with so that their views can be considered in decision making.

In June 2018, the Department of Health and Social Care published the Carers Action Plan, this sets out a cross-government programme of targeted work to support carers over the next two years. Through this, the Department is seeking to improve social workers’ awareness and identification of carers.

Last year I highlighted the work that we have done to develop a suite of resources for social work with carers. I am continuing to work with Research in Practice for Adults (RiPfA), PSWs and the wider profession to support the implementation of these resources. This will involve reviewing the resources to see how well they have been utilised and what more is needed to improve social work practice with carers.

I will continue to use these resources to push carers’ issues up the agenda nationally and to drive joined up support at local level. I will also continue to engage with the profession to build on the opportunities provided by the Action Plan to promote the vision and value of social work with carers and build awareness to further raise the quality of social work practice.

Reducing loneliness

In October 2018, the Government launched its first ever strategy to tackle loneliness. We all know that loneliness can affect anyone regardless of circumstances, age or gender and is linked to a range of damaging health impacts like heart disease, stroke and Alzheimer’s. Research has shown that up to one in five adults always or often feel lonely and 20000 older people have not had a conversation with a friend or relative in more than a month. It has also been reported that young people are often at risk of feeling lonely due to both psychological developments and the many transitions that young people can experience.

The Strategy sets out a powerful vision of how the Government will work together with the health and voluntary sector, local authorities and businesses to make it easier for people to build strong and lasting connections to combat loneliness in all age groups across the country.

Social workers are already at the heart of efforts to link individuals and families with social, therapeutic and practical support in their communities. I am working with Research in Practice for Adults (RiPfA) and the sector to look at how we can further increase social workers’ awareness and support for people at risk of chronic loneliness, both to ensure that loneliness is addressed in their assessment and care planning arrangements and that they are engaging with community development programmes and resources which help combat loneliness through building connections.

The Better Care Fund (BCF) continues to provide a mechanism for local authorities and Clinical Commissioning Groups (CCGs) to pool budgets for the purposes of integrated care. It has helped to join up health and care services so people can manage their own health and wellbeing, and live independently in their communities for as long as possible. In 2018/19, local areas have pooled £7.7 billion, of which £2.1 billion is committed voluntarily and above the statutory minimum required amount of £5.6 billion.

93% of local health and care system leaders said the BCF had already had a positive impact on integration locally last year. It is important to recognise that social workers are playing key roles in multi-disciplinary teams (MDTs) across the country, bridging the gap between health and care. For example, Dorset has a mix of urban and rural areas and a high population of elderly people with a lower than average proportion of young people impacting on the demand for accessible services in key localities across the county.

To manage this impact, across Dorset 10 Locality Hubs have now been established with a MDT approach, working in a co-ordinated and responsive approach reflecting local needs by supporting complex/frail elderly referrals through a community Virtual ward approach.

Because of the hubs approach, system working has improved. At a system level, the West of Dorset has seen a drop in over 75s admissions to acute hospital, as well as a drop-in readmission rates (where complex discharges are now better co-ordinated and supported). They have also seen an increase in Ambulatory Care as over 75s are seen through assessment units and then supported to return home quickly through the Hub teams.

Another example is in Weymouth and Bridport community hospitals, where there has also been a marked increase of ‘step up’ referrals from around 5–10% before the Locality Hubs, to 45–50% currently as a result of the Locality Teams admitting to the beds, and managing a short-term inpatient episode where overnight care or clinical monitoring, or intervention maybe required, but does not warrant a secondary care admission.

Improving the lives of people with learning disabilities

Transforming Care Programme

The Department of Health and Social Care has continued to provide assurance for the Transforming Care programme which aims to reduce the number of people with learning disabilities and/ or autism who are inpatients and support people to live well in the community. NHS England’s plan Building the Right Support set a target of reducing the number of inpatients to achieve a bed reduction of 35-50% by March 2019 (against a 2015 baseline).

So far, we have achieved around a 20% reduction and NHS England has transferred over £50 million upfront to Clinical Commissioning Groups that are closing hospital beds over the course of the financial year so that they can invest in community alternatives.

The NHS Long Term Plan commits to achieving at least a 50% reduction in inpatients (compared to the figure in 2015) over the next five years. By March 2024, inpatient provision will have reduced to at least half that of 2015 levels, considering population growth and, for every million adults, there will be no more than thirty people with a learning disability and/or autism cared for in an inpatient unit. For children and young people, no more than twelve to fifteen children will be cared for in an inpatient facility.

With increasing numbers of people with often very complex needs being supported in the community, social workers have a key role to play in ensuring they are supported to have good and safe lives. Social workers can play a key role in supporting people back into the community and to avoid inpatient admissions.

Learning from Deaths Mortality Review (LeDeR)

The Department of Health and Social Care committed, in the Government’s response to the 2nd annual Learning from Deaths Mortality Review (LeDeR) report to several actions to improve care for people with learning disabilities and/or autism to reduce premature mortality. We have recently announced that we will consult on introducing mandatory learning disability and autism training for all health and social care staff. The consultation is running until 12 April 2019.

As well as undertaking this training, the British Association of Social Workers (BASW) and RiPfA have developed Capability Statements for social work with people with learning disabilities and with people with autism. I hope these statements will enable social workers to deepen and strengthen their skills and knowledge to ensure that people receive the highest standard of support from social workers.

Improving life for people with mental health issues

Over the last 12 months I have had valuable assistance from Mark Trewin who has been on secondment from Bradford Council. He has been working with colleagues in the Department of Health and Social Care and NHSE to support the development of mental health social work and the Approved Mental Health Professional (AMHP) role, working with staff across the country to discuss the challenges facing mental health social workers and AMHPs and supporting practice developments in this crucial area.

Mark was very involved in Sir Simon Wessley’s review of the Mental Health Act (MHA), working with BASW and ADASS to ensure that the voice of AMHPs and the influence of social work was at the heart of that review. He has also been working with NHSE and the Department of Health and Social Care to advise them on how their policies and programmes can better reflect and benefit from the contribution of mental health social work.

One of the areas that Mark is working on is the development of new, positive models of integrated working for mental health social workers, alongside or within NHS Trusts. This work will also support the Social Work for Better Mental Health initiative, through developing these partnerships and providing guidance for organisations.

Mark has played a vital role in working with Health Education England (HEE) to ensure that social workers and AMHPs are a key part of the Integrated Workforce Plan for England and has convened a group to look at new roles in mental health HEE, to explore how the role of social work might develop in future.

Approved Mental Health Professionals (AMHP) workforce issues

In my 2017/18 report, I set out my ambition to support the development of the Approved Mental Health Professional (AMHP) role. In May 2018 the Care Quality Commission (CQC) published a very helpful briefing report on the pressures of the AMHP role with support from my team. This report provided an in-depth study into the AMHP role in 12 different areas.

One of the issues this report highlighted was the lack of regular data on the AMHP role. In the last year, I have supported colleagues in ADASS and NHS Benchmarking to collate a snapshot of the AMHP experience and in 2018 Skills for Care updated the National Minimum Dataset (NMDS) for local authorities to include where social workers and other professionals who are AHMPs and we received the first batch of information in December – telling us valuable information about the role.

