I am currently on placement at a charity that supports adults with disabilities in the local community. It was set up in 1997 and adopted the social model of disability in supporting local adults with disabilities and their families/carers by helping to reduce the barriers that people face in education, housing and employment. They have developed a number of projects which include a drama group, a cafi?? that offers training and employment for adults with learning disabilities and a self-advocacy group.
The agency is set within the local community and it acts as a drop-in for local people with learning disabilities. It is set within a large open-plan room with only two small offices for private working so at times it can be quite a vibrant place with people coming and going. A Student Unit has also been set up there and currently there are seven social work students based there and work is allocated to them as new referrals come in.
My role at the agency has been mainly of advocate, but I have also been involved in a user-led project that offers brokerage to people with learning disabilities that have direct payments or individual budgets. The brokerage mainly centres on looking at housing options, helping people to become employers and recruit their own personal assistants, or to help them expand their social network. Because of the nature of my placement and for the purpose of this assignment I will be discussing the government’s Valuing People (2001) White Paper which set out a framework to guide people that work with people with learning disabilities.
Tony Blair in his introduction described it as “improving the life chances of people with learning disabilities…. “. I will refer to this as ‘Valuing People’ throughout this essay. The Valuing People policy is the first White Paper in thirty years since Better Services for the Mentally Handicapped (1971). The aim then was to close large institutions and to integrate people into the community (www. mind. org. uk).
Valuing People aimed to transform the lives of adults and children with learning disabilities through a person-centred approach and to enable people to become empowered in order for them to be included in society. This policy is one in a series of policies that are an example of the political driver of change such as the White Paper, ‘Our Health, Our Care, Our Say: A New Direction for Community Services (2006) that are aiming to transform social care and to give service users more choice and to make the system more personalised (Johnson & Williams, 2007).
However, people with disabilities were also seen to be the main social drivers of this policy after years of fighting for equality and inclusion by groups such as People First, the United Kingdom’s Disabled People’s Council who campaigned for the Disability Discrimination Act 1995 and they also work at an international level in partnership with the Disabled People’s International group (www. ukdpc. co. uk). The four principles of Valuing People are rights, inclusion, choice and independence.
The Government’s vision was that the uptake of direct payments would give people more choice in how they choose to live their lives. However, the uptake of direct payments since the introduction of the Community Care (Direct Payments) Act (1997) had been particularly slow, mainly due to a lack of awareness and people, including professionals, can be very wary of change and taking on the unknown. The government therefore introduced new legislation in 2003 to make it a duty for local authorities to offer direct payments (www. dh. gov. k), but in 2006 figures reveal that out of a possible million people only around 46,000 had taken up direct payments (www. eastern. csip. org. uk) .
A pilot of Individual Budgets was then introduced for two years in 2005 to 13 local authorities. Individual Budgets is a system that brings resources together from different funding streams into a single sum that can be spent flexibly in accordance with their needs and preferences. Service users are free to choose to have the money as a direct payment or they can ask the local authority to provide services, or even use a mixture of both.
The main stakeholders from the implementation of Valuing People are people with learning disabilities themselves and their families/carers, as they were instrumental in pushing the government to push through with this policy. The government is obviously one of the main stakeholders and it could be argued that this was an economic driver of change. Latest figures from the Individual Budgets Pilot study revealed that the costs of people using budgets compared to commissioned services is not much different, but long-term, costs will be reduced as people become more independent and their support hours are reduced (www. dh. ov. uk).
This policy means change for the people that receive services and importantly for social care workers that will need to implement these changes in their work. It raised issues that people faced and set out eleven objectives which included people facing lack of choice and control, social isolation, housing, health, and poor partnership between professional agencies, voluntary groups and families.
The changes in social care that have been taking place since the policy have meant that the role of the social worker is changing and the publication of the Local Authority Circular “Transforming Social Care” (2008, p. ) described the role of the social worker as being “focused on advocacy and brokerage, rather than assessment and gate keeping”. This will involve better skills in listening, working in partnership with service users, families and other professionals and empowering people to take control of their lives. The changes are proving challenging because it means a shift in the balance of power and allowing people to take more risks. The policy helped towards developing new ideas at my agency. They had always used a person-centred approach to supporting people, but this had been more about supporting people in the community.
