Social Work Practice with Adults

Di Galpin, Natalie Bates

• Publisher: Learning Matters
• Year: 2009
• Print ISBN: 9781844452927
• eBook ISBN: 9780857252425
• Edition: 1
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

Based on the experiences of social work practitioners, this book provides a detailed account of contemporary practice issues that can influence social work with adults. Written by different authors, each chapter covers a range of topical debates from the assessment of needs, rights and risk in learning disability services, to direct payments and the implementation of individual budgets.

This book is a useful resource for social work students completing the Consolidation and Preparation for Specialist Practice (CPSP) programmes and those embarking on the Post-Qualifying Specialist Award in Social Work with Adults.

Chapter 1

Personalisation: from consumer rights to human rights

Diane Galpin

ACHIEVING A POST-QUALIFYING SPECIALIST AWARD IN SOCIAL WORK WITH ADULTS

This chapter demonstrates how you might meet the GSCC specialist standards and requirements for post-qualifying social work education and training.

Legislation, social policy and social welfare

Social workers will need to extend and apply their knowledge and understanding of all relevant legal frameworks, social policies and social welfare principles within their particular area of practice. This includes all relevant legal and policy frameworks and the range of statutory responsibilities associated with working with adults. It also includes relevant legal and policy frameworks relating to mental health and the welfare of children and young people, together with the law relating to equality legislation and human rights.

Introduction

Social work practice with adults in the United Kingdom has undergone significant change as policy from central government over the last decade has focused on the modernisation of adult social care. Personalisation has been central to policy development in promoting self-directed and independent living for those eligible for services. It has also provided practitioners with an ideological framework on which to develop their practice focused on enabling those who use services to increase the level of choice and control they have over their own social care provision. Central to this approach has been the embedding of person-centred planning in practice to develop individualised responses to individual need supported by the development of individualised payments to those who use services from government in the form of personal budgets.

This chapter seeks to analyse the development and implementation of the personalisation agenda to explore whether while appearing to empower some users of services, personalisation also has the potential to undermine the protective frameworks that currently support practice with adults as rights become synonymous with consumer rather than human rights. Could personalisation increase marginalisation and compromise the human rights of those most vulnerable in society?

Background

ACTIVITY 1.1

• What do the terms ‘modernisation’ and ‘personalisation’ mean to you?
• What policy and legislation underpins the ‘personalisation agenda’?
• How do these influence your practice?

The organisation and delivery of social work services across the United Kingdom has seen significant change in the last decade. Two key strategies have underpinned this process: first, a shift in governmental responsibility from primary provider to regulator of services (Waine, 2000); and second, a greater emphasis on the role of service users, carers and the private and voluntary sector in transforming statutory service development (National School of Government, 2007). Leadbeater et al. (2008) suggest improving provision for those who use public sector services is dependent on utilising their skills and capacity to develop and manage self-directed health and social care pathways that transfer patterns of provision from the public to private sector and control from the professional to personal realm. To support these improvements, government has developed a strategy of modernisation and transformation built on the concept of personalisation. While England, Scotland, Wales and Northern Ireland have their own legislative and policy guidance, the concept of personalisation provides a framework for social work practice with adults in statutory services in the UK today.

ACTIVITY 1.2

Team discussion – how does social policy relate to your practice?

Policy briefing: Modernising Social Services (Department of Health, 1998a)

This White Paper presented the new government’s plans for modernising social services provision. It stated the principles underlying the government’s ‘third way’ in relation to social care, which de-emphasised the status of the provider in favour of promoting independence and ensuring the delivery of quality services, and noted the establishment of a Social Services Modernisation Fund. The paper went on to outline proposals for improving services for adults and for children. It then set out proposals for general improvements in user protection, the system of regulation and workforce standards, and noted the intended establishment of the General Social Care Council. The paper’s concluding sections explained plans for facilitating partnership with the NHS and non-statutory bodies, and presented a framework for cooperation between local authorities and central government in promoting the delivery of efficient, high-quality services.

Key areas of particular concern included:

• protection of adults exposed to neglect and abuse;
• coordination to ensure individuals were not left in hospital too long;
• inflexibility of service provision;
• clarity of role, the general public did not know who would provide services, what services were available or what standards could be reasonably expected;
• consistency, there was a huge difference in standards and levels of service between different local authorities that led to a general feeling of unfairness, christened in the media as the ‘postcode lottery’.

This White Paper provided a framework for government to develop subsequent policy and legislation used in practice today. Look at the key areas above and identify:

• policy and legislation introduced since 1998 that seeks to address these issues.

Discuss:

• how successful these have been. (Where possible, identify any research that supports your evaluation.)

Personalisation and social care reform

ACTIVITY 1.3

• Produce a definition of personalisation – first, from a practice perspective, and, second, from a policy perspective.

