News and Comment

Can we afford to care?

Thursday 10 April 2014

By:

I had a harrowing day recently sitting with the top team of a really impressive local authority, trying to cut the second 40 percent out of the budget. These are good people, committed to their residents, running an efficient and effective organisation, with good performance – and they have already managed to take 40 percent out of the budget for 2010-14 without really causing much harm. It’s an ironic testimony to the competence of local councils that they managed to cut so much without residents really noticing, but of course it meant that there was nothing to stop the government from coming back for more.

But this time it will be different. This time valuable services will close. Community grants will be cut. Social workers’ jobs will be threatened.  I can’t help thinking how tragically short-sighted all this is.

We began to discuss the impact of cutting adult social care and children’s services – something councils have really tried to avoid so far, but you can’t take scores of millions out of a council budget without affecting the services that spend the most money.

We talked about how, twenty years ago, care services were run on far smaller budgets, with fewer social workers. But that was before the complex assurance systems that we now have were built up – before safeguarding systems were introduced, before everything was computerised and recorded, before regulation and inspection.  We seem to have created a very expensive, gold-plated set of care services – with highly complex accountability and reporting procedures which take a lot of time.

Participle have shown that up to 85 percent of social worker time is spent at computers or in meetings with other professionals, and only 15 percent actually with troubled families.

Eileen Munro, in her review of child protection, talked about “a defensive system that puts so much emphasis on procedures and recording that insufficient attention is given to developing and supporting the expertise to work effectively with children, young people and families.”

But now, with the cuts facing local authorities – we can no longer afford to do things in this complicated, risk averse way. We need social workers to spend far more of their time with families and children, intervening to help them rather than just assessing and recording.  Social workers will need to each carry greater case-loads, and will have to use their courage and wisdom and judgement to work out how to prioritise their work. We’ll need to spend less time feeding computer systems and more time caring for people. But at the moment, the regulatory and inspection machines don’t seem to recognise this – they are making no allowances for the scale of the cuts – and councils fear that they will be penalised if they try to reduce staffing levels or change working practice.

I had a related conversation with a young mental health care assistant, who said that now when she visits a service user with mental health problems she has less time to explore how they feel , because  she has a ‘script’ of questions to ask and  has to record everything she does.

A councillor I spoke to yesterday talked about “care organisations that don’t feel as if they care.”

The danger is that we put increasing pressure on the parts of the system that listen to service users, and respond to them, while keeping in place the control systems that squeeze the autonomy of professionals and makes users feel like cogs in a machine. The regulation and inspection regimes are going to have to respond to the fact that services can no longer be run the way they used to..

It might not mean more risk, if our social work leaders are creative, caring and wise. But it can’t mean continuing with the cumbersome processes that we established in the following years when 60 billion was pumped into public services.  Spending levels will soon be back to the levels of 2002 -3 – before we could afford this complicated assurance machine. If we can no longer sustain it, the sooner we begin talking about it the better.