Chapter 3: A changing context for social work: challenges and opportunities
We all aspire to live in a society that is healthy, tolerant, safe, inclusive and fair. Such a society needs a vibrant economy and excellent public services. Social work services have an essential contribution to make in achieving that goal. Their role has three main dimensions:
- supporting the most vulnerable and excluded members of our society to live fulfiling lives, working in partnership with individuals, families and communities and with other public, voluntary and private services;
- protecting individuals, families and communities at risk of harm from themselves or others through the use of statutory powers, then working to reduce and minimise that risk through helping people to change their behaviours;
- working with others to close the opportunity gap between the richest and poorest in our society, through helping individuals and families to take control of their lives, and develop hope and aspirations for the future.
Effective social work services promote independence and resilience, enabling some of our most vulnerable, excluded and even dangerous people to play an active part in society, through achieving change. In this way, they contribute not only towards the goal of delivering excellent public services, but towards developing the economy, helping people to become self reliant once more.
In looking to the future delivery of social work services in Scotland, this chapter explores trends that will influence future demands. Demographic, socio-economic and political trends have driven significant change in social work services since the landmark legislation of 1968 that underpins social work today. These trends and new ones will continue to pose new challenges and opportunities, influencing the future design and delivery of services. We summarise the major trends that we believe will affect how services are delivered in future, then consider the implications for the three main branches of social work practice:
- children and families;
- community care; and
- criminal justice.
An ageing population
In 1968 people aged over 60 years made up 18% of the population. By 2030, 25% of us will be over 60. In particular, the number of people aged over 75 has risen dramatically and is projected to increase by a further 60% by 2028. This poses a massive challenge for health and social services but also offers us a pool of abilities, talent and wisdom to call on in promoting the capacity of communities to care for themselves. Although life expectancy continues to increase, large sections of the population will spend an increasing number of their later years in ill health. For example, 60% of people aged 65-74 report two or more long term conditions. While this will not present significant problems to many of these people, it poses challenges for health and social work services in anticipating and supporting those people who will need help, promoting self care and improving long term management of problems.
Children in need
Not only has the percentage of the population under 16 fallen, by 11% between 1968 and 2001 with a further predicted fall of 18% by 2028, the numbers of children in our community are already drastically reduced. The pre-school population is now barely half what it was in 1968. (277,000 rather than 478,000). In the same period the numbers of children looked after by local authorities has risen by 4%. On this basis, there may be fewer children in future, but a higher percentage of them are likely to be in need, placing more pressure on local authorities to carry out their corporate parenting role and to find alternative approaches to protecting children at risk. Services will be under pressure to provide more effective transitions within and between services, particularly for those leaving care where we know outcomes are very poor: 60% leave school with no qualification, and a similar proportion don't enter employment, education and training. As many as 20% become homeless within a year. This is a challenge to the whole public sector, requiring an integrated approach to preventing predictable problems.
Medical advances mean that many more infants born very prematurely or with significant disabilities will survive into adulthood, some of whom will require life long care and support. Service providers will be under pressure to provide services that strengthen the capacity of these young people to lead fulfiling lives and to make smooth transitions within and between services. Further advances may rid us of physical conditions that have caused great need in the past, but the World Health Organisation sees chronic mental health conditions such as stress, depression and anxiety as among the biggest challenges Western Europe will face in the next generation. The long term consequences of substance abuse and other lifestyle choices, particularly amongst young people, will also shape future demand for services.
Strong relationships are an essential protective factor in determining mental health and wellbeing, yet as people have more choice in how and where they live, whether to marry or have children, more people than ever are living alone for all or part of their lives. The trend towards more fluid and fractured family relationships is likely to lead to more complex, and possibly weaker, extended family supports and more people living in isolation. Figures from a Scottish Children's Reporters Administration study (Gault, 2005) suggest that significant numbers of children grow up within complex and transitory groupings of parents, successive partners, extended family and sometimes local authority care. The study showed only 21% of children referred to the reporter were living with both birth parents, 16% were in foster care, and 10% were living with relatives other than parents, a trend reflecting the growing inability of some parents to cope, often related to substance misuse and mental health problems.