Hudson and Henwood (2008) suggest personalisation ‘has developed from the social model of disability and the emerging ideology of independent living’ (p18) that identified the barriers to achieving independent living that individuals with a disability faced. The report ‘Improving the life chances of disabled people’ (Prime Minister’s Strategy Unit, 2005) acknowledged that individuals with a disability were all too often viewed as passive recipients of care and dependent on the services professionals decided they needed. The report also suggested an individual with a disability was more than able to identify their own needs and, furthermore, to identify the best way of meeting them. Therefore, a new approach was required to enable those with a disability to take control of their lives and live independently. The Green Paper Independence, Well-being and Choice (DH, 2005), followed by the White Paper Our Health, Our Care, Our Say (DH, 2006) and Putting People First (DH, 2007b), provided further guidance on the government’s strategy of reform – to include the whole of adult service, not just those with a disability. These indicated that service provision should focus on a personalised approach that fitted service users’ needs rather than the needs of statutory services (Hudson and Henwood, 2008).

The central theme of personalisation is one of choice. Foster et al. (2006) suggest personalisation focuses ‘on the desired outcomes of service users. A commitment to assisting individuals to exercise choice concerning the types of services they prefer; collaborative and consultative decision-making processes; and funding arrangements that respond to, and uphold, the choices of service users, are core components of the personalised care approach’ (p126). Personalisation begins with person-centred planning, which provides a holistic foundation for social work practice to support individuals in achieving choice. A person-centred approach begins by treating ‘people as individuals with a unique history and personality, listens to their “voice” and recognises that all human life is grounded in relationships’ (CSCI, 2009, p123).

Carr and Robbins (2009, p3) identify ‘the introduction of individual or personal budgets as part of the wider personalisation agenda in adult social care’ and, as such, enabling service users to achieve the choice(s) identified in a person-centred approach. For social work professionals in the UK, this has resulted in government developing specific policy and legislation to support practitioners in promoting personalisation; for example, direct payments and individual budgets (Manthorpe et al., 2008). Direct payments provide monies from the local authority to individuals in lieu of direct service provision (Glendinning et al., 2008) while ‘individual budgets combine resources from different funding streams’ (Carr and Robbins, 2009, p2); for example, community equipment services, Disabled Facilities Grants, Supporting People, Access to Work and the Independent Living Fund (Carr and Robbins, 2009). Individual budgets (IBs) build on the experiences of direct payment and In Control projects (Poll et al., 2006). Research suggests individuals have more choice and control in determining the type of support they require, how it will be delivered and by whom, when a personalised approach is used built on person-centred planning, direct payments and/or individual/personal budgets (Glendinning et al., 2008).

Personalisation, arguably, facilitates a participative approach which Leadbeater et al. (2008) suggest ‘turns on its head traditional public service organisation. Traditional approaches put professionals at the centre of the process; participative approaches put the individual in charge’ (p11). In the context of social care, Leadbeater et al. (2008) argue that by giving individuals their own budget they are able to develop the service solution that makes most sense to them.

Evidence suggests personalisation has benefited some service user groups. Research by Hatton et al. (2008) on person-centred planning with individuals with a learning disability suggests that this approach can provide real benefits to this service user group. Recent research from Glendinning et al. (2008), in their evaluation of an IB’s pilot programme, suggests for those with mental health and physical disabilities, IBs appeared cost effective on social care and psychological well-being outcomes. However, for individuals with a learning disability results were mixed and for older people the evaluation states:

We found that older people were less likely than others to report higher aspirations as a result of the IB process. A statistically significant finding for older people suggested those in the IB group reported lower psychological well-being than those in the comparison group. (Glendinning et al., 2008, p19)

Although reasons for this are not yet fully understood the extension of personalisation continues.

Policy briefing

The future of adult service provision is outlined in two key papers from government.

Our Health, Our Care, Our Say: a new direction for community services (DH, 2006)

This White Paper builds on the Green Paper Independence, Well-being and Choice (DH, 2005) and states there will be a radical and sustained shift in the way services are delivered – ensuring they are more personalised and that they fit into people’s busy lives. The paper outlined the government’s agenda to increase direct payments to excluded groups with the introduction of individualised budgets and to develop a risk management framework to enable individuals to take greater control over decisions.

Putting People First: a shared vision and commitment to the transformation of adult social care (DH, 2007b)

This protocol sets out the government’s commitment to independent living for all adults, it also outlines the shared values and aims which will guide the transformation of adult social care, and it seeks to develop a collaborative approach between local and central government, the sector’s professional leaders, providers and regulators to facilitate the development of a personalised system of adult social care.

Personalisation and marginalisation

Defining marginalisation

• Marginalisation: being involuntarily disconnected from the economic and social mainstream of the society in which one lives; generally involves being discriminated against, being poor, having limited personal and collective power and being excluded from social opportunities.

Marginalisation is a multi-layered concept linked to social status, it shifts as individuals move through their lives. Someone employed in a good job can become marginalised by unemployment. Similarly individua...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Foreword to the Post-Qualifying Social Work Practice Series
• About the authors
• Acknowledgements
• Introduction
• 1 Personalisation: from consumer rights to human rights
• 2 Working with older people: managing risk and promoting interdependence
• 3 The rising profile of informal care: modernisation and the future of carers’ services
• 4 Assessment and practice in learning disability services
• 5 Direct payments and older people: developing a framework for practice
• 6 Transformation: a future for social work practice?
• References
• Index