The third sector and social work: who’s learning from whom?

While social work colleagues from around the world have gathered this week at the Joint World Conference on Social Work and Social Development in Stockholm, I’ve headed south to Siena in Italy. No, I’ve not just escaped from the Great British summer for a few days (though it is nice to see the sun again!). I’m giving a paper at the 10th Conference of the International Society for Third-Sector Research.

I’m contributing to a symposium on Personalisation, user empowerment, the market and the third sector with Dr Sarah Carr (Social Care Institute for Excellence) and Professor Alex Murdoch (London South Bank University) on Friday 13th July. The abstracts for our papers are:

Paper One:  Personalisation and Marketisation: Policy construction and practice implementation – implications for Third Sector provision of adult social care and support 

Sarah Carr

Over the past 20 years English adult social care and mental health policy has gradually determined that service users and carers should have greater influence in both strategic and frontline decisions about care and support (Glasby & Littlechild 2009; Carr 2010). This culminated in the New Labour Government’s 2007 Putting People First adult social care reform programme (HM Government 2007) which officially introduced and outlined the personalisation agenda and proposals for eligible people to have access to personal budgets, so that user choice and control over care and support could be promoted. The personalisation reform agenda has transferred to the Coalition Government (DH 2010) and a new sector-led body has been established to further support the policy implementation (TLAP 2011a). The reforms in England and in other developed welfare states have been linked to policies to develop markets in adult social care (Carr & Robbins 2009).

The implementation of personalisation in adult social care has been largely characterised by increasing the use of personal budgets (including direct payments), but their uptake has been uneven and overall impact on improving choice and control has been compromised in some cases (TLAP 2011b). Two of the main impeding factors have been the lack of diversity in the provider market and the capacity of the information, advocacy and advice service infrastructure to support such a large-scale reform (IPC 2010; NAO 2011; TLAP 2011b). The latter includes ‘user-led organisations’, which research shows can give people effective peer support to maximise the choice and control over their care and support offered by personal budgets, particularly if taken as a direct payment (ODI 2011). A challenge also exists in the shape of integration between health and social care funding and joint commissioning of services, particularly if publicly funded service users are choosing or designing their own support (Carr 2011).

The Third Sector, including smaller local community and voluntary sector services and user led organisations, has historically had an important role in providing care and support that mainstream or large block contracted services have not had the responsiveness or flexibility to offer (VODG/IPC 2010). The ‘Think Local Act Personal’ (TLAP) continued implementation plan for personalisation makes the vital link between personalisation and community development (TLAP 2011a). In this paper we will analyse some of the research and policy which supports an increase in Third Sector provision of social care and support, particularly on a small scale local level. We will also explore the effectiveness of newer models of support service, such as peer support and user-led organisations and the role of building community capacity and collective approaches for a policy which has been characterised as ‘individualistic’. This paper offers evidence and ideas about how personalisation is about changing the culture and relationships in adult social care (Beresford et al 2011), rather than just reforming the mechanisms of delivery and purchase. Finally, we will examine some key implications of this interpretation of the English personalisation policy for radically changing adult social care provision and argue that the Third Sector should be at the forefront of such changes, particularly in a current climate of severe economic constraint and significant restructuring of the public service infrastructure in England.

Paper Two: A third sector organisation shaping the agenda of personalisation: an analysis and critique of the development and impact of In Control

Alex Murdock

Personalisation is an established phenomena in many countries (Timonen et al 2006, Ungerson and Yeadle 2007).  The development of personalisation has perhaps advanced more in the UK than in other countries (Leadbeater 2004, Glasby and Littlechild 2009).  It has been promoted consistently by government policy  under both the proceeding Labour  Government and the current Coalition government.

In the UK  personalisation has extended into a range of client groups and has now reached across from social care to health care settings. It is well established as a mechanism  presented as a means of empowering the client / service user (Carr 2009, Needham 2010).  The extent to which it has been adopted in municipalities varies but in some municipalities it has now reached in excess of 50% of those eligible for personal budgets (Murdock 2010).  The target of the previous (Labour) government was for 30% to be achieved.

