Transcript: A watershed for social work in Scotland?

Podcast Episode: A watershed for social work in Scotland?

What follows is a transcription of the audio recording. Due to differences between spoken and written English, the transcript may contain quirks of grammar and syntax.

MD - Michelle Drumm
JL - Dr John Lincoln
AB - Audrey Burt
LW - Lynn Williams
SL - Sue Lavery
AB - Alan Baird

On 30th November 2016 the Health and Social Care Alliance, in Partnership with a number of Sector Organisations, including Iriss, posted a seminar entitled A Watershed for Social Work in Scotland. The event brought together people to explore the implications of the Audit Scotland Report on Social Work in Scotland. Michelle from Iriss.fm spoke to a number of people to get their views and reflections. Dr John Lincoln from Audit Scotland gave an overview of the challenges and what Councils are doing to tackle to.

MD John, thanks for speaking to me. Could you just give me an overview of the challenges facing Social Work Services?

JL Yeah there are a number of challenges that have actually come together for Council, Social Work Services, these include a think the first one is the demographic change in the sense that we would facing increasingly elderly population requiring more services for people and that will only increase over the next few years as particularly by 2035 there will be a huge increase in the number of very old people and I think thats leading to an increase in demand for services by about 1 % per year, every year. The second thing is that because of Health and Social Care Integration Councils are facing significant challenges in reorganising their services and where you have got reorganisation going on at the same time as lots of other things then that can create risks for Councils. Particularly in the light of the fact that Council Social Work budgets have been extremely squeezed for the past 5 years, although they have gone up slightly, they havent gone up to the extent that you, that would need to increase to meet the changes in demand due to the ageing population and I think finally there has been a lot of new legislation for example, the Carers Act, Childrens Act and several other pieces of legislation happened in the past few years and people that have I have talked to in the profession said they have never known such a large amount of legislation being implemented in the past few years and doing all of that takes up a lot of Management time, at the time of change.

MD So what are Councils doing then to sort of tackles these challenges?

JL Well, because of the financial restraints facing Councils, what they have been doing is changing their eligibility criteria to reduce the number of people that are eligible to receive services, for example, for older people the proportion receiving services has gone down from, I think, its seventy per thousand to fifty per thousand and the risks in that in the sense that you might towards prevention in the sense those people catching them early. The second thing that they have tried to do is they have contracted out a lot more services to the Private Sector and having done that they have then re-contracted out those services to try and save money, so they have put a real squeeze on their providers and thats let to reduced wages and wage pressures for those providers. I think they are probably the main things that they have done at the moment apart from in Childrens services where they have actually brought more services in house where they have actually brought people, children who, for example, looked after children, who were in special schools away from their Council, brought them back to the local area and looked at various way of keeping them within the area. Thats better for the children and also saves money.

MD And what would you like to see happen going forward then?

JL One of the main things that came out of this was that both providers and people who use services and their carers would like to be more involved in the design of services. Service Providers, some of the larger Charities work across the UK, work in 30 odd Councils in Scotland and they can input a lot in terms of best practice to help Councils, similarly there is an increase in pressure to design the, design services around the needs of people who use the services, rather than slotting people into services, for example through self-direct support and I think people who use the services would like to be more involved. So I think the challenge for Councils in terms of commissioning is to get everybody together, to try and design services better but to do that in a way that allows them to balance the budgets as well and we think that Council members and the Scottish Government need to be involved in the sort of National discussion on Social Work and where Social Work needs to go.

Audrey Burt, Alliance Associate Director and Chair of the event spoke about the purpose of the event and what struck her about the report.

MD What is the importance of this event today and bringing all these different stakeholders together?

AB I think as the title said, it is potentially a watershed for Social Work in Scotland, the thing for me and why I was really keen to chair it is, that it is getting it right for some of the most vulnerable in our society and if you looked at the beginning of the report one of the first things it says is we cant continue to deliver care in the way that we are doing at the moment. So this feels like a really pivotal moment and its very important that all voices are heard and thats why we wanted to do this, this day, to bring people together with lived experience and also with the experience of delivering services and across the whole sectors really, to reflect on well what does this mean and you know we need to take this seriously. The best way, we will be better coming together, we will be more than the some of our individual parts if we really look at what we can do together. So thats why I think today is really important, its not the end of the process of course but it is certainly an important step.