Although society as a whole has become more affluent and aspirations have grown, the gap between affluent and poor continues to widen. The gap in life expectancy between the most and least affluent areas grew by 45% over the last 20 years and is projected to grow by a further 19% by 2010 to 9.2 years, driven by poverty and lifestyle choices. This increasing social polarisation means that some families have experienced four generations of deprivation, worklessness and declining life expectancy. There is a strong correlation between low socio-economic status and the likelihood of becoming addicted to drugs and alcohol, or of being a victim or perpetrator of crime. 50% of Scotland's prisoners come from local authority ward areas containing only 17% of the population. Growing polarisation in terms of health, educational attainment and income leads to deprivation often being concentrated in defined communities, leaving social work resources particularly stretched. Society will need to find long term and more effective ways to change these communities if an inexorable rise in social problems and the caseload of social work services is to be halted. Social work will have a significant role in this, promoting community responsibility, resilience and capacity and linking people to resources within their community.
The shape of Scotland's working age population is changing. The number of people aged 15 and under is predicted to fall by 18% between 2003 and 2028 and the number of people of working age is projected to fall from 3.16 to 2.89 million. Competition to recruit to public sector services to meet growing need will be fierce and the capacity of the working age population to fund public services will be reduced. Employers will be under increasing pressure to develop, retain and make the most of a skilled workforce. Globalisation of services is already occurring with the use of call centres in other countries, and the opportunity to purchase and use social work services provided abroad is likely to develop further.
Scotland is becoming a more ethnically and culturally diverse country with an explicit "fresh talent" policy to encourage more people to live in Scotland to counteract the predicted decline in Scotland's workforce. The population is now predicted to drop below 5 million by 2036, although this is later than previous predictions as the birthrate and immigration have recently increased. The influx of new Scots provides both opportunities for the social services workforce, but also a challenge in supporting immigrant and refugee populations.
Choice, independence and personalisation
As demanding consumers of goods and services, users of public services will increasingly expect the same variety, choice and flexibility that they expect from the business sector. They will demand a more personalised approach, much greater involvement at all levels and more transparency about the level of services available. Because people are becoming better informed they have growing expectations that services will be delivered where and when they want them. Partnership for a Better Scotland (2003), recognises this, with a commitment to ensure that "public services are designed and delivered around the needs of individuals and the communities within which they live." This will require more honesty about what the state can or cannot provide, a realism about capacity and a clear willingness to say no to unreasonable demands.
Personalisation is an increasingly credible approach across all aspects of service delivery. The implications of personalised approaches to compulsory aspects of social work services, involving social control, will pose particular challenges, requiring rigorous approaches to enabling lasting change.
Technological progress will bring many opportunities and challenges. Easier mobile working can free up workers to spend more time with their clients, while information sharing tools can support integrated working. We live in an information rich age, which both influences people's expectations and provides new opportunities to deliver services. Technology can help in the effective planning of services, matching services to demand more accurately. It can also help vulnerable people to lead independent lives, and improve communication with workers and people who use services. The danger is that the "digital divide" will disadvantage those unable to afford its benefits. The challenge is to use technology to enhance rather than replace human relationships, to help workers 'work smarter', to promote social inclusion and to ensure the protection of the vulnerable.
Changing communities and fear of crime
Social networks and communities are changing and will continue to change. Technology will allow greater access to online socialisation for a majority of the population, creating new communities of interest, and changing traditional concepts of community. Some sections of the population, who neither want nor are able to benefit from this, may become more marginalised. Social tensions and increasing wealth may result in the growth of phenomena such as American style gated communities, which isolate themselves from the mainstream through physical barriers. Political priorities will continue to be driven by fear of crime and antisocial behaviour, potentially undermining further any sense of community. Social work providers face a significant challenge within this context of strengthening the capacity of communities to become more self sustaining.