What is significant in respect of the UK has been the major shaping role played by one social enterprise, In-Control.  This relatively small organisation has played a large part in both the development of personalisation and in the nature of evaluation (Poll et al 2006, Browning 2007, Tyson et al 2010).  The engagement of a third sector organisation at the early stage in influencing the strategy and direction of policy at both a local and a national level  would be remarkable in any context in a situation where the third sector is usually  seen at the delivery end of the value chain in the form of contracts for client services.

The paper will assess and evaluate the role of In Control and critique their  impact on personalisation in respect of its past,  current and future direction. In the climate of recession and reduced public sector resources there are inevitable concerns that personalisation may be viewed by some as a mechanism to conceal and even deliver service cost reductions.

Paper three  The role of the third sector in social capital enhancement and mobilisation: evidence from an ethnographic study

Martin Webber

A number of factors including increasing life expectancy, increasing expectation about independence and decreasing institutional care are creating a sustained growth in the need for social care services for adults in England (Care Quality Commission, 2009). In its vision for a ‘Big Society’, the UK Government aims to increase the role of civil society in the provision of public services such as social care (Department of Health, 2010; Her Majesty’s Government, 2010). Communities are to be empowered to develop local arrangements for the care of vulnerable and marginalised people, based on the reciprocal principle of providing and receiving services, facilitated by personal budgets. Integral to its aim of developing strong communities, the Government is committed to enhancing individual and collective well-being (Department of Health, 2011).

There is robust evidence that positive and supportive social relationships are associated with well-being (Aked et al., 2008; Webber et al., 2011). However, vulnerable adults in need of care services are frequently marginalised in communities and have restricted social networks (Catty et al., 2005). Some social care workers help people to build relationships and strengthen their connections with their local community (Huxley et al., 2009), but this is afforded a low priority by many (McConkey & Collins, 2010) in spite of increasing evidence of the importance of social capital for health and well-being (Kawachi et al., 2007). To address this, we are developing a social intervention for social care workers to use in supporting people with mental health problems to develop and enhance their social relationships. This provides training and a ‘toolkit’ of resources for workers in how to work alongside an individual to explore their current social network, identify their goals (such as increasing confidence or meeting new people, for example), and support them to achieve them.

The intervention has been developed from an ethnographic study of practice in health and social care agencies in the third and statutory sectors, and informed by literature and scoping reviews. This paper presents the findings of the Connecting People study, funded by the UK National Institute for Health Research School for Social Care Research, and will highlight the unique contribution of social enterprises, housing associations and other voluntary sector organisations in connecting people with their local communities. We will discuss the main themes emerging from interviews and observations with over 60 workers and 50 service users gathered over a period of twelve months. We will also present the intervention model which emerged from these findings, which dynamically relates the practice of workers to a cycle of change for service users, in the context of outward-facing agencies which are embedded in their local communities.

We will argue in this paper that the third sector is better placed than statutory agencies to support the participation of people with mental health problems, and other vulnerable adults, in their local communities. The Connecting People study found more innovation, flexibility and creativity in the third sector agencies in the project. However, in times of fiscal retrenchment and resource scarcity, the third sector will need to be more innovative than ever to maintain its success, which cannot rely indefinitely on voluntarism.

References

Aked, J., Marks, N., Cordon, C. and Thompson, S. (2008) Five Ways to Wellbeing. A Report Presented to the Foresight Project on Communicating the Evidence Base for Improving People’s Well-Being London: New Economics Foundation.

Browning D. (2007) Evaluation of the self-directed support network. A review of progress up to 31st March 2007. in Control Publications, London.

Care Quality Commission (2009) The State of Health Care and Adult Social Care in England London: The Stationery Office.

Carr S. (2009) The implementation of individual budget schemes in adult social care. Social Care Institute for Excellence, London.

Carr, S. (2010) SCIE Report 20: Personalisation a rough guide London: SCIE

Carr S (2011) Uniformity or equality? Integration, equity and the challenge of personalisation Journal of Integrated Care 19 (3) pp.42-47

Carr S & Robbins D (2009) SCIE Research Briefing 20: The implementation of individual budgets schemes in adult social care London: SCIE

Catty, J., Goddard, K., White, S. and Burns, T. (2005) Social networks among users of mental health day care, Social Psychiatry and Psychiatric Epidemiology, 40, 6, 467-474.

