Recognising the value of people who are paid to care

Katie Graham, Research Associate at the Social Care Workforce Research Unit, reports on care workers taking strike action in Doncaster.

During the last few months many care workers in Doncaster have been on strike. A three day strike ended on 22 April and union members have now started a further two weeks of action. UNISON members are taking action against changes to pay (including reducing weekend enhancements), sick pay and holiday entitlement. These planned changes are being implemented following the NHS loss of its contract to provide supported living services in the area. Given the rarity of unionisation and action within care work and the precedent that the proposed contract working terms and conditions would set (as more and more previously public sector services are transferred to the for-profit sector), it is curious that there has been such limited national coverage of the ongoing strike action.

In other parts of England social care providers and local authorities (the commissioners or funders of much social care) are subject to sharp criticism over the poor contractual conditions of care workers within commissioned services. Some home care workers have to endure zero hours contracts (Joseph Rowntree Foundation report) and non-payment of travelling time leading to below minimum wage payment. It has been confirmed by Care Minister, Norman Lamb, that there are 307,000 care workers on zero hour contracts (Community Care, 2013); work by this Unit has indicated that at least 150,000 workers in the social care sector may be getting paid less than the minimum wage (Hussein, 2011). And in 2013 the Low Pay Commission expressed its concern that social care workers are particularly vulnerable to poor pay and conditions of employment. The situation has been highlighted in the press and the House of Commons in part due to a recent court verdict in late 2013 (Whittlestone v BJP Home Support Limited) which ruled on the illegality of the non-payment of travelling time.

A recent review of the implications of adult social care budget cuts by Community Care (McNicoll & Stobart, 2014) illustrated the strategies councils are using to manage their limited budgets.  These included increasing the eligibility criteria (threshold for public funding entitlement), strict limits on care packages (e.g. no overnight care and reduction in the length of calls), increasing charges to service users, a ‘cap’ (upper limit) on council expenditure on social care, with budgets allocated to care managers to ensure they ‘understand fully the implications of their decisions’ on finances.  In spite of the government promising guidance for local authorities to address these concerns within the commissioning process another strategy seems to be the outsourcing of previously public run services and the re-negotiation of existing contractual arrangements with voluntary and for profit organisations. These may potentially reproduce the very conditions that have lead the care workers in Doncaster to take decisive action and the difficult decision to strike.

The Joseph Rowntree Foundation (Carr, 2014) recently released a summary of three major research projects looking at care work and low pay. These suggest that the evidence that connects low pay and poor quality of service is inconclusive.  However, it is emphasised that a combination of pay and working conditions including supervision, training, appropriate amount of time to fulfil tasks, need to be considered to ensure ‘job quality’ for the care worker and a quality service.

Historically there has been limited unionisation of care workers working in residential and community services, therefore there has been limited collective response to poor working terms and conditions. The policy of personalisation is leading to the development of a more dispersed and fragmented workforce. This makes the struggle, by those in a position to organise and collectively campaign, particularly difficult and important. By whatever means, there needs to be a wider recognition that ‘care work’ in its multiplicity of forms including practical tasks, assisting, prompting, skill development as well as relationship building, emotional support and developing trust in often intimate domestic situations, should be valued both financially and socially.

Care workers have always experienced low pay for demanding work so little has changed. In recent years we have seen undercover reporters exposing shocking images of abusive practices in residential settings and recently the BBC televised further instances of abuse and neglect of older people in residential care homes by care workers. Many such instances have been rightly responded to both by the criminal justice system as well as the regulator, the Care Quality Commission (CQC). However, there is a problem in individualising the blame (on a ‘bad apple’) rather than seeking to understand and address the systemic failings in how we organise and value front line social care. The combination of dismay at the regular practice of organisations creating savings by non-payment of care workers’ travel time and the ongoing strike action by UNISON members in Doncaster for commensurable terms and conditions of employment in an outsourced service, highlights the need for research and policy to take a holistic view of our care industry, recognising how the material and working conditions of the workforce must be directly connected to the quality of our care services.

Dr Katie Graham joined SCWRU in early 2013 and is working on a NIHR School for Social Care Research funded project comparing the costs and benefits of different models of adult safeguarding.