Social workers have to deal with uncertainty, yet they operate in a risk averse and increasingly litigious society. At the same time they will have to face increasing demand for more independently provided and personalised services which may be less subject to regulation and so potentially more risky. Service providers will need to manage this tension, working with partners and users of services to develop a common understanding of the measurement, recording and reduction of risk. They will also need to help people understand that the sort of society in which there is no risk is neither achievable nor desirable.
The creation of the Social Work Inspection Agency, the Care Commission and the Scottish Social Service Council has changed the organisational landscape in which social work is practiced in Scotland. They are part of a bigger shift towards setting clear and measurable standards as a means to both ensure public safety and drive up the quality of services. This provides an opportunity to promote and ensure excellent public services. It also provides a challenge for both government and services in making sure that over regulation does not inhibit the development of services. Regulators and services will need to demonstrate how they can work together to deliver coherent, trusted and responsive services.
A devolved nation
Post devolution, Scotland has begun to pursue its own distinct evolution of services and to determine the underlying balance of rights and responsibilities between the individual, the family and the state appropriate to Scotland, which will shape services. The ability to respond quickly and distinctively to the needs of Scotland's people has led to a plethora of new policy and legislation. Maintaining and developing effective political leadership will be essential if we are to see these aspirations come to fruition. Crucially, that leadership needs to be visible and credible at both national and local levels, making the most effective use of central direction and local responsiveness to needs.
Integration and social work services
All public services are increasingly working towards integrated service delivery. The theme of services designed and delivered around the needs of individuals, families and communities is at the heart of much policy and has already had significant impact on social work services. Developments in community care are perhaps the furthest advanced, through the Joint Future initiative and single shared assessment. Similar approaches underpin community schools and proposals for integrated assessments for children. Joint approaches to planning through children's service plans, community care plans and ultimately community plans provide a vehicle for joint development. Structural approaches such as the creation of community justice authorities and community health partnerships take that integration further into new partnership arrangements. All of this has a direct impact on the structure, planning and delivery of social work services. A significant challenge for social work services will lie in maintaining and developing the distinctive contribution of social service workers, while promoting joined up approaches to service design and delivery. The three branches of social work will face distinctive challenges, reflecting the changing needs and expectations of society:
Children and families
Family breakdown, fluid and unstable relationships, more children suffering chaotic lifestyles due to substance abusing parents, or from adults who have never learned to parent, and the growing numbers of disabled children living longer have all combined to create a growing number of children with a level and complexity of need barely imagined in 1968. Our understanding and recognition of child abuse, in particular child sexual abuse, mental health problems amongst children and the impact of domestic abuse on child development have grown significantly. Several high profile tragedies, service failures and enquiries have given child protection a very high political and media profile. This has led to a lack of acceptance of risk in the media and the public eye and a scapegoating of social work services when things go wrong. However there is also a growing understanding among partners that social workers alone cannot protect all children in need and that the universal services of health and education must take a greater role in delivering targeted services. Social workers are increasingly working in integrated early years services alongside health visitors and child care workers and in schools alongside teachers and school nurses, a trend which seems certain to continue. While residential child care remains the option of choice for a few children, many more are accommodated in residential provision due to a shortage of foster placements. The increasing complexity of problems faced by these children emphasises the need for highly skilled practitioners in the residential child care setting.
Youth crime and anti-social behaviour are high on the political agenda. Society is facing the consequences of rearing a group of disaffected, alienated young people with little stake in our society, though there is also some evidence of a growing intolerance of young people. Addressing this is the responsibility of all public services, not just social work services, which often deal with the consequences of alienation. Social workers will be major players in an integrated approach to youth justice. Their skills in engaging, persisting with and managing change in the most resistant individuals will be vital within partnership approaches to one of our society's most stark challenges.
The pressure on children and family social workers has been made worse, in recent years, by shortages of social workers able and willing to work in this demanding and highly pressurised environment. While the situation is improving, it has left a legacy in some authorities of unallocated cases, high thresholds before a service can be provided, inexperienced frontline staff, managers and a culture of crisis intervention.
