understanding welfare

Understanding Welfare

This essay will outline the major policy and legislative changes to social work services in Scotland since the 1980’s in relation to community care. Community care is an interesting area to study as it raises questions about how the most vulnerable people in our society should be cared for (Sharkey 1995). When Margaret Thatcher came to power in 1979, Britain had suffered a winter of discontent with wide spread strikes and unrest, social workers had been involved in scandals where they had been proven not to be doing their jobs (Fraser, 2003). Margaret Thatcher set about reforming the welfare state through a mixed economy of welfare (Fraser, 2003) as Beveridge’s ideas of a universal and comprehensive system of welfare were based on a nuclear family unit which was no longer applicable to modern society. The 1988 Griffith Report on Community Care recommended that care should be provided to those in need as a partnership arrangement between those requiring care, their families, voluntary agencies and the state (Fraser, 2003). The official government response to Griffiths was the 1989 white paper Caring for People, Community Care in the Next Decade and Beyond, which set out the government policy on community care, largely adopting the recommendations of Griffiths, the 1990 NHS and Community Care Act implemented these policies. Scottish devolution as established by the Scotland Act of 1998 devolved legislative power to the Scottish Parliament.

The Griffith report was commissioned following several House of Commons reports into community care, which were particularly focused on the closing down of institutions and the settling of people into the community. The efforts to do so were not being well managed (Sharkey, 1995) as the community resources were not in place. The Griffiths Report published in March 1988 stated that a single organisation should take control of community care and it recommended the local authority Social Services Departments (Sharkey, 1995). November 1989 saw the publication of the Whiter Paper, Caring for People, which contained Griffiths main recommendations. This was swiftly followed by the National Health Service and Community Care Act 1990 which stipulated the way health and community care was provided in the UK. This act had a major influence on the way people were cared for within the community with the emphasis on care management and the relationship between the purchaser of the care and the care provider (Balloch, Butt, Fisher & Lindow 1999). An emphasis on creating choice for the individual was paramount with a needs-led assessment which should lead to a care package ‘in line with individual needs and preferences’ (Balloch et al 1999). The subsequent use of both the public and private and voluntary sector would provide choices for the individual requiring care. However this arrangement was actually designed to prevent older people choosing a care home which the public would pay for without being assessed, therefore it could be argued that this arrangement actually created less choice. The role of the care manager is to carry out an assessment of the individual, arrange the community care services which the individual may require with an emphasis on providing and managing individual care packages tailored to individual need (Thompson and Thompson 2005).

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The National Health Service and Community Care Act 1990 had good practice requirements contained within it to ensure the quality assurance and control of its services (Gostick, Davies, Lawson & Salter 1997). The Act also introduced provisions for the inspection of all premises used in the provision of services. Quality suggests good standards of care appropriate to the individual needs. Quality assurance tries to ensure the care provider have procedures in place to ensure service users have a high quality service with set standards which are continually monitored to ensure these standards are met, with quality control standards to ensure any problems are dealt with effectively. A complaints procedure was put in place by each social service department to ensure the service user had a voice if they perceived there to be an issue with the care they were receiving. Inspections of care homes already existed before the Act with care homes being inspected twice per year however there was a wide disparity in the quality of inspections (Sharkey 1995).

The devolved Scottish parliament brought in new legislation on care provision in Scotland including The Regulation of Care (Scotland) Act 2001 which marks a major change in the way care is regulated in Scotland. The act is divided into five parts, however the main provisions were to establish two main bodies for the regulation of care in Scotland. Part one was to establish The Scottish Commission for the Regulation of Care (The Care Commission), part two established The Scottish Social Services Council. The Care Commission is an independent regulator of care services in Scotland, undertaking registration and inspection of services against a set of national care standards which were introduced to improve consistency in the standards and regulations across Scotland. All services are covered including care homes for adults, residential homes for children, early years services for children and day care services for adults. The Scottish Social Services Council registers all social service workers and promotes the education and training of those workers. Part three of the act was to make some provisions regarding guarantees, complaints and inquiries. The fourth part contained miscellaneous provisions such as the changes to social work registration and the fifth part was regarding the implementation of the act.

The Care Commission regulates the care of over 320,000 people in Scotland. All new care services must be registered before they can begin functioning, all premises are inspected at least once a year and inspections reports which are issued should be available to view by users and their families. The inspections are carried out taking the national care standards as set out by the Scottish Executive into account. The standards are based on the principles of dignity, privacy, choice, safety, realising potential and equality and diversity (Scotland.gov). The Regulation of Care Act gives The Care Commission the right to enforce change or if necessary close the premises. The Act also gives users the right to complain about a care service and part of the inspection process is to ensure a complaints procedure is in place and service users know how to make a complaint. Services can also make a complaint about the Care Commission which they must investigate.

The Scottish Social Services Council (SSSC) which was set up as a result of the act, with a responsibility to raise the standards in the Scottish social care workforce and make the workforce as professional as for example health care workers (Scottish Social Services Council). All staff who work in the care sector must be registered to improve the care and help protect vulnerable service users. Staff must hold an appropriate qualification for the job they do. Registrations began with social workers before moving onto other staff involved in the care sector. As well as registering staff the SSSC publish a code of practice for workers and employers.

The Community Care and Health (Scotland) Act 2002 legislated for a number of improvements in care services in Scotland, particularly including support for carers (Carerscotland.org). The main provisions of the act are an assessment of carers (including for the first time young carers) ability to care. Local authorities have a duty to inform carers of their rights to an assessment and must take into account the care provided and the views of the person receiving the care before making an assessment of need and deciding which services to provide. The fundamental provisions of the act are that the role of the carers should be recognised, they are often the main carer and have the knowledge and expertise required to ensure that the cared for person receives the best possible care suitable to their needs. The carer is a partner in providing community care.

As a result of the changes in community care, and a recognition that social workers weren’t as well equipped as they could be to work in a changing society a review was commissioned into social work. The review concluded that doing more of the same would not work, social work services do not have all the answers and the best use of the social workers skills are not being used. The resulting report Changing Lives- the 21st Century Social Work Review published in 2006 set out 13 recommendations for social work in Scotland. The recommendations of the review are that services must be designed around the people who use those services, the carers and the communities the service users live in. Services must build the needs of the individual, the carers and the community into their services providing a prevention and early intervention capacity into services. The most vulnerable in society must be protected and supported. The mixed economy of care in the delivery of services must be recognised. Safe, effective and innovative services must be managed effectively with emphasis placed on risk management. Social workers must be supported by employers to enable them to practice accountability and exercise their autonomy. A lifelong learning and development culture must be developed within services. Effective teams should be used to delivery services, thus ensuring a mix of skills and expertise. Leadership and effective management across all services must be developed. Monitoring and evaluating the delivery of services to ensure an improved outcome for the service user, carer and communities must be achieved. Service redesign and organisational development of services should develop the capacity and capability of service to transform the lives of those using them. Scottish social work services legislation should be consolidated by the Scottish Executive. The Scottish Executive have published a 5 year implementation plan aimed at building capacity for change across social work services (carerscotland.org).

The Standards in Social Work Education (SiSWE) introduced in Scotland in 2002 play a key role in developing community care in Scotland. From 2004 all social work students must achieve and honours degree in social work to become professionally qualified. The guiding ethical principles of dignity, privacy, choice, safety, realising potential and equality and diversity, treating everyone equally, valuing diversity and maintaining public trust and confidence in social services are embedded in the SiSWE, enabling new social workers in Scotland to delivery high quality services to the national care standards.

This essay has attempted to outline the major legislative and policy changes to affect community care in Scotland since the 1980’s. Community care in Scotland has moved forward from the Thatcher government and the scandals involving social workers in the 1980’s to service fit for the 21st centaury involving service users, carers and the community in providing high quality regulated accountable services where everyone has a voice. Community care is now the accepted way of caring for people who in the recent past were institutionalised. The 1988 Griffths report paved the way for the legislation which followed and Scotland’s devolved Government continued with legislation to strengthen the community care sector and make it accountable for its actions. A system to monitor and check care facilities ensure that community care in Scotland is suitable for the 21st centaury.

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Balloch, S. Butt, J. Fisher, M. Lindow, V (1999) Rights Needs and the User Perspective A review of the National Health Service and Community Care Act 1990. London: The Joseph Rowntree Foundation

Fraser, D. (2003) The Evolution of the British Welfare State, 3rd ed. Hampshire: Palgrave

Gostick, C. Davies, B. Lawson, R. Salter, C. (1997) From Vision to Reality Changing Direction at the Local Level. Aldershot: PSSRU

Sharkey, P. (1995) Introducing Community Care. London: Collins Education Ltd

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