Reform of adult social care – social workers say what's needed
Listen to social workers, co-design new systems with people who use services, exploit AI and reduce complexity. These were among key messages from social workers for Baroness Louise Casey as she starts her commission into reforming adult social care this month.
Health and social care secretary Wes Streeting said the commission aims to “grasp the nettle” and end decades of government failing in social care reform in England.
Casey is due to make “long term” recommendations for “deep reform”, including the creation of a national care service, in 2028.
Speaking at the launch in January, she said: “An independent commission is an opportunity to start a national conversation, find the solutions and build consensus on a long-term plan to fix the system.”
So as Casey begins her work, PSW asked social workers what they believe she should focus on…
Margaret Young, co-chair of BASW England’s adults social care group
My message to Baroness Casey is to consider what the social work profession has to offer adult social care, highlighting its value for people who draw down on care and support.
Social work has a distinct professional contribution that goes behind the more commonly publicised roles of carrying out Care Act 2014 assessments and reviews.
Baroness Casey should ask the social work profession what it can offer beyond what it is currently employed to do. For example, much more relational practice, described in BASW England’s 80:20 campaign, working much more closely with individuals to support better outcomes.
Prevention is another area where social workers are not used to the extent they could be. Their skills are underused in communities where the challenges of health and economic inequality are systemic. The review could consider the possibility of social workers facilitating self-help groups, taking a community focus working in collaboration with public health.
Social work is often considered as an ‘after thought’ but should be a central profession in integrated community health systems. As services move out of hospitals, social workers contribute with case management, assessment and care planning, risk managing, and offer valuable expertise in safeguarding.
Social workers are required when liberty has to be deprived and if Best Interests Assessments have to made in conjunction with other professionals.
Baroness Casey should also consider the social work role also encompasses advocacy for the people they support highlighting injustices where governance has been poor.
Julia Ross, chair of BASW
Many of the quick wins will be around working more seamlessly with health services, but in community-based services as much as the acute sector. The next stage plans for the future should be based on predictive analytical data, not assumptions or guestimates by vested interests.
Social work is integral to social care. Along with other key therapies and professions, we provide a statutory service for assessing for care, safeguarding, mental health and mental capacity and much more.
We work alongside clinicians, occupational therapists, physiotherapists and nurses, providing the essential safety network to protect and support vulnerable people. Social work is also used to support and manage change in difficult circumstances and so will have a valuable role in carrying forward changes in social care.
The world is changing rapidly and that means a fresh look at all possibilities. We need to take stock now and look ahead as much as we can to project future need. Better use of AI in service assessment and provision and predictive data analysis will be essential.
Social care has not kept up with the changes and needs now to escalate change, working closely alongside partners, including the health service.
Lyn Romeo, England's former chief social worker for adults and current BASW council member
One significant factor that influences improved wellbeing and better lives for people is the quality of the relationship between the social worker and the social care workers involved with the person needing care and support and their families.
Regulated professionals in the local authorities responsible for social care are the key conduit for people to access the right care at the right time in the right way.
Ensuring we have social workers and occupational therapists to respond to and work alongside people, unpaid carers, and with relevant health, housing and community sector professionals will improve effectiveness, efficiency and most importantly, the qualitative experience of people needing social care support.
The commission must ensure it recommends that this cohort of the wider workforce receives appropriate levels of investment and support to ensure it has the capacity and quality to deliver the best social care outcomes for individuals, families and communities.
Gerry Nosowska, co-chair of BASW’s special interest group on social work and ageing
I currently work in safeguarding for a charity. Here and across all my independent work, I see the impact on people and communities of lack of timely support.
I'd like a national conversation with voters about the kind of lives we want ourselves and our neighbours to be able to live, because any one of us can hit a difficult patch.
And I'd like to hear social work talked about as part of the solution when people struggle. We aren't just advisors and coordinators. We can provide therapeutic support. Let's talk about social work as a service in its own right.
Andrew Reece, professional officer for BASW England and former head of a disability service
My key message for Louise Casey is that she should speak to people who draw on social care and their families first and then frontline social workers and care workers. Social Care Future’s vision for social care expresses what people who draw on care and support really want. It says: “We all want to live in the place we call home, with the people and things we love, in communities where we look out for each other, doing the things that matter to us.”
BASW is ideally placed to help Baroness Casey. We have conversations with social workers who will be able to share their real stories of what works and what gets in the way.
Only when she fully understands the system from the frontline should she talk to senior managers.
Sarah-Jane Waters, social worker and expert by experience
A consideration for Louise Casey could be a more holistic approach to person-centred care, reducing siloed working practices. It’s also worth emphasising the importance of involving those who need care in the design of systems. Co-produced projects, for instance, have been shown to save £7 for every £1 invested. This not only improves outcomes but also saves taxpayer money.
The process of accessing adult social care can feel daunting and impenetrable to those who need it. My elderly mother, who is currently caring for her husband with dementia, doesn’t really know who to involve or when. She lives in England, I’m in Wales, and my siblings are in another part of England.
We’re all struggling to navigate the system and understand what support is available in her area, what is appropriate, what services she can access, and what practical help she needs.
We’ve all agreed that a visual flowchart would be incredibly helpful – not only for clarity but also for accountability when issues arise. Such a tool could show how dementia services and carer support fit within the broader adult services framework, list relevant contacts, and clarify when to engage each service.
It would be invaluable to see how GPs, hospital clinics, occupational therapists, and social care services interconnect, what to expect from each, and when to use them.
The current system is incredibly difficult to navigate, especially when each local authority operates differently and third sector organisations with short-term contracts are involved.
Rebecca Linton, a social worker in adults’ services
I think there should be a look back at what the Community Care Act was meant to achieve and whether this has been realised. With the mixed economy of care and purchaser-provider split the opportunity to commission a wider range of services came about.
However, if there was a vision of services coming from small local businesses then this has not happened and large scale companies predominate. There has also been a race to the bottom in terms of the pay and conditions of carers. This is unjust, exploitative and does not lead to the best care.
Adult social care should be a national service. People expect the same standards across the country and the Care Act applies nationally. If councils have to pay for social care then a large percentage of their budget is spent on services most people do not use.
This undermines local democracy as there is little to spend on services where the council has a choice and voting could make a difference.
What is social care? Much of what is now classed as social or personal care would have previously been seen as nursing. Any review of social care should look at the criteria for continuing health care.
The cap as proposed by Dilnot is regressive as those with modest assets will pay a much higher proportion towards their care. If the means test is to be more generous it would be progressive to have a more generous lower capital limit below which assets are ignored.