Mark Lymbery

A new vision for adult social care? Continuities and change in the care of older people

The reform of adult social care is a major preoccupation within England. It is presented as the inevitable consequence of the changed expectations of people who use services; in addition, the detail of policy is portrayed as being in accordance with what those people specify they want from social care. However, there appears to be little recognition of the complexities and contradictions that characterize much of the policy. Of these, the inadequacy of the resource base of adult social care is most significant; consequently, rationing of scarce resources will continue to be a priority. The paper also highlights problems in other areas, including the rhetoric that accompanies policy change and the evidence base for that change, the lack of connection between issues of independence and protection, the partial understandings of partnership that appear to characterize it and the inadequate conceptualizations both of the nature of those people who require social care support and of the character of that support. In discussing these issues, the paper emphasizes that there remain continuities in the context of policy, while noting the continual focus on discontinuity within government documents.

Education for people with progressive neurological conditions can have negative effects: Evidence from a randomized controlled trial

Objectives: To test the effects of a home-based educational intervention in reducing the incidence and the risk of falls and pressure sores in adults with progressive neurological conditions. Design: Randomized controlled trial with 12 months follow-up. Setting: Participants’ homes in the City of Nottingham. Participants: One hundred and fourteen people with progressive neurological conditions recruited from general practices in Nottingham, including 53 with Parkinsons disease and 45 with multiple sclerosis. Interventions: In the education group (EG), baseline data were reviewed by an expert panel which advised on actions most likely to promote each individuals physical, social and psychological well-being. An occupational therapist (OT) then visited EG participants to provide education and information and to discuss a personalized 12-month health action plan. The comparison group (CoG) received standardized printed information delivered to their home. Main measures: Numbers of participants reporting falls and skin sores at two-monthly phone calls during the follow-up period of 12 months. Results: The EG reported significantly more falls during the follow-up period and at 12 months (adjusted odds ratio 2.83 (95% CI 1.07-7.47), p=0.036) and significantly more skin sores (adjusted odds ratio 12.74 (95% CI 1.14-142.6), p=0.039) than the CoG. There was no difference between CoG and EG in the Nottingham Extended Activities of Daily Living score, but EG patients showed a significant rise in this score over the study period of 1.62 (95% CI 0.69-2.55, p=0.002). Conclusions: Our findings provide evidence that education for people with progressive neurological conditions can have negative effects.

Social work in general practice: Dilemmas and solutions

Closer working relationships between social workers and general practitioners (GPs) have been encouraged in the UK for a number of years, but the passage of the National Health Service and Community Care Act 1990 has given a greater impetus and focus to these recommendations. This paper considers the potential benefits and pitfalls in the location of social workers within general practice, within the context of community care. The literature on the links between social work and general practice is reviewed, in order to identify the most important factors to consider when establishing a project to locate a social worker within general practice. Drawing on the authors direct involvement with three related projects, the Significance of these factors is discussed, leading to conclusions regarding the most effective way to plan and implement such change.

Understanding personalisation: Implications for social work:

Summary This article analyses the centrality of the policy of personalisation within adult social care in the UK, with a particular focus on the implications for social work. It starts by considering the genesis of policy and continues by identifying different ways in which personalisation can be understood and hence analysed. Findings The article suggests that the dominant theme in the rhetoric of both government and the disability movement associates personalisation with the concept of social citizenship – whereby previously disadvantaged people will be enabled to enjoy the full benefits of society, which had previously been denied to them. By way of contrast, the article suggests that personalisation can also be analysed in relation to the critical perspective of neo-liberalism, postulating the idea that the policy is primarily concerned with the importation of consumerist ideals into social care. The article then considers the administrative dimensions of personalisation, focusing on the potential of the policy to achieve particular financial benefits and arguing that this is taking precedence over other interpretations. Applications The article concludes by considering the implications of the analysis for the practice of social work. It identifies the implications of the citizenship and neo-liberal perspectives, but concludes that imperatives of budgetary reduction are limiting the opportunities for social workers to practise within the context of personalisation. Consequently, while there is little prospect of substantial social work involvement in the context of statutory services, there may be opportunities for practitioners to engage with the issues in the context of smaller, often user-led organisations.

