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Self-Directed Support: Social Workers’ Contribution

Andrew Tyson on behalf of the Social Work and Care Management Project Group

May, 2009

This paper is one in a series from In Control’s Total Transformation Project 4 on social work, one of ten Total Transformation projects. Together these projects will enable Local Authorities to address outstanding challenges on the path to transformation.

Introduction and ContextThis project will provide a set of tools to contextualise, evaluate, prepare and convert care management capacity in a Local Authority for the transformation to Self-Directed Support system.

The purpose of this paper is to assist Authorities in beginning to think about what role, if any social workers might have under a system of Self-Directed Support.

This project has important links and dependencies with projects 8 and 9, on Workforce and Safeguarding.

The project outputs should be seen in the context of the work of other friends and colleagues, particularly those in Local Authority Social Care and Social Services Departments across the country. The project is working in concert with the Department of Health’s Personalisation Team and their social work project, led by Ali Gardener and Brian Cox. In Control has produced a number of earlier papers on care management, social work and related topics. They are listed in the References section below. This project builds upon this earlier work, and on the learning from Local Authorities in the Total Transformation programme.

Social Work and Care ManagementIn its 2008 paper, Social Work at its Best, A Statement of Social Work Tasks for the 21st Century, the General Social Care Council sets out a series of core values and principles. It quotes favourably “a widely accepted international definition” of social work:

“The social work profession promotes social change, problem solving inhuman relationships and the empowerment and liberation of people toenhance well-being. Utilising theories of human behaviour and social systems,social work intervenes at the points where people interact with theirenvironments. Principles of human rights and social justice are fundamentalto social work”

The Statement goes on to list a series of situations which it says require social work skill and expertise, and the outcomes of social work intervention, the first of which is “more control for people over their own lives and the decisions which affect them.”

Self-Directed Support and Social Work of 12

http://www.in-control.org.uk/

In page 153 of his book, Keys To Citizenship (2003), Simon Duffy talks about what he calls the professional gift model, where “care comes as a gift, something you cannot control or reshape, something decided for you by the professionals who have decided what you need.” Under such a regime “the disabled person is left entirely powerless, receiving the kind of help that someone else has decided is right for them.”

Most registered social workers will recognise more than a grain of truth in this; many will say that this state of affairs an unintended consequence of the professionalisation of social work and of social work’s role within an operating system that is now failing. Many will point to their traditional advocacy role on behalf of their clients, and will say that they have in fact acted as the grit in that old operating system, a cog in the machine that has brought individual needs to the fore wherever this is possible. Most will agree however, that care management hasn’t worked well for disabled and older people or for families, and that we now need to move on. What we now need, many social workers say is a new kind of professional social worker, a social worker who is encouraged to recognise and respect a very different power relationship between the citizen and the state, one where “professionals” of whatever discipline are clear that their skills must be made available to cherish, value and empower people, and never to disrespect them or turn them away.

With this in mind, In Control recognises and applauds the GSCC Statement, and welcomes in particular the clearly articulated commitment to promote choice and control.

Our observation is that in reality many Local Authority social workers are still asked to practice in ways very different to this. Since the early 1990s they have been asked to operate as care managers, that is as gate-keepers of the social care system, where their main focus is assessment and apportionment of resources to individuals. These tasks are important but they are not social work as defined above. Many of the gate-keeping tasks are of course also carried out by staff other than social workers. In any event, they are “old system” tasks.

In his 2007 paper on Self-Directed Support and care management, Simon Duffy quotes the 1989 White Paper, Caring for People which defined case management (not care management – but the two terms were used almost interchangeably at the time) as: .…an effective method of targeting resources and planning services to meet specific needs of individual clients. ...To be effective case management systems should include:

Identification of people in need, including systems for referral

Assessment of care needs

Planning and securing the delivery of care

Monitoring the quality of care provided

Review of client needs

This process as it came to be practiced in Social Services in England in the 1990s and 2000s was described in more detail in our earlier paper, Citizenship Through Social Work.