We have also received some excellent research from Kings College London about the reasons why social workers, nurses or occupational therapists decide whether or not to train as AMHPs and options for how we can develop this role.

This has been very useful for the development of the new AMHP workforce plan, which is currently subject to consultation and will support local workforce plans to consider AMHP recruitment and retention.

The Wessley review of the mental health act has highlighted the role of AMHPs and Mark Trewin is co-ordinating the development of a national plan for the AMHP workforce. This is currently out to consultation and will support the development, recruitment and retention of AMHPs.

Social Work England (SWE) provides a real opportunity to revisit AMHP training and support and I will continue to support Mark and his work with NHSE, HEE and other agencies to ensure that support for the AMHP role continues to be a national priority.

Mental Capacity Act review

My office has been working with officials in the Department of Health and Social Care and Social Work England (SWE) to support the development of the new Liberty Protection Safeguards (LPS) and ensure that the views of the social work profession are taken into consideration in their development and the forthcoming revised code of practice.

Social Workers will continue to play a leading role in the oversight of the Mental Capacity Act and LPS, including ‘necessary and proportionate’ assessments and comprehensive care planning.

Government continues to support SWE as it prepares to take over the approval of Best Interest Assessor (BIA) courses and develop the future Approved Mental Capacity Assessor role outlined in the LPS proposals. SWE is in the process of consulting on new professional standards for social workers, alongside the Standards for Education and Training (SETs) for social work qualifying programmes.

Developing research, evidence and best practice

It has been an exciting year in terms of growing the research capacity in social care – the National Institute for Health Research (NIHR) announced that the School for Social Care Research will continue for a further five years and that membership of the School has grown.

During the next phase, there will be new funding to support training for new social care researchers, helping encourage social workers at all stages in their career to engage with research and to support research that is truly imbedded in practice.

The long-standing Research for Patient Benefit (RfPB) programme ran a dedicated social care call. For the first time and this was supported by input from the Research Design Service. This programme is ideal for those at the beginning of their research careers and is specifically focused on research that will directly benefit service users.

I look forward to seeing how these projects progress and engage with practice. Information on successful applications should be available at about the same time this report is published.

November 2018 also saw the launch of the Top 10 priorities for adult social work research. Developed in partnership with the James Lind Alliance (JLA) and shaped by people with lived experience of social work services, carers and social workers, this approach is a world first for adult social work research and the first time that a JLA process has been used in a non-health area.

The top 10 covers a broad range of themes and issues for adult social workers:

The impact of social care legislation on improving social work practice and outcomes for people
The role and contribution of social work in integration
How we evidence the impact of social work interventions for people with specific care and support needs
The impact on social work practice as a result of financial and other pressures in the wider care system.

The Top 10 will improve our understanding of the social work approaches and interventions which work and why and help achieve best outcomes for people and carers.

The NIHR are working to turn the priorities into specific research questions to support calls for social work research. I urge other research funders to do the same and encourage researchers to come forward with their ideas of how to respond to these priorities.

Improving commissioning and markets for care providers

We know the social care sector is under pressure due to our growing ageing population – that’s why government have given Councils access to up £3.6 billion more dedicated funding for adult social care in 2018-19 and recently announced an additional £650 million of new money for social care in 2019-20. This includes an additional £240 million for adult social care to alleviate winter pressures on the NHS next year; and a further £410 million to improve social care for older people, people with disabilities and children. These additional resources will help councils commission care services that are sustainable, diverse and offer sufficient high-quality care and support for people in their areas.

The adult social care provider sector remains predominantly independent and has seen a 62% increase in the number of home care agencies since September 2010. In my many visits across the country, late last year I saw numerous examples of social workers working with care workers and managers to ensure that care and support for thousands of people across England was maintained during the transfer of Allied Healthcare’s business and services to Health Care Resourcing Group. This was part of co-ordinated plans between the Department of Health and Social Care, local authorities, health partners and the CQC to enact contingency plans.

83% of adult social care providers are good or outstanding (as of January 2019) according to the CQC – testament to many hardworking and committed professionals working in care to whom we owe a huge debt of gratitude. But still too many people experience care that is not of the quality we would all want for our families or ourselves and there is too much variation in quality and outcomes, both between different services and different parts of the country.

The forthcoming social care green paper will bring forward proposals to address unwarranted variation. It will consider what government can do to help local areas build quality, innovative care models fit for the specific requirements of their local populations, with a focus on maintaining independence and supporting all adults to achieve their aims and ambitions. This will include commissioning on a longer-term basis and a principle of co-production with people who have lived experience, as well as bringing forward proposals for sector led improvement.

Through the Care and Health Improvement programme,we have continued to work in partnership with the Local Government Association (LGA) and the Association of Directors of Adult Social Services (ADASS) to support local areas with their adult social care priorities. Practical, hands-on support is available from a cadre of Care and Health Improvement advisors who can provide tailored support specific to local need. This support includes improving commissioning, safeguarding, financial risks and efficiencies and furthering the health and care integration agenda. The Department provides a total support funding package of just under £10m through our partner organisations in 2018-19.

I have been visiting different parts of the country; Norwich, Manchester and Birmingham to promote the launch of the National Adult Social Care Recruitment Campaign ‘Everyday is Different’. Its aim is simple – to encourage more people to apply and work in Adult Social Care. 1.47m currently people work in adult social care and demand is growing as people are living longer with increasingly complex health and social care needs. There are approximately 110,000 vacancies across England at any one time and DHSC are working to promote and fill this recruitment gap to support the sector in its local recruitment activity, to attract the right people with the right values. My role in this campaign has been to bring awareness of the variety of job roles and opportunities available. I myself started out as a care assistant for older people before qualifying as a social worker. There are so many opportunities available to people starting out in the care sector and we need to change the perception of what people think working in the sector is all about, it could for example lead to a career in social work!

Question 4

Best practice and professional development

Accepted Answer

This section describes some of the activity that the Department of Health and Social Care has funded or encouraged with sector partners to develop and extend best practice and support social workers’ professional development.

The new National Adults PSW Network co and vice-chairs took up their positions in October and intend to build on the progress made to support the PSW role and continue to highlight their contribution across the sector. The chairs have already established stronger links between ADASS and the national and regional PSW networks, including extending ADASS membership to PSWs and the developing a joint statement on the PSW roles and responsibilities, to support employers and PSWs in appointing to the role. The statement will be published by the Department of Health and Social Care.

The chairs will lead a presentation at the ADASS Spring Conference in April to further raise the profile of the role. They have also been involved in several national groups, including the National Social Prescribing Network, helping share national social work and social care perspectives and will continue to do so.

