An alternative winter plan for social work

Following on from our recent Community Care piece, Michelle Janas and I have been discussing between ourselves and some others what our concerns are about the DHSC winter plan for adult social care and propose some alternative measures aimed at supporting social workers to support the people already bearing the brunt of the impact of Covid.

‘It is the responsibility of social workers across the world to defend, enrich and realize the values and principles reflected in this definition. A social work definition can only be meaningful when social workers actively commit to its values and vision.’

(Practice commentary note on the Global Definition of Social Work)

Concerns about the message sent by the easements

An important, so far overlooked, point is the message that the easements send to councils: that it is permissible to suspend key rights with Covid as pretext. As has been shown, few councils triggered the easements yet there is evidence that councils cut and denied support to Disabled and Deaf people during this pandemic.

We are particularly concerned that this message has been sent again, and backed by the Chief Social Workers, who have not explained or taken ownership of their position on this at all. We need more than ever our leadership to support and reassure us that they understand and take seriously the implications for social workers who are worried that they may be instrumental in admitting people to care homes in which there is possibility they may succumb to Covid. We need to keep Covid out of care homes and supported living schemes altogether, if at all possible. The winter plan as it stands, although not explicitly referencing supported living, allows for the possibility of Covid-positive people to be admitted to care homes or placed (dreadful word, though apt in too many cases) in group supported living homes, which, as has been shown, are not able to contain the contagion.

Home care

Home care also presents a risk. Due to the current system, multiple workers visit various homes throughout a given day. Discharging any Covid-positive or Covid-indeterminate people back home presents a risk to their families, friends and informal carers, to formal carers, and to people any of those people come into contact with. At particular risk are those other Disabled and older people that care workers visit in the day, as the risk of infection is far greater with close contact such as when providing personal care and Disabled and older people are at greater risk from Covid.

What is the argument in favour of the easements?

There is an argument that councils triggering the easements at least are acting transparently and accountably. Given few have done so and there is no reason to believe they will this time either given the apparent informal extra-legal suspension of rights. Scrapping the easements won’t stop councils doing that but it will leave intact those legal safeguards that enable people to challenge councils’ decisions. There is another argument that the ease and apparent impunity with which councils have cut and denied care and support to people presenting in need exposes fundamental flaws in the Care Act that scrapping the easements won’t solve. We agree with that but would contend that is an ongoing issue that needs addressing over time but for now it’s imperative to leave in place what safeguards there are.

Who are we listening to?

Inclusion London are campaigning against the easements on the basis of their members’ concerns, born of experience, that they are already particularly vulnerable to Covid and easements place them in an even more vulnerable situation. The recent Amnesty report is also an important document in that regard. It should be noted that, despite what the BASW CEO said in her recent statement, Amnesty do acknowledge the role of social work, albeit in a way that is perhaps not in keeping with the narratives the profession usually seeks to promote, by publishing parts of an interview with one of the authors of this piece, social work student, qualified immunologist and care home volunteer Michelle Janas, who raises concerns about the lack of engagement with the issue of Covid in care homes by the social work profession. A position her co-author on this piece very much agrees with.

We understand that directors of adult social care are worried about capacity during the second wave yet the fears of widespread staff shortages, for example, arising from Covid infection were not born out. Anecdotally, we can tell you that many adult social workers spent the lockdown safe at home arranging and overseeing, among other things, hospital discharges while literally thousands of older and Disabled people died, often alone, in care homes and supported living homes, as well as many hundreds of care workers. Having said that, there is likely to be increased demand and pressure due to the usual winter challenges placing strain on a health system recovering from the first wave. We note that the seven Nightingale hospitals built during the first wave were barely used, in no small part due to the fact that the NHS, already facing a shortage of nurses, couldn’t staff them. It’s one thing building hospitals, another staffing them in the context of a NHS staffing crisis exacerbated by the current government’s immigration policy. Social work should never support any plan that makes older, Disabled & sick people pay for ideological policy failings.

We believe social work needs to send a strong message that it does not accept that it should be complicit or instrumental in a system in which human lives are sacrificed on the altar of organisational and political expediency — a central plank of government’s response since the outset has been ‘protect the NHS’ — and that the right way to protect the NHS is to properly resource it, not victimise people whose vulnerability as a result of social circumstance is compounded by a pandemic which disproportionately impacts them.

At the same time, we must find ways to support social workers with the reality of what we are facing, because that funding is unlikely to materialise. However, we believe it is an important function of this profession to assert its values, principles and missions in the face of policy that runs counter to the rights, interests, wishes and aspirations of those we hope and aim to support.

Human rights implications

Lawyers at 39 Essex Chambers have produced an excellent note on the implications of the winter plan which summarises much better than we ever could the various legal and human rights ramifications of the plan. Social workers will be absolutely at the heart of these issues and we see a key role here for both the Chiefs and BASW to support them in negotiating the day to day practice issues and dilemmas that delivering the winter plan will throw up. We note with gratitude BASW’s work on producing guidance for social workers throughout the pandemic which is a good basis on which to build winter plan-specific guidance.

Recommendations

The Chief Social Workers should explain their rationale for supporting the easements and offer reassurances that social workers will be supported by their office throughout the winter challenges, and to state what that support will be.

Specifically, the Chiefs should detail their plan to support social workers who will be organising and overseeing hospital discharges, whether to care homes, supported living or to people’s own homes, within the context of the winter plan and the easements which they have advised government to continue.

BASW and the Social Workers’ Union should promote awareness of and discussion about the easements and to articulate the arguments for and against the easements before taking it to a members vote about the position BASW/SWU should take on the measures.

BASW should offer an alternative winter plan for social work comprising:

• Continually updated guidance on how to support, promote and uphold human rights in the context of winter pressures (drawing on the work of 39 Essex Chambers)
• Guidance on promoting creative models of practice in crisis. For example, The Amnesty report highlighted a lack of engagement from local authorities and NHS discharge teams during the crisis (see p17, p19, p24 and chapter 5), which contributed to the violation of the human rights of older people. To protect against this and to ensure that each residential facility has a direct professional social worker contact, local authority teams could divide care homes and allocate to individual social workers accordingly. Thus each social worker would be responsible for a select pool of residential homes. The social workers would be incorporated into the regular testing regime implemented in the care homes (and therefore ensuring residents are protected) and would become an approved professional visitor.
• Campaign and/or guidance to support the mobilisation of student social workers to enact the Care Act principles of prevention, reduction and delay through a programme of community engagement and capacity building. There is a wealth of knowledge and experience in practice and the academy who could potentially assist with this. Concerns about exposing students to risk of infection could be addressed by harnessing the new normal or tech-enabled remote working, about which there is expertise in the profession that could be readily drawn on
• BASW should promote a ‘Winter of Love’ for social care in which we reflect on what we love about social care and what, in all honesty, we don’t. Which bits do we want to keep? Which do we want to ditch? Support and promote a national conversation. Invite organisations like Social Care Future, In Control and user led organisations like Inclusion London to be part of the discussions and feed the findings into the forthcoming reform of adult social care. (We recognise that a ‘Winter of Love’ risks appearing ‘tone deaf’ or out of step with the concerns of citizens and social workers struggling with the winter challenges if not attended by proper acknowledgement of the concerns and a commitment to making social work and social care work for the people not for the systems and structures.)

These are just some of our suggestions. We would be very pleased if this contributed in some way to generating further discussion and ideas.