So, to be clear, as we use the terms:

Social work is a profession, based on a particular ethos, education and skill set. The title social worker is now protected and regulated by the General Social Care Council (GSCC);

Care management (or case management) is a function, one set of tasks in the old social care system, and one which can be carried out by a variety of people, social workers and others.

Self-Directed SupportSelf-Directed Support is of course the new operating system which In Control pioneered, and which is at the heart of the social care systems on the path to “personalisation.” In Control defines this as:

Self Directed Support and Social Work of 12

“Support that you decide and control. You control the money for support – your Budget. You choose what support you want and how to spend your Budget. You can get help to do this if you want.”

As is now well known, there are seven steps involved:

My money - finding out how much. The first step is to complete a person-centred assessment or supported self-assessment so that the person knows whether they are entitled to support from the Local Authority, and if so how much that support is likely to be worth in terms of a Personal Budget.

Making my plan. The second step is to work with others to create a support plan to set out what is needed to get a good life. Importantly, this process includes determining how the Personal Budget is used – alongside “free support” from family friends or community, and any other resources the person brings.

Getting my plan agreed. A manager from the Local Authority then signs off the plan. They will be looking at whether it moves towards meeting the person’s aspirations, and whether it is realistic and affordable.

Organising my money. The fourth step is to work out who is best placed to receive and take care of the Personal Budget. In Control suggests that there are six options: the person him or herself, their representative, friends and family, an independent organisation, a service provider or a professional.

Organising my support. The person then –with whatever help is necessary- identifies and organises their support in a way that makes sense to them. Increasingly, technical solutions such as Shop4Support will help with this. People may also need assistance with insurance, management and employment issues.

Living life. The sixth step is to get on with life, spending money, receiving support – and making a contribution in whatever way. The essence is to use funding and supports in ways that are flexible and which respond to life’s challenges and opportunities.

Seeing how it worked. Finally, things are reviewed. This is a process of reflection, learning, and feedback. The plan for the period ahead needs to change as life moves on. (this definition is adapted from the one given on the In Control website)

This, then is the new operating system, which is at the heart of transformed Local Authorities’ social care services. Currently these Authorities employ a workforce which includes significant numbers of professionally trained and accredited social workers. A key set of questions for transformed systems is:

Does the new systems need social workers?

If so, what might be their contribution, and how does it fit with that of others?

What is needed to equip social workers for new roles and responsibilities?

An important contextual point, stressed by the GSCC and made by a number of people in the course of our work: social work is, at its heart about human relationships and capacities. It is, in particular about relationships which support people at times of difficulty and stress in making and enacting realistic plans for the future, plans which keep them connected and keep them safe.


Professional social work is not now and can never simply be about “seven steps to Self-Directed Support”: it is about individuals of all ages and from all cultures in relationships, families, institutions and communities, and about their hopes, dreams and aspirations, and the resources they have at their disposal to make these real.

This of course is also the wider context for Self-Directed Support (and for personalisation). An awareness of this wider context needs to inform the way Local Authorities proceed with their change programme.

Social Work and Self-Directed SupportWith this in mind, the table in the following section seeks to set out the tasks and skills required to complete the seven steps. It tries to define where social workers might sit to help with a particular task. It attempts to define the distinctive role of the social worker in this. We are not asserting that there is any task in the list that can be done only or always by social workers: but we are suggesting that in many instances, in practice social workers are often best-placed to undertake a given task. The education and experience of professional social workers should be seen as a valuable resource for many Local Authorities, and as those Local Authorities plan the route to transformation this resource is one they will need to consider.

More than this, though: as we continue to refine and test the new operating system, now in scores of Local Authorities in England, where more than ten thousand citizens are getting control of their lives through Personal Budgets, we are faced with a number of new challenges. These challenges include:

a deep economic recession, with its impact on local economies and on public sector finances;

what Professor Luke Clements calls the “industrialisation” of the new operating system – moving beyond a few small pilots, with dedicated resources and innovative trail-blazing staff;

a growing realisation that personalisation simply cannot be effective if it is restricted to one area of work (“adult social care”) and not take root in others – children’s services and health in particular.

