My boss took part in a really interesting debate on the personalisation of adult social care earlier this week. It was organised by the excellent OPM as part of their Public Interest Seminar series, more about which can be found on their dedicated website. Photos from the event are here.
The motion for debate was that the success of personalisation would depend on the knowledge, skills and confidence of frontline workers. Since the seminar was organised around the premise of the debate, my boss spoke against the motion, taking a slightly more explicit and less subtle view than those our organisation actually holds. A version of his speech is available here. The central argument, though, is that the success of personalisation will actually depend on building the knowledge, confidence and skills of service users so that they can both navigate the adult social system and become part of it by offering their lived experience to improve outcomes for their peers. This represents a power shift from local authorities to service users and their representative user-led organisations.
The debate threw up some interesting perspectives, some of which I’ve briefly summarised below:
— Who do we mean by ‘frontline workers’: social workers, employees within the voluntary sector who provide services, PAs/carers, residential care home staff in the public and independent sector, or a combination? Personally, I interpret ‘frontline’ both to be the people at the front end of the social care system, providing the initial response to a care or support query and therefore shaping the type of journey someone may have through the system, and then those who take people through that journey. This essentially means social workers, though admits roles for other groups.
— The context of the social care system itself: The argument goes that social workers are bound by the institutions within which they work rather than their attitudes necessarily. Thus, whilst social care itself is relatively decrepit, social workers will always be constrained.
— Attitudinal change: A counter to the point above is that, irrespective of the institutional set-up and process changes within local authorities, it’s the attitudes of frontline workers that really matter. This is the hardest nut to crack, because it’s always easier to change other people’s attitudes than your own.
— Social workers as middlemen: The point was suggested that success will only be achieved by minimising opportunities for social workers to get between Personal Budget holders and the support they access. Thus, instead of the huge bulk of resource currently attached to care management and assessment, resource should be focused more on building capacity on the supply (service providers) and demand (service users) sides of the social care economy. This becomes the fundamental role of local authorities – not as employers of huge swathes of middlemen, but instead as commissioners who develop the market.
— Risk: Whose risk is it anyway? Many of the debates here are well known and tend to fall back to the common denominator of the local authority’s legal obligations to safeguard service users. A genuinely innovative idea raised during the debate, though, was for an explicit “risk transfer” agreement between the local authority and a service user.
Obviously, social care is a huge topic which covers a huge range of areas – long-term funding, public sector cuts, ageing population, market development, user engagement, the role of local authorities, third and independent sectors as service providers, workforce development, social capital, community wellbeing and so on. I’m fascinated by it because I see it as a harbinger of public sector reform more generally, and will continue to share thoughts and findings from key reports here as and when I can.
3 thoughts on “Frontline workers and the personalisation of adult social care”
I was at a conference a few years ago where there was a session on a similar theme.
The first questioner after the presentation asked: “Why do we use the term ‘front line’? Its an unhelpful military metaphor which reveals what central government really things of service users. The ‘front line’ is, after all, where you meet your enemy”.
I’ve never been able to hear (or read) the term since without thinking of his question.
Thanks for reporting this – was disappointed to not make it and sounds like it was an interesting discussion.
I suspect that the change required for personalisation to reach it’s full potential is far larger than most of us imagine. Everyone needs new skills, knowledge and confidence – or at least an environment that allows people to confidently try new things, and make mistakes along the way, and learn from them. This goes for those requiring support and those providing support – in whatever capacity.
My view is that the success of the personalisation agenda will very much depend on one currently disempowered group (frontline workers – of whatever guise) empowering another currently disempowered group (those requiring support) to make or lead fundamental changes. All of this of course in the context of top down requirements at a strategic level, little guidance at a local level (a good and a bad thing) and a culture of fear (not helped by the media) that really doesn’t encourage anyone to try and make changes.
I find the risk argument quite a difficult one – I can find you many, many examples of where the ‘current system’ has failed and people have come to terrible harm – we are not talking about swapping one risk-free system for another particularly risky one….but that has to be a blog for another day.
We should talk more…maybe even meet up 😉
Will – nice point. I’d not really thought about that use of language before, and agree with the essence of its implication.
George – thoughtful as ever, thanks. I agree with all you say, and particularly like your (correct) characterisation of success being dependent on the right people being empowered appropriately in their respective ‘roles.
Thanks both for taking the time to comment.