The current national policy agenda relating to the health and social care of older people has never been so active. The National Service Framework (Department of Health, 2001) for older people underpins the Government’s national strategy for older people. The strategy sets out a range of key targets including the role of person centred approaches to practice with older people, rooting out age based discrimination and addressing the current poverty of provision for mental health services for older people. The development of subsequent policy has focused attention on key objectives which apparently seek to shift the manner in which services and practices are organised and delivered, and in so doing, create improved, flexible and ‘person centred’ services for older people. The themes that run through a wealth of policy about older people highlight:

• Supporting independence, choice and control – for example, an increase in the use of direct payments;
• Improving quality of life, from the perspective of the ‘whole person’ – for example, using an outcomes approach
• Ensuring personal dignity
• Supporting the active participation of older people in decisions about their own care
• Integrated service delivery

Moreover, there has been a flourishing development in research and evidence based ‘good practice’ guidance. The good practice guidelines for health and social care practice in dementia care (NICE/SCIE, 2006) highlight for example, the importance of holistic and person centred assessment practice, proactive approaches in responding to behaviour which is perceived as challenging; and comprehensive training to enable practitioners to deliver person centred care.

Dissemination of research which promotes the active participation of older people continues to develop the knowledge base on what older men and women value about services (e.g. Allan, 2002), the ways in which they are delivered (e.g. Qureshi et al, 2000) and outcomes that are important to older participants (Glendinning et al, 2006).

Paradoxically, despite an apparently flourishing policy agenda, which increasingly articulates a notion of ‘good practice’, major challenges exist in the current provision and delivery of social and health care services. These challenges reflect a dichotomy between on the one hand, an imperative to operate within a managerialist agenda and on the other, develop preventative and proactive, user focused and user led services. This certainly creates a difficult set of tensions manifested in terms of managing tightening eligibility criteria, responding to externally derived performance criteria and persistent reorganisations against a stated aspiration to provide good quality services for older people.

The recent Commission for Social care Inspection review of social service activity and provision (CSCI, 2006) has evidenced how the tendency for councils to respond to the highest level of eligibility within Fair Access to Care (FAC) (Department of Health 2003) has reduced the overall level of provision. Services go to fewer people. The consequences include that fewer people receive any form of services. Moreover, the emphases on responding to only those in greatest need, stymies attempts to develop any comprehensive response to the preventative agenda. Informal carers are also managing the consequences of reduced levels of provision.

These tensions raise a number of critical issues which require urgent discussion and debate. First, it is clear that social workers with older people are managing increasingly complex workloads. If the preventative agenda is to be taken seriously, then this will add to the demands for a skilled workforce with appropriate gerontological knowledge, skills and values. Second, reductionist approaches to assessment and intervention for older people with complex needs can create the experience of a negative or inadequate response to a person’s need. Moreover, such approaches can serve to reinforce negative assumptions about what older people need. Third, in an environment where inter-agency collaboration is commonplace, social workers need to know and be confident about the knowledge, skills and values they bring to the table. There is, finally, a need to re-examine the knowledge and skill base in respect of social work with older people. How for example, should the gerontological research and knowledge base be utilised to inform practice?

It seems to us that there are now major challenges facing social work with older people. Not only are qualified social workers disenchanted, we have seen social work students, previously committed to working with older people ‘turned off’ by their experience on placement: social work with older people is ever more driven by ‘process’ with many complex tasks previously undertaken by qualified social workers being carried out by social care staff.

The advent of the new social work degree (General Social Care Council, 2003), with its emphasis on the application of research and the integration of, knowledge, skills, values and practice offered the potential for the development of a more theoretical, evidence based, knowledge driven social work with older people along the lines of that pursued in other areas such as social work with children and young people or mental health social work. However the social work degree is a generic qualification and the extent to which ‘gerontological’ social work is addressed in those academic institutions that do not already have an interest in gerontology is questionable. Disappointingly, in the new post-qualification framework (GSCC, 2005), social work with older people is not regarded as a specialist subject area but is subsumed within ‘social work with adult’, alongside younger adults, physical and sensory impairment, learning difficulties, chronic and/or terminal illness, drug dependency and people who may be HIV positive or have Aids. Again, the extent to which training in gerontological, rather than process-led social work training will be developed is open to debate.