Since Valuing People the charity introduced a project that would support people with direct payments or individual budgets. They became involved with a local authority in the Individual Budgets pilot scheme and worked closely with a number of people with disabilities in the local community. They also set up training courses in person-centred planning and brokerage and were commissioned to train social workers in a neighbouring local authority. The agency also set up a student unit to offer social work students placements and they were instrumental in setting up a self-advocacy group for people with learning disabilities.
The self-advocacy group is facilitated by the students and have been part of the regional Valuing People Working Group that was set up to implement and monitor the policy. It is clear that the changes that were introduced at the agency since Valuing People such as brokerage and person-centred planning training and the brokerage service were successful and careful planning meant that they were able to generate income which helped to sustain its other voluntary activities in the local community.
The principles of rights, inclusion, choice and independence set out as the vision in Valuing People have clearly been achieved in some peoples lives, and whilst at my placement I have met some of the people that were involved in the Individual Budget pilot. Their lives have been transformed in that they are living independently and feel included in society. They often present their stories in brokerage training to service users and families who are looking to embrace the new changes in their lives. There are many people still living in residential care and they spend most of their hours in day centres and lead very oppressive lives.
Shakespeare (2000, p. 57) describes the failings of institutional care as having “inflexible routine, lack of choice, dependence on others, lack of privacy” and community care as still creating maximum dependency. However, care needs to be taken that these people are still supported when they do live independently, as years of residential care has not prepared them to live in society and adequate risk assessments should take place to address any areas that could leave them vulnerable. There are still barriers to overcome towards meeting the principles in Valuing People.
Individual Budgets in some areas are being replaced by the Government’s In Control Personal Budgets. In my local authority budgets are not integrating other funding streams and service users will not have their needs met fully due to a lack of resources. The approach is initially person-centred with the service user involved in developing their support plan, but the plan is finally decided by the initial care assessment, based on a points system and will ultimately not lead to people being empowered to promote their independence.
Funding is also not only a problem in the statutory agencies but is a major on-going issue especially with smaller voluntary agencies such as where I have my placement. Planning of services is based on an “economic model of decision-making” (Johnson ; Williams, 2007, p. 102). This means that services can only be provided if enough funding is generated. However, my agency adopted a new model of working that involved setting up a Student Unit; they approach local universities and invite up to ten social work students to have their placements there.
This has proved successful in that referrals can be taken and initial costs are low as there are no salaries to be paid, but it is a challenge in that the students are only on placement for a set period of time which can have an effect on how much effort and time they can give to a client. This does not appear to be in line with the guidance set out in Valuing People (2001, p. 49) which aimed to create an approach where “planning should start with the individual (not the services) and take account of their wishes and aspirations” .
The agency use their policies and procedures to ensure students present new clients with a student proforma that sets out clearly their time at the agency. Other influences that can have an effect on planning and delivery of services come from the culture and organisation of an agency. Statutory agencies have the challenge of working from a number of policies, guidance and legislation from government and many as in Valuing People aim to encourage “working alongside service users in planning and implementing personal change” (Johnson ; Williams, 2008, p. 14).
Barriers to this can come from the style of management and whether direction from the top level has the same value base as frontline workers and whether they take notice of the views of these employees. The social workers themselves, however, can have an effect on the delivery of services especially if they lack social work skills and knowledge and do not share the values and ethics of social work. Social workers are also accountable to the General Social Care Council and must adhere to the Codes of Practice (2002) and especially when delivering services make sure that they are “… ccountable for the quality of their work and take responsibility for maintaining and improving their knowledge and skills” (Code 6).
This also means that they are developing their professional identity as a social worker. Whilst on my placement I am developing my social work identity through learning new skills and knowledge which are mainly centred around person-centred planning, brokerage and advocacy which the General Social Care Council see as the new skills needed for the role of the social worker in the 21st Century .
I am also aware that as a professional worker within this agency I am accountable to the service users that I am supporting, families/carers, the trustees and management of the charity, the GSCC, my university, as well as to society in general. Being accountable to so many can “lead to conflicting demands as we attempt to balance the best interests of one group against those of another” (Trevithick, 2006, p. 243).