Chairs are developing national priorities for the Network during 2019/20, to include:

Development of an eBook to celebrate World Social Work Day on 19 March
A new Facebook page to support communication in the network and allow PSW’s to exchange ideas and views
Two Call to Action days – on Deafblind Awareness (June) and World Mental Health Day (October)
A joint conference with the Child and Family PSW Network in July focused on mental health, in society and in the profession
Co-production should be a constant theme for national Network meetings, and TLAP have been approached to support involving people with lived experience and carers at meetings.
Development of a PSW Newsletter to be circulated following every Network meeting to ensure that all members are kept informed of the progress of the network and to include examples of strength based practice to promote across the Network.

The British Association of Social Workers (BASW) is the independent professional association for social work and social workers across the UK. We represent over 21,000 individual social worker members across the UK, and engage with thousands more through our events, training, consultations and publications.

Founded in the grassroots of the profession through our membership, we draw on the very best of social work practice, insight and research, to influence national, regional and organisational policies, legal reform and professional thinking. We also provide unique individual support to social workers on professional and employment matters and therefore have detailed understand of social workers’ daily experiences in work and how to improve these for better practice, recruitment and retention.

Working closely with the Chief Social Worker for Adults on shared agendas and projects which is a highly valued aspect of our work. Together we can promote excellent practice and support the workforce. This year we have continued to work with Lyn to deliver our shared priorities for the adult social work, including:

Being an active member of Lyn’s cross-sector Advisory Group.
Supporting the social work recruitment and retention campaign, including developing, hosting and promoting resources on behalf of the whole sector on the BASW website to highlight careers in social work.
Publishing with Lyn (and the Chief Social Worker for Children and Families) a statement to integrate the BASW-hosted Professional Capabilities Framework (PCF) and the Knowledge and Skills Statements (KSS).
Taking on the refresh of Practice Education Professional Standards (PEPS) on behalf of the sector, mandated through Lyn’s Advisory Group.
In partnership with Research in Practice for Adults, leading development of new capabilities statements and continuous professional development (CPD) pathways for social work with learning disabilities and autism. We are also continuing work to embed the CPD pathway for social work with older people previously developed by BASW for the Department of Health and Social Care. Together, this work will provide a suite of resources and implementation plans for these vital areas of practice and enhance the KSS and PCF.

The learning disability and autism work will support implementation of the Named Social Worker pilots for people with learning disabilities, autism and mental health conditions and help embed national autism assessment guidance.

The work to develop embed capabilities for older people will promote current good practice and the professional innovation needed to improve services in the context of new policy directions and contexts for adult social care.

All these projects are underpinned by our support for the assets and strengths-based approach to adult social work promoted by Lyn and providing critique and practice knowledge about the impact of social care funding and uneven resource allocation across services.

We are also:

Working closely with Lyn and the Association of Directors of Adults Social Services (ADASS) to develop a joint BASW/DHSC/ADASS position statement, events and a learning curriculum on the role of social workers in emergencies and disasters. This drew particularly on learning from recent experiences of social workers and citizens affected by Grenfell Tower and the Manchester Arena attack.
Working alongside Lyn and Department of Health and Social Care officials to ensure a strong voice for social work in mental health and in the mental capacity reforms. This includes working with the social work mental health lead on the review of the Mental Health Act and contributing extensive social work input to the review of the Mental Capacity Act.
Contributing extensively to the consultation and subsequent dissemination of the priorities for adult social work research led by the JLA.

It is a pleasure to work with Lyn and her team to support the ambition for a confident and effective adult social work workforce. Together we will continue to promote the new directions in practice and leadership required for a changing society and to support the development of an effective and sustainable social work workforce.

Leadership and strengths-based practice

Funded by DHSC and working with the sector, SCIE have co-produced guidance on leadership and the strength-based approach.

Changing an existing culture can be difficult because it involves changing how we as individuals behave. Many councils and adults social care departments have been working from a Care Management- deficit- based- needs led, perspective for a long time. It can be a challenge to get everyone in each department (including current leaders, lead members and commissioners) on board with working differently from how decisions are made, to how much professional judgement is trusted, to how supervision and team meetings are carried out, to how processes and guidance is designed, etc. all in line with the key principles of the new culture that leaders want for the organisation.

An organisational culture is defined by how people inside the organisation interact with each other and with people outside the organisation.

We create our organisational culture by the actions we take and by the messages we relay, by our behaviour. Culture is learned behaviour, it is not a by-product of operations or rules or key messages only.

When leaders start to model the behaviour they want their staff and teams to emulate, this is where a shift in working practices to a Strengths and Asset-Based approach has been successful.

A strong leader supporting and enabling the change to occur, by behaving in a way aligned with the strengths-based practice themselves, is the best way to cultivate and reinforce a culture that is relationship based and strength based and for them to lead with these behaviours and take actions that promote the importance of this ethos.

Leadership can and should be effective at every level within the organisation. How we behave as leaders drives the kind of culture we want or that we end up with.

If you believe that your organisational culture needs to become more ‘service user / or client focused’. How have you enabled this? Are managers in the organisation modelling the approach towards the front-line workers? Is there time and space set aside, on the Management Team Meeting Agenda to discuss how to improve service user / client experience? Are front line workers meaningfully involved and considered in decisions? How much time do managers and leaders spend on outreach work, meeting with service users, groups etc. or talking on the telephone? Or is this only to deal with complaints or issues?

In the strengths-based approach practice framework and handbook, we dedicate a short chapter to enablers of strengths-based approach, highlighting the importance of local leadership to create the necessary conditions for strengths-based practice to be successful in an organisation. We mention things such as: trust in professional judgement by front line professionals, appropriate qualitative and quantitative performance indicators, flexibility in processes and systems, consistency in messages, whole systems approach, wide range of activities within the organisation modelling strengths-based approach (i.e. supervision, quality assurance, team meetings, etc.).

It is up to the local leaders to create the necessary culture within organisations for cultural change to be successful.

I am very excited to work in a strengths-based approach way with clients, and it is motivating to put in practice my social work skills, but our processes are very rigid and don’t really allow the necessary flexibility to be adapted to the individual circumstances, for example it is a real struggle to convince managers that I have to visit the individual more than once.

– Community based social worker

It is amazing the amount of times leaders think that to implement a strengths-based approach all that is needed is to upskill their frontline staff. In a lot of occasions, front line staff already have the skills, and most of the knowledge, what is missing is the necessary context (i.e. processes, systems, decision making processes etc.) to put the approach in practice, leaders must model the behaviour throughout the organisation.

– Carmen Colomina, Social Worker and strengths-based approach trainer

Guidance on Transitioning from children’s to adults’ services

SCIE and the Innovation Unit are working on guidance for social workers supporting young people with learning disabilities as they prepare for the transition to adulthood is proceeding well. A lot of research material has been gathered and will be further analysed for its continued relevance.

SCIE have met with young people with disabilities and their parents and carers from a number of different local authority areas and online survey has been shared on SCIE’s behalf by the National Network of Parent Carer Forums.

A project steering group – involving Principal Social Workers and topic experts – has met twice to agree a skeleton framework for the guidance, which will include key principles, and practice framework, a resources section, and a section on legal frameworks in adults’ and children’s services. The guidance will be published during summer 2019.

