I read a blog post on the Community Care website this morning about the need for social workers to ‘challenge consumerism in social care’ and particularly in care for older adults.
Generally, I agree with much of that written. Since I qualified as a social worker – apart from a couple of years out of the profession entirely – I’ve worked in older adults’ services either in generic or mental health services specifically and the push towards a mixed up kind of consumerism has not served users well.
There are some elements that have been helpful and positive – from the introduction of direct payments and personal budgets to the increased support that is now afforded (quite rightly) by carers.
The post though draws some interesting points and although I think there is obviously limited space, there were some particular issues I wanted to pick up on. The authors, Professor Keith Brown, Dr Steve Keen and Andrew Harding – write
Consumerism is supposed to be synonymous with choice, efficiency and a rise in standards. In reality, it has contributed to an indifferent attitude where abuse and neglect has been institutionalised. In this context, ‘choice’ has been thrust upon a social group who often feel either unwilling or incapable to make consumer decisions. be empowered by the decisions inherent with consumption.
While broadly sympathetic, I’m not sure that I would necessarily make a similar statement.
There are two tiers of consumerism, certainly. There are two elements at play in the process since the implementation of the 1990 NHS and Community Care Act and I think it’s important to differentiate between the effects.
The first is the introduction of the purchaser/provider split in the provision of services in adult care where directly provided services by local authorities were able to be tendered for the lowest bids. This was the Thatcherite model of consumerism = greater efficiency.
Initially, I remember back in my first days of qualifying, completing extensive ‘unmet needs’ forms and having a greater ability to work within the budgets that we were ‘given’ on the basis of needs which we would do in conjunction with users, of course. Then the money started to run out. The flexibility and the criteria narrowed. Local authorities developed larger contracts with private providers and agencies after phasing out their own directly provided services and the choices we had as care managers narrowed substantially as we could only use the services that had been ‘block purchased’ by the local authority. Whether that was residential care or home care. Quality did drop as although these block contracts were monitored, they were often tied up in reams of red tape which was unable to be broken and the ultimate decisions given to the service user or the care manager were very limited. Agency A or Agency B. Often with the same carers working for both agencies.
Yes, direct payments were introduced which greatly helped some people. The post in Community Care seems to have dismissed the positive response that some people have had to increased choice by talking about a ‘social group who.. feel unwilling or incapable to make consumer decisions’. The answer is not to take that decision making and flexibility away but to better implement advocacy services – whether by qualified social workers or not (I don’t see care management as being a reserved social work role) rather than ‘blaming’ the service users for not wanting to engage with what are discriminatory and ‘broken’ systems.
The post goes on to say
While it may be insensitive to assert that young disabled adults have had a relatively ‘good deal’ from recent legislation, older people certainly have not. Similarly, legislation surrounding child care provision has shown signs of evolving and learning from the tragic cases of Victoria Climbie and Peter Connolly. A comparative learning process, or evolution has yet to take place within the social work profession for for older people.’s services.
And with that, I’d broadly agree but authors go on to blame the social workers who are working in adult services for not advocating sufficiently for the user groups that we work with and I would strongly challenge that.
As someone who has, since qualification, been advocating as strongly as I can within my own service for an equality of access and opportunity for older people, I find it a bit irritating that academics who are so far removed from front line practice, lecture to me about what I should be ‘challenging’ and assert that ‘we (social workers) should be more vocal’.
Well, maybe there’s a different in societal perceptions of older people that is also working against us and maybe, you know, we need the support of the wider social work community to put the needs of older adults at the forefront of every campaign that is run. There is poor general understanding of what social work is in general but particularly social work with older adults, I’d guess, unless someone has direct experience.
There are fewer social workers working with older adults and it is important not to discount that younger disabled adults generally are better able to advocate for themselves and children, of course, get all the press attention, there are fewer organisations and less general public sympathy to pull on for those of us advocating for older adults.
And it shouldn’t need to be an ‘us versus them’ type of challenge. I think that one of the ways that older people do lose out is that ‘age related disability’ has been allowed to draw fewer funds than equivalent disabilities which may be experienced pre-65.
So to the authors of that article, I’d like to ask them, genuinely, about the experiences that they all have in delivering care for older adults as social workers because there are many many voices within the profession and within the offices advocating internally but our voices cannot be heard outside our own echo chambers because there is no one ‘on the outside’ picking them up.
I would also ask them this. How much of the social work course in Bournemouth covers working with older adults? What do university courses need to do to ensure that there is an equivalence of training in their own departments in working with the needs of older adults?
I remember when I went into my first post-qualifying job in a older adults team, some of my course mates mocked and scorned as they thought somehow my job was ‘easier’ than their snazzy front line child protection jobs. I remember saying quite passionately that I wanted to work with older adults because I felt there was so much more that needed to be done in that area and that often the needs of the user group lagged behind other ‘areas’ of social work. I wanted to make changes. I wanted to advocate. I wanted to make it a more progressive area of social work to be in and where all the brightest and the best social work graduates would immediately want to come because of the dynamic work that is being done with older adults services.
I still think that to be honest, but I have come to realise that I can’t make all of those changes myself. I don’t want to step away from front line practice either. I do think that it isn’t just front line social workers that need to promote and push – perhaps some of our university based colleagues can also do more work on advocacy and promotion and challenging assumptions. In the end, working together and building new models of working requires more than saying ‘you guys in the front line – you aren’t doing your job well enough – you should be challenging more’. It requires changes throughout the profession and the professional training processes so that work with older adults is not seen as second rate but as first choice. It always has been for me.
So maybe they should consider wider issues of the lack of a role for advocacy in social work before laying the task at the door of those of us who have been desperately shouting for our voices to be heard for many many years.