History, human rights, social work and Integration

This one is for PSWs as a number of them requested a copy at an event we had today. The below is a talk i gave at an ADASS and PSW integration event on the unique role social work could have in integration. It is written as a talk so you may have to read it aloud in the mirror for it to make sense!

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Today is an important and welcome day.

A day that allows us to look at, reflect upon and challenge ourselves around the ideas of integration.

It’s positive to have so many speakers looking at how integration has worked what it could look like and the journeys ahead from a social care perspective.

I wanted, however, to take a moment to consider the past and the creation of social care and social work as we know it now.

What makes social care so vital in the realms of public service and equality.

In 1968 Fredric Seebohm set out in his report the foundations of a modern forward thinking independent and responsive social services system.

Fredrick Seebohm was born and bred in Hertfordshire and spent most of his life, bar his time at Trinity College Cambridge and a period of active service, living in Hertfordshire.

Now as PSW for Hertfordshire this does mean that I can formally claim Hertfordshire as the home of modern social care and more importantly social work.

It is important to consider why Seebohm was commissioned in the first place and what this report can tell us about how we should approach our concepts of integration now.

In reality the Seebohm report and its recommendations led to the disintegration of any elements of combined integrated social care, education and health systems.

We did have some precursors to the modern integrated mental health trust in existence from the mid-50s throughout the 60s.

Mental health officers and the early state employed social workers were imbedded in what was an NHS in its teenage years.

But Seebohm changed all this.

Throughout the late 50s and 60s the NHS was rocked by a number of ‘scandals’.

The abuse and degrading treatment of people with mental health problems, learning disabilities and the elderly were appearing in the public eye. These scandals began to Challenge society’s concepts of how they viewed the worth of all members of our communities.

The early commissioning documents that defined the reason for and the remit of the Seebohm committee clearly cites these concerns as a driver for the review

The commissioning document for Seebohm stated

Given concerns raised in both houses and by her majesty’s loyal subjects over the ill-treatment of persons in the care of the national health service, the Committee should consider the government’s function and that of local government in the oversight of the national health service and how independent oversight could be applied to the stated service.
Obviously Seebohm also had a much wider remit but this key element led to some of the core concepts of modern social care and social work.

The idea that social work was so much more important than the treatment and diagnosis of illness and or conditions, it was about people.

People in all their complicated, messy, wonderful, aspirational, sad and inspirational ways. It was people who counted, as a whole, not one part of their care.

One of Seehboms key recommendations in the final report was

we recommend a new local authority department, providing a community based and family oriented service, which will be available to all. This new department will, we believe, reach far beyond the discovery and rescue of social casualties, it will enable the greatest possible number of individuals to act reciprocally, giving and receiving service for the wellbeing of the community.

You wouldn’t be surprised if you found that paragraph in the Care Act now.

Seebohm understood that the value in social services were their ability to work with people, understanding the implications of a society that was far from equal and how this shaped communities.

The understanding that working with social disadvantage could come long before any intervention need from health services.

That the enabling of the disabled, families, and the elderly was as preventative as it was just.

The report also noted the specific role and value of having a social services that provided independent oversight and challenge of the NHS at that time.
I think he also pressed a few buttons

In a fantastic letter to a British medical Journal a doctor wrote

Dear Sirs

I have no shame in declaring my ignorance of the Seebohm report. I do wonder perhaps that these sociologists are too pre occupied with their own paradigms to concern themselves with the fact that they are fundamentally no more than coffee shop blaggards. The idea that such inferior ‘arts’ can in any way challenge our long founded and proven approaches to dealing with societies flaws is ridiculous.

You realise that’s all of you he’s referring too,

Seems nothing’s changed in health and social care correspondence then.

The world has changed greatly in the 45 years since Seebohm

Not least we’ve had a decade or two of care management that has done little but damage our roles and deliver industrialised models of social care.

But the inherent values that Seebohm set in motion are as valuable today as they were in 1968.

It is these key values and the unique role that social work has that we need to fully understand if we are to make integration work.

We need to firstly ask ourselves what we mean by integration.

There is a lot of emphasis placed on the merging of the system, the sharing of buildings and the single budgets of employers.

Whilst these are key conversations for the future delivery of social care and health we must look much wider.

It would be too easy to get wrapped up in the commissioning of models and business and fundamentally miss the point and the opportunity of integration. It has to be about people.

So what is the role of social work and what can it bring to integration?

