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The future of personal social services in Health Boards: policydocument.
Item type Report
Authors Department of Health (DoH)
Citation Department of Health,1983. The future of personal socialservices in Health Boards: policy document. Dublin:Department of Health.
Publisher Department of Health (DoH)
Downloaded 20-Apr-2018 14:58:48
Link to item http://hdl.handle.net/10147/334752
Find this and similar works at - http://www.lenus.ie/hse
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,POLICY BoeOM'ENT ~', '. ' .
. ,;1'. The Fatare of , \
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Personal SOcial Services '" I,
in Health· Boards (~~ ~rvt)
Campaign Group for the Development of Personal Social Services
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POLICY DOCUMENT:
FUTURE OF PERSONAL SOCIAL SERVICES
IN HEALTH BOARDS
November 1983
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,face
.S-Q:.,.;.;,N...;T;....;;;;E_N~T_.;;;.S
Comlni·t~ent to Change
Quotations £rom speech b~ Hr. Ba~ry Desmond, Y~D., Minister for Health 0.,.'
):-: -, .. .:, .. :
~~r" "- ~ -~P~:agraph . ~ . ). .'
'. :INTRODUCTION d~ "~;:~ " 1~1~1 The NSed for a Polici Docum~nt
*11._r~.- -. """, ~ ~\ f. 2 The 'development· and future dire-ct1on
:!t' ;,: :';:'::~il,' J . .... .
of Personal Social .. Services in beal.th. b.o.ards •
Background History - The need for c!'lange.
, The present social work service and str~9tures - how i~ L~.·
Analysis of Personal Social Services &'structures and the implications of developing services within current
··s true tUre s.
A separate prog~ammefor Personal ~ Social Services
- How it cou~~ be.
Page
1.
'- 2~
3._
4.,:
R CHANG 5 ..
, ;'?'.
for
Legislative provision for 'Personal SOCial Services
Provision for Personal Social Services under Heal th Act, 1970.
, . ,
\ Home Help Service i.
Rehabilitation Services.
Limitations
Legislation prior to Health Act, 1970
Children
Homeless.
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5 •.
5.
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7 •. '
7.
7.
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Paragraph
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2.4.3
2.5,_ ';·1
2.6
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" .,' . ,~:. 2.8 ;~·l~.· "
:)~~." :.~.;.
2.9
2. 10
2. 11
2. 12
2.13
2. 14
2. 15
2. 16
2. 17
2. 18
2. 19
Grants to Voluntary Agencies
The employment. .0[' Social Workers
Health Boards .
McKinsey Report.
Development of Community CarB teams in E.H.B.
.l
Psychiatric Service.
Community Work.
Medical Model.
What McKinsey envisaged.
Lack of ~olicy and Planning.
Need fori~~parate programme.
Inbucon Report.
Rejection of Community Care structure - from discontent to critical
evaluation.
Need for separate programme endorsed.
Children's Bill.
Requirements for reform' of the system.
Page
·9.
9.
-9.
i 0 •
11.
12.
12.
14 •
14 •
15.
17.
17.
19.
20.
20.
THE PRESENT SOCIAL WORK SERVICE & STRUCTURES
- HOW IT IS
3. 1
3.2
3.3
! 3.4
3.5
3.6
3.7
3.8
3.9
Crisis or fire brigade service.
Staff numbers and nature of service.
Misuse of current staff resources.
Current Priorities.
Prevention.
Reception Into Care.
Foster Care.
Children in residential care.
Specialist role in work with single parents.
22. , 22.
22.
23.
24.
24.
24.
24.
25.
26.
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Paragraph- Page
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3. 10 Work with Voluntary Agencies. 26.~
3. 11 Adult Psychiatric Service. 27.
3. 12 Child Psychiatric Servic~. 28.
3. 13 Specialist Psychiatric Settings. 28.
3. 14 Communit~ Work. 29.
3. 15 Priorities. 29.
3. 16 Structure of Community Care Programme. ' 30.
3. 17 Review of Programme. 30.
3. 18 The structure in r~ality. 30.
3. 19 rnforma~_ Network. ~2~
3.20. Social t~,p,:rk Structures. 3;L
Chart I Proposed Organization For Community Care j 1-. in the Health Board.
ANALYSIS OF PERSONAL SOCIAL SERVICES & STRUCTURES, AND THE IMPLICATIONS OF DEVELOPING SERVICES WITHIN CURRENT STRUCTURES. 34.
4.1 The Structural Difficulties in Delivering a Service.
4.2
4.3
4.4
Lack of Control Over Budget.
Lack of Planning.
The Delivery of Services in the Community.
4.5 The Implications of Developing Additional
34.
34.
35.
35.
Services within current structures. 36.
A SEPARATE PROGRAMME FOR PERSONAL SOCIAL SERVICES HOW IT COULD BE' 38.
r::; . 1 .)0.
.5.2 Policy on the basis of need. 38.
The thinking of the Minister for Health 38.
Health Board Management Structure Modified -J9 .
The features uf a separate programme. 4 1 •
Budget Control. 41.
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Page Paragraph 5.,4.2 Qualities of Personnel Employed. 41 •
5.4.3 The Need for systems of review 42.
5.4.4 Services planned and provided on the basis of neFo..:t. 42.
5 • 4 • 5 C h art 3 Prop.;scxi structure for tic delivery of Pcrscnal Sccial Services. -
5.4.6 Variety of Personnel Employed.
5.4.7 The need for co-ordination.
5.4.8 The need for flexibility.
5.5 Conclusions.
Submission on Structures in Social Work in Ireland. D.A.S.W.I L'.G'.'P'.S·.U.9
,,'
Information Profile of Social Work, and staff~ facilities and resources in each E.H.B. Community Care Area.
***!!f1***~*
~3.
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I I I I i I i I t I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
Pg. 1.. commitment To Change ,;. -,' .'~
MR. BARRY DESMOND, T.D.
MINISTER FOR HEALTH*:
frhere is a grow.ing view that there will not be optimum health
in a future society unless the ill effects of poverty and
social deprivation have been reduced by action outside the
health care system. " ;
II am strongly of the view that we ha~e to effect a shift in " . resources to ~nable us to provide primary health care and
community care that~~~ as effective ahd efficient as possible.
This policy shift will enable us to improve the quality of
the services available to the psychi~trically ill and the
mentally handicapped. It will enable us to improve the
social Services available for young Children, for
and. for the old."
.•. relatively little discussion of community services .•.•.
ommunity services lack .•••.. major visibility. An elderly
erson fading away from lack of human contact is a far less
ramatic subject than the technology and skill of a new
perating theatre. The kind of chang~s about which we have
.h ta~king will not be made possible no matter how committed
lprofessional your officers may be unless the political agenda
·cts a commitment to change~
very necessary tv think tnrough on how attitudes can
~ed, on how structures need to be adapted at national, I
:arid local levels in order to bring abo~t change,
~? fie e r san rl p r f) f ~ ~ s i!::- !1 3 ~.:; :-: e e d ::: b 8 : U p P .: r' ted .i r:
" to effect change."
lover
to health boards printed under the title
change'in 'Contacts' (the journal of the
Board), Vol. 9, No.3, May/June 1983 p.p. 6- 8]
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Con t P'g. 2.
CHAPTER
I N T ROD U C T ION
, The Need fur a Pulicy Document
This document has been cumpiled- by s(lcial,wor,ker's an.d -.c.om.ra.uni.t.y
workers employed directly by the Eastern Health Board. It
respresents their views on the urgent need for change in
the organisation and structures of Personal Social Services
within health boards.
Personal Social Servi6~s are thuse ser~ices "lying outside
'r the general fields of health and education, which are
~adjusted in some special way tu the particular social needs
-~of individuals, families ur groups and which require
-~ personal contact between provider and recipient."
he develu ment and future direction of Pe"sonal Social
.Services in health boards.
~he document will focus on the development and future I I I I-~:
! .. - :,di~ection of Personal Social Services in health ~oards.
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" uch uf the discussion' of existing Personal Social SQJ'"'Ti--ees
'!Mill inevitably focus on social.work as it is the only
fersonal Social Service which ~as been developed ur
,to~ordinated to any degree. Whatever other Persunal Social
~r~~~ices do exist (e.g. horne help serv~ce), a,re provided by
0~ oluntary agencies which are grant aided by health boards
aJt1~r than being provided directly by health buards.
if;: '::1 ,;?~,
!~~"'''ducument will outline the princ1pl~s on which such services . I:;',"
, h~~ld be developed, in particular the necessity for services
,~ b~ provided according to need as:presented and determined by
eople themselves. It will assert the importance of
,onsulting those with the information and knowledge (i.e.,
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,. f Con t. p g. 3 •
~ local.~pmmunities, consumers as well as service providerst
~and.,~~~olving them in the formulation of policy and in
.~.de~{;ion-making on the allocation of resources. ~ ',J ...• , ,"
:fitJ.':·document will then proceed to set out the structural
.~.' i~'p-iications if services are to be developed as required.
~~kground History - The need for change.
~Chapter 2 will describe the context in which the need for
;change has arisen. It will demonstrate the limited
~legislative provision for Personal Social Services. It
jwill proceed to out1ine how the limited range of social
. jwot-+f~'ic$.s. ,have gr~9.'wn· up piecemeal ,i.in health boards
:'(using the Eastern Heaith Board as an example), and how they
-:were added on to the Community Care Programme because this
was the only one to which they could be allocated. It will
make clear the considerable dissatisfaction social workers
have with regard to current services and the structures
I:. provided to implement them.
resent social work service and structures - how it is
Chapter 3 will provide a description of present social work
:serylces, from child car~ 3nd family work to social work in
psychiatry and community work. It will include reference
'. to' Whatever special isms and posts in particular settings
It)' have been developed. The chapter will then· proceed to outline
,! th~ structures of the Communi ty Care Programme wi thin which
I I' ;;,,' :-' ~~~;f,e services are delivered.
/?~~~~;~:' ~ " ~: ... ; .,~ nalysis of Personal Social Services and structures and. the
I I'~i~p'~~~_ca t i un::; vi deve lOp! ng s,:;rv ices wi.,th in curre n t s truc t ures
'. -r:~,;,:.S,9,~~~:f~r 4 will develop the description of the present services
I I . , i'h;.~',;t;,p;f,,w!:-;:' ',: \J~~~l}YSing the problems arising in the delivery.·r,f the
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. '~iln'M~~~s~, The weaknesses and problems ensuing from the present
<. :J:, i~~:~~t:Wlll be discussed. The chapter will warn of the dangers ·~:·!·:""I;'·)~!!1lptlng to implement new developments within the
. ~:l,~;~~~lfty,,~f Community Care. In particular, i twill give
: ;:;:~~ilj"'i~:; ~.gL~:} ~ 6;~¥{:;;;:: '~'. 10 v e r
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, ------- -' ~--~ --.--, con f;"p g . 4.
he,example of the pending changes likely under a new
~iidren~s Act. It will argue that such changes are not
tJ~sible to implement under current strvctures.
se for Personal Social-Services
_ bow it could b~.
hapter 5 proposes an alternative model to Community Care,
nd outlines the advantages of a separate programme for
ersonal Social Services, which would be additional to the
hree eXisting programmes of General Hospitals, Special
ospitals and Community Care.
his policy document~~oposes, like the Seebohm Report did
or Personal Social Services in Britain in 1968, the need
n Ireland for a separate programme, where P~rsonal Social
ervices will no longer be considered solely as an adjunct
o the older profession of medicine. At their present
tage of development, the Personal ~ocial Services require
frective co-ordination and consolidation within boards which
re enabled to develop a wider brief than health.