Social workers speak out: Remembering our beginnings

Katie Graham, Research Associate at the Social Care Workforce Research Unit, on why we should listen to the recordings of a group of interviews with social workers from the early 1980s.

The Social Care Workforce Research Unit at King’s recently hosted the launch of The WISEArchive Cohen Interviews, a fascinating collection of conversations with 26 social workers reflecting on the early days of the profession. We heard how Alan Cohen during the 1980s had sought out social workers he felt to be pioneers of the profession charting social work activity as early as the 1930s including well-known members of the profession, such as Clare Britton (later Winnicott), Eileen Younghusband, Rose Mary Braithwaite, Enid Warren and Margaret Simey amongst others. These tapes have thankfully been revived, transcribed by volunteers at WISEArchive and edited by Tim Cook and Harry Marsh after 30 years in storage.

Maggie Cohen, herself a social worker, Alan’s partner, shared Alan’s journey through social work, Family Service Units, Social Work lecturing and returning to full-time social work before retiring in 1996. Alan Cohen undertook the interviews with the intention of developing a book, but this did not materialise. Tim Cook described how he and Harry Marsh were invited by WISEArchive to edit, annotate and add context to the interviews with the aim of beginning to realise Alan Cohen’s vision. This work, along with all of the interviews, have now been archived by the Modern Records Centre at the University of Warwick and published online together with the original tapes.

Speakers at the launch of the Cohen Interviews

Participants at the launch on 28 November at King’s (left to right): Olwen Gotts (volunteer transcriber), Harry Marsh (editor), Maggie Cohen, Tim Cook (editor), Barbara Prynn, Helen Ford (Modern Records Centre), Pauline Weinstein (WISEArchive), Professor Jill Manthorpe (King’s College London)

One of the first questions Alan Cohen asked of his interviewees was how and why they chose social work. At the launch event, Pauline Weinstein, the director of WISEArchive, posed the same question to Barbara Prynn. The answer given by Barbara, as I suspect to be the case for many social workers both now and then, is not entirely straightforward and prompted many questions and comments from the audience. Remembrances of social work’s foundation as a negotiation between common sense, practical social work and the ‘psychoanalytical fringe’ and the cycles of policy making and changes in perceptions of ‘good’ and ‘oppressive’ practice. These interviews narrate the forming of ‘Social Work’ as a profession from the formative social sciences course at the London School of Economics (amongst others) and disparate professions of Psychiatric Social Work and Almoners. The coming, going and perhaps coming again (in Scotland at least) of community work, genericism versus specialism in practice as well as more foundational perspectives of the social work role and analysis of the individual and of structural inequalities were also areas of discussion and comment.

Listening to some of these interviews whilst writing this blog I would urge social workers and anyone interested in social work to play the tapes (very easy to do).  When Alan Cohen asked Enid Warren why she became a social worker she described it as, not an active choice, but the result of a ‘process of elimination’.  Geraldine Aves said ‘I had no intention of being a social worker’, but became a social worker ‘very much by the backdoor’ and Clare Winnicott took a long pause before she cited her family’s influence. Although the route into social work may not have been clear, there seemed to be a common thread amongst the interviewees of a determination to do something that could be useful.

Entry into social work is probably rarely uneventful and neither is the career. For myself, the daughter of two social workers, my choice may have been unimaginative. As a social worker I have experienced ambivalence about statutory social work practice this event and these archives offered the opportunity to look back, hear social workers talk about their experiences and dilemmas, and reflect on them in our current situation. The history of social work is a history of change, within, outside and hopefully because of the profession. Drawing on this history during the introduction to the launch of the archives Professor Jill Manthorpe of the Social Care Workforce Research Unit at King’s College London, the host of the launch, positioned this as its strength, adding her personal view that ‘all social workers are pioneers’, members of an evolving and hopefully responsive profession. I left this event in a reflective mood, keen to listen more and would like to thank all involved in making these archives accessible to us all.

Katie Graham is Research Associate at the Social Care Workforce Research Unit at King’s College London. The launch event took place at King’s on 28 November 2013. Those with an interest in social work history may also like to join the Social Work History Network.

@scwru | @wisearchive | #cohenint

Nearly there? The Care Bill and adult safeguarding

Caroline Norrie and Katie Graham provide an update on the progress of the Care Bill through Parliament with particular reference to its impact on adult safeguarding.