MD So some of the recommendations was the real focus as we say, working stronger together, involving people who use services and lived experiences. Is that really realistic and achievable or is it baby steps to get there?

AB I think if we look at the current situation with the IGBs, the indecreated teams in a way they have just got their governing situation sorted out, it feels very early days for them. I think what is really important is that there hearing this message, that people do need to be involved in the decision making, not just one a one to one basis but in planning services and how to deliver them as well. So I personally think its realistic as an ambition, I dont think it will be achieved over night and I do think we can, there is a huge elephant in the room and its around budgets. I think maybe there is an important discussion that has to be had around the funding that we are putting into these sectors. You know what is it we need to be thinking about in the future. Realistically we cant keep doing what we are doing. Do we need, certainly within the current envelope, do we need to widen that envelope. I guess is one of my questions here, which a question for wider society, I think, really. I mean one of the things that I was struck when I was looking at the report was on the re-ablement work that is going on and the impact that, that has, not just on individuals because if you ask any one in that situation getting back through independence, getting to as full activity as they can do, getting back to their own home will often be their goal. So prevention work like re-ablement is crucial for individuals but also in the best spending of a tight budget. You know so Im really keen to hear a bit more about some of the prevention work thats happening and how other can learn from that and see that it makes sense in every regard, really.

MD Following this event today, what would you like to see happen?

AB Well I would like to see us do some thinking about well what should the future hold, you know, what is it we need to be doing differently, what bold steps do we need to be taking, because you know its all of us in the room who can play a part in that. So some creative thinking around that, some challenge to all of ourselves and maybe some pointers where we can head, some of those baby steps as you called them where we can step off and start to make that difference cause we cant wait. I think the report says this very well and its not new, its not a new message, we need to be hearing it.

We also spoke to Lynn Williams, Carer, who bravely shared some of her story and told us what she thinks is working and whats not and how she is trying to bring a real life perspective to policy.

MD From your perspective what do you think is working in Social Services?

LW I think integration of health and care has got great potential. I think the intentions are there, I think the intentions are good but I think its got a long way to go before we get to that point. I think within the Social Work/Social Care that sometimes I think what works is largely down to luck and its down to having a professional that you know and you trust, so for example, we are working with an Occupational Therapist just now, who is fantastic, incredibly supportive, works with us as a family and that kind of, you know, has coordinated things for us, so that worked for us as a family, someone who was able to pull in the right services and the right support and knew about things that we didnt know existed, so someone who worked with us every step of the way, who listened to us as a family and sadly sometimes I think thats down to luck, rather than something you would expect. So there are things that do work but sadly I think they are either hidden or they are pretty rare and kind of you know, not easy to find and think whats easier to find is what doesnt work just now in terms of, you know, eligibility criteria changing, the massive increase in care charging which is pushing families towards the edge and some of the complexity that some of these services actually embody I think for me and I think for me as a carer its that complexity and the masses of bureaucracy. You know for me, if we could cut through some of that, that would make life so much easier. Is the willingness there, I would like to think yes. But I think there is still a sense of protectionism of between different services, you know, like this is my service and hopefully on the ground, I mean, I havent, our experience with the local rehabilitation team has not been, Ive seen people working together and thats good so whether you allow people on the front line to their jobs, because they know what to do and not be, let them make decisions, let them do what they do and what they were trained to do. The problem with Social care and I think the Audit Scotland Report really outlines that are the challenges that we are facing. These are important services. They touch your life quite profoundly in very profound ways and its difficult to get that right and we know there are financial challenges but there is also an incredible amount of waste in the system as well, you know, people duplicating things, having to tell you story again, again, again, again, you know there must be ways around this and I think there has got to be political will there as well, so unless there is political will to have a real debate about the future of care in Scotland then we will never move on we are just going to be tinkering and putting sticking plasters on which is kind of what we doing just now and not having a really honest debate about the future of social care.

