chapter  2
13 Pages

Social care approaches


In the United Kingdom (UK) local authorities or councils with social services responsibilities possess particular powers and responsibilities. They can arrange, pay for or provide services for adults – among whom are disabled people, people with mental health problems and carers. In some areas, provision for older people with mental health problems is very much a joint activity between local authorities and the NHS. In other areas, the NHS provides primary and secondary services, but local councils commission social care services and their delivery is largely in the hands of private and voluntary organisations. The latter are also the main organisational providers of social care for people who pay for services, typically running home care services, alarm systems and care homes. Legislation generally refers to community care but the term social care is increasingly

employed as a way of describing what local authorities do in terms of commissioning services for eligible people, providing such support themselves, and working with other stakeholders to promote mental health and community well-being. In England and Wales, the bedrock of their responsibilities to individuals remains the National Assistance Act 1948. This enables local authorities to provide a range of welfare services to disabled people – providing a safety net of support for many older people and others. It is the only part of William Beveridge’s post-Second World War foundations of the welfare state that is still in force (Manthorpe 2009). Ideas about need and disabilities have changed, with growing emphasis on human rights, equalities and citizenship, but the role of the local authority in social care remains fundamental. Other laws relevant to older people with mental health problems widened local autho-

rities’ powers and duties. For instance, the Mental Health Act 1983 placed duties on

local authorities and the NHS to provide after-care for people who have been detained in hospital. The NHS and Community Care Act 1990 (Department of Health 1990) obliged local authorities to conduct community care assessments or assessments of social need at a time when local authorities were moving from being the main providers of social care (home helps and old people’s homes, for example), to purchasers or commissioners of services from the private and voluntary sector (Means, Morbey and Smith 2002). Many laws in the area of social care and mental health affect adults of all ages who

have a range of disabilities or long-term conditions that make caring for themselves difficult, and present risks to their own health or well-being, or those of other people. Laws and guidance also apply to distinct client groups and settings. Such is the current complexity that the law in this area is being considered for major review and consolidation, with the Law Commission (2008) describing it as inadequate, incomprehensible and outdated. One example of this complexity forms the basis of the case study below, where a team is working with a person who has decided to use her social care resource allocation though a Direct Payment. Initially, older people were excluded from the Community Care (Direct Payments) Act 1996, which allowed local authorities to make payments to people who are eligible for social care services (sometimes known as a personal or individual budget). Older people are now eligible and local authorities have a duty to provide Direct Payments in certain circumstances (Health and Social Care Act 2001). Furthermore, under the revised regulations of the Health and Social Care Act 2008, if a person lacks the capacity to consent to Direct Payments, for example a person with severe dementia, a payment can be made to a suitable person to manage the Direct Payment on their behalf. I touch on this below. For anyone working with social care colleagues, the local context also matters. This is

not simply because different geographical areas may have different needs and traditions of provision; it is because local authority social care is part of local government. This is distinct from the NHS and the private sector, and gives rise to advantages and disadvantages. On the positive side, it means that local authorities have discretion over what they spend on social care, as opposed to parks or swimming pools, and may view social care as important to community well-being, or it may mean that there is apparently unhelpful political interference or a seemingly endless need to get political party agreement to get decisions ratified. Elected members may be very keen to support services that meet the needs of their constituents and know much about these needs, or they may have a keen interest in keeping council tax low and distrust professionals. The separation of children’s and adults’ services, common in most parts of England, may give older people’s needs a higher profile, or it may mean that adult services are only a minor element of a local authority’s interests. Team working in a local context is framed by tradition, organisational agreements,

political choices, professional preferences and happenstance. There may be patterns of team working that have been generated by enthusiasts for co-location, where primary care and social services share buildings and much more, despite the limited evidence that this leads to better outcomes. Much seems to depend on two elements. In one study of joint working, both social workers and doctors interviewed described weaknesses in their working arrangements with their counterparts in social and health care and attributed them to two factors (Kharicha et al. 2005). The first was a fundamental lack of understanding and clarity of each other’s roles, responsibilities, pressures and organisational procedures. The second factor was particular local combinations of local

policies, structures and organisation. Good relationships between middle managers from different agencies may stem from their shared understanding of management roles and similar experiences of pressures in the public sector. Together they may have the capacity to shape local practices and policies, to some degree.