The Care Bill—described as “the biggest overhaul of social care rules for 65 years” (The Guardian, 9 October, 2013)—had its first reading in the House of Commons last week after completing its passage through the House of Lords. The scope of the Bill is extensive, attempting to amalgamate the dispersed and patchy adult social care legislation and including stipulations around social care assessment and funding changes. However, as researchers working on a project about adult safeguarding, we have been following the new adult safeguarding components of the Bill with much interest.

Katie attended the second reading of the Bill on 22 May. Lord Howe presented wellbeing as a central principle of the Bill whilst outlining plans for care funding arrangements (following, though not implementing, all Dilnot’s recommendations), a response to the Francis Report (not including the recommended regulation of social care and health care assistants), a strengthening of carers’ rights and a commitment to place adult safeguarding on a statutory footing.

The principles behind the Bill appeared to be welcomed by many of the speakers that day in the House, although with important caveats. Lord Howe alluded to one of the fundamental difficulties enacting the vision when saying “[a]s a nation we are living longer, which I am sure all noble Lords welcome. Managing the fiscal consequences of this will be a key challenge in the coming years”. Baroness Wheeler brought into stark reality the dire state of local authority funding, highlighting that councils “…by the end of this spending round, will have been stripped of £2.7 billion from their adult social care services, equivalent to 20% of their care budgets, as demand for services increases”.

More recently Caroline attended the House of Lords to listen to amendments tabled at the Bill’s 1st sitting of the report stage on 9 October. Discussions included an amendment which was successfully tabled by the Patron of Action on Adult Abuse, Baroness Greengross, to introduce a duty on councils to provide people with an independent advocate during assessment and support planning if they would otherwise have difficulty in understanding or communicating information, and have no one else to represent them.

Baroness Greengross also proposed amendments aimed at giving social workers powers to obtain court orders to gain access to enter private homes where they suspect a vulnerable adult is being abused but coerced into silence. These amendments were defeated with ministers arguing that existing legal powers were sufficient and social workers needed to improve their skills and knowledge in applying them to protect adults. (Power of entry is already available to social workers in Scotland.)  A survey of The College of Social Work members last year showed strong support for a qualified power of access by a social worker to interview a vulnerable adult where this was being blocked by a third party. Lobbying on this issue continues.

Other elements of the Bill with specific implications for safeguarding practice include:

Enquiries by Local Authorities

The Care Bill proposes a new legal duty for local authorities to make enquiries when they have a reasonable cause to suspect that an adult in their area has a need of care and support, is at risk of abuse and neglect and is unable to protect him or herself. The local authority must make whatever enquiries it thinks necessary to enable it to decide whether any action should be taken in that adult’s case. The Care Bill also confirms, for the first time in law, that “abuse” includes financial abuse. That includes having money or property stolen; being defrauded; being put under pressure in relation to money or other property; and, having money or other property misused. Advocacy organisations including The College of Social Work have been active in lobbying to ensure that people with complex needs are assessed by ‘appropriately qualified staff’.

Safeguarding Adults Boards

Safeguarding Adults Boards are to become statutory and to be composed of multi-disciplinary members. Again, The College of Social Work, amongst others, has been vocal in lobbying to ensure that the local authority representative on safeguarding adult boards should be social work-qualified.

Safeguarding Adult Reviews

The Care Bill proposes local authority Safeguarding Adults Boards must carry out a formal case review if an adult at risk in their area dies in circumstances where abuse or neglect are known or suspected. It must also carry out a review if it suspects that an adult has experienced serious abuse or neglect. Any review must identify the lessons to be learnt from that adult’s case, and apply those lessons to future cases. The stated aim of a review will be to ensure that lessons are learned from such cases; not to allocate blame, but to improve future practice and partnership working, to minimise the possibility of it happening again. With regard to this issue, The College of Social Work has argued for Safeguarding Adult Review teams to “include a social worker with substantial experience of safeguarding work”. Our Unit continues its work on the current system of Serious Case Reviews for adults.