Professional social workers offer much in precisely these three areas: a focus on economic disadvantage; familiarity with the vagaries of Local Authority systems and procedures; and skills in thinking and working with whole systems.

It is perhaps this last –the absolute necessity of a focus beyond the individual which we have recognised as now needing most attention: Nic Cosby and Pippa Murray have developed and promoted the concept of real wealth (this is described in the paper by Duffy and Gillespie on Community Capacity and Social Care and by Crosby and Duffy on the whole life approach)- strengths, connections, understanding and assets – a mix of gifts and attributes which we all have to varying degrees, and which all citizens using Self-Directed Support bring to the table. The ethos and focus of professional social workers, as the GSCC sets it out should mean that the profession is almost perfectly poised to work with people in just this way: to amplify strengths, make connections, foster understanding and capitalise on assets. Whether the profession can do this in reality is highly dependent upon the culture of each Local Authority, and upon their explicit and implicit expectations of the social work workforce. The table below was developed by discussion with the eleven Total Transformation Local Authorities who are members of the social work project group; it was informed by a workshop at In Control’s Big Event in March, 2009; and by a second workshop with In Control authorities in London and the South East in May, 2009; and by work by John Waters in discussion with social workers in several Local Authorities around the country. The table is prefaced by an overview statement about the role and tasks of social work in a transformed system.

An Overview: Social Work in a Transformed System

1. A transformed system of social care aspires to put citizens in control of their own lives. The profession of social work also seeks this.


2. The ethos and values of professional social work, as set out in the General Social Care Council paper, Social Work at its Best, a Statement of Social Work Tasks for the 21st Century, accord very closely with those of In Control and with the system of Self-Directed Support.

3. The profession of social work and In Control agree upon many things, including the following value judgements about individuals and society:

Human rights are important and valuable. We should value in particular the right to live an independent life.

Human relationships are important and valuable. These are manifested through family, friendship and community.

Individual expression and self-determination are important and valuable. This means choice in the wide sense, and control in the wide sense.

Society has an important responsibility to provide resources and assistance for some of its members to enable them to make choices and to achieve control.

4. Self-Directed Support requires a set of administrative and financial arrangements, (an operating system) by which Local Authorities can help to create communities with these characteristics. Social work is a profession whose core purpose is to assist in just this task.

5. Self-Directed Support is based upon a set of practices which value and promote individuality, community and diversity. The education, training and experience of professional social workers equip them with expertise to nurture these practices. There are a number of specific roles which Local Authority social workers adopt to do this. They include :

Gateway to support

Navigator of support

Quality checker

Co-ordinator

Hazard checker

Link to others in the community

Counsellor

Professional social worker1

Officer of the Local Authority

6. Those Local Authorities seeking transformation might now consider the contribution to be made by professional social work. In Control is clear that the new operating system and the new “personalisation” culture require different roles for paid workers, including professional social workers. Each Local Authority should now engage with local communities to consider the nature of these roles, in their particular locality. They then need to incorporate the new roles into their transformed operating system, and they need to take appropriate measures to assist staff to change.

1 In this context we are referring to practice reserved for the profession of social workers, as determined by statute or otherwise by virtue of the professional role – for example as an Approved Mental Health Professional; when taking measures to secure the safety of children or adults; in Courts of Law; or when seeking to make Best Interests decisions. Some of these practices may involve invoking the law to deprive people of their liberty or to take children out of the family home.


7. This work-stream (Total Transformation Network: Social Work and Care Management) and this paper (Self-Directed Support: Social Workers’ Contribution) are designed to assist the process.


Step Tasks, Skills and Knowledge required Roles: a role for

professional social workers?

Step One: My money, finding out how much

Inform people/explain/FACS screening/support self assessment/financial assessment/Benefits advice/income maximisation/manage expectations

Communications: including a positive sell; giving accurate information; specific skills for people with specific needs; formats (including electronic), languages, cultures.