As Seebohm set out all those years ago social work brings a unique approach to working with people, communities and society as a whole.

The concepts of equality and personal growth through enabling and strengths based practice,

The belief that personal independence however small and in whatever area of life is something so very precious and that the championing of individual and community aspiration are key to not just fulfilling lives but healthy and happy lives.

The international definition of SW is agreed as

“Social work is a practice-based profession and an academic discipline that promotes social change and development, social cohesion, and the empowerment and liberation of people. Principles of social justice, human rights, collective responsibility and respect for diversities are central to social work. Underpinned by theories of social work, social sciences, humanities and indigenous knowledge, social work engages people and structures to address life challenges and enhance wellbeing.

If your social workforce does not do this now then you need to consider why and rectify it very quickly indeed.

The last 15 to 20 years has seen the requirement of social workers as assessors and guardians of care packages grow.

If we do not allow Social Workers to practice as they trained to do, then any future integration will fail.

The irony is that in times of severe and unprecedented economic pressure on social care, true social work is the answer to our wicked question.

Connecting people, systemic understanding, risk positive approaches and resistance to industrialised responses to systems pressures are not only cheaper they are the right thing to do.

Social work over recent years has found itself being moved to the front and back doors of hospitals.

In reality it should be five miles down the road working with people to prevent social or health issues and maintain or regain control of their lives in the face of adversity.

Social work in our communities should understand the key causes of distress and health conditions, addressing them proactively to prevent.

It is the removal and restriction of such thinking and practice that will damage any success of integration and more importantly the ability to integrate around the person,
In preparing for today I put this question to Twitter

The importance of SW in integration, what would you include?

The overwhelming response was not the who and how we work but the need to recognise that Social work is based fully and rightly in human rights.

Enabling and protecting participation in true communities through prevention, wellbeing and personalisation.

Recognising that there is greater risk in the restricting of people’s lives, choices and rights through irresponsible care control.

Challenging the prescribing of disabling and risk averse care that in reality only makes people more dependent on the system not free of it.

There was also challenge and plea one insightful tweet from Rob stating that

If we don’t think differently about organisational integration it will do two things 1) fill up all the care homes and 2) fill up the court of protection.

The key point is that all professionals bring something unique and valuable to the health and social care world

The idea that we will have a single homogenised professional is naive and dangerous.

We can clearly share elements of work but in reality these are elements that were never about the profession rather they were about the systems and bureaucracy’s we have created.

Social work embraces the ideals of self-determination,

even when such self-determination promotes the right to fail.

A right to fail that in the eyes of social work could be another step towards personal growth.

Social workers legal literacy and ability to lead careful consideration on the use of law, power and control are a vital protection of the individuals rights

They are also a promotion of their strengths.

The ability to resist pathways to inappropriate care and control defined as a duty of care, will allow for shared and inclusive discussions placing people at the heart of decision-making.

But when law needs to be applied we can rest assured that social work will be confident in its application and apply it in a way that is morally ethical and the right thing for that person at that time.

Leadership will be key in the delivery of any future integration but leadership on its own will not be enough!

The need for social work and social care to be ingrained in heart, culture and DNA of any integrated service has to be a given.

An acceptance that social care and social work is different, delivering different, wider and whole person outcomes.

If you have an organisation that requires a 100% a risk assessment rate, then you will develop risk averse practitioners who over provide care and control.

We must also remember that integration with one key partner done incorrectly could damage the natural partnerships elsewhere.

Housing, education, children’s services, neighbourhoods, probation and the police are all natural partners of social work.

Enabling supportive responses to difficult situations.

We have to ensure any future model or design is wholly inclusive of these key elements and partnerships.

The role of social work in areas of poverty, crime, domestic violence, community cohesion and social justice to name but a few can only be continued if social work remains at the heart of all these areas.

So whatever the future of integration we do need to fully understand the role of social work within it and importantly embrace what true social work can deliver.

The thinking, analysis and outcomes of social work done in partnership with people is worth so much more than any bricks and mortar or beds and sheets that a commissioner can commission.

We should see integration as the opportunity to re-embed the values of social practice,

Positive independent challenge and ethical scrutiny of partners,

and an understanding that human rights underpins all of the health and social care laws that we apply.

The right to be an included citizen is a right that must be upheld. If you aim for citizenship you will deliver good care to make it happen. If you aim for good care then you may just get good care, not citizenship.

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