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Cont. Pg.5. ! i
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._ .• - _._-,"-" -'--.-.-~':'~' •• =", ... =-='-'-'---= ... ~. --";:.":':'.;;:..:.. : .. ---- ._--------.. __ .-... ,-_._--. -'._-. __ .. - ...... __ .- ---_ .... --.:....-
C HAP T E R 2
1 .. BACKGROUND HISTORY - THE . NEED· 'FOR CHANGE
'; ack of f~r~a-m-e-w-o-r-k--a-n-d--p-o-l-i-C-y---fOr Personal Social Services
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; The absence of a guiding framework or policy document is one of the
fundamental problems in the field of Personal Social Services. There
is no clear policy within the Community Care programme. The origins
of the various duties, powers and policies for this area at present
are to be found scattered through a number of Acts (going back to ", -.
I I' the Children's Act, 1908), Ministerial regulations, Department of
" Health memora~dums and a series of precedents and practices which have
I I, 'i:'" ~volved in a somewhat irregular and unplanned way over the years, often
indeed varying from one Community Care Area to'another, and from one
Health Board to another~
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','
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egislative provision fot Personal Social ~erli'ces
, Health boards were established under the Health Act, 1970. They were
, ';set up to perform functions formerly carried out by local authorities
~. in relation to a variety of Acts as follows:
Acts 1947 - 1966, Mental Treatment Acts 1945 - 1966, Birthsl~nd
Registration Acts 1863 - 1952, Notification of Births Acts 1907
. ne.J,915, the Acts relating to the Registration of Marriages, Sale of
ood and Drugs Acts 1875 - 1936, Part I Children's Act, 1908 and
Sections 2 and 3 of Children's (Amendment) Act 1957, Rats and Mice
(p.,t~,truction) Act 1919, Blind Persons Act 1920, State Lands (Workhouses) ·...:~ .. .,..h_: .. ::{.
cts ,1930 and 1962, Registration of Maternity homes 1934, Midwives Act , .. j (;;··t" ', ....
1.?'4:~ Cas amended by Nurses Act 1950), Adoption Acts 1952 and 1964, Poisons ..•.• ;/) •. :,> ..
~ct1961. It will be noted from this list that few relate to personal
< )C;f~l, . Services • . ·~!J.~i·i~t:>\·.:. roVii'sion for Personal Social Services under Health Act, 1970 ;:, ··-:\·,f~::;~',': . I
hr!~~~fovisions related to Personal Social Se~vices can be noted in the 'J.1-·~/i; .,.. .. " eal-,tfi" A ,:fv"~'~> ct 1970.
,o~~::Ii~~p Service
~'fi:~9n,,61 provides that health boards may noake arrangements to assist :.; .... , .
·% ... th~maintenance at home of (a) sick or .infirm person or dependant,
.?);;!,,)~J:CPectant women or dependant, (cl person who, but for the provision
,/ this serVice, would have to be maintained otherwise than at home •.
Ihis section is entitled 'home help service' and is included under chapter I -)' :neral Med iea 1 (sic) Services.' While the powe r5 under th i 5 ~:::~ on
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" ..... ''1~. :.;:_, ............... ~,~. ,_, •• '~"_ 'p .~. __ ., ,', • ,",_I... " " .... -.
I lcont. Pg. 6. j .,
,'~ J~~: ";.. : : .. , '" " ,:' i. '. c"
~re only permissive, they are open to flexible interpretation.
:'~They have been used not only as the basis for the home help :.: t ,.' ~ervice, but also for grants towards day nurseries and meals
, ! ,
'~n wheels services. " j - I ,,', , j, 'f~-practice, the home help service has regarded the elderly
~.r;,~~he priority target group for its service. They constitute
Lbout three-quarters of the total number of beneficiaries.
';-t t'~resent there are ~ver 6,500 home helps""the majori,ty being
art-time • This servic~ could approp~iately have been •....
".:. ehabilitation Services
le~tion 68 entitled Rehabilitation Services requires health
:'foa;r,ds to prl)vide a service for the training of the disabled
,;.~, I) r , em p loy men t sui tab 1 e tot h e i r he a I t h • He a 1 t h boa r d s .!:!!!!l
-'"rovide and maintain workshops for this purpl)se, or provide
:.::, , q:,u,ipment or materials tl) individuals. This section is
:,;, r:tc.1uded under Chapter 5 'Other Services~i
" "ealth informatil)n and advice
'Ie~ion 71 requires health boards to make information and
: ._I~.~lce a vaila ble on ma t ters rela ted to health and health services.
Lmita tions
.,1,' i,~~111 be noted, therefvre, that the Health Act 1970 relates
o ainly to health and mediCine, rather than tl) Personal Social
'"~le~,ViCC;. ~·li.h.l1 v[ "ill:: ~UWtH'S are olscreJ410nary, rather than
_"~lla'C'ing clear d uti es and res ponsi bi 1 i ties on hea 1 th boa rds
. 0 provide services. Nor has there been any consolidating
"egislatil)n ur co-ordinating structures provided for
arsonal Social Services.
lover
I .. , - .... ;;,.I!!!!"'"~, ... ~~ ...... ~. :._':"::' .... ::-:-: ... -:--. ~ ~ - - -.!. _. - - -- "." ••• " -• ____ • ________ .• _::-.' •• '.0." __ ;,. .. ·0 •• ___ _
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P g. 7 •
. .. ;';1':5 1 at ion rio r to Health Act a
the Children Act, 1908 requires health boards to
some children in private foster care. The Health
7~:' 1953 (Section 55) provides for children to be received
nto care under certain limited circumstances and the health
oards may maintain such children in children's homes or place
hem in foster care. The Boarding Out Regulations 1954
1983) lay down specific requirements in relation to
in foster care. Health boards have ,largely delegated
re'sponsibilities to social,.workers. However,
s~cial workers have b~en required to provide a service to
children and families far beyond the legislative requirements ". .~.
and without the staff and resources to enable them to do so.
To"give three examples:- Many children necessarily received . .'.~; (I :
into care are not strictly legally eligible for such service.
i ~e~ith boards are seen to have responsibilities for services _ ~.0,~; .';, I to' children and families where children are considered at
~tional 6r physical risk by the Department of Health
on non-accidental injury to Children' 1977*
does not have any legal force and relies on co
between agencies. Health boards increasingly seek
Orders from the courts under the Children Act 1908.
in doing so, they are merely using a power that
person" or citizen has to bring a child to the notice
Court and offer to be responsible for its care. The legal
for this may be open to question. What is clear is that I
boards are not legally obliged to act in this·manner.
Act 1953 (Section 54) requires health boards to
lover
Non-accidental injury to children, Dept. of Health, Revised (and produced in booklet form)
on the identification and management of ,~,·.''-''''·i.~.,' " C ide n tal in j u r y to chi 1 d r en, Jan. 1 980 •
d again Feb. 1983.
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'. his. d·ep.endants."
and .. _C,o,mmun i ty Care . !"l .... ' ,'" .
The Eastern Health Board General Hospital
programmes purport to fulfil this duty
··thro·ugh· the wooden building at Bru Chaoimhirl, Cork St., Dublin,
~'h~O:Ugh grant aid to Regina Coeli and Women's Aid, and.
J.h-r.O,iJ g h pay men t for Bed and B I" e a k fa s t a c com 0 d a t ion v i a
~u~-~l'ementary welfare allowance 0 This service is a totally
nsatisfactory pruviSion for the homeless.
to Vol un tal" encies
been left largely to voluntary agencies tu pioneer ...
n:d. attempt to develop: the PersonaJ. Social Services in the
·s.ence of 1 egi sla ti ve and statutory res ponslbi 11 ty for
·:.~iS .. Health boards use. the·permiss.iv .. e--power. __ of Sec.~lon 65
,~:the Health Act 1953 to grant aid' a host uf voluntary
"'I~ ... :~.:.~~es in a haphazard, unplanned and unco-ordina ted faSh.i~n \,' ~p~bl e them to provide Ber-v. ices similar or ancillary too ..
"~,:Z~" clih i ch boa rd s ma y t hemsel ves make a va 11a ble ."
,,~, $,.1 ...
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. "~~~ ~~~~~' ~ ate d pol icy be h i n d s u c h g ran t aid is:
~ I '~"\< Po, ~: ~1
-t(';:(a't<~.to encourage and stimulate the formation of new . · .. J.\loJ·' - :~: .• /',:.:i.,:r!,~: .. · " i1t;~~f:~rt.·. bodies an~ the expansion, wher~ desd:r ab'le'll of existing ,{gan1~,~tl.Ons, part1cularly where there 1S a high degree of
.l~~~on~·!." .. ;nvolvement by individual members in the services '1rov1decL .~,. " ':." ..
·I~:' tJ~ihbourage the forma tion of Social' Service Councils
Jf~'Wh\d<.;~i~ vol un tary bodies wi thi n a Communi ty wuuld ha ve
~P,~:se~.;~f'.iC':;. Tilis racllitates the co~rdination of services,
... ; ,;.ei:-provJ'~Jon of advice and information centres, and liaison ~ "'£ \;? '. . >:: ii',;,:;};: :. ,:.
:!: :;:·}itn,.t:~e· various voluntary organisations and central and t':;~~~r~':st~~'-t'~'tory auth 't' ,,* . , f,";;-', ,'v ' ':-"";i',,-;,. or1 l.es. '
; !:!,C;'~, the focus of such volun tary organi sa ticns in
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~Cont .. ,;;Pg. 9. :l': .';: ··.,.>f:.'~ c! " .
~r ~:d ~1~ t .; (, f g ran t sun d e r (b) abo v e has bee nth eel d e r I y, wit h ·: .. l·~";l t -to i", . :t(~f ~rovision of SU~h services as - da~ centres, meals un
.~ heels, laundry, ChlrOpody. A decreasln~ number employ social
.' orkers, and these are the ones which may provide services
: I~~'f~milies - casework, material aid, children's summer projects,
.. ' .... ,' laygroups. These are the exception rather than the rule.
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here is an urgent need fur development and co-ordination of
uch services in a planned way, and in response to need as
re~ented and determined by local people.
he em loyment 'of Sociil Workers
The employment of sociQI workers in any great numbers in
' .. relfind is a relatively recent development. Up to the
. ar~y sixties, with a few exceptions, health-a~tborities
I. onfined themselves to fulfilling their statutory duties·
el~ting to children." * Professional social workers until . '-;.:- ~
~ ~,n were employed mainly in D~blin, and worked for voluntary
rganisations or hospitals and clinics.
' .. : ;.· .. i:_ ........ .\. eal th Boa rd s
much more strongly in the overall employment
Report published during ~970/71 by the American
consultants recommended new structures for the
lover
I Cont. 10. I I
I , delivery of health services, and divided these into
{J,·otn:~t.ll:lfty care, special haspi tal care and general hospi tal
I , . '.'
I I I , '.
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I I I I I I I I'
r .
dare~ each headed by a programme manager. Community Care
'~s~to comprise personal, preventive and environmental
ealth services; and welfare services (welfare payments
* ndsocial work.)
ommunity Care was to retain responsibility f~r services
hat are "primarily community based where local knowledge
nd" 'ins igh tis of grea tass i s tanc e to their e ffi c ien t,
dministration and where constant communication and contact
ith .. the local population is essential." ** The McKinsey
odel~envisaged a community care team in each area headed
;~:a"Director of Communi ty Care, and to includ'e medical
publii h~althnurses, assistapce officers (now
welfare officers following the Supplementary
Act 1976), social workers, and dentists~** Such
referred to variously as "multi-disciplinary" and
.II# ••. -'_·· .. ..,.:c 0 - s ;) cia 1 ," " w 0 U 1 d b r i n g to be a ron the pro b I ems 0 f
JJamily or the individual the concerted efforts of a
fragmented work of individuals from
services." *;t**
of Communit Care teams in E'H.B.
teams have corne into being in the Eastern
~oard from 1972 until .. as late as 1978. Prior to
·I·there were only three community based social workers :~:;~~?iiJ;:;;..> .. d ire c t 1 Y by the E a s t ern He a 1 t h Boa rd. ~HU Y. ro· The imp e t us
'~ng 1974/75 with the development of most of the
care teams. By May 1976, 9 senior social workers
based social workers wer~ employed. lover
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:" . . .