The Named Social Worker programme, funded by the Department and Social Care and delivered by Innovation Unit in partnership with SCIE, involved nine local authorities, over 25 named social workers and over 200 people with learning disabilities, autism and mental health needs. It took place over two separate, six-month phases between 2016/17 and 2017/18.

The sites tested the difference having a named social worker would make for the individual and their family what it would take in practice for people to have a practitioner who could be:

a trusted and responsible practitioner who supports an individual and their family with a meaningful and consistent relationship
a dedicated case worker who coordinates care and helps make people’s aspirations a reality
a professional voice of challenge and advocacy.

The evaluation of the pilots found that despite the short time frames, there were positive indications of the impact the approach can have, including:

People felt more supported and involved in shaping their plans for the future. In several examples this led to positive outcomes such as faster discharges from institutional settings, overturned restrictive decisions and placements being sustained where they were previously breaking down.
Social workers felt more confident, skilled and knowledgeable using their judgement to advocate for and support people, and in turn more satisfied. For example, confidence to meaningfully engage people to deliver a person-centred plan increased from 47% to 94%
Examples where better coordination of care and a more intensive support offer has improved outcomes and reduced the cost of care packages. A predictive financial return of investment analysis estimated an average of £5.14 could be saved per £1 invested.

Further detail on the pilots including impact on practice and the wider health and care system can be found on the SCIE website.

Skills for Care

As the Department for Health and Social Care’s strategic partner for delivering its programme of support for the adult social care workforce, Skills for Care continues to work closely with the Chief Social Worker for Adults on her priorities for social work.

With the publication of the Post-qualifying standards: Knowledge and Skills Statement for adult social work practice supervisors at the end of 2018, we have been working with the CSW and her team to prepare for implementation of the statement from April 2019.

As has been evidenced through our evaluation of the Assessed Supported Year in Employment (ASYE), practice supervisors are critical to the outcomes of that programme. Supervisors are, of course, of vital importance to the development of excellent social work practice and in providing leadership to individual social workers at all levels of the workforce in their work and continued professional development. Employers have told us they feel that the KSS provides a clear framework and set of standards to support supervisors and promote a consistent approach to supervision.

Over the last year, we have been working with Lyn’s team and the sector to develop a skills and development pathway, which has been designed and tested with employers from all over the country, including six early implementation partnerships. Employer partnerships already focussing on supervisor development have engaged with this development work expressing a ‘willingness to further build on the learning from (our) course, strengthen how we both teach but also assess our supervisors – to further develop confidence in, and capability of our supervisors’.

Principal Social Workers (PSWs) are key local leaders focussed on creating the conditions and supporting quality social work practice. The role is pivotal in leading social work in local authorities and NHS Trusts and in connecting with national policy and practice direction. Despite this, the role is too often combined with other functions, impacted by organisational change or undertaken by someone who is newly appointed.

That is why the PSW Professional Leadership and Development Programme (PLDP) is so crucial. In place since 2016, the programme offers a combination of systems leadership workshops, action learning and individual support, and a leadership impact project. Feedback collected from participants both formally and informally, demonstrates how the programme is meeting the need for networking support and shared learning, this being the highest rated pre-programme expectation, as well as the highest rated benefit. The level of professional peer support participants are able to give and receive from each other is frequently commented as being a positive and highly beneficial experience.

The systems leadership work really helped me identify and develop my partnership and to be more strategic about the approach…I was looking more across and down and it’s made me think more up.

– previous participant

A fifth cohort of the programme is planned during 2019/20 and is being used to inform learning and development for child and family PSWs.

This programme has also provided the rationale for development of a PSW Capabilities Statement, setting out the skills, knowledge and expertise required for the role, similar to the KSS for newly qualified social workers and practice supervisors. The statement, together with forthcoming additional guidance byADASS and the PSW Network for employers to consider when recruiting PSWs, will help achieve greater consistency in how the role is constituted and supported.

Skills for Care were also pleased to become the operational delivery partner for the Adult and Child and Family PSW Networks, following a successful procurement exercise. The work is managed through a two-year contract with the DHSC and DfE until September 2020 and is already enhancing the quality of support for the Networks and the PSW role in adult services.

Assessed and Supported Year in Employment (ASYE)

The ASYE is led and delivered locally by every employer of social workers. It has become the ‘industry standard’ for supporting newly qualified social workers as they make the transition into working as a registered social worker.

I am of the view that the ASYE is vital in securing, supporting and developing our NQSWs and that we are improving in relation to the quality of support and resources we offer our ASYEs and Assessors.

– anonymous employer

Skills for Care has a well-established process developed with local employers to enable a clear level of support and consistent assessment of developing practice. Another employer has commented that

… it has been pleasing to see the development of the adult ASYE scheme over the past few years and it now feels very robust.

Resources enable the assessment and moderation activity, supported by key best practice messages, which in turn promotes continued improvement of local programmes. Programmes focussed on developing every social worker to be a confident practice leader within their own sphere of work.

Skills for Care continue to monitor trends and changes in the adult social workforce through analysis of the National Minimum Dataset (NMDS), providing high quality evidence and analysis to policy and decision makers at national, regional and local level.

As at 2017, there were an estimated 19,500 social worker jobs in the adult social care sector. The majority of these jobs (16,200) were within local authorities and around 1,000 were in the independent sector. Data from NHS Digital shows that there were around 2,400 social worker jobs in the NHS. This contrasts with the adult social care sector as a whole, which has as seen a shift away from local authority jobs (7%), compared to independent providers and direct payment employers (78% and 9% respectively).

Vacancy rates for both social workers and occupational therapists increased over the 2017/18 period (by 2.6 and 2.9 percentage points respectively). Although the rate of increase was slower, this could point towards potential supply issues for adult social care at a time where demand is increasing due to a rise in the ageing population. The turnover rate for social workers is 15%, slightly higher than that for occupational therapists (13.8%), but much lower in comparison to the social care sector as a whole (30.7%).

The numbers of social work graduates increased by 5% in 2016/17, with 4220 leaving with a social work qualification, with three-quarters (73%) of these employed as social workers six months after graduating. While government support for Frontline, Step Up and Think Ahead, along with the new Social Work Degree Apprenticeship announced in November, is creating a variety of routes into social work, the majority of adult social workers continue to qualify through mainstream social work programmes at undergraduate and post-graduate level.

Think Ahead

Think Ahead is a charity running a graduate programme to train mental health social workers, funded by the Department of Health and Social Care. Graduates and career-changers who join the two-year programme learn on-the-job in community mental health teams and qualify after a year, then work towards a master’s degree in social work while working full time in their second year.

The programme aims to further strengthen the contribution of social work in mental health – by bringing talented people into the sector, raising the profile of the profession, adding to the evidence base for what works and nurturing leadership.

In 2018, the first intake – who started their training in 2016 – completed the programme. Many participants produced original research as part of their master’s degree. The programme’s alumni network was launched to enable the charity to continue supporting participants in their careers.