Since the closure of large institutions in the 1990s, social workers, occupational therapists and social care staff have made huge positive contributions to the development of better adult care services, increasingly in partnership with NHS colleagues. This has meant:
- new assessment processes;
- new ways of delivering rapidly expanding services;
- opening up a diverse provider market; and
- managing huge budgetary transfers.
Many people who were receiving institutional care have exceeded society's expectations of their ability to live fulfiled lives in the community. Innovative services have evolved to enable them do so. The increasing aspirations of previously marginalised groups and the subsequent increased demand for services are a consequence of past successes.
Adults with learning disabilities increasingly expect to live ordinary lives in the community. Services have to be open to developing their aspirations, but must protect those who may be vulnerable from bullying and challenging behaviour. This goes beyond individual casework and will challenge society's attitudes, especially around sexual relationships and parenting. For people with mental health problems, many of the themes are similar. The incidence of suicide and self harm in Scotland challenges how we make services available. Services will be shaped by the increasing emphasis on rights and responsibilities of people experiencing mental illness, and the needs of their carers and families. An integrated approach to improved mental health will require further development of partnership working with health, housing and other services.
People with physical and sensory impairment will continue to challenge services to personalise care. Good work is already being done using technology to increase capacity for independent living, driven by a rights based approach to services. Similar challenges face the delivery of services for older people, in helping them maintain healthy, fulfiled and independent lives in the face of greater prevalence of long term conditions. This means that services must work together to promote self care and enable early responses to problems, reducing isolation and finding truly personalised solutions to people's needs.
People with substance misuse problems have needs which cross service boundaries, further challenging services to develop personalised approaches that make effective use of specialist expertise while meeting people's health needs, addressing the impact of the substance misuse on children and families and protecting the community from any associated offending behaviour.
A better informed public will have growing expectations of public services and will be more knowledgeable and confident in producing their own care solutions with appropriate support. Developments such as direct payments will place more emphasis on self assessment and self-care strategies to support independent living, and on the role of unpaid carers and local communities as providers of care. The introduction of an unregulated workforce, in the shape of workers employed directly by people who use services, needs to be fully understood and managed.
All this will only be achieved by stronger partnership between social work services, health, housing and others, within a mixed economy of public voluntary and private sector provision in which all parties have a stake.
Demand on criminal justice social work services will continue to grow, driven by the need to reduce serious and violent crime, the desire from communities for decisive action on anti-social behaviour and the need for a wider and more robust range of non-custodial options to tackle an ever increasing prison population. Increased awareness of sexual abuse will challenge services to balance public protection with the rights and needs of their clients, requiring closer partnership between police and criminal justice social workers to manage high risk offenders.
The development of partnership approaches will drive service development in the foreseeable future. Work on the throughcare of prisoners, for example, has seen increased partnership between social work and the Scottish Prison Service. Prison social work services will play a more dynamic role in making sure there is continuity of assessment, supervision and treatment between custody and community. community justice authorities will bring social work in public, voluntary and private sectors into new partnerships, with a vital role for social workers in engaging with those whose behaviour makes them a risk to communities. Evidence to the review has demonstrated how social workers can use their distinctive knowledge and skills to change the behaviour of those who are motivated to change and to control those who are not. The use of such skills in personalising work with offenders has to be balanced with the strong enforcement required for public protection.
The challenge facing social work is to develop a common understanding and language of risk with partner agencies, and a shared research and evidence base. The perspective of victims will play an increasing part in the criminal justice system in informing sentencing, contributing to treatment and in receiving services in their own right.
An emphasis on public protection will require that crime and the fear of crime are reduced and that standards of monitoring of dangerous individuals are improved whether provided in the public voluntary or private sector, by social work or other staff.
The needs, demands and expectations of society for social work services have changed and will continue to change. If social work services and the public sector as a whole are to be sustainable in future then they must also change. Our recommendations in chapters 5-7 aim to secure this future.