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,\~!
'Y~':'::.:':·'·I-:;-:·:I "' '.,', c () n t ~ P g • 1 1 •
·,l·. ; ••
':currently (1983) there are 11 senior social workers and 76
£0~mtinity based social workers employed. The stated aim
iof'the Eastern Health Board was "to provide a well-organised,
~~ained and structured social work servi~e within the 0,..; ..... , ••••
~rGposed community care teams and to integrate all social
~ork; activities within the board including those engaged in
, )J~ ~~:;~ Car e and the P s y chi a t ric S e r vic e ." * . - ".' - .' .
~cial workers provided by voluntary bodies funded by the
oard were to be integrated with the Work of the Board's
and the aim was "to achieve an overall ratio
ii'one community socia,l worker (includ.;ing all Health Board
pdlNoluntary and other statutory agency staffs) to each
'.~' 10 t ,0.00 population. n **
. ,s',chia tric Serv ice
-', >P1t?~:'·~'~'bl i n Heal th A u thor it y fi rs t employed "psych ia t ric
.' "6'~i. a 1 w 0 r k e r s II in the 1 ate f i f tie s . By May 1 97 6, the r e
'~'~'f:e 21 posts in the Eastern Health Board. Because at this .~~~: . i.~:e the social work services at community level were being
. ~~ . 1 .. ' ',~i'tlated, growth in the psychiatric service (both in the
I •• ';~\.;?,~ . ... :a :~~p,l tan d chi 1 d s e r vic e s) hal ted, and the n u m b e r 0 f soc i a 1
. ';6~}krs currently (1983) involved in this work is 19.
'<'I:~:~F~ . 0 f the s tat u i:. 0 r y p s y chi at ric s e r vic e in the Dub 1 ina rea
c; ,',~~it£,r 0 v ide d by vol u n tar y age n c i e s fun d e d by the t1 e a 1 t h boa rd.
j1~}~~;~;;'S t . Patrick' s and St. James' s H tJ S pit a 1 s, St. John of
:i.f:7:~j~ 0 s pit a 1 and C 1 u a i n M h u ire (A d u 1 t s e r vic e) and Mat e r
.'1~~,tJ:tal, ~t\~ John of God at both Orwell' Road and Cluain
;t1!\"b~.:,;t e (c h 11 dan d fa mil y s e r vic e ) . The soc i a 1 w 0 r k s e r vic e
'~'iff{-I'" '-\-' v v::"'U1J l.od!'y ::>ec('or nas develo,ped much .more rapidly
lV;~; ~e~~~; years than its health board coun terpart.
'~'~:;~;.j.~_ . /0 v e r
:·il:it1.1,1.>: ~'as.tel"n He'allhi:tg6ard., c'ciinin'u'ili ty. Care Prugramm'e - Irrferltn :R"e:p0rt
':~~7 ~:~o:: 50, .... _ -.c<~~~ __ .,;,.
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:' Con ~~ .. f' ~ • 1 2 . ._:.' !. h;::-:: .~.
the Dept. of Health sanctioned the creation of
eh~&ew community work posts for the Eastern Health Board,
n~'ln respe~t of each commuriity care area, the first of these
e:lhg appointed during 1978/79. Prior to 1977 one social
o~k" post had be"en allocated to community work. This
as created some years previously by the Chief Psychiatrist
D,.~blin North Central community care are!i:i as he saw
ri~ad for preventive work with the local inn~r city
omInunities ser..ved by' St. Brendan's Hospital. Apart from
~~,other social work~rs have used community work methods
J:"rri d i cat e d by nee d sin 1 0 cal are a san d wit h i nth e to est r a in t s
time and personal inclination. Those in the
~w'community work posts have had to face constant conflict l' ·I:;~;~. "~r' the purpose fOi"·-which they were set up, and the Eastern
·""''''·i'''~.'''''
h Board management has treated community work with
~~strust. This ongoing dispute shows no
of being resolved. There has been a resistance to
g community work the sort of support and encouragement
uires if preventive work and the development of
nity services is to be enabled with the involvement of
Seven community workers are currently employed,
posts are vacant.
have been employed within a medical model
Directors of Community Care and Medical Officers
and dominated by health priorities and perspectives.
d reservations about the concept~of Community Care
e possibility of multi-disciplinary teamwork within
It should be noted that few social workers
,,,.-., .. ,',',1>",,'" ,1 rea dye m p loy e d by the he a I t h b 0" a r d,s 0 new r e c r u its .. , t well placed to negotiate their position in the
lover
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.':~':--:'-~'~=.::=-----.. -.~~---------'----------"----_.-- --- .
cont. Pg. 13 •
. !~~ ~~:~ ~
rlh~~~ructure. Unlike's6me other groups a~ready employed J .
):"':cfn'd';established, such as dent.ists and community welfare
~. ~iflcers who opted out of the new structure, social worke~s
-·~·t:empted to work wi thin this new system.
.. 'H'owever, the subordinate medical ancillary role which
be~an in the earlier subordinate relationship of medical
·ii'n·d psychia trlc social workers to themedlcal professhm,
~~'no lunger acceptable to us. Social workers have become
~hcreaslngly aware of' their own identity and their dist~rittive
,i professional contribution to the meeting of human need.
The enabling model of social work places a high value
·.PI!:: the client's involvement in ·the process 01 :-nelpi:((.g
himself. The client in this model jointly participates .:: '-:~.
!ri~identifying the problem and exploring alternative . '\ '.
~.~~tutions; and he is expected to take responsibili ty for
.o:.drr~ win g con c 1 u s ion san d m a kin gd e cis ion s • K now 1 e d g e and \' - .':~j~~." .
-: ;:~~~reness of community needs and reSOUf'ces is an integral
.~~t of the model. This contrasts' with the authority
;' ~~~}ucture of medicine where other disciplines have usually •.•.• ;0., ..
. :: .. ~;~:~n subservient to the doc: tor .T h e willingness of many
" -:;q:~'ti,e I" dis c i p 1 i n est 0 un d e r t a k e any t ask g i v e n tot hem " ..... ~ , . :";~'7;" .. li'~~~~.trasts with the negotiative behaviour o'f social workers
':":'<~hcii:do not accept that medical st'aff can legitlmately give
" .
instructions. This results in a va~iety of expectations
reg a r d to aut h 0 r i t Y s t rue t u res wit hi nth e c () f'l1 mil!" ; t ~'
team, the outcome being the absenc~ of any meaningful
. ' ... :.;;Twork and an uneasy truce. Indeed it is the curren t
·~{~.r.!Ucture which hinders the development of the kind of multi-
'1'~4t~diPlinary teamwork it was intended :to facilitate.
··'~~.:it~ontrast, negotiation between disciplines each with
. t Hfi I" 0 W n s t rue t u res u i ted tot hem and wit h m u t u a 1 res p e c t
f.~Ji.~·~eJCh othe~ is' more likely to result in ef·fective ~~",.,~.,",
ici~J1rani'~fUl t~&mwork.
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, Cvn t. Pg. 14.
t McKinse ed ';' J ;~-!
heMC.~insey Report envisaged that Community Care teams ~ ~.... !
· )w0uld~operate by an initial assessment uf need in each ~ ... ~'r:,::" .. ~ar~~~.production of an overall plan for services tu meet
· :.~~66;·ri~~d, determination of priorities as. part of this plan,
· ':~'~~~iSi tion of the necessary resources and funds tlJ '.,.: .:: ~ , ~ .. ~g}¥~ent the plan, ~nd finally delivery and management IJf j,e- •• : .....
h~ services thus provided.
McKinsey failed, to take into account was the
ealth or medical dominance of the Commuriity Care team
embership. ~the ten services included in the Community Care , * rogramme, eight are medical or para-med~cal servlces,
. ,,/
. . **~ income maintenance servlce, and sucial work and
o~munity work are isolated as the only representatives
,f:",ferse:nal Social Services.
of Polic and Plannin
h~·employment IJf social workers by health boards - whether
n;<ramilY and child care work, community work or in the .. : :~.;
\: hiatric service - has taken place in the context ~f an
p:~'ence of any national policy being formulated, and- ten
later the situation remains the same, bedevilled by
.~, .. ",'_,,··,·, .. hucery" and lacking any coherent policy or planning. , partment of Health sent a draft memorandum ***
llliJ!,:~",~,'>;';'i'"
lth boards in 1972 suggesting guid~lines for the
yment of social workers, but has not followed this up.
aft mentions statutory obligations to deprived
~ en as being the first priority, as trained social I
s could be employed, for example, (a) to "advise
community on co-ordination of voluntary and
social services" ( b) encourage development of
lover
health doctors (Assistant medical officers), general it+on~r~, publ~t health ~ur§~~! ~e~ti~t~, ~~~~t~ 1n~~~cto~~,
lanaI theraplsts, phYS'l(itnerap1s-t-s;' heal th educa'tion """'\'·~"fi.~\"l , , ina.t 0 r s '; .. '. , .' :. ::: .\
ity Welfare Officers.
,Dept. of ,Guidelines for Development of Social Work er;es in Com~unity Ca:e Programmes. (Draft of memorandum "" .,h,~.~l t h boa r d s ) M a v / J \J n p 1 a 7 ::> .'.: :'. _.I. ••
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;:,
~ cont. Pg. ~ ;
15.
o voluntary effort and introduce initial training for volunteers.~"
- ~and(2) to "enable participation of the local population
h in id~mulation of selflhelp groups such as clubs, day
'centres, etc.". Thirdly, the document shows itself less
. kee~}on the employment of what it calls "f-amily caseworkers."
:~It····dbrisiders that they can be "justified" in areas of
,,-~il~iJ~l deprivation with a high number of problem cases, . '''8ul'~th erwi se the i r employmen t would a bsorb too many
so.cial workers,
likely to make II a be too expensive, and even then
major impact o~ the resolution .of
'problems." It states that other aspects of social work
'~~ld be given priority. Otherwise, the document tends to
~~~~gue and does not go into any greate~ detail about the . " -- "0 f soc i a 1 w 0 r'k e r s, 0 rap 0 1 icy f,~ r soc i a 1 w 0 r k . The
!oyment of "specialist social workers e.g. medical social
I(ers and psychiatric social workers" is mentioned
dGalt witt in the draft. There appears to have been
thinking on this by the Dept. of Health or
·th board management and social .work policy has been left
dividuals or local teams to decide inan Uhc'o--'0rdina ted,
c,unplanned and unsupported manner. Such an excuse for
work policy is totally inadequate to the needs
ramme
of the functioning of the Community Care
the years has led us to the inevitable and
conclusion of the need for a separate programme.
of the Community Care medical structure I
the similar structure in the Psychiatric
to respond to nefHl~ in t-.hp "'71'31 f'~I"'P ,11"'_.?'O"'",''':?:!. 'II
·1 Ser'vice3 field and to -develop thJ3 .. ..s--ervice has resul ted
poor mor&le and -in- our rejection of ,,' It has also led more positively to the
etion tha~'~lternative structures ~nder a separate
m me u f fer the hop e for a ~ . .b-e t tel' s e r vic e and res 0 u r: c e s -.---
lover
/,.,.