MD Are you speaking tonight, is that just about your story or whats your focus on?

LW Em, well partly our story but also, Im also, dont want to use the word activist, but as a carer Ive spent a lot of time challenging and you know hopefully trying to bring a real life perspective to policy. Ive also worked In policy so I understand how policy works. What Im bringing today is the voice of other carers as well, so Ive spoken to carers from across Scotland that I know really well, Ive asked for their experience, what works well and mostly its what doesnt work well. So hopefully, yeah, partly for myself but partly for those carers out there who are just fighting against a brick wall and the relentless bureaucracy and just feeling of the services that are meant to support them are the ones that are fighting them, you know, its that kind of. So hopefully I will bring a bit of their voice as well today, fingers crossed. There are avenues for people, for carers to have their voice listened to but sometimes they are seen as being a nuisance politically and I think thats incredibly wrong and Ive a lot of that recently, people are felt they are being a nuisance or they are being negative and all they are doing is saying this is what my life is like. You know you are a Politician, you have the power to change this. So for Local Government officials who are listening to this, to Government Ministers, MSPs, you do have the power to change this but let us do it with you. You cant do it yourself, this is, you cant find a solution that you alone, legislation wont cure this issue, it will need investment, it will need a re-think about how these services actually work, it will need a re-think about how communities operate. So you know communities have lost a lot of things that create demand in these services, so this needs to be a complete re-think about how these things work and going back to the principals that Campbell Christie developed, to me, those four principals in the Christie Report are as relevant now as they always were, so that simplicity, the prevention, co-production, all these things that are widely banded about are still really important, so for me thats where we start.

Sue Lavery also a Carer gave her views on support and what needs to change.

MD You are at this event today, what do you think is actually working in social services?

SL Home Carers, they listen to mum, they respect mum. The Home Care Manager, as well listens to mum and respects mum. Number 1 she has her dignity but she is weaker and they help to empower mum, they listen to me as a carer. Mum self manages verbally but physically she has to reply on my husband and I and these wonderful carers. Day and night they come out. So that works and if more people had Managers like their Manager, their Line Manager, then I think there would be far more communication amongst the Carers. We want to care, we actually want to care for our loved one but we are human and we need support, the person needs support to maintain their autonomy as well. But I would say what works is good communication. But what I seek for from a policy is the words coming off the paper and being in acted and frankly unless somebody like Audit Scotland for example or COSLA, ensures, lets use the word, ensures that the higher archay of Management, the decision makers, higher up are engaging in practice, that they are persuaded to realise how vital it is to work with individuals who wish to self-manage and who are able to self-manage and the carers. I think some of them will need some persuasion, I think possibly, I have found it inaccessible to access higher Management, maybe an email but they have not respected my mum enough to come and ask if its possible to speak with mum, to get her opinion, is she able to or will she advocate that I speak with her, you know, on her behalf. They do not want to hear, we get emails oh we are looking into it. On evidence that I have seen, there needs to be something to, in the paperwork, that says they must communicate with carers. Yes in group settings but also where individual issues arise because how can they assess when problems are brought to them, when they completely ignore the individual and make the person feel as if they are not even her on this planet, they are ignored completely. I think they need to hear from the other side of the front door, what is working. What is the great stuff, what is the good stuff, what do the actual people who are requiring the support, minimal or maximum, their careers, what is working, what suggestions would we make because I have worked for many many years in the community, Social Work and in Health and working as a Carer gives you a very different insight, day to day. I meeting with other Carers, the reality.

MD Did you change your practice as an Occupational Therapist given your experiences as a Carer?

SL Yes.

MD So you can see things that you would change?