Active listening and support; a genuinely personalised approach to the assessment process, where individual circumstances, needs and wishes influence the response.

Provision of accurate, straightforward and timely financial & Benefits information. RAS and Self-Assessment processes need to be integrated with the LA financial processes.

Sensitivity to crisis, and ability to access short term resources. The initial response needs to be designed with awareness that many people approach Social Services at times of stress and crisis. Staff need the skills and resources to respond to this effectively and pragmatically.

Problem solving and signposting: many people approach Social Services because they are unsure where to turn for help. The initial response needs to be open, facilitative and well-informed about local resources.

Contact centre staff will remain the first point of contact in many places. They need to be extremely well trained, managed and supported to make the best of challenging roles.

Finance specialists, communications specialists and others have key support roles.

Professional social workers have a role in helping some people understand and complete the assessment process; and in coming to terms with the emotional impact of life changes and their need for support. Social work training encourages a more holistic view of the person in their social and economic environment, and this perspective is often crucial at this stage.

LAs will need effective systems for ensuring that social workers are called upon where they are needed.

Step Two: Making my Plan

A Plan which sets out what is important, what will make life better/ is safe and sustainable/and affordable/meets needs/is likely to be signed off by LA/ and considers risk to LA

Interpersonal skills to engage with, affirm, sustain and support the person, within the bounds of the support planning process. This is the central skill-set for this step.

Knowledge of Person-Centred Planning/Support Planning techniques and resources

Facilitation skills: ability to lead the processImagination & creativity: to provide options for the person

Information: about available resources in local communities to help the person plan.Knowledge and skills about wider networks: particularly how to deal effectively with issues that are outside the skill-set of the support planner.

This must be decided by the person him or herself.LA needs to help create options: friends, family, other IB users, brokers or others.

The skill set and interests of many professional social workers are ideally suited for this set of tasks, and in some instances the social worker will be the best person to do it. Social workers, are for example trained to help people to assess, manage and take appropriate risks, and as LAs move away from overly risk-averse policies and procedures, social workers are well-placed to assist with more person-centred ways of managing


Risk: ability to assess deal with and then take appropriate risks.

Outcomes: ability to help the person define outcomes, what is it they are looking for in life, and how will they know when they have it

Conflict management: ability to help the person manage and resolve issues of conflict in their network.

Financial planning: ability to help the person cost their plan.

risk.

Professional social workers should also possess the skills to support and facilitate other people to make best use of their own interests and skills, including technical skills with IT, photos, drawing etc

Social workers have taken important roles in Planning Live groups (and similar) in some places.

There are two very important caveats.

Firstly: that many people prefer and are better served by people who they know – support planning is not a difficult technical task.

Secondly: it is very different in nature from care planning, and social workers must beware of reproducing old system practices.

Step Three: Getting my plan agreed

Ensuring that the plan is safe /Does it meet needs?/If so, which needs?/Ensuring the plan is within RAS allocation/Ensuring the plan is sustainable.

Analysis and evaluation: ability to consider whether a plan is comprehensive, coherent, realistic and achievable. Need to do this without “judging” the outcomes or the means to achieve the outcomes.

Coherent framework for signoff: decisions to agree plan (or not) need to be justifiable and defensible. This needs grounding in policy and specific decisions need to reflect this.

Understanding of safeguarding and risk: decisions need to reflect necessity that risks are considered and dealt with appropriately. Needs to link to safeguarding policy and practice and to Risk Enablement arrangements.

Local knowledge: plans need to be evaluated in the light of an understanding of local cultural and community resources, to assess realistic prospects for success.

A role for Local Authority managers. Many will be (former) social workers. Core social work skills are of great relevance and many of the decisions needed will be familiar to social workers from other areas of practice.

Social workers should be effective and experienced in challenging support plans when these are not completely fit for purpose, and in so doing helping people to make real, informed choices.

Local Authorities need to be very thoughtful about the checks and balances they put in place at this stage of the process, as there is a tremendous temptation not to “let go.” The focus then, needs to be on attitude and aptitude, perhaps more than skills as such.


