The Origins Of Community Care Social Work Essay
The beginnings of community care date back the Griffiths Report in 1988, particular Community Care: Agenda for Action and the government White Paper Caring for People. (Guthrie; 2011) The papers emphasised choice, independence and involvement service users and carers. A series of shifting strategies and priorities developed such as; move from institutionalisation to promote independent living within community, from service led to needs led provision. (Petch; 2008) In 1990, the NHS and Community Care Act (NHS&CCA1990) was introduced that draws attention to the term “care in the community” which for many service providers opened door to market of services, leading to privatisation and managerialism. (Ferguson & Woodward; 2009) Although community care was introduced by the NHS&CCA1990, this operated in Scotland to amend the Social Work (Scotland) Act 1968 (SW(S)A1968). The addition of section S12(a) into the SW(S)A1968 created a duty to assess the needs of the individual who may require services.
Potentially the statutory legislation that could be used in the case of Mrs. Sheerer are; Mental Health (Care and Treatment) (Scotland) Act 2003, (MH(C&T)(S)A2003), Adults with Incapacity Act 2000 (AWI(S)A2000), mentioned above SW(S)A1968 amended under section 13(za) and Adult Support and Protection (Scotland) Act 2007 (ASP(S)A2007). (Mackay; 2008)
It seems to be very unlikely to use MH(C&T)(S)A2003 because there are no clear evidence that Mrs. Sheerer suffer a mental disorder, defines as; a mental illness, personality disorder or learning disability which is caused or manifested S328(1) of MH(C&T)(S)A2003. She also based on information provided, does not appear to put herself or others on significant risk and her decision making is not obviously impaired. It is worth noting that the act is very controversial due to impact of stigma, coercion and breaching of human rights.
The AWI(S)A2000 could be used on the grounds that Mrs. Sheerer is deemed to lack capacity to make decision in relation to her future care needs, S1(6) of AWI(S)A2000 states “incapable means incapable of making decision” and this seems to be relevant to the case. It is important to note based on legislation that if Mrs. Sheerer is unable to make decision in some areas, she is likely to take decisions in others. In Scottish law, there must be clear evidence that a person lack of capacity before any action will be permitted. (Scottish Government; 2008) However, in England and Wales the same rule is statutory, the adult must be assumed to have capacity unless proven otherwise as stated in S1 of Mental Capacity Act 2005 (MCA2005). It may be questioned if Mrs. Sheerer actually lack of capacity, based on single SMART test in hospital condition. Hospital could exacerbate confusion, as a result of unfamiliarity, lack of sleep, medication or pain. When intervening in Mrs. Sheerer live, the principles defines in S1 of AWI(S)A2000 must be taken into account such as; intervention will benefit the adult and will be least restrictive option in relation to the freedom of Mrs Sheerer. Account shall be taken of the present and past wishes and feeling of service user and the views of other relevant people. It is worth noting that principle three only requires views are taken into account but it does not mean they are given effect to. The principle four of the AWI(S)A2000, to promote the participation in decision making, is slightly different in England and Wales, where decisions being taken in the best interest of and adults according to S1(5) of MCA2005. It is important to check if Mrs. Sheerer did not take advantage of the options such as; negotiorum gestio, which allow the authorised person to act on the behalf of an incapable adult, attorneys or guardians to take decision on behalf of an adult. An attorney is appointed by the person before lost of capacity, at the presence of the solicitor whereas, a guardian is appointed by the sheriff court. (Guthrie; 2011) Application for a guardianship order when Mrs. Sheerer is in hospital ready to discharge, could cause unnecessary process known as delayed discharge code 51X. (Scottish Government, 2010) The delays in guardianship order could be caused, by difficulties in obtaining legal aid by relatives. If social worker felt the delay in discharge result in negative consequences for Mrs. Sheerer, it would be considered taking over the guardianship application. To apply a guardian Mrs. Sheerer according to S57 of AWI(S)A2000 must be incapable and it must be likely that incapacity will continue. Therefore, the application for the guardian could be irrelevant in a situation of Mrs. Sheerer because there are no evidences of continuity of incapacity and the current state can only be temporary. If Mrs. Sheerer was not able to make decision, only for a short period of time, regarding her welfare or finance, where decision had to be made quickly, a social worker of behalf of local authority has duty to apply for an intervention order under S53 of AWI(S)A2000. Potentially AWI(S)A2000 could be used to imposed care at home or residential care to Mrs. Sheerer.