/
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I I I I I I I I I I I ,
for th~.clientele we ~im to serve and, therefor p , a
, ,I,'_i'~ a r g e'~'.: s h are of the cake and a brighter future fur
r ~ers~~~l Social Services. k,i,__ _ -,:--
~ .,:'~:'
r:· . .' . .-ourij~ew has been further supported and reinforced by the
, It:suPp:i~men ta ry Report of the Chi Id Task Force wh i ch s ta ted: . :~I '-_ _'~",",-
. ,:",~~,; not consider tha t the Communi ty Care programme·
co U 1 d~ ass u mer e s po n sib iIi t y for the fun c t ion san d .. ~:=\ . ,; :.:.' .~.,;~:~;t~ ... ·,
;~~,res])~~?Sibilities of the new C.C.As." (child care
: ~~~Y;,f:~~?ri t i ~ s • ~ " We h a v ~ con sid ere d va rio u s m"' d i fie a t ion s I~~~~he eXlstlng communlty care programme to enable the t.' .. ·:·.:~tl.·';' ,
child care system to function within it Qut none of them
the bill. II ;* It went on to recommend a new progr::amme
known as the Family and Child Care programme.we would
his further and recommend a separate programme for
re Services or Personal SOCial SerVices, or what will
tu as a "fourth programme."
be said that a majurity of the members of the
Task Force held that the new developments they
sed could be implemented wi~hin the current Community
** programmGs. However, they acknowledged that some of
r members had reservations about the capacity of the
structure to adapt appropriately:
consider that the health boards, including the
programme, were designed in the first instance
liver the health services, with welfare services
I I,~' minBr role and bei~g relatively weakly I
the policy and decision-making processes. "
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I r' I I I I
that with a medically dominated servi~p th~~~
distinct danger of concentrating effort and resources
he pathological aspects of the services at the expense
lover
Force 0n Child Care Services Final Re ort to the Minister ealt nown as ask Force Report , Stationery
Prl. 9345, Sept. 1980 P. 396 (paragraphs 6.6.5)
P. 95 (paragraph 5.6.3)
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. --'.-.. _ .. -.--.... ~.,... -_._-
1:·· . t pg. 17. . con • , .
~ of other aspects of the servic.es. 17 *
,'·IThe n;~~' for a s~parate programme was endorsed by a
'~meeting'in 1981 vf senior social workers frvm all
. '~~~~~.;;:heal th boards, and the Secretary of tha t group
l~rcaeie:~on the 23.6.81 to"the Department of Heal th ; .... ;.
recommend that if it is decided that Health
bXr.ds are bod i e s to have responsi bi 1 i ties for prov i si 0n
~~~delivery vf services in relation to the Task Force
eport, a separate programme in each Health Board must be
stablished to carry out this function.".
: ..
Report** (published~in 1982), while it
confirm the openly' acknvwledged faults of
~~mmunity care prvgramme, was disappointing in its
ificial treatment and lack of any real understanding
the basic issues pertinent to Personal Social
Little publicity was attached tv the report.
as any report yet issued as a result of the subsequent
w of the organisation of Community Care.
of Communit Care structure
discontent to critical evaluation
workers, community workers and senior social
t~~ therefore, been experiencing increasing
·tent and frustrations in delivering a 'service
~ the real interest, support and commitment of
lover
Services Final Be ,paragraph
(known as the '!nbucon Report') Dept. of Health, March '82.
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18.
thei~health board colleagues and managers. We were
conc.erned about the lack of any meaningful role in
~e~i~ion-making, bud~et allocation or priorities, input -j ,'. . int,¢ "p'ol icy ,I .... the lack of i .
decisions at area and central level, indeed
policy and services generally. We had sought
bu~~bt received the understanding, support and commitment -;~.:". .
~h~~h,would have been necessary for the delivery and
, /~e:\(·~.vppmen t of an e ffec t i ve serv iCi;!. Persona 1 Soc ial
,1er,~i.ces had been starved of resource-'s because heal th under
·;'~edi-c.~l Directors had understandably been viewed as the
1r1ority. Welfare similarly had tak~ri sqcond place at "\ . '. - ' I ,
I , I , I ,.,
:J~~.~~:r.al level because the flow of information had been
.... -::..:::~h·~p:.ugh doctors. Social work, which previously had some .,
'tjIi'·"i'!W,"" : mal policy input at Programme Manager level was
pst rue ted to use the single formal channel of
l' Directors who showe~ little interest. Social
d, therefore, no formal policy input at Programme
or Health Board level.
I , .... : .t~r.;>:j';;,:lW,i'i.:');~~" dimension, basic also to the Child Task
had been shown to be foreign to the training,
and experience of doctors. Thus, Community Care
delivered by way of a medical model which I , .... I l:.~·; ,
I I:: • I, I f ~ •
I '~.'Q' I , I I:
I I
a para medical team more appropriate to the
.. setting.
lover
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.,---- ... :._----:.:.. . . --. .r-.'.'
;~T~{~~discontent and frustration resulted in a poor level I I .. 'of·~!'·~al. a'inOlig all workers. This came to a head and reached
break.:ing po i n tin grow i ng ex pec ta t ions of seni ors and
I ,. ·d·e~\~~~as for change. Social workers and community workers
ha~~h unreal expectation of what influence and power the
I , 'l.F~~:1~~~.:: :~ 0 cia 1 w 0 I'" k e I'" s had in r e 1 a t ion tom a nag em e n t • The c<s·er·s -responded by seeking a meeting wi th the directors of ~;:7",'.:{ti' ..
\ -c6~~uhity care which only served to confirm their worst I .. the lack of commitment and priority accorded to
\
nal Social Services. The notion of teamwork implicit
I ..h'~ McKinsey Report and the thinking behind the setting
~r~ommunity Car~ teams were denied. Senior soclal workers
I eting with Directors of Community Ca~e were informed that
~ere merely· like "a ,delegation c6ming to a County
I The views of the seniors would be heard,
~6en the seniors could go away and the directors would
I I I I I I I I I I I
on what action was or was not appropriate. There
o indication that seniors would be advised of the
tors' decisions. This confirm@d our worst fears that
anagers were not open to involvement and teamwork
y meaningf~l way.
1"'0 ramme endorsed
ctings w~rc held in June 1982 of all E.H.B. social i..- ,
~ ~t which papers were r~ad and discussion took .... I,
~n the above issues. Dur~ng the summer each team \
i n d I'" a win g u pan i n fl,O I'" mat ion pro f i 1 G 0 f soc i a 1 ',/0 r k
, .. ~ .'t".''';':!,~;~.'!lI:,s~"t'a'!'f, facilities and rcsource~ in thClr area·t This
\ ~:~~~f.Jjl~~::;- t ion was pre sen ted a t a fUr tile r ,g: en era 1 m f.' l' t ; ,., ~ :. :-:
!1";,'~\j;.1,;:iM~:~'i::;.·. e r 1 9 8 2 wit hit s imp 1 i cat ion s \l 0 r po ric y, and in
structures. The meeting erldorFad the need for '. ,
programme for Personal Social Services and
.~ ed a group with responsibility fo~ preparing this
Pel'sonal Social SGT"VTc-cs-·,c.Quld not develop and ........
/,"\'1r __
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,':,
Pg.20.
.. : '". :it· "
be64~e effective without being accorded their own
idi~tity and financial independence. Expertise, autonomy
an~~fleXibility were required at area leiel. Professional
soci-al work direction at policy level was essential, as was ,,'
~n{~peded communication between each level. It should be ~-"'.·"i·
add~d that the community dimension is considered equally
, c'rJ~~ia 1 for the 1 oca t i on of the p sychia tr ic serv i ce in ~. '~.,
hi}~mmunity rather than dependent on hospital beds. tl\"(Y;';""'<'Ll~ ",;\
to a community orientation, and the
opment of community psychiatric services is urgently
meeting on the 2~th June '83 an outline of this policy
presented to a meeting of E.~.B. social workers,
~as endorsed by them.
Bill
also took place at the June meeting about what
lopments were likely to arise under the new Children's
,and their implications for the social work service. ,
a welcome for the proposals considered likely
"~,",;.,",,,e included in the promised new Children's Bill, but the
to be clear about what is required in order to implement
ervices was agreed, and that this cannot be done
commitment to staff and finance them adequately,
deed without appropriate structures.
rements for reform ;of:'the s stem
1 workers employed by the Eastern Health Board are 1" n i ~ 0 ,..... ,.. h "":! "" +- a ,.,J •• ..; ... ~ ~ \- _ _ • ~ ",_ .,.,. ,- ..- L.. _.&- ,"'t •• _ L- •• __ _ - ~ ,.... ~ T""': ~ •• r .! L. __
... _. - - . - - - - - - - - - - .. - ... ... .., ..... ..... ............. ...... .I....... _ .... " ...... - .... ............ ....... -..,I "-4 U, U, - .I. .. - .... J .. within which they work, and its ability to enable the
bility, expertise and autonomy of decision making that
o urgently required in the Personal Social Services.
reqUire a structure which facilitates the sty~~'of
which is necessary to this field of work, and the
lover
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Pg. 21.
'.' : .... ~recruitment of management with the necessary and relevant
',,_'W
~expertise and the interest and commitment necessary to
;~in resources for this deprived branch of health board
·,,:-;'provision, and the will to develop community s·ervices.
~~~0They are no longer prepared to take on duties and .....•.. , ""':'
,responsibilities without the necessary finance, staff, .. -....
;;;/ )?facili ties and resources necessary to implement them . . ~ .....
.They demand the formulation of a coherent and agreed
~~wA·~policy and plan for Personal Social Services.
it':' ** ** ** ** 'li ***
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~_-~.:.r....._ ..... ~.-.,.~~.~'!~ ......... ~------~ .. -~_~._~,---
, .' ~:.j; , .
JJ~Cont. Pg. 22 "i~
•• :.0-
.:" cc:~~ c' C HAP T E R 3
~ . .'l;·~ :,',t. JTHE PRESENT ,.', ,
SOCIAL WORK SERVICE AND
. -~---.~.'.
STRUCTURES
I I '~};J' :j;~:
I 'r"~:) :l:~'.c:~jt~~
HOW IT IS
";"-lCrisis 'or fire brigade service
·.>rt
I r .lhis chapter should be read in the context that the curreht
~c ocial work service has had to be limited to a crisis or fire ',;'!:
I ,~<:
I I I I I I I I I I I I I
igade service. Social work has been added as an appendage
o a Community Care Service whose priorities are medical.
Community Care takes second place to the Gene~al Hospital
.ervice, then Welfare Services at Comm~nity Care level come
ast in order for attention: staff, services or money. If an
dequate social work service is to be provided at community
.. evel, then this requires policy and pla~ning at national,
and local level, with a reordering of priorities and
less being given to hospital and institutional
~rvices, and more to developing community services. A similar
~direction is required from medical to social needs - whether·
9ucational, honsing, or community infrastructure and services •. If I . .
social work service is required, then .the staff, services
~tructures to enable it to function must. be provided.
are convinced 'of the value of social and community work as
service in terms not only of social bt'eakdown but
physical illness (currently almost the total preserve
medicine.) A redistribution of resources is urgently required.
ff nunmbers and ature of service
e relatively small number of staff alS0 n~~rl~
ount. Each Community Care area has be~\een 5 and 9 social
rkers based in Community Care, who cover local areas, and are
inly involved in family and child care work. One of the team
nerally specialises in home finding f"or fostering and adoption,
ough other team members'are also involved in this work •
. ve out of ten areas employ a single community worker within
as ranging from 90,000 to 180,000 population, though two
.:er areas employ a second community worker. Three areas
I I
: I ..
I I I I
.. . ;" - I . - .