See the paper Quality Assurance and Support Planning on the In Control website for a range of ideas and suggestions about this step.

Step Four: Organising my money

Ensuring all options for managing the money have been considered/A clear understanding of the contractual obligations each entails/ Specific issues for providers and in-house services understood/ Ensuring social workers are themselves in a position to manage the money for someone.

Knowledge of the full range of options to manage money: the six routes to managing the money each need to be clearly understood in principle and in local practice. This requires a range of skills:

>Interpersonal and influencing>Financial management>Contractual (including arrangements to deploy Budgets with Independent Living Trusts and with other legal bodies)>Legal (including scope of Direct Payments regulations, and use of Well Being powers of the Local Authority.)>Understanding of provider culture and practice>Understanding principles and practice of Individual Service Funds (ISFs)

Where a social worker is nominated to manage the money this will require additional skills:

>Hands- on financial skills and knowledge (including knowledge of costs of in-house services and how these are dealt with locally)> Awareness of employment law, payroll issues, HR issues, awareness of IT solutions (eg PayPal)2

This step necessarily involves many people inside and outside the Local Authority.

Within the Local Authority it includes:

Commissioners, finance and contracts managers, legal section staff and operational managers.

Social work core skills will be highly relevant for many of the decisions required for someone to complete this step. Social workers are often in a good position to mediate between the person at the centre and the Local Authority as commissioner, and this role will be just as important in the transformed system.

Social workers may have important specific roles in relation to arrangements such as ISFs, where there may be a need to advocate on behalf of the person, as providers get used to a new way of delivering support.

In the longer term we would hope that the reliance on social workers as advocates will diminish, as person centred thinking becomes more pervasive.

Step Five: Organising my support

Ensuring each disabled person has the support they need as a customer/ensuring that a full range of types of support are available locally/ensuring that direct help and assistance with service design is available for those who need it.

Empowerment and organisational skills: there is a need to work with disabled people and

This step involves large numbers of people in different roles in local systems. Each person and each community will be different and will need a different response. Family, friends and other natural supports are at the heart

2some step 4 skills overlap with those in step 5; they are all included here for clarity


their organisations (“user led organisations”) to ensure that the widest range of good support arrangements are available locally.

Communications: the system needs to make available and communicate about the full range of support options.

Overcoming disability discrimination: there needs to be the capacity to ensure that local support options (including mainstream) are non-discriminatory and able to meet the needs of PB users.

Direct work: some people need direct, practical help to organise and manage their support. This requires a range of life skills/ management skills, including time management, financial planning, negotiation and advocacy skills and general awareness of mental and physical health and wellbeing.

Individual service design: some people will need help to actually design and build a service around them. See Simon Duffy’s paper on Individual Service Design to read more about this.

for many.

Centres for Independent Living, providers and brokers all have roles to play.

Professional social workers have broad based skill sets, which are responsive to both individual and system, and which should be particularly well attuned to these complexities.

This may be particularly important where someone has no-one else in their life to provide help. But there is no doubt that this is a challenging area for social workers, many of whom have not been asked to work in the very broad-based, lateral-thinking manner required. If Local Authorities do see a role for the social work workforce here, social work staff need the development opportunities, remit and the time in their work schedules to take on this set of tasks.

Step Six: Living Life Ensuring that people have the fullest range of support options available to them locally/ensuring that they have the information and means to access these and use Personal Budgets to purchase what they need to achieve the goals in their plan.

A means to take an overview of the local market for support and to act to plug gaps. This requires a systematic overview of the support services people want to purchase; and the means to work with providers and others to plug gaps. An IT solution such as Shop4Support is key here.

Skills in engaging with the full range of service providers. There are particular issues in relation to “mainstream” providers (statutory or otherwise), which social care commissioners have very often seen as low priority.

In relation to service design and tailoring of support: where someone has a particularly complicated life, or is very significantly impaired unusual arrangements are sometimes necessary. These will involve planning and designing a service around the person’s very special needs. Sometimes, this may lead to a

Hitherto a task for “strategic commissioners” in Local Authorities.

Under a Self-Directed Support model, there needs to more engagement with the wider community.

Social workers are often well placed to take roles in terms of the provision of “market intelligence” and in service design and with individual PB users. They should know both the individuals the local community, and are in a good position to provide a form of on-going “quality check” on what is in place.

Under the pre-existing system social workers have been in a relatively weak position vis-a-vis more senior


contract with a single provider for the whole designed service, sometimes it leads to the need to build a service from a number of components. To do this, requires a very good understanding of the particular issues facing the disabled person and a high level of planning and organisation to design or commission the support as specified.

Ability to contingency plan/respond to crisis There is a need to be flexible and responsive when things don’t go to plan.

Systems are also needed to:

> check it’s legal to spend money in ways proposed >assess when arrangements are failing and take appropriate action

commissioners and other managers who have had a more explicit financially driven focus. Social workers need the support of their seniors to undertake the sometimes difficult and complex tasks involved at this stage, as well as the systems in place to assist individuals to become “citizen-commissioners.”

Step Seven: Seeing how its worked

Ensuring that people have the opportunity to check whether things are going well, to learn and to make adjustments where necessary/ ensuring that the wider community sees money well spent/ ensuring that other disabled people can learn from the person’s experience.

Energy, enthusiasm and openness to engage with the person, and to make changes and promote learning.

Negotiation skills with the disabled person and their network about how best to build on learning and make changes.

Ability to evaluate the total situation and come to a view about whether arrangements are sufficiently robust, and sufficient progress has been made towards agreed outcomes.

Conflict resolution where this arises in the network.

Assertiveness and confidence to follow through on conclusions where different views prevail.

Financial management where budget issues arise.

Belief and confidence in the values of person-centred approaches and citizen-led solutions. May be needed to challenge others who do not support spending plans or who prefer a service-led solution.

Increasingly, we would want to see a leadership role for the person at the centre (“self review”) – with people telling their own story in their own way.

There may be a role for other key people in the person’s network, for community leaders and for Centres for Independent Living or other user led organisations.

Professional Local Authority social workers will however often be the leaders, and in the early days of SDS many Local Authorities will want their staff to lead the process.

Professional social workers bring skills in guiding people through life changes: the journey to make effective use of a Personal Budget over time is all about such changes, and social workers are well placed to help.See the paper Reviewing Progress on the In Control website for further guidance on this step

Next Steps for Local Authorities


In Control’s advice is that Local Authorities need to think about the full range of workforce issues very soon now: for many this is already in project and programme plans, and work is underway. The scope and the methodology for such a review is something that we hope to go on to consider with leading volunteer Local Authorities.

Some Local Authorities – many under great financial pressure – are now making decisions about the future shape of their workforce, under a transformed (Self-Directed) system. In Control’s advice is that such decisions may be premature, without consideration of the sorts of issues raised above, and without consideration in particular of the role and contribution of social workers.

References

Julie Casey and Alex MacNeil (2007) Developing People: New Learning for a New Way of Working in Social Care, In Control website

Nic Crosby and Simon Duffy (2008), A Whole Life Approach to Personalisation, In Control website

Simon Duffy (2003), Keys to Citizenship, Paradigm

Simon Duffy (2007), Care Management and Self-Directed Support, Journal of Integrated Care, 15.5, October, 2007 and In Control website

Simon Duffy (2007), Individual Service Design, In Control website

Simon Duffy and John Gillespie (2008), Personalisation and Safeguarding, In Control website

Simon Duffy and John Gillespie (2009), Community Capacity and Social Care, In Control website

General Social Care Council (2008), Social Work at its Best, A Statement of Social Work Tasks for the 21st Century, GSSC website

Helen Sanderson and Simon Duffy (2007),Reviewing Progress, In Control website

Andrew Tyson, Jeanette Thompson and John Waters (2008), Citizenship Through Social Work, In Control website

Andrew Tyson, Helen Sanderson, Carey Bamber and Dave Spencer (2008),Quality Assurance and Support Planning, In Control website


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