All social workers increasingly work alongside other professionals in multi-disciplinary settings or even across sectors, and this is particularly the case in social work with older people. This should not, however, mean an automatic loss of identity. To the contrary, in order to best advocate with, and for, older people social workers should be encouraged and supported to develop an identity that is located in specialist as well as generalist knowledge, shared values and anti-ageist practice, and both traditional skills and those honed towards gerontological social work. We would argue that, in the current climate, there has been a loss of both identity and confidence in social work with older people. Social workers have become resigned to their lot. We think it is time to ‘fight back’ (Stevenson, 2007), to find ways of restoring confidence, amongst social workers working with older people and at the same time provide the highly skilled, multi-agency workforce that is necessary in order to ensure that those older people who make use of services are both included and best served. One way is to start recognising the complexity of the work that is regularly undertaken by social workers who work alongside older people and their families and the way in which this mirrors many of the debates currently being addressed within the social gerontological community. For example, issues relating to service user involvement, identity, gender, ethnicity, disability, lifecourse transitions, family relationships and conflicts, loss and bereavement, management of autonomy in the face of change quality of life, as well as those relating to the management of crises resulting from ill-health, abuse and neglect. In addition, social workers support and enable carers, many of whom are also older people. Such complex work needs a sound evidence base of ‘good practice’ which is not just about ‘ process’, nor generalist social skills but should be rooted in specialist knowledge, skills and values and which enables social workers to uphold the rights of older people, better negotiate eligibility criteria and argue for resources. The recognition of a ‘shared’ evidence base might go someway towards encouraging a shared identity. Our view is that such an evidence base already exists within the welter of social gerontological research but that it is not consistently being accessed by hard-pressed practitioners. Given the lack of specialist training in gerontological social work identified earlier, we would go further and argue that many social workers are not even aware of its existence.

Despite a potential shared knowledge base, a shared vision and value base, the gulf between social work practitioners and the social gerontological academic and research community has grown wider. For example, few practitioners attend our annual conference or subscribe to our journals. At our own University, fewer social workers than in the past undertaking post-graduate courses in gerontology. Funding opportunities that were available in the past have been severely curtailed – specialist training and education in gerontology is no longer seen as a priority by cash strapped social work employers.

We think that there is a pressing need for social gerontologists to consider the way in which they might develop alliances with professional social workers, and vice versa. We have some ideas of how this might work. For example, just as we have sought to involve older people in research, we should be actively encouraging practitioners to ask ‘research questions’ of researchers and academics (see for example Orzeck et al 2001; and the work of the CLSC Renee- Cassin Institute of Social Gerontology of Quebec ). We would argue that we need to make greater use of initiatives such as Making Research Count to work alongside practitioners – bringing together gerontological and social work research and knowledge and social work practice. We want to actively encourage the development of regional, national and international gerontological social work special interest groups within established organisations such as the British Association of Social workers; JUSWEC; British Society of Gerontology; International Association of Gerontology, as well as making new alliances. We would like to see social gerontology included in the curriculum of all social work degrees. And finally, we would like to see more applied research, with academics and researchers actively seeking social workers, as well as service-users, as potential partners in research.

We now wish to invite the readers of Generations Review, social gerontologists and social workers to respond to our challenge of finding ways of developing meaningful alliances in order to ‘fight back’ and reclaim best practice in social work with older people. We invite you to use the pages of the journal to explore how social work practitioners, academics, researchers and older people can more effectively work together.

References

Allan, K (2002) Finding your way: Explorations in Communication Stirling , Dementia Development Centre, Stirling University

CLSC Renee Cassin Institute of Social Gerontology www.geronto.org.ca

Commission for Social Care Inspection (2006) Living Well in Later Life www.csci.org.uk

Department of Health (2001) National Service Framework for Older People , London , Stationery Office

Department of Health (2003) Fair Access to Care, Department of Health London : The Stationery Office

Glendinning, C. Clarke, S. Hare, P. Kotchotkova, L. Maddison, J. Newbronner, L. (2006) Knowledge Review of outcomes focused services for Older People York University, Social Policy Research Unit

GSCC (2003) Reform of Social Work Education and Training www.gscc.org.uk

GSCC (2005) Reform of the Post-Qualification Framework for Social Work Education www.gscc.org.uk

National Institute for Clinical Excellence and Social Care Institute for Excellence (2006) Dementia: Supporting People with dementia and their carers in health and social care (Final Draft: Pre-publication Issue) London , NICE/SCIE

Orzeck, P. Guberman, N. Barylak , L. (Eds.) (2001) Responding Creatively to the Needs of Caregivers: a resource for health care professionals Montreal : Les Editions

Qureshi, H. Patmore, C. Nicolas, E. Bamford, C. (2000) Learning from Older Community Care Clients Research Findings from the Social Policy Research Unit, York University, Social Policy Research Unit

Stevenson, O (2007) Review of Phillips, J Ray, M and Marshall M Social Work with Older People 4 th edition Basingstoke/BASW and Palgrave in Ageing and Society Vol 27 2 p 315