Last week saw the third reading of the Bill in the Lords; a time for tweaking with no major changes suggested. However, there was considerable discussion over an amendment that was tabled, but which after discussion was removed. This focused on safeguarding of vulnerable adults in ‘approved premises’. Lord Patel of Bradford argued that vulnerable people in probation services are not adequately catered for in the Bill and called for a review on “the discharge by probation trusts of their responsibilities for safeguarding adults residing in approved premises” a year after the enactment of the Bill. Lord Patel argued that planned privatisation of probation provision could make it difficult to ensure effective safeguarding provision for those people using probation services. This abandoned amendment raised once more the question of the clarity of roles and responsibilities of all agencies working with people who may be at risk of abuse.

When summing up her contribution to the second reading of the Bill Baroness Campbell said that much depends “on how local authorities choose to implement their responsibilities and powers under this legislation. There is a great danger that this Bill could be ignored as fine words but without teeth”. We await to see what changes, if any, will be made to the Care Bill as it now proceeds through the House of Commons.

Caroline Norrie and Dr Katie Graham are both researchers at the Social Care Workforce Research Unit, King’s College London. They are working on: Models of safeguarding: a study comparing specialist and non-specialist safeguarding teams for adults – currently in its fieldwork stage.

Practice into Research

Katie Graham, who recently joined the Social Care Workforce Research Unit at King’s College London, reflects on practice, research and the recent Department of Health conference on Adult Safeguarding.

The connections between practice and research seem pretty obvious in theory given the emphasis in social work training upon becoming ‘research-minded practitioners’. But they are often difficult to realize, with increasing workloads and the pressure of daily practice pressures of risky, even worrying, situations. I started working at the Social Care Workforce Research Unit at the beginning of April after having been a social worker in a specialist adult safeguarding team in a local council.

My transition between practice and research has been a fairly smooth one – particularly once I’d overcome the urge to case note each conversation I had! I am working on the ‘Models of Safeguarding’ project, so this research is directly connected to my recent practice. Last week I attended a Department of Health organised conference ‘Adult Safeguarding: A Return to Practice’ which further helped to ease my transition as it was a conference specifically designed to make research available to practitioners. The event was an interesting mix of policy discussion related to the Care and Support Bill and practice guidance from ADASS. There was a discussion of the neglected role of housing in adult safeguarding and practice innovations in the prevention in adult safeguarding. Of great relevance to the Unit was a discussion by representatives from SENSE about the complexity of safeguarding alerts with adults who may be perceived to be ‘at risk’ but where no intentional harm is evident. The speakers from SENSE described their approach to safeguarding when working with deafblind people who communicate through touch. I will be talking more to the Unit’s Phd student, Peter Simcock, about this – since this topic is the focus of his doctoral research. A final presentation from Dr David Orr related to his research around self-neglect.

Mike Briggs from ADASS (2013) outlined its new ‘top tips’ for adult safeguarding. His presentation contained vital information for any practitioner and researcher in this area. However, what was striking was how policy statements hide the complexity of daily work in social care, whether working as a social worker, personal assistant (independently for an employer) or support worker in a large organisation. The potential to place adult safeguarding on a firmer statutory footing with the Care and Support Bill (2012) is welcome, however it will be its eventual guidance that will likely be most useful to social workers’ daily decision-making. Jeremy Hunt, the Secretary of State for Health, has said of adult safeguarding that councils have been “ticking the box, but missing the point” (in ADASS 2013: 3) suggesting an over-reliance on processes rather than outcomes for people.  Rigid constructions of ‘abuse’ and ‘harm’ and a person ‘at risk’ may be as damaging as inaction but, as a recent article by Angie Ash (in the British Journal of Social Work) suggests, social workers often do not take action.

The conference emphasized that adult safeguarding is ‘everybody’s business’. However, from my own perspective finding my feet in a research environment, it is also clear to me that research and practice are not (and should not be) far apart in this area of work. It is through dialogues (and the potential of action research –  see Joan Rapaport’s earlier blog), including the experiences of people perceived to be ‘at risk of harm’, that we can develop interventions and gain the skills and confidence to effectively minimise the risk of harm. Social workers have a strong tradition of respecting people’s rights to self-determination but also their rights to protection. The Models of Safeguarding project, investigating how different councils organise their safeguarding adults responsibilities, is engaging with these complexities.  I think that this resonates with everyday social work practice.

Katie Graham is Research Associate at the Social Care Workforce Research Unit.