This can prove challenging and can mean that in some situations I may have to use my own personal judgement in making the right decision which could possibly mean losing the trust of my service users or challenging decisions that I disagree with and may feel are unethical at my agency. The organisation I am placed at has created its own identity based around the Social Model of Disability and presents an emancipatory approach to social work through supporting people to develop life skills and by promoting individual budgets as a way forward to independence.
Other changes that have been taking place in social work is the idea of integrated working in practice, and many statutory teams now work alongside health care workers such as community nurses and occupational therapists. There are challenges to be faced such as differing professional ethics and values, models of working, policies and procedures can all lead to conflict. These difficulties were expressed in a recent report and it described how “tensions between professions are often expressed through power and status issues” (Frost, 2008, p. 4).
This is understandable if you compare health to social care professionals, where historically, health professionals have had to gain higher educational qualifications and have suffered less criticism from the media through highly publicised cases of neglect. However, the report also recorded experiences of social workers embracing the idea of integrated teams as long as they held true to their social work values. From my own experience I can see there is also the benefit of having the opportunity to increasing my knowledge base in other areas that will also be beneficial to service users.
Performance management is recognised as key to improving services and delivering better outcomes and in larger organisations this can be seen from setting clear targets and monitoring by data analysis (Johnson ; Williams, 2007). My placement is a small charity and performance management is not explicit as in statutory agencies where targets have to be met and data is produced in reports to reflect standards of quality and to show accountability.
I was surprised that there is no system to monitor referrals or assessments as data analysis can be useful, especially for small charitable organisations, in bidding for funds that can be used to sustain existing services or to introduce new projects. Many funders expect to receive end of project reports that show some analysis of how successful their funding has proved to be and could mean further funds being released to continue a project. This also contrasts to statutory agencies who are expected by the government to show that their services represent “best value” (Johnson ; Williams, 2007 p. 86).
The performance of staff at my placement is monitored through regular supervision and procedures such as service user feedback forms and a complaints policy are used as tools to monitor services and performance. The use of the feedback forms are particularly useful for social work students in that they can be used as a reflection of their practice and be evidenced in their portfolio. Research can also be an effective tool in performance management and agencies that use questionnaires and surveys can be useful in improving current services and the use of focus groups in communities can help to create effective partnerships with service users.
However, this could also lead to services being cut if they are not seen as being cost-effective. Research that has been published can also be used by social workers for integrating evidence-based theories into their practice and means there is more chance of producing better outcomes for service users. On reflecting on my placement I can see that it has been an invaluable opportunity to really understand the needs of people with learning disabilities.
I have been fortunate enough to be offered the latest training in brokerage and person-centred planning which has increased my knowledge base and I have learnt new skills in communication and supported service users through advocacy. Social workers in general have large case loads and their time with their clients can be quite limited and can have an effect on building successful partnerships. The placement has taught me how important partnerships are and can work towards solving problems, or building on people’s strengths so that better outcomes are possible.
These partnerships also need to be effective with other professionals to enhance practice. I have also learnt that being a social worker means bringing a holistic approach to your work which means drawing on your own strengths and value base and integrating this with the social work values and ethics. Sometimes, however, this can be difficult and I have learnt that it is important that as a social worker you can recognise when your own values may cause conflict or tension and that you can learn to put these to one side and concentrate on values such as being non-judgemental and showing respect.
Sometimes this can be particularly difficult when working with service users and their families, especially in the area of learning disabilities where it is common for families to be over-protective and at times oppressive in their care of their son/daughter. When I first arrived at my placement I lacked the skills and knowledge to understand these situations and did not recognise that care can sometimes be controlling and not enable people to be empowered and more recently I have been able to use advocacy skills to make sure that individuals I am working with have their voice heard.
There have been negatives from being in a placement that lacks an efficient system of recording written information, but I have been able to overcome this by implementing my own recording methods as I know that if my next placement is in a statutory agency I will have a clear duty to do so. To end on a positive note, the placement has taught me the importance of working from within the Social Model of Disability and policies such as Valuing People (2001) if implemented in practice can bring about change in society for people that are excluded and discriminated such as people with learning disabilities.