Department of Health (2009) A guide to getting direct payments from your council: a route to independent living. Department of Health, London.

Department of Health (2010a) A Vision for Adult Social Care: Capable Communities and Active Citizens London: Department of Health.

Department of Health (2010b) Carers and personalisation: improving outcomes. HMSO, London.

Department of Health (2011) No Health Without Mental Health: A Cross-Government Mental Health Outcomes Strategy for People of All Ages London: Department of Health.

Dickinson H. and Glasby J. (2010) The personalisation agenda: implications for the Third Sector. Third Sector Research Centre, Birmingham.

Glasby, J. & Littlechild, R. (2009) Direct payments and personal budgets Bristol: Policy Press

Her Majesty’s Government (2007) Putting People First: a shared vision for and commitment to the transformation of adult social care London: HM Government

Her Majesty’s Government (2010) Building a Stronger Civil Society. A Strategy for Voluntary and Community Groups, Charities and Social Enterprises London: The Cabinet Office.

Huxley, P., Evans, S., Beresford, P., Davidson, B. and King, S. (2009) The principles and provisions of relationships: findings from an evaluation of Support, Time and Recovery Workers in mental health services in England, Journal of Social Work, 9, 1, 99-117.

Kawachi, I., Subramanian, S.V. and Kim, D. (eds) (2007) Social capital and health, New York: Springer-Verlag.

Leadbeater C. (2004) Personalisation through participation: a new script for public services. Demos, London.

McConkey, R. and Collins, S. (2010) The role of support staff in promoting the social inclusion of persons with an intellectual disability, Journal of Intellectual Disability Research, 54, 8, 691-700.

Murdock (2010) Evaluation of Personalisation in London Boroughs : A report for BHug social enterprise  (unpublished)

NAO (2011) Oversight of user choice and provider competition in care markets London: NAO

Needham C. (2011) Personlization: from story-line to practice. Social Policy and Administration 45, 54-68.

ODI (2011) Independent living strategy: Support planning and brokerage London: ODI

Poll C., Duffy S., Hatton C., Sanderson H., and Routledge M. (2006) A report on in Control’s first phase, 2003-2005. in Control Publications, London.

Timonen V, Convery J, Cahill S (2006) Care revolutions in the making? A comparison of cash-for-care programmes in four European countries Ageing and Society 26 pp.455–74

TLAP (2011a) Think Local Act Personal: A sector-wide commitment to moving forward with personalisation and community-based support London: TLAP

TLAP (2011b) Personal budgets: taking stock, moving forward London: TLAP

Tyson A., Brewis R., Crosby N., Hatton C., Stansfield J., Tomlinson C., Waters J., and Wood A. (2010) A report on In Control’s Third Phase – Evaluation and learning 2008-2009. In Control Publications, London.

Ungerson C. and Yeandle S. (2007) Cash for care systems in developed welfare states. Palgrave Macmillan, Basingstoke.

VODG/IPC (2010) Gain without pain Oxford: IPC

Webber, M., Huxley, P. and Harris, T. (2011) Social capital and the course of depression: Six-month prospective cohort study, Journal of Affective Disorders, 129, 1-2, 149-15.

In my paper I draw on findings from the Connecting People Study which have been heavily influenced by the practice of the third sector agencies in the study. The intervention model which we are now piloting across England in both statutory and third sector organisations has arguably been shaped more by the latter than the former. While innovation and creativity can flourish in the third sector to help people make new social connections, its reliance on volunteers and charismatic leaders (particularly in the smaller agencies) diminishes its sustainability.

Using a case study approach, I provide examples of how workers have effectively connected people with mental health problems with other people, thus enhancing their access to social capital. The paper aims to showcase this practice to facilitate learning for social workers and social care workers across both statutory and third sector agencies.  If you’re interested, the full text of my paper can be downloaded here. Also, Sarah’s paper can be downloaded here.

Finally, Twitter conversations about the conference can be viewed below: