Sir Ed Davey’s emphasis on valuing social carers was a notable feature of the 2024 British general election campaign. All the parties in their different ways claimed a concern to press forward with the reform of social care.
Commentators such as Mark Carney, former governor of two central banks, political historian Peter Hennessy and Irish equality commissioner Kathleen Lynch argue in recent books that care is going to be a crucial focus for policy in the next 30 years.
Further back, on becoming prime minister, Boris Johnson claimed that his metaphorical back pocket contained an oven-ready reform of social care, but the Conservative party offered nothing in its manifesto for the 2019 election in which he won a strong majority. Perhaps behind this was a lack of consensus on how to avoid a repeat of the hammering received by Teresa May’s proposals for the 2017 election, slammed as a ‘dementia tax’.
Ideas put forward by Johnson in 2021 for a ‘health and social care levy’ the following year to fund, firstly, NHS recovery from the COVID-19 pandemic, would only shift to social care funding in later years. Some money was spent on the NHS, but the whole idea was abandoned two prime ministers later by Rishi Sunak.
Since at least the late 1990s, political debate has recognised that British social care needs reform, multiple committees and think tanks have opined. But proposals have been made and left on the shelf.
Why is it that British social care reform is so difficult? One of the problems is that the UK has always failed to understand the crucial importance of social work in any society.
All societies need social work because ‘the social’ is a crucial aspect of people’s lives. Human beings are social beings, so solidarity through social links and structures is essential in human life. To be a human society, there must be a profession that strengthens ‘the social’ in all its aspects.
People prioritise professional health care, but ask the older woman in hospital about what she needs, and she will often talk about the family and community relationships she is missing or that the problems her absent social contribution are causing. Societies aim to build equality and freedom through economic and political systems. But governing social and health care involves more than ‘delivering services’; human life requires what Lynch calls ‘affective equality’, rights to care for others who are important to us, and in turn be cared about in human, social relationships.
British social care sees social work as a limited adjunct to a wider service delivery element of the economy – social care. Those policy limits mean British social work only provides minimal support for child protection and for people moving on from health care.
Global diversity among a range of social works is much broader. Various streams of social work thinking seek to engage people in building social capital through education and social actions. To engage with services, people need social strengths through interpersonal connections and social structures. They need a profession committed to community-near networks of interpersonal relationships. I argue that all social work requires co-production, working alongside people, not as ‘service users’ but as partners sharing in and supporting human solidarity and social structures that work for caring.
In 2022, the World Health Organization drew on its experience of disaster work and the COVID-19 pandemic to argue that the social care workforce requires ‘basic psychosocial skills’ to provide community services, more than the smile and hello of customer care. Social work brings a strategic approach to make such actions more effective.
Stella is someone who has benefitted from the underrated social work strategy of making arrangements. She is a 93-year-old woman who broke her leg in a fall at home a year ago and was admitted to the local hospital. She had one not-very-close relative, a niece, living at a distance, and paid-for social carers visiting her home three times each week. The hospital, unaware of her home life, treated her broken bone, provided a sheet of exercises introduced by weekly physiotherapy, and expected shortly to discharge her home. Two social workers from her local church found that her previous resistance to entering a care home had evaporated. She needed to talk about the physical insecurity and social loneliness she now felt.
Building back some of her confidence that there were still possibilities for Stella, the social workers talked through her options and discussed possibilities with her only relative, not just that of the hospital’s discharge home. The fall had destroyed her self-confidence, and fear of loneliness during the coming winter meant that she now wanted full-time care, with the option of going home later.
Inspection reports on local care homes mostly rated them ‘good’, so they were no help in deciding a way forward. The social workers used their professional experience to explore the detailed commentaries and identified homes that she might find acceptable. They took Stella’s niece to see the main possibilities, and she made the choice after talking through what she’d seen with Stella. The social workers arranged for an assessment by the chosen home, the hospital arranged transport and Stella settled in. A church volunteer who was also a qualified physiotherapist helped Stella use the hospital’s exercise sheet.
A year of regular visits by several church members, covering most days of most weeks, and a regular Sunday trip to church leaves Stella happy and secure in her new accommodation.
‘Making arrangements’ sounds simple and routine, but social work connects the arrangements with relationships and community social networks. It ensures that the personal and social are both fully explored. By building up the personal strengths and community assets, social work is more than being kind and supportive through basic psychosocial skills. It stitches up the social fabric of people’s personal, family and community lives and gives them the solidarity to live as human beings.
Malcolm Payne holds professorial roles at Manchester Metropolitan University and Kingston University London, having worked in a wide range of social work practice and management roles and in social work education in Europe and the UK.
Listen to Malcolm speak on the Transforming Society episode, How to use social work theory in practice.
Why Social Work is Important by Malcolm Payne is available on the Bristol University Press website. Order here for £21.99.
Bristol University Press/Policy Press newsletter subscribers receive a 25% discount – sign up here.
Follow Transforming Society so we can let you know when new articles publish.
The views and opinions expressed on this blog site are solely those of the original blog post authors and other contributors. These views and opinions do not necessarily represent those of the Policy Press and/or any/all contributors to this site.
Image credit: Ante Gudelj via Unsplash