Assuming that Mrs. Sheerer does not have appointees and lack of capacity to make decision about future care needs, it would has to be considered if the application for an order under the AWI(S)A2000 is necessary or alternatively use the power of the SW(S)A1968 amended under section 13(za). This section, give social worker a power to provide community care services that has been assessed as needed to Mrs. Sheerer due to incapability to consent receiving such services. In accordance with S13(za) of SW(S)A1968 Mrs. Sheerer could be move to care home or agree with proposed care intervention. Before using any of those two acts, the issues to discuss are; adoption of principles, deprivation of liberty, assessment of needs and risk as well as financial arrangements.
The last but not least legal option to consider is ASP(S)A2007, the act refers to the law that concerns not only protection but providing support to promote independence and welfare of service user. Mrs. Sheerer meets two condition of the act to be applied such as; she is at risk and may need protection of well-being, due to her lack of capacity, poor nutrition as well as risk of falls. The ASP(S)A2007 gives social worker working on behalf of local authority duty to investigate and assess Mrs. Sheerer. Most of assessments are undertaken on a voluntary basis but the act gives power to assess without consent of service user and is known as the first of three “protection orders.” (Mackay: 2008a) The act also established a duty to cooperate between agencies and creates multi-disciplinary Adults Protection Committees to implement, monitor and support the work.
One could envisage that the use of ASP(S)A2007 seems to be the most appropriate option because is the less restrictive according to Mackay (2008) pyramid of statutory intervention. What is more, the act itself does not stigmatise, the least breach human right or freedom. It will give social worker time to get know and build better relationship with Mrs. Sheers. Consequently, it will result in having more information and better picture of situation. When using ASP(S)A2007 one assume Mrs. Sheerer’s situation could be caused by experiencing some difficulties in her life or even suffer distress such as bereavement, lost or abuse. The intervention in Mrs. Sheerer live will depend on many factors to be discussed; service user’s opinion, adaptability of house to current needs, the condition of house and accessibility, opinions of other professional and relatives. One might expect that Mrs Sheerer, regardless of age but due to femur fracture will require intense home care services or adaptation of the house such as; raised toilet seat, grab or lifting handles, community alarm, hospital bed or others. The application of the above will be possible under S13(za) of SW(S)1968 envisaging that Mrs. Sheerer expresses consent to such services to be provided. Social worker has duty to assess the needs of Mrs. Sheerer under ASP(S)2007 but the consent to provide services is needed to use S13(za) of SW(S)A1968. Otherwise, social worker could take action under AWIA(S)2000. The principles of these acts required to take the view of Mrs. Sheerer and carers if involved, into account when deciding what services to provide, this is also in accordance with Community Care and Health (Scotland) Act 2002 (CC&H(S)A2002) amended under S12(a) of the SW(S)A1968. It is worth pointing out that Mrs. Sheerer was nutritionally compromise but had home care services and limited family intervention. This raises the questions of why it was not noticed, how adequate is the result of SMART test in hospital conditions and how this had affected Mrs. Sheerer. There are a lot of speculations and factors to consider but taking into account the limited information that were given and assuming social worker investigates this case for the first time, it seems be discriminative to use other legislation. One must remember that legislative context of intervention, mainly, is driven by the relationship between social worker and service user, which is a core element to success intervention in social work. It is an important source of information to understand the reality behind the situation and how best to help. Wilson et al. (2008: p.7) referring to relationship-based practice called it “the medium” through which social worker can engage with and intervene in the complexity of internal and external world of service user.
This part of the essay examines responsibilities, rights and role of people involved. The legislation gives the social worker acting on behalf of local authority a general responsibility to promote well being, to minimise the effect of intervention and give an adult the opportunity to lead as normal live as possible. Local authority is responsible for assessing needs for community care services, arranging and providing these services as well as cooperation with other professionals such as; occupational therapist, housing officers, GPs. This is according to the integration agenda between health and social care services. (Age Scotland, 2011)
Social worker has statutory duties underpinned not only by the law but also professional codes and values. Expectation of social work profession is presented in code of ethics issued by British Association of Social Workers (BASW) and code of practice represented by Scottish Social Services Council (SSSC). Social work values grew on the idea of respect for the equality, worth and dignity of all people. Human rights and social justice are at the heart of social work intervention. The five principles indicates by BASW (2012) regarding human rights are; to promote and respect well being, support people to make own choices and decisions, promote involvement, participation and empowerment of people using services, treating each person as a whole to recognise all aspects of service user’s life, identifying and developing strengths. While, code of practice (SSSC; 2007) requires; to protect the right and promote the interest of service user, maintain the trust and confidence, promote independence while protecting from harm and danger, respect the rights of service user.
The Scottish Parliament and public authorities are required to uphold the European Convention of Human Rights, incorporated into the UK law through Human Rights Act 1998. (Johns; 2008) It can be in some cases that the law can breach human rights. Therefore, in relation to Mrs. Sheerer social worker most of all has to respect, Mrs. Sheerer’s right to liberty and security, the article five established three conditions to be met before it will be breached such as certified mental disorder within significant degree and persistency. Article eight states that Mrs. Sheerer has the right to privacy, family life, home and correspondence. (Johns, 2008) She also has the right to access a solicitor or advocacy included under S6 of ASP(S)A2007.
The role of social worker will be to ensure Mrs. Sheerer understand legal processes and if she is aware of her rights. The legislation framework is complex, consequently; information given must make sense and be understandable for service user, the role of social worker is to take time to explain and answer questions. Social worker must use appropriate and effective method of communication and skills to understand and to be understood. The aim is to support Mrs. Sheerer to make informed choices as far as possible. Social worker must ensure that Mrs. Sheerer’s views are heard and she understands a situation. There are six core roles of social worker such as; case worker, advocate, partner, assessor of risk and needs, care manger, agent of social control. The above roles are affected by changes in wider social context, welfare policy and ideology like for example demographic changes, communications technologies, consumerism etc. (Scottish Government; 2005) Social worker role is to work together with Mrs. Sheerer to assist her to address personal issues, provide information and advocacy. Provide services to meet the needs of service user and not to try to fix Mrs. Sheerer to services available.
This part of the essay attempts to show the prospects of anti-discrimination, participation and empowerment in social work. Social worker is obligated by law, values and ethics to support and work with service user in anti-oppressive and anti-discriminatory way. Knowledge and understanding of professional codes such as; BASW and SSSC is crucial in being aware of anti-discriminatory practice in social work by defining rights and responsibilities. The anti-discriminatory trends in social work values and practice are deeply rooted in radical social work that aims to work towards a society based on equality, justice and involvement. According to the maxim popularised by Marx “from each according to his ability, to each according to his needs.” (Doel; 2012, p. 27) Social justice is still a basic value in social work practice. Dalrymple and Burke (2006) refer to emancipator issues that driven contemporary social work such as social justice, empowerment, partnership and minimal intervention. Participation is a key element in the development of anti-discriminatory practice. Wilson (2008) refers to involvement of service user in social work practice based on partnership and empowerment. The term partnership is used to refer to practice, based on working with service users, towards together agreed goals, rather than doing things for them. (Thomson, 2011) Dalrymple and Burke (2006) defined partnership as process of information sharing and involvement in decision-making. Taking the above into account social worker have to involve Mrs. Sheerer in the process of decision making and intervention such as defining needs, decide how best to help, implementing, agreeing and evaluating. Empowerment is not simply a matter of facilitating or enabling. It also involves taking account of the disadvantage and oppression that are so characteristic of the service user day to day experiences. (Thompson, 2008) Work in anti-discriminatory way means to see Mrs. Sheerer within her wide social context include environmental, societal and cultural factors such as race, gender, ethnicity, age, sexual orientation, disability and so on.
The last section of the essay assesses social policy that inform legislative context of this case. It is seems to be clear that social worker needs to work in integration with other professionals within all aspects of assessment and intervention process. The legislation defines responsibilities in social work but social policies outline a plan of action, a set of rules that guide practice.