Meanwhile, the second intake qualified as social workers and took up full-time roles in mental health services, the third intake began their training year and the charity has started recruiting its fourth intake to start in summer 2019, meaning Think Ahead is on track to reach a total of 400 new trainees recruited by 2020.

To date, the charity has partnered with more than half of the NHS Trusts in England, and around 30% of Local Authorities. It has also provided training in social interventions to over 70 existing practitioners, who took on the roles of Consultant Social Workers (supervising participants during their first year).

Think Ahead has also maintained its commitment to raise the profile of mental health social work within the health and social care sector and beyond – in 2018 participants and staff from the programme were featured in several media outlets including the Guardian, the Metro, the Independent, the Evening Standard, Community Care and Professional Social Worker.

In 2018 the Local Government Association Return to Social Work programme attracted more than 60 qualified social workers back into the profession.In 2019 we are planning to extend the programme to include social workers who have been out of the profession for 5-10 years.

Returnees completed 12 weeks of high quality training with hands-on work placements. This unique opportunity provided candidates with comprehensive coaching and mentoring, including dedicated interview preparation to enable them to re-register with the Regulator and be ready to re-enter social work.

Returners have been successful in gaining roles across councils as a result gone into various roles:

I started in the Adults team a month ago and I love it. I feel very settled and as if I never left the profession. Thank you for the opportunity!

Question 5

Social work leadership in practice: case studies

Accepted Answer

In previous annual reports I have presented a wide range of case studies from across the social work sector. This year we are doing things a little differently. Moving the report to GOV.UK rather than a printed format, means that we can update your contributions and make this section more dynamic. To kick this off, we have selected the following case studies to illustrate effective local leadership, where social workers and others are making changes and improvements that take the profession forward and better protect people and carers. I will use my blogto provide further updates over the coming months, enabling us to develop a comprehensive picture of social work practice leadership.

Leadership themes:

Strength-Based Approaches – case study: Southend – transformation programme
Preventing and reducing needs – case study: Birmingham
Integrated services – case study: Bournemouth
Professional leadership – case study: Calderdale
Efficiency and effectiveness – case study: Newham
Specialist best practice:
- End of life care – case study: Princess Alice Hospice
- Dementia care – case study: Stockton-on-Tees
- Hoarding and self-neglect – case study: Camden/Lancashire

I think that Southend’s transformation programme is inspirational and I have arranged a short video to capture what they have done and its effects on people. You can view this here:

Social work leadership case study: Southend Council and Jacob’s story

We have deliberately removed personal details from the case studies. If you would like to contact the individual social workers and their teams who contributed these pieces, please contact the chief social worker’s team at chiefsocialworkerforadults@dhsc.gov.uk

Case Study 1. Southend-on-Sea. Transformation Programme

Southend’s Adult Social Care Transformation Programme aligned to our 2050 vision is changing our approach to practice. The re-design is a ‘whole system transformational approach’ to embed a preventative ethos and culture to ensure we adopt a strengths-based approach that focuses on individual abilities and community assets.

We have developed Integrated Locality Teams based on an approach of staff leadership and activation. The approach has shown success and our strength based training has created a new culture of improved understanding and trust amongst staff groups. The teams have identified the future vision of staff practice, which is strong on collaboration, proactivity and supporting individuals to draw on their own expertise and skills.

We have created a direct pathway between social work and primary care by positioning social workers within GP surgeries. This has improved inter-organisational understanding and delivery between Health and Social Care, which is a key driver for improving outcomes for the people of Southend. (Appendix A)

Service Transformation introduced a Moderate Needs MDT bringing together a plethora of expertise. This integrated approach to community-based support has evidenced how partnership working has improved relationships between agencies, prevents hospital admissions and improves the quality of life and wellbeing for residents. (Appendix B).

We have established a network of Community Hubs providing additional street level social work to support a preventative approach for our residents. The introduction of our interactive asset map identifies community based resources improving the accessibility of advice and information. (Appendix C).

We continue to develop projects alongside our local University and its institute of social justice. The Transformative approach has influenced the development of the social work curriculum within both the undergraduate and postgraduate programmes.

Southend-on-Sea case study – Appendices

Abigail, 72, reported to the GP with hip pain, painkillers prescribed. She advised she was reliant on an elderly friend for personal care and the GP referred to social services via the initial access team. She had a telephone call by social services and advised she is alright and does not require a care package.

Two weeks later she contacted the GP again that the pain is still bad and she is relying on her elderly friend a lot. A joint visit was booked in for when the social worker was in the surgery and undertaken the next day. The GP reviewed the condition and medication. Abigail initially declined care but when the social worker asked the friend if he wants to continue with the care provided he advised her he is struggling and wants to have support for her. Abigail was reassured by the social worker and agreed to a referral to re-ablement. Risk of falls was identified toileting at night and a commode ordered that day.

Eric, 100, recently lost his wife and was grieving and very lonely as identified by the GP and Advanced Practitioner on home visits. The social worker visited and reviewed his care package, explored equipment to assist with hearing and connected him to a befriending service local to him. Eric was already going to a club on Tuesdays which he found beneficial but it was a few miles away. The befriender started visiting on Wednesdays and connected Eric with a church in Southend which he visited on Mondays. Eric was interested in attending an activity everyday as it helped him cope with loss of his wife. The social worker referred him to care navigators who helped him connect with a tea club at a local church, consider a quiz night locally and helped his daughter apply for a blue badge to make parking easier when she takes her father out.

Eric enjoys the additional services he visits as it helps him cope with grief.

Appendix B – Individual case studies – the Moderate Needs MDT Model

Tony is a 26 year-old street homeless person who had regularly attended A&E for alcohol and substance misuse related seizures, self-harm and suicide attempts. Tony was also identified as an at risk individual for radicalisation and had declined previous engagement for conventional support.

The MDT co-ordinated a collaborative interagency plan utilising substance misuse, mental health and third sector services to co-work the case and enable Tony to work towards his previously undisclosed gender reassignment goal. This has resulted in Tony feeling more comfortable with his identity, more supported and less reliant on drugs and alcohol.

Henry was well known to statutory social care, he was socially isolated and no strong network of support for him. This led to an increased vulnerability whereby he was allowing strangers into his home under the guise of friendships. A number of incidents ensued whereby Henry was taken advantage of and threatened, a particular incident of note occurred where two men gained access to his home and stole £250 at knifepoint.

These incidents led to numerous safeguarding episodes and Police investigations but ultimately Henry remained in his home, albeit with additional security measures such as a key safe and key code entry system. Henry was referred into the MDT in September 2018 from his care providers who continued to have concerns regards his safety and well-being but felt at a loose end as to what next steps to take as many agencies had already undertaken assessments and implemented safety measures.

The first step the MDT took was to gather information from social care staff with prior involvement. Following this we linked Henry up with Care Co-ordination whom were tasked with addressing his health needs as well as looking into his social interests. South Essex Advocacy Services were also tasked with contacting Henry and looking into his financial situation, to reaffirm safety advice and look into his support networks.

