1 Who needs social care or social work and why?

At some point over the course of our lifetime, many of us will have contact with social care or social work services, either for ourselves or for a family member, because they need extra help with everyday life. This could be for a variety of reasons, perhaps the impact of disability, family pressures, illness, or ageing. Social care workers provide that extra help. Social care is about providing practical and emotional support for people to enable them to realise their potential and live as independently as possible. While social workers provide less of the ‘hands on’ work, they do organise social care and undertake more specialist interventions.

Social care practitioners and social workers work with people across the life course. They support children, young people and parents, adults and children with physical disabilities, learning disabilities, sensory impairment, people with acute or terminal illness, older people, carers, people with mental ill health; people who are homeless and people with alcohol and/or drugs dependency. This variety of people and their needs creates a wide range of roles and requiring social care practitioners/professionals to work in people’s homes and communities. 

Watch the video below featuring Ruth, Karen, Peter, Carolyn and Hameed, where you will hear about their lived experiences of using social care and social work services.

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Transcript: Contextualising social care and social work: perspectives of people with lived experience

Hameed

When I first accessed social work services, I was overwhelmed because it’s quite a difficult system to understand. However, with the support of various other people who had been through the system, they encouraged me and supported me to know that social work services are actually there for my best interest and not there to make my life difficult, but to help me to have a better life.

Sometimes, I got it wrong. I was expecting more than what they could offer. And at times, I was surprised in what they were offering because I didn’t realise they could offer that as part of a support package. It was a time of excitement, knowing that I’m going to get their support, time of anxiousness, not knowing what I’m going to be offered, and also feeling overwhelmed with the systems that you don’t have an understanding of.

Sadly, my first experience when I got sectioned was not because I wanted to. It was not because of choice. It was done because of law. The law said I needed to be admitted to hospital. So law doesn’t always come across as positive, even though it might be done for your best interest. But at times, it can come across as a way of controlling and commanding and taking people’s liberties away from them.

Going back, looking at in hindsight, it could be done in a different style. It was almost done like, we are going to take you. And if you don’t come, we’re going to take you by force. I think, later on, it was the same thing done, but in a different style, where I would have said, you can either go with us voluntary – that offers you choice, and you can get a second opinion – or we can section you. And you think, I’ll take the voluntary option by going by choice. You felt a little bit more empowered.

Peter

I’d been very ill. And I’d been in hospital for a while. And when I came home, the effects of the operation and the longer-term effects had changed quite considerably. And so somebody said to me that I might be eligible to claim what was then Disability Living Allowance, which then became Personal Independence Payment.

And a social worker from the Money Advice Unit came and went through the form. And she just went through the form, just sort of, can you do this? Can you not do something else? Tick, tick, tick. And then went away. And I didn’t get PIP. There was no real relationship. There was not really a sense in which she’d got into my life, if you like.

When you first access services, you’re in a foreign territory. You don’t know anything, really. You don’t understand how the system works. You’re always kind of thinking, is there more? Should I be doing more? Should I be doing something different? Is there some other service that I might be accessing? For me, it was really kind of scary.

At the beginning, you feel very, very vulnerable because not only are you trying to manage a situation in a practical and emotional sense, but also, you’re trying to access the help that you think is out there. You know, to some extent, you’ve got to be quite proactive in order to get those services. And it’s probably not going to happen that somebody’s going to pitch up and say, oh, hi, I’m a social worker, and I want to help you. You know you’ve probably got to go out there and do it. And at the time, we certainly were not feeling in a strong enough position to do that. So it’s quite – it was a very difficult process, actually.

Carolyn

Mmm. Yeah, it was quite a different experience for me, accessing social services for Mum, because, by then, I’d fought a lot of battles over our daughter’s health and met with different multi-agencies and had to go into hospitals and speak to all sorts of different people. So I was more ready, in a sense, for it. And I felt more in control in that I knew a bit more of the system and had done a lot more research as to what would be the way forward because my mother’s own GP was not admitting or accepting that she actually had dementia. And I had to push because I knew.

She was brilliant, absolutely brilliant at putting on a show. Whenever she went to the GP, she suddenly got adrenaline and managed to answer all the questions and be lively and OK. And then, for the rest of the month, she was not remembering things and confused and leaving doors open and inviting anybody in and – very big safeguarding thing. So we had to push. And social services came to do assessments. And that was very helpful.

When I found out that there’s an organisation that helps carers, and they suggested having an annual carer’s assessment, then I asked for it. And in the early days, they were very easy to get. They would come out to your flat and talk to you. And that was, on the whole, a very good experience. But latterly, it’s been much more difficult. And then, obviously, during COVID, it had to be on the phone.