The first significant policy in terms of promoting partnership working across health, housing and social care is Joint Future 2000. This is a unique partnership between the Scottish Executive, the Convention of Scottish Local Authorities (CoSLA) and NHS Scotland that focus on to improve joint working through financing join services, management and resources. A key component of Joint Future has been development of Single Shared Assessment (SSA) that aims to shorten and improve flow of information between professionals and agencies, avoid duplication, provide faster access to support with less bureaucracy. (Age Scotland, 2012)
The policy Changing Lives 2006 has concerned on anti-discrimination, to do not look at service user in the context of vulnerability but to focus on strength and building true relationship. The aim set out through report were promoting participation; taking a whole-person approach; understanding each individual in the context of family and community. (Scottish Government; 2006)
The another policy that seems to be important in relation to scenario, with the assumption of that Mrs Sheerer is an older person because the policy aims mainly to older people, is All our Future. It supports older people to stay at home as long as possible by providing free personal care, telecare development programme, care and repair, travel scheme; free bus travel etc.. (Scottish Executive; 2007) It is noteworthy that Mrs. Sheerer may be entitled to free personal care that was introduced by the Sutherland report and statutory implemented through the CC&H(S)A2002. (Guthrie; 2011) In Scotland every person over 60 years is entitled to free personal care in other cases it will depend on needs, priority and categories of risk. The policy Reshaping Care for Older People (SCSWIS; 2011) focuses on the “3R’s” rehabilitation, re-ablement and recovery to optimise the independence of people at home. The reablement is a new service, initially aims at people coming out of hospital. In Glasgow it is a partnership between Social Work Services, Cordia, NHS Greater Glasgow and Clyde. If Mrs. Sheerer lives in the area, she will be provided with services up to six weeks, the reablement aims to build confidence by helping to regain the skills to do what Mrs. Sheerer can and want to do for herself at home.(Glasgow City Council: 2011)
Recent consultation on integration agenda, set out proposal to inform and change the way that the NHS and Local Authorities work together and in partnership with the third and independent sectors. This includes integrated budget and joint accountability. The proposal extends the services provision to all adults and not only older people, so the speculations regarding the age of Mrs. Sheerer would not be needed. The Integration of Adult Health and Social Care Bill will bring forward legislation to create Health and Social Care Partnerships, which will replace Community Health Partnerships and will be the joint and equal responsibility of Health Boards and Local Authorities. (Scottish Government; 2012) Ineffective partnership between health and social services is a real dilemma of contemporary social work practice. On the one hand, the problem is finance and the eternal question; who are going to pay for services? On the other, the issue of finding appropriate resources that will meet the needs of Mrs. Sheerer, both processes are time consuming. Consequently, Mrs. Sheerer can be detained in hospital longer that necessary that can affect her emotional and physical condition, which usually will deteriorate. Other issues are; blocked bed and retained the flow of a new patient. One strongly believe that new integration agenda of health and social care such as one budget and consolidated partnership will make a difference in new social services. The new social policies and legislation present a wide range of possible options and choices such as; personalised services and self-directed support. It this week government has been discussing the Social Care (Self-directed Support) (Scotland) Bill (SDS Bill) that has been passed stage three on 28th of November 2012. (Scottish Parliament, 2012) What that means for social work today is a shift from service led to outcome led provision, The Talking Points: Personal Outcomes Approach promoted by the Joint Improvement Team will change the process of assessment of needs that now will be more focus on targets. Based on SDS Bill social worker will have a duty to offer; direct payment to Mrs. Sheerer in order that she will arrange her support; can make arrangement for services that have been chosen by Mrs. Sheerer or can select appropriate support and make arrangement. (IRISS; 2012) One could seriously question if Mrs. Sheerer will have skills and knowledge to manage these variety of options such as; possibility to employ own carers or buy own services, if she have not done before. It seems to be clear that the role of social worker will have change form procedural care management towards support and brokerage.
To sum up, contemporary social work practice drifting away from paternalism to seeing service users as experts of own life an illustration of this is work in partnerships, service user involvement or SDS. There is no doubt that relationship between social worker and Mrs. Sheer is a key in the process of intervention. It is significant to talk to and listen to service user. The more time spend, the more social worker will understand Mrs. Sheerer within wider social context. One must remember that when intervening in someone’s life taking no action is an action, otherwise the option of minimal intervention or less restrictive option must be put in place.