Several weeks of building relations and rapport with Henry enabled us to establish he had family members in Eastbourne and was keen to re-locate to the area. Through our work we contacted and re-connected Henry with his family and found him housing and assisted him with securing said accommodation. Through the MDT we were further able to utilise the transport service via Age Concern to transport Henry and his belongings to his new home when this became available. Henry now resides in Eastbourne, in close proximity to his family who can now support him alongside the local authority of the area who were notified of his history and new residence in their area.

Appendix C – Individual case studies – the Community Hub Model

Anna attended her local community hub to seek unrelated housing advice and, realising the social worker was present, she disclosed that she was struggling to care for her husband who had vascular dementia. Anna explained that her husband had significant care needs throughout the day and night causing intense stress, exhaustion and depression.

The social worker connected Anna with the local carer forum and the Dementia Navigator located in the hub. Through this support her husband received a community dementia support review and she received much needed peer support through the form of carers groups. Anna has gone on to become a peer befriender in her locality. The outcome of this would have been vastly different as it is likely this case would have moved into crisis point had social workers not been visible in the hub.

Martin is an 81 year-old man who lives alone and rarely accesses the community, he has never used the internet before. He was keen to contact his family in his native Spain, especially his brother who is critically unwell. At the community hub, Martin was taught how to use the internet, send and receive emails and access maps of the local area. He was shown how you can look up properties via street maps on Google and was overcome to see his family home on the screen. Through the support in the hub, Martin was able to arrange a Skype call with his extended family in Spain.

Case Study 2. Prevention. Birmingham

I want to thank you from the bottom of my heart, when I found out I couldn’t stop crying.

– Mr C’s Grandmother

Mr C left college with certificates in catering but was not able to find work. Mr C is a young man with Autism and from college he moved to day care. Mr C was not happy at his day care centre. Amanda an innovator from Northfield, using a conversational approach, met with Mr C and explored with him what he wanted to do, what support was available from his family and friends, what he enjoyed and what he was interested in.

Amanda found out that Mr C had enjoyed his time at college studying catering and had a passion for Birmingham City FC. In the spirit of doing things differently Amanda contacted the Corporate Catering Team at Birmingham City, and to cut a long story short, Amanda supported Mr C at his interview where he was offered a contract to work on their catering team. Mr C has been allocated a mentor and ASC&H are offering training on working with someone with Autism. Mr C’s uncle has agreed to drive him to work. Mr C’s proudest moment so far was receiving his Birmingham City ID Card with his photo on it! He is looking forward to spending his wages!

No wonder Amanda commented ‘for me this is ‘real social work’ and what I came into the job to do!’

This example from Hodge Hill team: Neighbours and professionals had raised concerns about the health and wellbeing of Mrs B. She is in her 70s and living in very poor conditions. Mrs B had no family. She has a long history of a hoarding lifestyle and there were concerns about rat infestation. In the spirit of 3 conversation – ‘stick like glue’ to resolve a crisis together, Paulette has been engaging with Mrs B, visiting her weekly and helping her to declutter. Paulette said that she constantly reassures and encourages the lady to focus on one thing at a time – ‘creating that clear space on the floor’ – 10 black bags at a time. The relationship between the two of them is formed and is productive as this lady is gradually moving in the right direction in getting her quality of life back. There is a lot more to do and the social worker has this all in hand as she progresses sensitively to enable this lady to take control of her situation. Mrs B commented I look forward to you coming, we convers while filling the bags. This is a different kind of company.’ This is clearly demonstrated in how Mrs B engages with her and allows for the filling and removal of the bags, something she has never done before.

Paulette says she gets a ‘fuzzy feeling’ when she leaves as she is making a difference and has given Mrs B back ‘Hope’.

These are just a couple of an increasing number of stories coming from our social work innovation teams using the 3 conversations framework showing how they are achieving positive outcomes with and for citizens.

Birmingham has a clear commitment to Prevention First with the aim to build off people’s strengths and assets as well as connecting them to their community. We are 6 months into the roll out of the new social work framework which includes 3 conversations, Family Group Conferencing, Local Area Co-ordination and the commissioning led Neighbourhood Networks. These combined approaches have been chosen following a research and evidence based review of what has worked in other local authorities.

Staff Feedback

This feels genuinely person centred.

Instead of just signposting we are linking people up.

It’s empowering.

It allows for creativity.

We can focus on the specifics rather than trying to ‘tick’ lots of boxes.

People and Family Feedback

We were happy with how the visit went… I thought it would feel like an interview which is what someone told me it would be like… I am really pleased that I was given various different options, which ex-wife and I could discuss after the visit.

The family commented that it had been really nice to talk and to share his worries and concerns with me.

The adult said they felt empowered and in control.

Doing things new or differently always takes time and is about change. I am really pleased that working with Erdington team has been exceptionally good. We have started to develop a strong professional relationship that enables us to make a huge impact on the citizen we are working with. I believe we have collectively started a journey of Change which will have a huge impact on citizens of not only Erdington but the city of Birmingham. I am looking forward to the future with optimism.

Case Study 3. Integrated Services. Bournemouth Drugs and Alcohol Safeguarding Team

The case evidenced here was one open to the Drug and Alcohol Safeguarding Team when ‘Y’ first became known to services in 2013 when fleeing from domestic violence. Y has multiple and complex needs that were challenging as they included polysubstance misuse, social and personal history factors. She was at a high risk of overdose and death because of her drug use and risky behaviours which included rough sleeping, begging and on-street sex working. Y’s health became increasingly fragile, and she remained at risk of physical and sexual assault whilst on-street sex working.

Solutions

By focussing on a relationship based approach, the SW was able to acknowledge the effects on X of adult attachment, separation, loss, change and levels of resilience witnessed previously. She was able to bring this knowledge to the situation to understand that the cycle of domestic abuse was fuelled by a co-dependency and exacerbated by coercion and control to fund both their substance dependency. The SW had an established network of both internal and external colleagues and so was knowledgeable in the services that could support X. She was skilled in working collaboratively in situations where there were high levels of complexity, and ambiguity. This was particularly evidenced through the development of a sustained model of engagement in fluctuating circumstances characterised by hostility and risk.

Outcomes

Relationship based social work facilitated the SW to identify what was important to X which included substitute prescribing, support to stabilise her health and well-being, together with accommodation that would enable X to have her own ‘front door’.The SW approached Housing First, an innovative housing initiative that recognises the multi-faceted needs associated with chronically street homeless people. A key element in the Housing First offer is ‘wrap around’ support and this was offered to X whilst in prison, on release and into her tenancy.To date, X is undergoing a detox residential programme in a women’s only facility that specialises in Trauma Informed Care.The SW involved in the case has been invited by Bournemouth University to contribute to research into the wider effect substance misuse has on relationships.