When I asked for a carer’s assessment, when I first found out about them, I wasn’t aware at all about legislation, policies, anything like that that was undergirding it. It was just an offer of help. And they rang up and said, oh, we can offer you some vouchers to help – therapy vouchers, massages for stress, amazing things. And they had a little group that did outings once or twice a year for carers. And that’s how it seemed.

But I did have to start looking into it because things changed. And they started telling me that I wasn’t entitled to things. And I asked, under what legislation were we operating? And I got sent some of the Care Act, which is enormous anyway, but some relevant pages. And I really started looking into it. And then I spoke to a couple of social workers. And I had to really go into it to find out exactly what they were offering me and why they started to refuse to offer things. Things changed a lot. I was assuming it was all down to budgets, and I still believe it is or was.

So I, on that one, looked into the Care Act a lot. And with Mum, we looked at deprivation of liberties, didn’t we, when she got very, very bad in the home. And they were wanting to move her out of one home into another, when we had sold her house, and all the money had been spent. And she had privately funded herself. And there was not any money left. And they wanted to move her into a much less quality home. But because she had certain needs, and this home were meeting them, we had to look at, were they contravening her –

Peter

Care, I think.

Carolyn

Care. Yeah, that was the Care Act again, wasn’t it?

Karen

I find social services, actually, to be one of the better aspects of mental health services. And obviously social services covers a wide variety of different areas of practise. And mental health is only one of those. But I always had got the distinct impression from the social workers that I did work with that they were values-driven. They genuinely wanted to help me as a person. And they saw me as a person. And I want to probably credit that particular service that involved that multidisciplinary team, including the social care team.

So was I happy with services that I used? Not always, no. On the other hand, then, you do meet people who change your life around. It’s almost like the good teacher at school. I had a miserable seven years at high school. But there was one guy who was just brilliant.

And the social worker at the Personality Disorder Service that I met on a one-to-one basis was absolutely fantastic. I really do credit them with my being here today. He didn’t work in isolation. But he was the one that worked with me on a one-to-one basis. So good eggs and bad eggs, mixed experiences. But ultimately, it came good in the end.

I saw a lot of people in the course of my psychiatric career – a lot. But this one fella stands out in my mind. The entire service he worked with stands out in my mind, but him in particular. The key message from that, I think, is that one good person doing one potentially relatively small thing can make a huge difference.

End transcript: Contextualising social care and social work: perspectives of people with lived experience

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Contextualising social care and social work: perspectives of people with lived experience

The video provides an insight into the different types of social care and social work, and explores what Hameed, Peter, Carolyn and Karen felt was good or not so good about the professional practice they engaged with. The video also illustrates the impact of the social care or social work intervention on them and their family members’ lives.

In the next activity, you will look at some more groups of people who may receive social care or social work services and consider the role that social care workers and social workers may have with them. As you do the activity, keep in mind that the kinds of intervention provided by social care practitioners and professionals can include any of the following:

Protection or safeguarding: This type of intervention is undertaken to keep children and adults safe from harm, by protecting them from maltreatment from abuse or neglect. Safeguarding work involves undertaking an assessment of risks (and strengths within families) and putting together a plan to keep people safe. It occurs when parents/carers are unable to take care of their children due to circumstances of mental health, disability, addictions or domestic abuse. It can require a crisis response, particularly if children are left unsupervised or for very young children who cannot take care of themselves. Safeguarding is also undertaken with adults ‘in need of care and protection’. Some adults are dependent on others for care and support due to disability, illness or age, and may experience harm from family members. Abuse can be physical, emotional, sexual or financial. Safeguarding work can also involve protecting people who may be a risk to themselves through self-harm and can involve restrictive practices such as detention in hospital and removal of people’s liberties and freedoms.

Personal care: Also known as intimate care, this is a range of activities associated with support and supervision of daily personal living tasks. This can involve assisting people with personal hygiene and toileting, helping people to get up or go to bed, helping people to wash in the shower or bath, dressing, styling hair, shaving, brushing teeth and nail care. It can involve food preparation and assisting people to eat. For people with additional needs, it can involve support with catheter and stoma care, skin care, incontinence laundry and bed changing, reminders to take medications, and support with mobility. Social care practitioners are often trained in the use of hoists, manual handling, food hygiene and first aid, where these are part of the care required. The care provided is tailored to meet the person’s needs and may involve different interactions over the course of the day by a team of staff.