SL Yes I would do. I have more awareness of, that lady was talking there Lynn about the financial situation of having to buy cutlery, that utterly resonated with me both as an Occupational Therapist and my mum, my mums situation where we bought cutlery. It would give me far more understanding in to the demands of the individual, you know, when arranging visits and hearing what they say. You know I always try and think daily, weekly, now how can I be a better Occupational Therapist from this. Im far more aware of the third Sector as a result of this. The voice of the individual, no matter, for example like my mum who has sensory impairment but she knows her thoughts but she needs to be given the opportunity as does not happen with higher management, she needs to be listened to, she needs to be heard. She is a person with her own views, her values. Im simply there, as I say to mum, to give you support, even though she is physically weak, Im still not there to be mum, Im there simply to try and support mum, to be mum. She is still my mum and I love her. So thank you very much for your time Michelle and thank you so much for health and social care alliance. Thank you for everything you are such a support to myself and my family and the information you disseminate and you take from individuals like myself it keeps us very connected, especially as at the moment I am a carer and not able to interact so much. Thank you Health and Social Care and Iriss, etc. Thank you.

At the end of the seminar there were a number of short reflections. We heard from Alan Baird, Chief Social Work Advisor for Scotland.

AB Can I congratulate the Alliance for organising today and the richness of contributions that we have had this afternoon. They have been very influential for me and I guess for people in this room. Equally I think for John and his team ( unclear) Scotland the timing of this report is actually really critical. I was fortunate to have a number of very very good conversations with John as part of the process and I have to say John and the team have been very responsive and listening to some of the things certainly that myself and colleagues suggested. Im just picking up a number of things that I want to reflect back today. One of those is we have got a system that is far, far to complex. Lynn and I were reflecting in different Carers roles that we have about how complex the system is to work.

By all accounts if you dont understand the system or have no experience and it very struck also by the importance of coordination. For carers and users of service trying to find your way through this muddle is not easy and professionals dont make that any more straight-forward, we need to do something about it. The ( unclear) my point of view and I spend a lot of time out and about, around the centres, understanding in fact, Im in Aberdeenshire at the crack of dawn tomorrow morning. But what is clear is we need to de-bureaucratise the system. The system thats compliant to Carers is as complex sometimes as the professionals that work in and too much time is being spent in a process rather than what Social Workers and Managers as well say, we actually need to be spending that time, the experience, the knowledge, the skills, that we have not, not sitting behind a computer. We talked about consultation earlier on. I was very clear that we have gone far beyond the world of consultation, a world that actually gave lip service to what people thought (unclear) as professionals, what we thought was best. So, this rich engagement, I think, has begun, not just today but I think we are moving in to a world thats listening much more. Im struck by the First Ministers a thousand conversations with young people as leading the way and how things are going to change in the Care system as a result. We need to value our frontline staff, much better. It is essential that it was rightly pointed out today that feels undervalued and that came up in the Health and Sport Committee when I was with the Cabinet Secretary a few weeks ago, talking about the health and social care, workforce. We all need to contribute to valuing that better. You need to share excellent practice. There is, despite, some of the issues we talked about there is fantastic things happening everyday across this Country and we should be really proud of what we are achieving for those Carers and those who are in receipt of services but we not sharing the good practice and this one of the gaps for me. We need to, I think, begin talking, we talked about coordination. In Childrens Services and Children and Young Persons Act we talk about professional, there needs to be a lead professional in (unclear) care services. If that goes back to the coordination. We need to replace time and task with outcomes. That may cost a lot more money but I think it would be using the resource better in a way that I think we would be able to be used. So, the conversation on this complex and very challenging task has begun and we need to continue and I agree with you, Audrey, I think we need a National Conference that brings together representative that you have got today but on a much bigger scale. Well we need to plan that, we need to think about what we want to achieve and Im sure the write up from today will be very, very critical in influencing that. Somebody talked about turning a tank around, honest I had written that down before you had even said it. But we do need to turn the tank around. We need to point it in the right direction, where we actually meet all the right people, not just to turn it around but actually to get it to the place that the people of Scotland richly deserve and need and you know something Health and Social Care integration is fantastic and it will take time, that if we dont have the right people on more contributing and influencing that change and if we dont have a strong social care section then I do, I do have concerns about the future, although I think we would learn something but Im sure in fullness of time will change the way this country cares for those vulnerable systems.

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