Leadership

Professional leadership was accessible to the social worker from peers, through practice guidance; operational management levels, both informally and through more formal organisational structures. The SW was supported to reflect on the influence and impact of her own values on X’s situation. The achievement of positive change was influenced by the effectiveness of her relationship forged with X. Skilled support was provided to the SW to maintain and develop liaison across a wide number of agencies which was essential to ensure X was supported, but also to understand what the limitations of each partner might be. Issues or risk were approached in a person-centred way so that involvement, choice and control were maximised for X whilst not losing sight of X’s desired outcomes. The SW was supported with professional decision-making whilst balancing difficult risk decisions within a value-based ethical approach. Necessarily, this was a negotiated process so that the quality of the relationship was not jeopardised.

Case Study 4 – Professional leadership and development – Calderdale

In January 2018 I attended the Critical Reflective Practice (CRP) programme for Practice Supervisors, an experience of learning which for me was transformative. Consequently, I set out to enable a culture of critical thinking within my organisation starting with one Adult Care team whom I supervise.

The initial challenge was to engage practitioners whom identified themselves as reflective already in a process of thinking about underlying meaning which underpin assumptions. This is powerful as the ‘knowing’ without any action of construction (thinking) will inevitably fail in challenging dominant ideas/structures.

I arranged for the team to attend 4 days of ‘participatory learning’ which was experienced therefore allowing for change on an individual level. Then to imbed CRP to enable cultural change I established weekly reflective sessions applying a model performed on any discourse and supervisions sessions which focused on personal discourses.

The challenge in applying the reflective models was the absence of an experienced facilitator; thus, it was natural for the approach to become solution or case management focused. Therefore, I identified tools to act as prompts to keep the reflections focused on perspectives and their construction. While also using activities to increase confidence and reflective questioning for example using quotes, challenging their meaning from different perspectives, engaging in personal/professional values our beliefs and behaviours.

The objective moving forward in 2019 is to strengthen ‘organisationally’ practitioner’s reflective skills as this further underpins ‘how’ to approach holistic and strengths based conversations/assessments. While supporting continuous learning though ‘knowledge building’ which is generated contextually as CRP places the emphasis on uncovering the power relations and in doing so holding the potential for social change towards outcomes for enabling social justice.

It is clear each practitioner engages with CRP on a different level, as the process is an individual ‘learning’ experience but to date the feed-back has been positive.

Feedback taken from post evaluation forms

After the training I have a better understanding of ‘reflexivity’ and ‘use of self’ in practice.

I have a better understanding but still lack confidence, because I am not familiar enough with reflexivity in practice.

Case Study 5. Efficiency and effectiveness. Newham – Review and Move On Team

Since 2015, The Review and Move On Team have worked hard to ensure that the overall cost of placements for London Borough of Newham (LBN) has reduced but also the quality of placements have increased. The team have worked alongside Providers and Commissioners to improve partnership working between all.

The greatest outcome though for the team has been its work alongside Customers especially those who have been in long stay residential or support accommodation, funded by LBN. The team undertook a massive task in reviewing all Customers with the change to the Care Act being implemented. The team looked at the current presenting needs and what the Customers wishes is in regards to their future. In many cases, it was found that Customers were independent in many aspects and the team was able to challenge Providers. The team was able to liaise with the Housing Department and Private Landlords to explore the options available to Customers to step down. Two Customers that were interviewed are good examples of many where this has produced very successful outcomes.

Customer S had been in services for a number of years with prior involvement with Children Services. Following getting pregnant, The Review and Move on Team worked with various Providers to ensure that the right support and accommodation could be found for this mother and child. With the help of Review and Move On Team, she was able secure her own flat with no support now required.

Customer E had a long past with the Criminal Justice System and had been in and out of prison several times. The Review and Move On Team were able to advocate for him to be able to move to his own independent flat where, with a need for just a small amount of support, he has thrived. He has stated that he has enjoyed the freedom to do what he wants and the increased independence to do things for himself.

Through research it is recognised that housing and good mental health go hand in hand. The team’s ability to support Customers to live their lives as independently as possible and to network with a wide range of Providers has been very rewarding, and the team continue to support new Customers to achieve independence all the time.

Case Study 5. Annex A

S 14/12/2018

As a baby and growing up, I was always under Child Protection due to the difficult relationships my mother was involved in. As a teenager, I first got involved with mental health services under CAMHS.

I was diagnosis with BPD and self harm. I used to get very depressed. A Social Worker came to visit me and believed that where I was living was making me worse. She advised me to move out.

I moved into supported accommodation where I stayed for around 5 years. I had a key worker who came to see me but as time moved on, I was a quick learner and able to be more and more stuff myself.

I was scared of moving at first but the place was small with 2 other tenants. I ensured I did lots of activities each week.

When at the accommodation, I fell pregnant with my son. At the time, the father of the baby also had mental health problems and not in a good place. So Children Services were involved and we split up. One time, my partner slapped me so Police was involved, again Children Services came to assess and monitored the situation for a period but all was fine.

The supported accommodation was good as they allowed me to stay there and have my baby till a suitable place could be found. I moved into my own council flat about 2 months ago with my son who is nearly 2 years old.

It was difficult at first as I was moving with nothing. I relied on the Review and Move On Team to support me a lot and I was always on the phone chasing them up. The team was helpful, supportive and explained/talked me through all the planning.

I really enjoyed living here now and my son has settled very well. I am still paying off a loan which I took out to help me buy some furniture but that’s ok. I do have to fight for my mental health every day but I have not self harmed for over 4 years now.

Case Study 5. Annex B

E 11/12/2018

I was ill in prison around 1993. I attacked 2 police officers when first unwell and spent 18 months in Rampton Hospital. After a period, I was moved to a Medium Secure Unit and was discharged on a nominal section 37, back into the community.

At the time of discharge, I got a job as a Bouncer where people were taking drugs etc so I started to try and got involved in this scene. This is where I went down hill. I was in the community for around 3 ½ years but then I did another offence and attacked a Social Worker. I went on the run but was arrested and charged with attempted murder.

2002, I went back to Rampton Hospital and spent about 5 years there. After this period, I went to the John Howard Centre for around 4 years.

I then stepped down to a Low Secure Unit where I spend about another 3 years.

I was finally discharged to a residential unit where I stayed for 3 months then into supported accommodation for around 18 months. I enjoyed my time there as got on well with staff but it was messy living with other people.

I then went into a semi supported accommodation where I had more freedom. I reconnected with an old friend and we jointed the gym together. The main problem was that there was still drugs and alcohol around but I refused to get involved and kept my distance. I was aware that I had spent 14 years inside and didn’t want to go back. I was in the accommodation for around 2 ½ years.

After this time, I was supported to move into my own council flat in Newham. The Review and Move On Team were very helpful, with setting me up with utilities etc. I also painted the flat myself which was a big achievement.

I enjoy living on my own; it gives me more freedom to do what I want to do. It gives me more independence and I can do things for my self. I see my family often. I enjoy being able to budget.

I work as an expert by experience for the local trust, sitting in on interviews, supporting the training of professionals and DLR Team. In 2017, I won an award which I am very proud of for my work as a Service User.

I have had several staff work with me over the years. I remember a Doctor who I did not see eye to eye with but a Social Worker was able to advocate for me and really support me to get me to where I am today.