Promoting independence and self-care: This type of social care work is related to the personal care activities listed above. However, promoting independence means the social care practitioner encouraging or assisting a service user to do what they can for themselves. For example, an older person can be assisted to get in and out of the shower and provided with support to ensure they do not fall, however the service user can wash their body. So, it is about doing things ‘with’ people, not doing things ‘to’ them. Self-care activities can also be about more than just personal care. For example, encouraging or helping service users to make a meal for themselves, or accompanying them to an event in their local community to help them stay connected to family and friends, feel included and reduce isolation.

Rehabilitation: This is related to promoting independence by improving a person’s functioning. It recognises that if a service user temporarily cannot do something, that they are given the skills and support to regain a good quality of life following an illness, injury or addiction. Rehabilitation is also a form of support provided by prison and probation services, to help people not re-offend, or adjust to life in the community if they have spent a long time in prison and have little support from family and friends.

Support for carers: A lot of care is undertaken by family members (and sometimes friends and neighbours). This is known as informal care, which is unpaid and often intensive for family members. Many carers are older, and may be looking after their partner, or an adult child with disabilities, and many are women. Informal care can be very stressful, especially for family members who live with service users, and provide care every day, with little time for rest or breaks. Support for carers can involve respite care, where the social care practitioner spends time with the service user, enabling the carer to get a break from caring responsibilities. For example, they can go out of the home to visit friends, go shopping, or do hobbies. Overnight sitting services also enable carers to get some sleep, while social care practitioners attend to service users' needs through the night. There are also support group and advice services for carers.

Financial/benefits advice: This involves helping service users and carers access financial support to help with additional costs associated with their needs. It can be challenging as navigating the welfare benefits systems can be complex. Lack of the right information about eligibility and access can mean some people lose out on financial support that they could be entitled to. People can use additional financial support to access additional services. Some people use ‘direct payments’ which means money is paid directly to them and they buy in their own services, rather than asking for services from organisations in the statutory, private or charity sector – some of which have a limited menu or strict criteria about who can access their services. Carers are also entitled to a carers assessment which may result in accessing services to meet their own needs.

Activity 1 The needs of service users

Timing: Allow 30 minutes for this activity

The images below represent some of the different needs of people who use social care services. Think about the needs that the people in each image may have. Then, in the boxes below each image, note down your thoughts about the roles, activities and services that might be provided by a social worker and a social care worker.

Children at risk or in need

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Close-up photograph of a young girl aged about 12. She is looking sad as she rests her chin on her hand.

Children at risk or in need

Social worker	Social care worker
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Adults with learning disabilities and their families

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Photograph of a mother seated on a sofa with her adult son. They are both smiling as they sit with their arms around each other.

Adults with learning disabilities and their families

Social worker	Social care worker
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Comment

You may have noted the following points regarding the types of service provision that each of these groups might need.

Children at risk or in need

Social worker

Social care worker

Assessment of need and risk Identification of preventative or support services; these might be residential, day or community services Financial assessment and advice Reviews and monitoring of care/protection plans Liaison with other agencies Ensuring that legal duties and rights are fulfilled, for example in relation to education needs, health needs and support for parents/carers Writing reports and attending court Acting on emergency interventions where a child is at risk Assessments, reviews and support for substitute carers such as in the context of fostering and adoption

Support within a range of settings including day services, residential provision, transport, education or health settings In any of these settings, the role of a social care worker would be to meet social needs including personal care (washing, dressing, feeding), play or supervision of parental contact

Adults with a learning disability and their families

Social worker

Social care worker

Assessment of need and risk; assessment of support needs of carers Identification and referral to other services; these might be employment, educational, residential, day or community services Financial assessment and advice Reviews and monitoring of care plans Liaison with other agencies Ensuring that legal duties and rights are fulfilled, for example in relation to education, employment, health needs and support for parents/carers

Social care in day, community and residential settings. This can include helping with personal care (washing, dressing, eating) and/or supporting social development (helping with budgeting, travel, employment, social interaction, communication) Respite care Support with transport

This activity should highlight two important points about difference: that it affects how people interact with others, and that difference is often superficial. Your notes will probably have noted the differences in both physical attributes and personal values.

On first meeting, everyone makes assumptions about ‘others’ and, consciously or subconsciously, categorises them according to how similar to or different from themselves they are. Attributes such as age, size, sex, ethnicity, class, dress, and so on, are used as indicators of identity, and influence how people see and relate to others whether they like it or not. While some characteristics may be crucial to someone’s identity, qualities they wish to be recognised and respected for, they might regard other features as irrelevant or misleading.

Social care and social workers will often be working with the same people, but with a different focus in their roles – although there are, of course, some overlaps in the skills and responsibilities that they have. In the next section, you will explore some of the core concepts that are important for all social care professionals to understand.