Social Work: A Companion to Learning

PART 1: INTRODUCTION Social Work in Challenging Times - Mark Lymbery and Karen Postle PART 2: CONTEXTS The Political, Societal and Economic Context of Practice - Bill Jordan The Place of Values in Social Work Education - Richard Hugman Uncertainty: The Defining Characteristic of Social Work? - Jan Fook Social Work and the Use of Self - Kaeren Harrison and Gillian Ruch On Becoming and Being a Social Worker Why Bother? The Truth about Service User Involvement - Advocacy in Action Research Mindedness - Beth Humphries The Rise and Rise of Interprofessional Education? - Colin Whittington Social Work in an International Context - Steven M Shardlow PART 3: REQUIREMENTS AND PROCESSES Social Work Law - Robert Johns The Process of Social Work - Jonathan Parker Assessment, Planning, Intervention and Review Communication Skills in Social Work - Juliet Koprowska Understanding the Lifecourse - Paul Bywaters Partnership Working: The Interdisciplinary Agenda - Malcolm Payne Practice Learning In Context - Vicky Harris and Martin Gill Social Work in a Digital Society - Jackie Rafferty and Jan Steyaert PART 4: THRIVING IN PRACTICE Social Work in Its Organisational Context - Mark Lymbery Continuous Professional Development - Helen Gorman and Mark Lymbery Professional Development in the Workplace - Tina Eadie Partnership Working - Peter Beresford, Fran Branfield, Munir Lalani, Brian Maslen, Anna Sartori and Jenny, Maggie and Manny, All Service Users from Shaping Our Lives Service Users and Social Workers Learning and Working Together Using Supervision - Jeremy Peach and Nigel Horner Support or Surveillance? Management - Vicky White and John Harris Value Conflicts in Practice - Karen Postle PART 5: CONCLUSION Opportunities and Threats: Social Work in The 21st Century - Karen Postle and Mark Lymbery

Austerity, personalisation and older people: the prospects for creative social work practice in England

In common with other European countries population ageing in England creates particular problems for social care and social work. This is exacerbated by the continuing financial crisis, which has led to an unprecedented assault on the resources needed to maintain older people within the community. At the same time, a policy of ‘personalisation’ is being introduced within social care that is intended to change the nature and balance of services. The effect of financial cuts means that there is substantially less money to respond to peoples needs, despite the demographic changes that indicate there will be an increasing number of vulnerable older people in society. As a result the need for stringent rationing of resources will continue to be a priority, as it has been for many years. This has particular implications for the development of social work practice with older people: there are distinct possibilities that it will reduce in size and scale. This is despite the international recognition that has been given to the specific circumstances of older people, as well as social works commitment to challenge injustice. If the needs of older people in England are to be more effectively addressed the implications of these factors needs to be considered and strategies for the full engagement of social workers within them need to be agreed.

Community care in practice: social work in primary health care.

SUMMARY This paper examines the establishment of social work within primary health care settings in Great Britain, following the passage of the National Health Service and Community Care Act in 1990. Although the improvement of relationships between social workers and primary health care teams has been promoted for a number of years, the advent of formal policies for community care has made this a priority for both social services and health. This paper presents interim findings from the evaluation of three pilot projects in Nottinghamshire, Great Britain. These findings are analysed from three linked perspectives. The first is the extent to which structures and organisations have worked effectively together to promote the location of social workers within health care settings. The second is the impact of professional and cultural factors on the work of the social worker in these settings. The third is the effect of interpersonal relationships on the success of the project. The paper will conclude that there is significant learning from each of these perspectives which can be applied to the future location of social workers to primary health care.

Troubling Times for British Social Work Education

Although the creation of a new framework for qualifying education in social work combined with the introduction of a new framework for post qualifying education appears to have clarified and protected the future of social work in Britain, there remain a number of problems which these developments have not resolved. Indeed, as I will argue, their implementation has created a set of new questions that could derail the best intentions for the development of British social work. The purpose of this paper is to identify the scope of these problems, which potentially affect the provision both of qualifying and post qualifying education. It is suggested that while these issues may particularly impact upon social work education in England, it is probable that they will also present a problem for other countries in the United Kingdom.

Understanding and working in welfare organisations: helping students survive the workplace

In preparing students to function as competent social workers, educational establishments have to be mindful both of the need to communicate the ideals and values of the profession and the requirement to produce practitioners who are capable of functioning productively within the organisational environment. It cannot be assumed that these two tasks are necessarily complementary. Feedback from former students suggests they feel less well prepared for the latter. This paper explores the way in which one Diploma in Social Work programme attempts to prepare its students for the realities of the organisational context of their work with service users. It focuses on a module which aims to teach students about some of the key tensions inherent in social welfare organisations by arranging for them to interview managers and practitioners in their chosen pathway setting. Their findings are analysed in relation to the theoretical teaching given at the start of the module. The positive feedback from the students suggests the overall learning experience for the student group is very positive.

Building a Safe and Confident Future: One Year On—Reflections from the World of Higher Education in England

The publication of the detailed proposals of the Social Work Reform Board in England represents an important milestone in the development of social work education. They address many of the recommendations spelled out in the earlier report of the Social Work Task Force. However, in the changed financial context for public services across the UK, the proposals do not contain sufficient detail of how they are to be implemented in an era of austerity. Indeed, some of them—particularly relating to practice learning—would have proved impossible to implement even if the financial climate had not worsened. This paper addresses a number of the key contextual issues that will significantly affect the education of UK social workers in the future, arguing that a failure to resolve the financial problems will inevitably change the dynamics that affect the delivery of social work education.