Case Studies 6.1 Specialist Best Practice. End of life care. Princess Alice Hospice

Social Workers working in a medical environment are the lead advocates to ensure a patient’s social needs are identified into a holistic assessment. In a hospice environment the focus can be on symptom management and it became clear that intimacy needs can be lost in the management of medication, pain relief and packages of care focusing on practical care. This need became evident when supporting a young couple in their 40s, where the lack of intimacy for the couple was significant.

As the lead social worker I set up a task and finish group with a Senior Social Worker and other health care professionals to audit how many conversations were had with patients around their intimacy needs. The audit produced very low numbers of conversations around this subject; this identified a need for education and a leaflet to promote these discussions both on the In Patient Unit and in the Community to promote a person centred and holistic assessment of need.

Social workers in palliative settings need to be courageous on a daily basis, facilitating discussions around breaking bad news and helping people to have a good death that the patient defines. This can be challenging for health care professionals who are committed to ensuring safe practices in a micro medical environment and the implications they felt if allowing patients and their partner’s intimate time. We overcame this by providing the task and finish group a train the trainer course on the subject whereby health care professionals could then be confident with the subject. A number of stories evolved from this process, so we developed a poster to show at the Association of Palliative Care Social Workers, which had the success of winning ‘Best Poster’.

Case Studies 6.2. Specialist Best Practice: Dementia Care. Stockton-on-Tees

By enhancing collaboration between Health, Social Care and the Voluntary Sector, Stockton-On-Tees Borough Council is working to improve access to information and support for people living with dementia, with a particular focus on timely interventions following diagnosis. Key to this approach has been the development of the LiveWell Dementia Hub which provides a one-stop-shop for dementia related information and support in the Borough.

The Hub team have played a leading role in coordinating local partners in order to offer a single first point of contact for the public as well as a single-referral point for professionals, the Hub is available on a drop-in basis facilitating easy access to specialist information at the time and frequency that is right for individuals.

Alongside specialist workers from the Council the Hub provides a base for colleagues from the voluntary sector and NHS. The co-location of multiple agencies within the Hub allows people affected by dementia to access related services within the same venue or during the same visit.

Collaboration with Stockton Memory Clinic has enabled the Hub to work alongside families at an early stage, helping people to access community support and develop the knowledge necessary to maximise self-management. These early interventions have helped bridge the gap between a person’s diagnosis and services offering more intensive input, relieving pressure on other teams within Adult Services and ensuring resources are targeted effectively.

Despite the challenges of multi-agency working, the Hub team has shown leadership in promoting shared agendas and building knowledge of and trust in the service. As a result the Hub now hosts a full timetable of activities based on what people with dementia have highlighted as important including cognitive stimulation therapy, user-led and peer support groups, carers education sessions, talking therapies and appointments with both Citizen’s Advice Bureau and the Memory Clinic.

Feedback from service users has included:

I am getting better at coping and more confident and that’s especially down to you.

It’s opened so many doors.

It’s my lifeline and I couldn’t cope without it.

Establishing the link has made me feel more supported.

I feel more prepared for the future – far more aware of what is out there.

I know I can pick up the phone and feel listened to and supported.

The advice given has certainly helped me navigate my way around the system.

I have attended groups and events and there’s definitely less stress for me as a carer.

It’s like a goldmine of information and just to come to the Hub is such a relief of stress.

The reason [my wife] is coping is because of the help we’ve received.

From not wanting to go out anywhere… he’s getting out a lot more… I can’t believe it.

An invaluable source of support… without it we would have been really struggling.

Before my appointment I felt so alone and depressed. It was so helpful for someone to listen to me and give me actual help. I now know I have a lifeline and I’m not alone. Someone is there for me and my husband.

Stockton-On-Tees is very fortunate to have such a fantastic service.

A woman and 2 men people sitting around a table. The men are holding a book together and smiling. — Left to right: Mary Mackie (carer), Ian Mackie (person living with dementia) and Peter Otter (hub co-ordinator).

Case Studies 6.3. Specialist Best Practice. Hoarding and Self-Neglect. Lancashire

Multi-agency working and building of relationships when working with individuals who self-neglect

As the Principal Social Worker (Adults) for Lancashire County Council, I have been leading on developing a Multi-Agency Self-Neglect Framework. This will ensure that all of the Lancashire Safeguarding Adults Board partners will work in a consistent way, keeping the individual at the centre of the process.

This framework has been developed with colleagues in Adult Social Care, Clinical Commissioning Group, Lancashire Constabulary, Lancashire Fire and Rescue Service, Environmental Health and Community Safety, and Housing.

I completed the PG Cert course in Advanced Social Work for Care Act Implementers at MMU and led a workshop on self-neglect at the National Conference; during this time I also identified the need for a more cohesive approach to self-neglect as an area that needed development in Adult Social Care and developed guidance for staff within LCC to work to.

Although it has taken 2 years to develop a framework that all LSAB partners with statutory responsibilities has been happy to sign up to, everyone involved has been passionate about seeing this through. This is because we are all aware that although we have our own roles and responsibilities, policies and procedures, at the core we are all responsible for ensuring that vulnerable adults are encouraged to be as independent as they can be, have a real voice and are enabled to make choices that are relevant to them; this has to be balanced with safeguarding them against abuse, even if that is potential harm from themselves. I believe that this will have a positive outcome for the citizens of Lancashire.

The Framework will be launched around March and I have shared this with colleagues in Blackpool and Blackburn Council, with a view to promoting it as a Pan-Lancashire approach soon.

We had two community teams in Central Lancashire offering to pilot this approach with colleagues from other agencies. This is what they had to say about the experience: During the last few months that Adult Social Care have been working with other agencies (including Environmental Health, Housing, Health, Emergency Services, Voluntary sector and Advocacy) our ability to progress individual cases has improved. This has been assisted through agencies physically coming together to discuss risks and concerns, and developing an action plan or Best Interest decision (depending on mental capacity) which focusses on shared responsibility and ownership towards the individual citizen. The action planning process has enabled shared learning and raising awareness of the different options that might be available. It has also provided opportunities to recognise the different legislative priorities that agencies have, and how to manage and implement this to enable the citizen to achieve the best outcomes that improve and maintain their wellbeing. Consideration has also been given for the benefits for the direct neighbourhood in terms of property maintenance, health and safety, and public health. An example of positive outcomes include a woman who was living in severe squalid conditions, socially isolated and self-neglecting to be now supported in Sheltered Housing, being able to access the community and has much improved mental capacity and physical wellbeing. A further example of another citizen whose home was so cluttered he could only access a small portion of his home, is temporarily in supported living and receiving assistance via several agencies to plan for his future needs, and being able to return to his own home.

(Community OP/PD Team Managers)

We have also managed to link in with a mental health colleague working in the Wyre area and the MDT provides an ideal opportunity to work collaboratively on these difficult cases, and we definitely want to continue building on the start we made during the course of last year; I believe there are a lot of positives to the approach.

(Head of Environmental Health and Community Safety)

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