I I I I I I I I I I I I I
I I I I I I I I I I I I I I I I I I I I I
Cont. Pg. 23.
;~
r have none. 7 areas emplo~ b~tween 1 and 3 social workers to service the
~ Adult Psychiatflc Programme Service. Three areas where the Health ~l-.
~. Board provides a Child Psychiatric Service employ five social :~
w .. o r k e r 5 bet wee nth em. I ... ~
. ?~
area is headed by a senior sO'cia:l worker. As team' lead.er,
required to relate to each of these areas of work, ! I "
.' ·.~hil·e relating also to a large number of sO'cial worker's in a'
: . variety of 0 ther agenc i es on whom much of the work depen9s.
is ~l~b invblVed directlY'in a selected' number of
One senior cannot undertake in any ~eaningful way the ..
of functions expected aT him/her.
team is'se'rviced by one clerk typist, who "may also have to
t as rece~t1Qnist. Priority is given to .record keeping which is
ucial in so.cial .. work .. , Filing/r·etrieval., .etc., is all done by
workers .and the senior as w~ll ·as .much administ-r.·ativ·e work~
to nine social"~orkers based in 'Community Care contrasts
over thirty public health nurse~. This has clear implications
team work at a ·local. leve~. The small numbers of social
kers allocated to the Psychiatric Service contrast ·with
other disciplines in those settings.
the t~n area teams,' there is the Fostering ~esource Group
ted ·c·entrally. Its five social workers and senior have been
ve in'highlight ing the needs of 'children in h.eal th board care
gh ·media. campaigns, public education programmes and training
'es, a'nd in 5 uppal" t ing area teams in the recru.i tmen t 0 f
parents and the development or a fost~ring service •.
~~ :'~.J.CllL. ~l"aIr resources
stern Health Board is fortunate to have in its ~mployment
':- ly qualified and skilled resource, namely its staff of 115
workers, 90 per cent of whom are pF~fessionally qualified
.. workers. 70 per cent of them have- over 5.· ye.ars experience.
' .. figures are inclusive of senior social workers,
workers based both. in Community Care and the Psychiatric
:. , and community workers). It is a .misuse of public funds
th.e training,
I I
. . I ,- - ",' I .,.~ , I
I I
. -. ,
I . .
I I I I I I I I I I
) I . .
. . I I
I I I ;cont . Pg 24.
,- ,jstructures and resources necessary to make maximum use of
I ~ -2their knowledge and e~pertise, their training and experience. ::t
I I icurrent Priorities j.4
t j1n the context of a crisis service and on~ which is under
I "",~developed in staff and ~tructures, priorities have had to be ~. "'T i
~j~j~~t;def ined, and t he area 0 f work confined wi thin rea 1 is tic 1 imi ts . I "jl~' ~f;;
I I I I I I I I I I I I I I I
" revention
workers are available in health centres weekly. A large
of their time is spent in work with single or separated
rents (mainly mothers) who are living in unsuitable and
satisfactory circumstances, and they attempt to support them ;
wt~te~er way they can to care for th~ir children. Much time
spent also in support of two-parent families who are having
fficulties in coping with the care of their children.
support is more often required in the context of the
qf support services in the community - whether day care
playgroups, day fostert~g), family resource centres,
Because such. services are limited or non-existent,
eption into care may occur which would not otherwise be required.
tion Intc Care
in relation to children who are neglected,abandoned, or
and whose parents are unable/unwilling
These children may have to be received into
(deipite social work support given or often again because
of support services) either voluntarily or increasingly
ugh the courts. Full information must"be gathered on each
,'child. The aim is to place such children in foster care.
less.
V~~W ur scarce resources, this not only is
form of care th~n residential care but also
ork required in the recruitment of foster homes, and in
reparatio~ of prospective foster parents through training
mmes is extremely time consuming. Depending on the
I I I I I I I I I I I I I I I I I I I I I
Pg. 25.
': '~'. j~~ I. "., :~. ~.-
h;dniC needs of some of the children, we sometimes have to
ry;again and again, going through the process of advertising,
f6rmation evenings, training programme and assessment. '.'
. 0 ~ive two current examples: , ,,::.
. A boy 0 f s eve n yea I' sol d who has g r o_w n u pin ins tit uti 0 n a 1
. care since infancy, and
infant of nine months, born with multiple physical
- one leg, colostomy, one kidney and several
deformities.
recruitment and education is approached. on a broad front,
will continue to contact us with the idea that
ing is the same as adoption. It Is essential that social
.ra convey to them that fostering is about helping children
special needs in partnership with the health boar,d.
board has responsibilities for the child, so it is
matter of handing the child over to the first family
applies. :iather social workers must assess and be able
the ability of applicants to cope in the long-term
the child's special needs. This is searching work
does not end either with the child's placement; the health
then must support the placement, and enable the foster
make it work. Particularly during the early stages
acement, but again at times of crisis, and indeed
. ghout, this work requires commitment and time.
in residential care
care should not be seen as a long-term plan for any
Rather the aim should be either to 'rehabilitate the child
,his own family or recruit a foster family for him. HI)T.'H"'':':-',
~~ ::,<;; :i...lllll.Cat..lons placed on the s~cial work service
of adequate staff, children remain on in residential
be rehabilitated, or placed for adoption or
In practice, social worker! :can only concentrate
with a few such children in an active way at any
Their work otherwise is largely at a crisis level.
lover
~.\ ., d H
it 1·1'· ~i
, '! :
(; ;
\i " ':' 1
I I I I I I I I I I I I I I I I I I I I I
., ., .-:."n-,....,._.~
Cont. Pg.26.
This is most unsatisfactory. Staff are required to enable
meaningful reviews to be carried out, and an active plan of
work made for each child.
A recent survey of children in Residential Care showed a
total of 469 children) at least 202 of whom are considered
potential candidates for foster care.
Specialist role in work with single parents
Health board social workers have developed a specialist role I
in this field. Social workers support mothers who keep their
children, many of whom are living in vulnerable circumstances.
A multi-disciplinary approach is required in providing support
and education to enable them care adequately for their children.
also work with mothers during pregnancy and subsequently
enable them make decisions about future plans for their
and to consider each alte~nativeo This entails provision
adoption service - recruitment of adoptive homes, work
with mother towards decision to place child for adoption,
'consents, etc.
uch of the work in this field presents itself in terms of
risis work, and we are unable to do as much as we would
regards real prevention. This involves community work
formation of self-help or support groups. If there was
variety of more kinds of such support services in the community
would not have to take as many children into care as we
... e social worker allocated to St. Patrick's Mother and Baby
e uses group work to provide information and education to
ngle mothers and enable them to make decisions and plans
their children.
k with Voluntar encies
ause of the large number of multi-problem families and the
Lk number of staff available to the health bo~rd, we have
.'
I I •
I i·~;
I I I • I I I I I I I I I I I I I I I I I
':~'.
{.~- .. }.:. : .... ) . ,- .. -".
"
Con t. r~. 2 7 •
to rely heavily on social workers in voluntary agencies. This
in many respects ~_an present as Hlany problems as it solves,
Such social workers present the s~nior social worker with
crisis situations as well, and in such cases he does not have
the advantage as with his own staff of ~lose contact
with or knowledge over a period of time of clients. For example,
a social worker from a voluntary agency may request care for
a child. Because of the health board policy to maintain
and support children in ·.their own families, this requires a
whole discussion to establish whether the health board
criteria for care applies. Such work is extremely time
consumIng, and has impli~ations in terms of organiSing the
seniorls work in an ordered way, Time· needs to be set aside
:by the senior to do planned work and to lead and support his/her
Relating to such a large number of workers takes away
from the performance of such work effectively.
.Adtll t Psychia tr i c Serv ice
'The social workers are concerned in particular with family
unctioning, and have a crucial input to make to a multi
isciplinary Psychiatric Service. Their ratio to other staff ""-"""1 G.r
role difficult to fulfill. They ~ concerned with
and care of children in families where one of the
psycbiatrically ill. (Much of their work is in
elation to the severe problems encou~tered by Single mothers
th psychotic illnesses, where their role is one of support d sup e r vis ion j 1 0., ~ ~.,.-c ..... ~~.. ,...;... (_.-(f!I:... .• ~ ~'-4-.r""_ p:'f;tv-.f
Ct-.r(' ("·t-"--d c...:. Ccr-........... ;..~ OJ" ~ ~t.."e,j ~ ~ t...t.4d 6-rr~tI-:,_
ey provide a support service to families with chronic (/.G~i' 1;,"~'l·:J /2';'.· /' . '/ .. !
tie n t s (~i-z-o'p-h-r-e-fl-i:-e-s-) inc 1 u din g w 0 r k wit h t;..h:e .
C'W'l~79-'~i"-€~b-a~,.s..lWC; a r. i. ".:C... '!'!; c ~. ,v:i. t: ",i s one ot' pr even t i on
d enables the maintenance of patients in the community through
.pport of their families, thus preventing relapse and admission
hospital. (Research clearly docume.nts the need for family
as preventing more frequent ~elapses of SChiZOphreniCS.)
./ ,1(2 " ) "t'. c4 flU./, .-.' '-I. ""/.7" . e j .. l.~ tt;'rJ7 ~ ,Ff·- CJI-&.A' --.I t._} /Ct')'tf. ~ . " .. ' .' ..
a 1 soh a v ear 0 lei n c...9...=.Cl..P-d-i-fl-a-t-fn-g- C a !lIt1. U Il i t Y -s-e-r-v-i-e-e-s--,-.. and '~. .
alternative accommodation (fiostels, group homes) "nding suitable / ..... • J , .. , !d" .... J...,p,.... G'
Ii'
I I t,
r:'" I':"
I .,,:, I·.·
I r I I I I I I I I I I I I I I I I
.~-.. ---'.-.- .. ,'
Cont. Pg.28. ,0
" ere indicated~ It is clearly e tablished that accommodation ;"'\ ',.
ted where family dynamics " .",' 1
n r e dU-€-e---'(h e f r e que \hc-t.._-,-" -"
s~parate from the'Jamily is indic
","i;,:~, iT o\z:.://lntense, ~hd ___ ,t-.hJlt,- this c
. Cif relapses.
. . ':"~' .
'..(,
:<.,~,',' ..
;
Psychiatric Service \
Child Psychiatric Service is 1nVOlved where specific problems
e identified in r~lation to chi dren. Their work is in the
sessment and treatment of ,such problems in the context of
e child and his family. Such a bervice operates only in
'llyfermot, Castleknock, St. Loman's and St. James's.
addition, a social worker is a member of the team at
rrenstown House, a residential treatmeht centre for children
acute problems.
Ps chiatric Settin s
,e Eastern Health Board provides a Forensic Service on behalf
all eight health boards at the Central Mental Hospital,
This service is for psychiatric patients remanded
courts or who cannot be treated or maintained in the
or local psychiatric hospital setting.
: single-handed social work role in an inter disciplinary team
that of maintaining or creating a link with the community
lor family for the patient. It also means involving the
al community in the institution, and providing more social
lets and skill learning opportunities for patients e.g •
. ching (V.E.C. I, literacy classes, A.A. Follow-up is
vided for selected patients on discharge. Group work is
o undertaken with young delinquent and disturbed adolescents
~~~ana vay Centre.
social workers are located in the Alcoholic Treatment
tre at St. Dymphna's. Group work i~ the method of choice
this setting. ,
lover
l
f i: I) f:
~i
I I ,
I
. --... :--.-:.---.-.-.~-.- ...... ':'-' - . -:..:.:.:.. ... ~.~'.:::::.. ........... -............... --............. -..
~lllJ~J:.g"....o:::.:J~--:....---::.----_______ ~---·-"--."7_,,-_ ...
Work
I I. 'co~munity workers in the Eastern Health Board employ a community
development model of community work. This ap~roach inc~udes I 're's'ponding to social need and problems in the areas where I: '. t~ey work, and working in a preventive ana developmental
I ,~·~i:.r. ~':I1l!.~~.acity with 10'cal people to build strong, self supportive
unities.
I I I I I I I I I I I I I I I
has been found practical for community workers to focus
~~~a definable local community and on particular proje~ts :>w~':thin that area. It is important to have members of the
:, .ar>· . :."t'eam who can be allowed the opportunity to develop projects
" ;
. '''' ..... , •. ;." ' .. ,<., .'~'h i c h will a 11 e v i ate the sit u a t ion sou t l,. i ned abo ve . .~ . ,':.C:ommunity work is not a luxury; it is essential as a method
. '''''!~'
:i&r work for many more social workers in health board teams ",".
real progress is to be made in~prevention.
iorities
are in the areas outlined above, and tend to be
sentially a family and child care service, along with a
sychiatric service, both of··which are~limited crisis service~.
client groups within the community receive per force
ttle or no service - for example, referrals from huspitals
follow-up, those without children, elderly, physically
mentally handicapped, drug abusers.
and supervision are required from the senior in
.crisis work. Thii~ as has already been noted, leaves inadequate
planned supervision. The health board has neglected f' n Y' n 1 !:),., to"\ ~ ,,",:t' ..... ¥" .... -. - -.~.. • " ,'0'...., _____ ..... Q.I. WVl I\.
ensure the necessary structures and
the work. In-serVice training is a
;;;~I'VLC~ oy ~t.S rallure
adequate staff to .
totally neglected area
is a misuse of qualified staff (note the budget of
£150 for each team and the lack of any planned approach
to training with some one person given specific responsibility
for it).
lover
'w. ___ •• __
--.
j, i:
\' I I t· i: I),
.{
~lj 1\ II
I I .~' .' '
: Con t '0 ,_ P-g' , 3 G • r; _' .,)\,
.~./':··~f.-
"~Structure of Communiti Care Programme ·:~i,' .
:lThe medical bias of Community Care originates rrom the decision :~" :.\ ~of the Minister for Health in 1972 to overrule the principle \~" . lof the McKinsey Report by extending the title of' the area manager
I I I I
of Community Care Services" to "Director of
t.1a.;'~~~';\lommunity Care and MedIcal Officer of Health'" thus confining
t to doctors, It was agreed that this decision, w~uld be
tt~~~reviewed following three years experience of community
are teams. In the event, there were considerable delays in
introducing the new structures part~ularlY in the Eastern
ealth Board area, and it was not until June 1978 that the then
I I 1E:j,.;,j),>\~~
I I I I I I I I I I I I I
Health agreed that the organisation had settled
n sufficiently to enable the review to proceed.
of Pro ramme
phase of the review was conducted in 1980 and 1981
y Inbucon Ltd., whose report was submitted to the Dept. of
alth in March 1982. It should be noted that the management
were specifically asked to provide a "factual
sessment ll of the position as they found it and were not ask~d
take account of ex~ected developments or to make recommendations
or changes or improvements.
second phase of the review, which began about May 1982,
volves discussions wifh health boards and staff organisation~.
this review is to find solutions to the problems
in the Inbucon Report as well as considering
changes in the light of the planned developments
Care over the next five to terr years.
proposed str~cture is shown in Chart I on the next page.
practice, it has worked out differently. Senior Area
ical Officers are appointed Acting Directors of Community'
e in the absence of the Director of Community Care and this
ects the balance of the team. There is a longstanding
tructi6n to members of the L.G.P.S.U. not to co-operate with
lover
"
I I t
1
1 :: .\ ,. ,
: ~ I
:' " , I
:\1 :\ ,
" .,
.,
.. . . ~
I I I I I I I I I I I I I I I
. " ", . . , . ~ ........... ,- ... - ... -'·4.'.,.; .... ~.!:.::-_7.=~~'_~·: .::.~:::··~:.:·.7;~·'~·:::.. .... ..,:;.:;'2:._· . ~~~'~...::..~._'::'.",:, ., ........... ~ •..
P g • ~"3'.' -~-- . "'- : .. -.
PROPOSED ORGANIZATION FOR COMMUNITY CARE
IN THE HEALTH BOARDS
PROGRAMME MANAGER
ADMINISTRATIVE
SUPPORT STAFF ~----+----------t SENIOR SPECIALIST
ADVISORS
DIRECTOR
OF COMMUNITY CARE
t ADMINISTRATIVE
STAFF
DENTAL
OFFICERS
SENI9.R PUBLIC
HEALTH NURSES
PUBLIC
HEALTH
NURSES
':'
HOME
ASST. INS
ASST.
OFFICERS
GENERAL PRpCTITIONERS
AND, PHARMACISTS
" ..
SENIOR IAL
WORKERS
OMMUNITY.
·AllE TEAM
DISTRICT -----.'
~----
DISTRICT
PSYCHIATRIC
STAFF
TEAM
. I
I ~ !
n~\ 111 . ~ . . :,,1 i:;:j
;~. ·1 .. , J.
','I
I I I I I
\ .
\':-
I I.
- ,- . -~ .... -. . _ .. -.- .... _--_.-."_._-_.-
Cont. pg. 32.
_!i;;~"~,,~: L
iuch acting appointme~ts which the union considers should ~~.
be open to each discipline. Dental officers and health inspectors
do not participate in any way in Community Care teams. Community I~ i
jelfare Officers, while th~y may ~ttend me~tings, acknowledge "', c-) j
~o reporting relation~hip or accountability to Directors, ,:!',
I I I
1~:;,~;.!",.ilhUi;5'n t report directly to the Programme Manager. The new
sciplines added to the programme - occupational therapy,
ysiotherapy, health education - together with the position
public health nurses as the largest numerical group within
\ffjr~~~~rhe team have tended to add to the medical bias wi thin the
I I I I I I I I I I I I I
.. ormal Community Care team structure. There are no senior
ecialists advisors to the .Programme Manager so formal input
social work is through the medical me ... d.ium of Directors only.
here is little or no formal liaison with the Psychiatric
gramme at area level and boundaries do not even run concurrently.
Network
multi-disciplinary teamwork is often more fruitful,
owes nothing to.the formal structure. Social workers
members of a variety of informal team networks which are
requently as important, often more important than their
.ormal team membership. These involve for example, a
ultiplicity of voluntary organisations, teachers, lawyers, y
ster parents, child care workers, psychologists, etc., etc.
formal structure does little or nothing to facilitate
links and teamwork.
Work Structures
position is that there are two ~rades of post only
the social work structure, i.e. social worker and senior ... - , .... v'" r..c" 0 ine 11mltations of this ar~ obvious in terms
a support and supervisory structure, training and a career
ructure for the profession which will help to motivate
d encourage its members, and result in:a better service
the public. A joint L.G.P.S.U./I.A.S.W. committee drew
a policy document on Social Work Structures during
79/80 which was agreed by the memberships early in 1980.
appendix A).
I ,1
I
J
I!:
I I I '.,'
...... I I,
I I I I I I I I I I I I I I I I I
.~:" :
;~:
~However, during 1980, 1981 and early 1982, the Department
tof Health failed to honour their long-standing commitment .. /.: .
set up a working party on the role and grading of
workers. Following meetings during May 1982 with
Department to ~esolve the industrial dispute over
failure of the Department to initiate the long-promised
Community Care and of the post of Director of
C~re and Medical Officer of Health, the Department ~greed to the establishment of a "working group" with the following terms of reference:
~To consider and make decisions on a range of matters ' . )
.. ffec t i ng s02-i a 1 work, i ncl uding gradi ng,'" The worki ng
gr.oup first met in June 1982 and has not yet finalised its deliberations.
I I I I I I I I I I I I I I I I I I I I I
, ,
, I 1).: ~ ~I'-l" '~<1t,,;~<t~)-.JJH:~ ~ .. : ~", ''',; _:~
Cont. Pg. 34.
C HAP T E R 4
. X A N A L Y SIS 0 F PER S 0 N..;;.A;...;;;L~...;;;S...;;;O...;;C..;.;I..;.;A..;.;L_.;;;.S.;;;.E~R,~V.;...I.;...C E;;;..S.;...-.;...A;.;..N_D __ S_T_R_U_C_T_U_R..;;.E;..;;.S , ,:/ • AND THE IMPLICATIONS OF' DEVELOPING SERVICES WITHIN " -----~~--~~~~~~~~~~~~~~~--~~~~~~~~~ t,: ~ CURRENT STRUCTURES }:. ;t
l The Structural Difficulties in Delivering a Service.
It has already been shown that personal social servic~s are
delivered a~ an aqjunct to a medical and health service w~~hin .,
Community Care Team.
high ~egrce of attention which th~ Health Board has given
:'~o the d~velopment of t~e Health Services as opposed to the
develoPlJ1ent of Welfare Services stems fr-o'm the traditionally
powerful position of the medical profession.
Lacl< of Contr_ol Over Budget
It is evident from looking at social services as they exist
within Community Care that the bulk of the money over the
years has gone into health and medical services and little
or interest has. been given to social services.
t~ statistics published by the Department ?f Health
the year 1981, total.nan~capital expenditure was £850m
out of this £15.6m went on personal social services. This
represents 1.8% of total non-capital expenditure in the eight
health boards together.
£15.~m was spent as follows:
4.6m on Home Help Services.
I, /' - v..'::> 0::: (,; \" .1 0 n b 5 g ran t s i. e. vol tin tar y g g e n c i e sma i n 1 y
O.6m for Mothers and Babies.
1.1m on Foster Care.
1.0m on Social Work 5alarie~~
lover
#
:1 .I ,
i II 1\
'\ Ii ,~
II !! . {
, \; I
,I :,1
;
, ' , ' ; ;
I , I
I i·
f I
~ :
r • j
:
'I
I ii i:l .1
:!i ];
I I
," :;'rI
:f Cont. Pg.35. ~'.
·f
; Lack of P lann ing. " ;,:
\ We have demonstrated that there is no legal framework at .~'.
I I I I I I I I I I
for the delivery and development of personal social
Hence no person is vested with the responsibility
~.i~~~ of looking at needs, formulating an overall policy, and co
I I I I I I I I I
ordinating the delivery of such services.
done within the Eastern Health Board by the Social
1982 ~ shows that very little plannirig goes on at
time. Even basic Wp ulation figures and details concerning
area were not availabl~ at Community Care Team level.
All areas stated that there ~as either no planning or each
discipline planned separately. This form of planning, due to
the lack of information and co-ordination with other disciplines,
'could only" be haphazard and limited.
Community Care Team meetings should provide a focus for
but most of these seem to be used for discussion
and information giving, if they take place at all.
contact with other service-giving agencies in areas
was practically non-existent and not part of the normal " "' unning of the Community Care Team. Nobody in the area has a
o-ordinating role to facilitate this development. The conseq-
is an overall lack of planning.
e Deliver of Services in the Communit
e Community Care Team lacks a mechanism within its mana~emp.nt
~ructure for identifying and articulating felt needs. A system
ould exist where it is possible to filter up needs to /\.-
,ecision making levels, either through ground level workers,
cal groups or individuals. This approach to a delivery of
rvices does not exist at present in the Community Care Teams
or various reasons:
See Appendix B lover
1 r
I I I I I I I I I I I I I I I I I I I I I
The emphasis on .. the .medical m-ode...l .. as-·a mO<1e of·'·int·er-:
vention into social problems. A doctor is trained ·to
give directions t6 his pa~ients and tell his patients
w hat to do and w hat is' best for the 1Ii • ,T her e suI tis a -
directive rather thah a team work approach.
Social workers ·have~due to.l~ckof staff, resources and
back up servi~es, restricted their area or involvement
largely to Child Care and more specifically relating to
Children-at-Risk. This limits them in their assessment
·6t'areasof·need·and does,no~ provi~e for:.ccimpreherisige
planniQg in an area.
.. ~here has been. a lack of·commitment to:and recogn~t~on of
Community Workers by management. The community worker
should playa crucial part in identiTying overall needs,
enabling local groups and communities to express their
needs~'·belping them bring these to the attention of the
policy-makers, and working with communities to find and
develop the ,resourc.es within themselves to meetthel.C:" needs • . '. ,. '," . ;', .) .
These .fac.t,~.rs .. and the la~'·~:·O·f;SUC.,h amtjcha.nism in ti'l~tructure have led to a limi.ted ~nd haph.az.ard service with virtually
no p~anning for'a future service. Socia~ work and other
personal social services have stood still while problems
have incret;lsed.
s of Develo Additional· ervices Within
pre'seli·t', ·the planning of a'd-ditional servtc.p,·~ rl~O'Cl' ,,",,'1""'\ +-. ~ - _.... . .- - - ..... ....,tJvuu
u ~ocallY ~xpressed beeds. When, in the~inner-city areas, the
started snatching handbags from cars driving
a'rea, it was the national outcry that made- the
alth Board react and set up speci~l pfojects - like two
eighbourhood Youth Projects.
e same pattern is happening with the drug pToble~, identified
a growing p~oblem years ago; The workers have had to cupe
, i
I 1~ 'f
11 ;, ,: i !
I I I I I I I I I I
~.Cont. Pg. 37. '.
~.~for years with these children and addicts without the adequate -"; :::~
,back-up services. , ',' .
. ~~
~ ..
fUp to now such workers have not had the legal responsibility b
. :ithrough statutory obligaiions. In the very near future, with . . ,·;..·~~·,~~r :
. '~the introduction of the Children's Bill, these responsibilities
likely to be placed on social workers.
two examples of increased responsibility:
The age of criminal responsibility is likely to be raised.
This would mean that children,who are committing criminal
offences, would no longer be classified as criminals
a development to be welcomed. They would be in need of
care and protection. Social workers could not take
I these children under their wing without increased manpower
and back-up services, both statutory and rooted in the
community. I I I I I I I I I I
Supervision Orders.
Children would remain at home under the responsibility
, of the Community Care area. The implications for social
workers dealing with supervision orders are serious.
Many cases of child battering in Britain, in which social
services have taken an enormous backlash from the media
and publlc'., .. related to children who were· under supervision
orders.
'" The social worker with a supervision order' has to accept
the role and responsibility of a children's home manager,
without the advantage of living under .the same roof
as the child.
The implementation of additional services would not be
feasible within current structures.
~. I
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i
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Cont. Pg. 38. C·.: HAP T E R 5
A SEPARATE PROGRAMME FOR PERSONAL SOCIAL SERVICES
HOW IT COULD BE
osed new structure
structure that we propose is that the present Community
Care programme be divided in two, leaving the medical and
health services under Community Care and setting up the
new program~e for Personal Social Services. (see Chart 2
on the next page.)
Policy on the basis 6f need
structure of this new progra~me wouid be such that needs
resources identified at local community care level would
the basis on which policies .and objectives would be defined
central level. A maximum level of community participation
would be essential if planning was to be effective. We firmly
. believe that services m~st be planned and resources allocated
on the basis of need as identified at local level.
The Programme's main objective would be to facilitate local
communities in developing new services for themselves and to
ensure that the Board's statutory services were provided
according to local need. A programme of this nature implies
orientation towards preventive services.
thinkin (
of the Minister for Health
e quote from a recent speech by the Minister for Health,
* Desmond, T.D., because we belieye that our thinking
.,regarding the future direction of Personal Social Services
e fIe c t scI 0 s ely the a p 0 r 0 ~ r. h !'! rl ,..."., to '" rl h " :!'::: ~~:. :-. :. .:. ::. "'. .
'" he Minister has stated:-
lover
major speech to health boards printed under the title
Commitment to change' in 'Contacts' (the journal of the
astern Health Board), Vol. 9 No.3, May/June 1983 p.p. 6 - 8.
I.
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' • • ' T I . . . I
. -"
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. - : . I I I I I I
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-
. ~
This chart shows the present structure of the Eastern Health Board modified as to our idEas as
to how it needs to be changed so that the service provided is both effective and efficier.t.
HEALTH BOARD MANAGEMENT STRUCTURE (MODIFIED)
Health Board Chief Executive -Members Officer
.. \ J
Finance
Officer
./
1 I Personal Social Services Community Health
1 Programme Manager Programme Manager
-
J
Personne~
Officer
~ , General Hospital
Care
/.\
t Programme Manager
.-
Planning and
Evaluation
Officer
Special Hospital
Care
r Programme Manager
- - - -- - -- - - -- ------- -
I I I I I I I I I I I I I I I I I I I I I
.-," "O~ -""_01-____ ----- -,_ ... ..,.._ .... .......-= ...... ~ •. :::.:.:~: .. ~.----~-=--
------.--~ .. -~ '.
:P'g~" 40 '" ;~-
N' t
, 'OJ, The r e is a growing view that there will not be optimum health -' ~) , f~
~n a future society unless the ill effects of poverty and
deprivation have been reduced by action outside the
car e s y s t e m ~ 'I
see a need for a much more active and widespread approach
o preventlon~'"
will be asked, and rightly so, both from without
the service about the way in which resources can
be deployed so that people are giverr'a service that is
effective and efficient~"
am strongly of the view that we have to effect a shift in
to enable us to provide primary health care and
ommunity care that is as effective and efficient as possible.
his policy shift will enable us to improve the qualixy
f the services available to the psychiatrically ill and the
handic~pped. It will enable us to improve the
r-se-r'll.ices a'vailable for young children, for
for the old;, "
. ~ ..• relatively little discussion of community services .•••
mmunity services lacK,~ ....• major visibility. An elderly
rson fading away from, lack of human contact is a far less
amatic subject than the technology and skill of a new
erating theatre. The kind of caarries ~bout which we have
en talking will not be made possible no matter how committed
,r professional your officers may be unless thQ political
enda reflects a commitment to change .. "
.•• it is very necessary to think through on how attitudes
changed or how st~uctures need to be adapted at national,
lover
..... --....... -'.
I I I I I I I I I I I I I I I I I I I I I
Cont. Pg.41.
. regional and local levels in order to bring about a change,
on how officers and professionals need to be supported in
. their efforts to effect change."
Minister, in ~is speech, draws attention to the· fact that
sense of crisis induced by the present recession has
provided an opportunity to examine critically the services
are providing. In the last year, social workers working
the Eastern Health Board have been doing just this and we ~"
now is the b.st time to look for change.,
The fea tUre s 'of a sepa ra te ,-,programme
,A separate programme for Personal Social Services existing in
its own right and with clear aims and objectives would have
a much better change of attracting necessary finances.
Budget Control
The programme would h~~e control over its own budget and how
resources were allocated. This would mean that coherent planning
and policy formulation could be undertaken.' One of the hallmarks
,of this programme would be its allowanc~ for flexibility.
and resources would be allocated to an area on the
that area's needs. So, for example, in budgeting
','or staff needs in a particular area the programme administrators
uld take account of the social indicators of the area in
ciding on what staff and how many the area required. Staff . I
.buld not be allocated on the basis of numbers of population
1y but rather the areas of greateit need would get orioritv
~,Jt:: ~mp.L oymen t 0 f the req IJ ired ,:mu 1 t i..;.d i!c! ~l-inaf'lY ,~. p e rs onn e 1 .
alitiesof Personnel E~ 10 ed
separate programme would have all the problems of a bureaucracy
d of personalities that are inherent in human institutions,
t, if the roots of the programme were kept in the community,
ese problems would be less of a hindr~~ce: than they would
. --
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11 I' "' 1,! !"! I
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I I I I I I I I I I I I I I I I
Cont. ~g. 42.
normally be. This programm~·would recruit jts staff
specifically to meet its requirements. This would ensure
that those employed within it had a sense of direction about
its aims and objectives and were aware of their responsibilities
for the delivery of the service. We are aware that a new
administrative structure could not be set up over night.
Good management would be essential and some highly motivated,
skilled and trained personnel would have to be recruited.
The structure of the programme we propose is such that
it would allow fo~ input at policy and decision making level··
from those professsional people equipped with knowledge,
skills and expe~tise in the area of Personal Social Servic~S. \.
We believe th~t those paople employed at m~nagement level
should have had prior experience of personal Social Services at
local and community level. The Program~e would have its own
Programme Manager, Administrative and Professional Staff.
need for systems .of review
needs are changing all the time. As services would be
on local needs, it would be essential that the programme
inbui~t system of monitoring the effectiveness
the service provided. At the mt1'ltt~o!nt, services are set
and continue to operate for years because nobody bothers
why they are there or if any purpose is achieved by
them. [Jl
lanned and rovided on the basis of ne d
he following chart is a suggested structur~ for the delivery '-'
.f Personal Social Services within a given locality. It starts
ith that locality's neAd~ ::Inri ~:::::·...::(..c.3. iiu:~ programme
employ people )~ local level, area level and health
level. It would draw heavily on local volunteers.
area would have an trea Social Servi~es Co-Ordinator.
person's job would be to carry out essential planning and
~o-ordin~te services within the area. At local level there
be 2 person responsible for assessing needs and co
services. The Area Level Co-Ordinator would form ~
lover'·
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C on ~_._0.! __ 4.3:-·--------·--···
part of the central m~nagement team which would be responsible
for the overall administration of the programme.
Chart 3
Needs Local Level Resources I .... ~ {--.- --- -- -- ---- - ----------------- ---) t:\
\' '\ -4' ,1'\ / / , ~ /.. /,' , , I Core people recruited /.. Local People
specifically to respond
to area's n~~ds.
I I
Local Voluntary I
I Organisa t ions
\ ,\, I I /.
/
I Local Co-Ordinator
/_ 'Area Co-Ordinator
I: , Area' Level
\ ! "' Health BO.ard
\ \~ Assistant Programme Managers
Programme Manager
The s t r u c t u :' e w 0 u 1 d a 11 0 w tor. cl ire ct· . con t act from 1 0 cal
level to Programme Manager level when necessary. The programme's ..
objectives administered centrally would be adapted
the area's needs and resources. J
ariety of 'Personnel Employed _
would Fecruit people on a full-time, part-time, ,
essional and voluntary basis. The nature and number ~f
ore workers would be determined by the area' s need~ ,hilt.
.i g (I C. 1 n c 1 u des 0 m e 0 f the follow i n g per s 0 n"b e 1 :
ommunity Workers, Child Care Workers, Social Workers,
orne Help Organisers, Home Makers, Youth Workers, Community
elfare Officers. The approach to the ~elivery of services
uld be multi-disciplinary, so in response to the needs of
area, people with specialist skills could be recruited by
e programme. Liaison with those employ~d in the other
alth board programmes would of course be essential, li'.,O ..
_., -'--
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:,'-c-ont.-.-~4·.
but---the-'pr>u-g-ra-mme "r-Of'-:-P~S'oncrr-:so~~hrS"01ll-e-t,im,es
need to recruit its own specialist staff, for example, in
response to a particular problem within an area some of the
followirig people might be recruited:
, Voluntary Worker' with specific skills
Alcohol/Drug Addiction Counsellor,
Adult Education Officer
Drama Therapist
Speech Therapist
Occupational Therapist
Solici~or, Nurse, Doctor
Marriage CounsellOr
Chiropodist
Teacher/Remedial Teacher
Family Therapist
Play Group Leader/Play Therapist
Psychiatrist/Psychologist
Accountant
, The need for co-ordination
, -.
