by Dymphna
A personal view of the social work scene I have, from time to time, in these pages mentioned the problems of the local authority Social Services Departments following the Seebohm re-organisation. I hasten to reiterate that these problems were not solely due to reorganization: had they arisen from a mere amalgamation of existing services we should all have been seeing daylight long ago.
What made matters so difficult was, firstly, the simultaneous flow of other legislation, notably the Chronically Sick and Disabled Persons Act and certain sections of the Children and Young Persons Act 1969; secondly, the very sharp rise in public demand for service, due to several different factors; and thirdly, a confusion amongst social workers as to their proper role in a changing society. This confusion was arising in the late ‘sixties and has turned into something of a crisis under social and legislative pressure.
Well, the combination of all these factors has been very difficult to cope with and I would be less than honest if I did not record that some local authority Departments are still flat on their backs and that in many areas morale is low and confusion high. It does not help matters to know that some of the remedies? notably an increase in social worker staff?will take years to produce because of the problems of setting up increased training facilities.
However, I would also be less than honest if I did not record that many other authorities are now beginning to see daylight. Reorganisation itself is complete, the structures have been erected, the senior posts filled, their occupants have made their plans.
Numerous problems remain to be overcome but at least the problems have been defined. Where the road of social work became considerably pot-holed? notably by the loss of experienced front-line workers to senior and managerial posts?new materials have been rushed up, patching has taken place and the traffic is beginning to flow again.
Some individual services are already definitely better than they were even a year ago, and I would particularly select the service for physically handicapped people. Others remain diluted: the child care service, for instance. It has been suggested that the mental health service has deteriorated, but I am not sure that this is so: I suspect that here professional expectation has risen faster than professional performance.
As I have said, however, as certain issues are resolved, so certain problems emerge for definition and examination. Social workers who a year ago were obsessed with ‘structure’ are now obsessed with their personal roles within the structure. The problem which I would like to take up is not, however, particularly connected with reorganisation. It is almost a perennial problem. It is one which worries me very much. It is, simply put, the problem of residential service.
I have to state it rather crudely. The development of preventive or community-based social work services means that clients who, twenty years ago, would have been removed to an asylum of some sort are now helped to keep going in their own homes. Often this is successful.
Extra care
When, however, the client does ultimately break down and has to accept residential care he is often in a much more parlous state than he would once have been. This means that he needs extra care in a residential setting. This means extra staff and a higher calibre of staff: it means in certain situations placing on the residential staff burdens which flesh and blood simply cannot stand. It means very high costs. Budgets are limited. Every new Home which is opened inevitably means that a thousand pounds a week is taken out of the resources which might otherwise have gone to the preventive service.
This sort of pattern, which looks at first like a vicious circle, exists in various sectors of the social services. It exists in child care; it exists in the mental health field; it exists most dramatically in the field of geriatric care. In the course of one decade, the average age of residents in old people’s homes has soared to the middle eighties and inevitably the proportion of those residents who are mentally confused has risen from something negligible to somewhere around 30%. Staff of geriatric wards’ in general hospitals could tell a similar story. All residential staff are faced with an increasingly difficult and dispiriting task. Can we really ask colleagues to carry on with it? Do we not unthinkingly condemn them to drudgery? Can we lighten their load by pouring resources into community nursing and such services as meals, laundry, night-sitting?
I do not know what sort of balance ought to be struck. Maybe social workers should be less reluctant to offer asylum to people who have not deteriorated too far. Maybe expensive residential accommodation ought to be offered to people who do not really need it as individuals, but who can make a positive contribution to the residents as a group. Maybe a complete halt should be called to the development of community services, which seem to be doing more harm than good.
But there is one flaw in this argument which my readers will by now have spotted. I have argued on an either/or basis: either full support in the community or full residential care. Surely there is an extremely strong case for development down the middle: for a massive extension of day care? In terms of the dignity of the client; in terms of community participation; in terms of ease of staffing; in terms of the concentration of supportive and rehabilitative services; there seem to be overwhelming advantages. And apart from these arguments, can we really assess the total need for residential accommodation until we have pushed day care to its limits ?
If this argument is accepted, is it not the more reprehensible that the Government should have announced that no funds will be made available for day centres and that local authority building programmes will be limited to residential establishments? This sort of decision does no good at all. It spreads experienced and devoted residential staff ever more thinly; it means reducing the resources available to the community-based services; it perpetuates the concept of the ‘last refuge’, under-staffed and demoralised; and, by obscuring real needs under the threatening clouds of the either/or dilemma, it makes proper planning impossible.
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