Appendix 2. Social Work Policy
The context for social care procurement includes policies for social work and social care, which social care procurement makes a major contribution to delivering. Those policies include:
Changing Lives: Report of the 21st Century Social Work Review73 - The Report states that demographic, social and political trends pose challenges of growing need, demand and expectation, that will influence the future design and delivery of services. The solutions will need to engage people as active participants, and will involve professionals, services and agencies from across the public, private and voluntary sectors in a concerted and joined-up effort. The report proposes building capacity to deliver personalised services through building individual, family and community capacity; refocusing on prevention and earlier intervention; creating whole system responses to problems; and making effective use of the mixed economy of care. The report proposes building the capacity of the workforce to better use the distinctive knowledge, skills and values of social workers. The requirements will include leadership and effective management at all levels, including a new focus on citizen leadership which will enable people who use services to have real influence; a new focus across the sector on performance improvement and the delivery of agreed outcomes; and a structured approach to re-designing services and delivering change.
National Care Standards74 - Scottish Ministers developed the National Care Standards to ensure everyone in Scotland receives the same high quality of social care no matter where they live. The Standards explain what people can expect from any care and support service they use, written from the point of view of the person using the service. There are 6 main principles including all of the Standards: dignity; privacy; choice; safety; realising potential and equality and diversity.
Getting it Right for Every Child: Proposals for Action75 - The vision for children's services is that they: are accessible, and locally based; are of high quality; clearly demonstrate 'we're here to help'; encourage ambition; provide proportionate, timely and appropriate responses to each child's needs; promote and secure children's safety; strengthen the capacity of families and communities; take responsibility for action to improve children's lives; and are accountable to the communities they serve.
Modernising Community Care: An Action Plan76 -- established the initial programme for modernising the way local authorities reach decisions about community care as central to achieving quicker responses and better care by tackling five main areas: building effective partnerships with people who use services and their carers; setting clear strategic goals; reducing bureaucracy; making decisions more quickly; and delegating financial responsibility. The Action Plan said that local authorities' own services (especially residential care) are also usually treated differently to external services. To achieve the new aims authorities need to develop a detailed and uniform approach to buying and budgeting.
Community Care Outcomes Framework77 - The CCO Framework underpins the national performance framework and, under Single Outcome Agreements, allows local partnerships to understand their performance locally, at a strategic level, in improving outcomes for people who use community care services or support, and their carers. The CCO Framework has four national outcomes and 16 performance measures, grouped into 6 inter-related themes: user satisfaction; faster access; support for carers; quality of assessment and care planning; identifying those at risk; and moving services closer to users/patients.
Response to Care 21 Report: The Future of Unpaid Care in Scotland78 - Government policy is to support the objective of expanding choice to both carers and cared-for people, including proactive and targeted provision of information to carers, and the need to integrate carers' interests in service redesign. There is an expectation that carers will be engaged in local strategic decision-making, and ways should be found to ensure that people who use services and their carers have a strong voice in the way that they are designed and delivered.
Self-Directed Support - National Guidance 79 has indicated that self-directed support in Scotland is part of the mainstream of social care delivery, targeted at empowering people. It puts the principles of independent living into practice and enables people to be active citizens in their communities. This means that assessment of need will focus more routinely on individualising the support a person can receive, including offering eligible people self-directed support. This will require significant service redesign so that resources and support can be allocated on an individual basis.
Mutual Care Approach
Within the context of the Reshaping Care of Older People programme, it is also now proposed 80 that one of the key features of social care procurement should be the need to develop a 'Mutual Care Approach' that enables commissioners, providers and service users and carers to work together in mutually supportive ways to achieve agreed policy goals. A Mutual Care Approach would emphasise the community of interest which should exist between those involved in arranging and providing care with those who require support. The term also brings with it a focus on empowering and enabling individuals, treating them as citizens. It also recognises the key role played by individuals and communities in creating physical and social environments in which people with care and support needs can live independently for longer. This Mutual Care Approach requires a recognition that current service configurations do not always contribute toward meeting policy objectives. For example:
- The core policy objectives of enabling people to sustain optimum independence can be inadvertently undermined by services that all too often "do things to people" rather than support people to do things for themselves (for example maintenance based care that disables rather than re-ables);
- The policy objective of seeking personalisation of care can be undermined by block contracting of services based on "inputs" rather than "outcomes" (for example home care services based around specific tasks and time slots or contracts that result in large uniform care homes offering limited choice);
- Funding streams may 'lock' resources into tightly defined services and sectors that are based on past requirements and militate against the provision of flexible, responsive personalised care.
In order to achieve a 'Mutual Care Approach', the three key stakeholder groups: planning and commissioning agencies (Council Social Work and Housing Services and NHS bodies); service providers (statutory sector and private/voluntary sector organisations); and service users/patients and their unpaid carers (mostly families and friends), will all need to endorse clear common aims and purposes that recognise the mutually reinforcing roles each of these key interests brings.
This is likely to lead to a change in emphasis for each of these interests:
- Planning and commissioning - may need to be less prescriptive, setting down a clear strategic framework agreed with providers and users/carers that enables commissioning for outcomes. Personalisation of care through individually commissioned, outcome based care should flow from commissioning strategies, and this might be achieved through self directed support or through person centred outcome based contracting; agree
- Providers - will need to respond to outcome based contracts by focussing on supporting and enabling their service users to do as much for themselves as possible. Personalised care programmes tailored to meet agreed outcomes will set the context for service provision; reablement is not for all with shift a high % will be maintenance and should be recognised
- Service users and carers - should be at the centre of agreeing the 'outcomes' that are desired and recognise they will play a significant role in achieving these, with support from external providers.
The mutual care approach recognises that care is a compact across the state sectors (planners and commissioners), statutory, independent and voluntary sector again suggest use private and voluntary or independent as vol is independent(providers) and people and communities (users and carers), in a comprehensive whole system that provides a coherency to the approach.