Social work's diminishing voice in a system investing in failure

Audit Scotland's latest briefing on community health and social care performance makes for sobering reading and confirms what social workers have consistently told us since the introduction of integrated joint boards: the current model of integration is failing to deliver. They are not meeting the needs of the workforce nor the communities they serve. 

For integration to work, Integration Authorities and HSCPs must genuinely elevate social work voices in strategic planning. This means that social work leaders must have genuine decision-making authority over budget setting, service redesign and workforce planning, not merely operational management responsibilities.  

Behind the statistics on delayed discharges, emergency admissions, and declining satisfaction with services lies a more fundamental problem: we are investing heavily in managing health and social support failure instead of building the preventative and community-based systems that could avoid it. 

The data reveals a system struggling under increasing demand, driven by high levels of poverty, increasing health inequalities, an ageing population, and diminishing early support, driving people towards crisis, while making minimal progress on the very shifts in practice that integration was designed to achieve. Despite a decade since the Public Bodies (Joint Working) (Scotland) Act 2014, we have seen only a 2.5 percentage point increase in adults with intensive care needs receiving support at home. Emergency admission rates remain stubbornly high, with significant variation across the country that cannot be explained by demographics alone. Integration in its current form has not only failed to solve the problems it was intended to resolve, it has created some new challenges of its own. We see social work and social care increasingly being used as a tool to help support a struggling NHS. Our members tell us that they often feel professionally lost and undermined in integration settings, where social work values are not always best used or understood. 

Most tellingly, the proportion of the last six months of life spent at home or in community settings has barely shifted: improving by less than one percentage point since 2018/19. This speaks to a profound failure to reorient services away from institutional care towards the community-based, person-centred approaches that evidence consistently shows deliver better outcomes. 

The Social Work Perspective 

What is particularly concerning from a social work standpoint is how these findings reflect the diminishing influence of social work voices and values in strategic decision-making. Social workers understand the importance of early intervention, relationship-based practice and addressing the social determinants of health. We see daily how preventative support can avoid crisis, how community connections sustain wellbeing, and how inequality drives demand. 

Yet the data suggests these insights are not shaping investment decisions. We continue to pour resources into managing avoidable crises - delayed discharges, emergency admissions, institutional care - rather than the preventative and community development work that could reduce them. The Audit Scotland briefing notes that only 31.2% of carers feel supported to continue in their caring role, a figure that has actually decreased since before the pandemic. This represents both a moral failure and a strategic one, as supporting carers is one of the most cost-effective interventions available. 

A System Designed for Dependency 

The evidence points to a system inadvertently designed to create and maintain dependency rather than to promote independence. When two in five adults feel they lack a say in their own care, when access to GPs deteriorates year on year, when people wait months for assessments while their situations deteriorate, we are not just failing individuals, we are guaranteeing more expensive interventions down the line. 

Social workers are trained to understand these dynamics, to work with complexity, to build on strengths rather than focus solely on deficits. Yet across Integration Joint Boards and Health and Social Care Partnerships, social work leadership and influence has been progressively marginalised. Chief Social Work Officers often lack the strategic authority to shape resource allocation as social work perspectives are routinely overshadowed by acute healthcare priorities in decision-making. 

The Path Forward 

 Audit Scotland's recommendation for Public Health Scotland to develop comprehensive performance indicators is welcome, but we need more fundamental change. We need to shift investment from reactive, institutional care towards preventative, community-based approaches. This requires courage from political leaders to invest in interventions whose benefits may not be visible within electoral cycles. It demands that Integration Joint Board members - councillors and health board representatives alike -challenge the default towards acute service protection when this undermines longer-term sustainability. 

Most importantly, we must recognise that social work is not simply another profession delivering health and social care services. At its best, social work offers a distinctive perspective on human wellbeing - one rooted in social justice, relationships, and community. As Scotland anticipates the launch of the National Social Work Agency, there is an opportunity to reclaim this voice. But structures alone will not suffice. We need the political will to genuinely reorient our health and social care system towards the preventative, community-based model that integration promised but has manifestly failed to deliver. 

Read the full report here: NHS reform plans must be delivered | Audit Scotland