WTthi" each lQcality a number of resources already exist. ----..:------ .---.-.. -.:.. • --. - -, m' • _. • • I
A person employed at area level would have ·t:he·"r-e"S.po~bHi~-Y--__ "--:1 for co-ordinattng these resources and harnessing them to 1
needs of the area. If resources were co-ordinated I,
funded by the programme, local community and
voluntary organisations could more effectively and efficiently , «\ Ian to meet the locality's needs. At the mcment money is paid
y the health board to many different groups within an area
ithout giving mUCh, if any,thought to the needs of the area
a whole.
or flexibilit
,me possible services existing at pres~nt which could be
ann~d and co-ordinated at area level to meet that particular
ea's needs are the I.S.P.C.C., Barnardo's, Child and Family
'idance Clinic, Foster Homes, Childrens' Homes, Information
treg, Da y C en tres for the Elderly, Pre-School PIa ygroups,
; , I . :
) .-, tU
I I I I I I I I I I I I I I I I I I I I I
"
,f, ;~ Cont. Pg. 45.
~. " , .~
I Psychlatr~~ H0stels, Nursing Homes, Welfare Homes, Day
Hospitals, Sheltered Workshops, Transport needs. If these
services were part and parcel of a separate programme for ,~ ~; t ,Personal Social Services, this might involve in practice
,~ one group being asked to co-ordinate with another group
in meeting an unmet need in an area; yet another group
might be asked to scale down one aspect of its service and
build up a different aspect. The Area Co-Ordinator would have
the responsibility'to plan and develop preventive and supportive
services. In this context a 'Neighbourhood Resource Centre might
be a first priority wi,thln a given locality.
Conclusions
We are convinced of the n~ed for a separate programme within
the Eastern Health Board responsible for the delivery of
Personal Social Services. What we are talking about is a service
that would have to be planned and developed and does not
actually exist at the mo~ent. This programme as we s~e it
would have some essential characteristics which are not
present within the current structure in which we work. These are:-
The programme must have control over its own budget.
Planning must be based on needs as identified at local ,_t~
and area level.
Services must be co-ordinated. ,
The structure must allow for flexibility in meeting over-,
all needs. ~
The personnel, employed in the structure including those
responsible for its administration must have a basic
understanding of what Personal Social Services consi~t
and entail.
6. The personnel employed in the programme must have a sense
of responsibility for the service which implies ~n on
going monitoring of its effectiveness.
~ _. -- _._- -
I I I I I I
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I I I I I I I I I I I I I I I I I
..
.. Cont. Pg • .46.
Ultimately the foundation of the separate programme would
be a Philosophical one based on the belief that services should be provided from, by and wjth the community rather than -- -to or for the community. -It would demand knowledge from the ground level right up
to the top echelon. This kno~iedge would have to percolate
freely in all directions at all times, so that services could be planned on that foundation.
J I . ~ i.
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'f. Pg. A1. A P p. END I X A.
SUBMISSION ON STRUCTURES IN SOCIAL WORK IN IRELAND
The Joint Committee (LGPSU/IASW-) was established t .. o fo,r,m,u.late
a structure for social work which could apply to any of the
eXisting agencies in Ireland, be they statutory or voluntary.
This task has now been completed. ,All existing documentation I
or structures within various agencies were': revte-wed a~Q sub.mi..s.sions
were received from groups nationwide. This submission is,
therefore, representative of all the work that,has gone
before and of all the current. feeling about. st.ructures in
aocial work. .' --._."
Obviously, within the time allow&d it has not been possible for
the Committee, representati~e tho~gh it 1s of all fields of
social work, to draw up a detailed structure for each individual
agency in the couDtry~, Given tha't this submission is agre.e.d,
the next task will be to adapt the overall structure to
individual agenCies and areas of work.
The eommittee focused mainly on a grading str..ucture for ~cial
work and also considered training, both in-service and post
~ualification, part-time/sessional employment and staff ratio
as related to grades.
,PROPOSED STRUCTURE IN SOCIAL WORK
" GRADE 1
~
_pRADE 2C
,/ ~ GRADE 3 "','" ) GRADE 4
~, 5/ -GRADE
i I, ,I'
I'
- - ------ -GRADE
1
2.
J.
bO 0..
QUALIFICATIONS
B. Soco Sc., Dip. Soco ~c.
C.Q.S.W.
CoQ.S.W. (career grade)
EXPERIENCE
Not applicable
Not applicable
Minimum of ,) yrs. post-qualification experience.
- ---_.-RESPONSIBILITIES
As de$ignated by Team Leader - Grade 4
As ('e3ignated by Team Leader - Grade 4
Could have special responsibilities in particular fields, including supervision and/or training within their field and supervision of students as as~igned by Team Leader. Personally responsible f~r own case-load wit~ access to consultation. Administrative responsibility to Grade 4 -Team Leader
NOTES
This g"ade should only be emp19yod where regular superv:sion is available and sh(,uld never be expected to wor~ in isolation.
This grade should have regular supervision as a member of a Team.
Any Graje 2 with 3 yrs. P03}-qualificatioll experielce can ~e appoint,~d to thi's grade, subject to satisfactory asses ment by an Assessment Board. The Board to consist of (i) an independent, Chairmar, (ii) a Grade 5 Social ~orker, (iii) a Gradl 4 Social Worker - this person being the Team Leader for that area of Nork. In the event of a candid~te being unsuccessful he/she w)uld have recourse to an Appea.'_s Board - compri.sing of exterllal Assessors. : There .. should bl! a minimum number of desigrated Grade 3 post~ in each Egency. These should be fillec by open competition., It should also be possible for persons in Grade 2 post to be upgraded within their own agency on successful exaroinatic b the A ~oard.
-------------------~ . ;
GRADE
4.
5 .
6.
QUALIFICATIONS EXPERIENCE
C.Q.S.W. Minimum of 3 yrs. post-qualification experience.
C.Q.S.W.
C.Q.S.w.
Minimum of 6 yrs. post-qualification experience including at least 3 years in a Grade 3 or 4 post and some administrative experience.
Minimum of _6 years post i
qualification experience including at least 3 years in a Grade 3, 4 or 5 post.
RESPONSIBILITIES
Team Leader (Grade 4) -supervision of staff mainly in Grade 1 and 2. Induction of new staff. Arrangement of student supervision within the Team. Education of other disciplines within the agency, allocatio~ of cases &. will have responsibility for the administration and delivery of the services from all Grades within the Team.
Responsibility for administration of a specified area or institution and delivery of social work services withi that area or institution and the evaluation of such services. Responsible for allocation of staff, formulation of policies and staff training.
Management and advisory function to central management staff on soci~l work policy and services. ~o-ordinating role among Grade 5 social workers in agency without admin; istrative responsibility. This Grade would have close involvement in decisionmaking processes and in the allocation of finances and resourc~s at central evel.
NOTES
This grtde sft6uldcarry a 1 iml ~E; d 'e:el se-l~~d.'.,
May carr~ some cases as apprcpriate.
Grade 6 would be a post appropriate only to large agencies where a social Kork. jnput to central decision-making and allocation of finance and t'esources is requir~~. On the basis that we totally support the notion cf social work involve, ment in the allocation of resources we would like to set
~ I I I I I I I I I I I I I I I I I I I I
., .. " ~'., .' .. .: -.. . . ..;.. ... ,,: ... ; .. ,. ~-.,.ZI+ ... ~ ' .. '
-...~~. I .. ':I '." 'JI
-.: ... Io..~""'.
l EXisting Staff. ,(
In recognition of the difficulties of assimilating all
existing staff in the above structure due to the current
difficulties in securing training places, the following provision
must be made - on the date that the new grading structure is
introduced, or a subsequent agreed date, those staff holding
Bachelor of Social S~i~flce degrees, or equivalent,would be
credited with their relevant experience to allow them access
to the other grades. This should be'a once for all measure.
':':,"lmmunity Work.
~he Committee ackncwle~3e that difficulties may arise in
applying the main proposals to Community Workers because of
the present qualification ~cqutrement ~.e. B. Soc. Sc. not
essential and the inavailability of ap"propriate professional
training in this specified area. In order to rectify the
situation, we have adopted the main proposals as follows:-
The qualifications for Grade 1 Community Work posts will remain
as at present. Community Workers applying for Grade 2 would
require the C.Q.B.W. A Community Worker applying for assess
~~nt for Grade 3 would need a minimum of 4 years experience
as a full-time Community Worker at Grade l~vel, or 2 years
experience at Grade 2 level as outlined in the overall structure.
These structures Shq~ld be accepted as an interim measure for
Community Workers until such courSJS and adequate training
becomes available.
TRAINING
Trainee Social Workers':-
::~~~uc ~u~idi ~orKers Should be paid ~t Gra~e 1 salary scale
both in their trainee yearS~, and during their academit training
period. They should be allowed 2 years in which to,obtain'a
place on a C.Q.S.W. course. Their contracts should also include
payment of full academic fees, travelling expenses to their
place of study and while on placement, sUbsistence boolcallowance.
lover
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~~~~~~~~~~-~------~
I I I I I I I I I I I I I I I I I I I
and travelling expenses for one visit home during the period
of academic course including where place of study is overseas.
All trainees should become permanent employees immediately
following receipt of C.Q.S.W. subject to satisfactory medical
examination.
In-service training:-
All Social Workers should have the option of a minimum of 12
days paid leave per annum for attendance at seminars, courses,
etc. in addition to the in-service training courses within
the agency. As mentioned above, the Grade 5 post carries
responsibility for staff training and the development of
such training is seen as vital in each alency. The Committee
would like to stress the necessity for such training.
Po s t - qua 1 i f i cat ion t r a i n i l'l:g 1r.-:-
It is necessary for this area of training to be explored and
developed along appropriate lines.
PART TIME I SESSIONAL EMP0YYMENT
Where part-time temporary staff are employed they should be
entitled to 3 weeks paid annual leave - Holiday (Employees)
6 weeks sick leave with pay, maternity leave
and the terms of notice as outlined in the Minimum Notice and
Terms of Employment. Act, 1973. The question of permanent
part-time employment should be fUl'ther investigated.
hey should be given incremental credit wh~le remaining
emporary and receive credit for relevant experience for
ncrementjl purposes in ~ho ~~~~~ v; uecom~ng permanent.
RATIO,
e Committee made the following recommeridation on staff ratic
ving consulted with various bodies overseas and in Ireland.
thin a general hospital setting, it is generally agreed
at there should be one Sucial Worker per 50 beds. In other
I I
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age:cc i es it i sd iff i.cu 1 t .. t o· es t.a.bl i sh ·-precis e····s·t.a f-fi ng-r-a tios .
because of the wide variations in population distribution, but
the information obtained by the Manpower Planning Committee
on Personal Social ~ervices could be of assistance there.
.. <::-~~~
Ex per i e nee has s how nth a, t Soc i a 1 W 0 r k e r s s h 0 u 1 d not w 0 r k com p 1 at·e l y .
in isolation and the Committee recommends that all Social
• Workers should be attached to a t~am. The team should consist
of 5 members - 1 Grade 4 (team leader), 3 Social Workers
(ideally, all with post-graduate qualifications) one of them
at laast on Grade 3 salar~ scale, 1 Community Worker, plus one
trainee. National VoluntarY Organisations should deploy
Social Workers in team on1' a regional basis.
. It is recognised that these proposals would involve a
large financial commitment, but the Committee feel that this
is necessary for the welfare of the client and Social Workers
should not be expected to service, along, a wide geographical
area.
It is als~ important that formal links are established between
:all social work agencies.
" "