Social workers are put into difficult situations on a regular basis. The Health and care professions council (HCPC) set guidelines to aid the challenges social workers face. To remain registered, a social worker needs to abide by the HCPC code of ethics to ensure delivery of the best possible service for users. Working within the guidelines set can be challenging as it may cause conflict with the service users values or potentially the social workers own values. For the purpose of this essay, ethics will be defined as “professional obligations and rules of conduct” (Meacham, 2007). Social work values will be defined as “a range of beliefs about what is regarded as worthy or valuable in a social work context” (BASW, 2012 p17). This essay focuses on two areas of the personalisation agenda that can cause challenges for social workers; accommodation and personal budgets. The target service user group for the purposes of this essay is people with disabilities. Using the definition stated in the Equality Act, (2010) “A person is considered disabled if they have a physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on their ability to do normal daily activities”. Legislation and requirements to support adults with disabilities is increasing for the “over eleven million people with a limiting long term illness, impairment or disability in Great Britain” (office for disability issues, 2012). However, disabled people report mixed feelings and reactions to the legislations and rules put in place regarding their care and allowances (Dalley, 1991). The social philosophical approaches to social work will be used to deal with the challenges and conflicts social workers face. This essay touches upon Kant’s deontology; Bentham’s and Mills utilitarianism and Biestek’s 7 principles approach.
Immanuel Kant (1785) developed the theory of deontology. This means that social workers need to be promoting good actions and the correct motive, however the consequence is not important and the idea of an acceptable motive is subject to judgement (Adapted by Hartsell, 2006; Banks, 2001; Reiman, 2009; Meacham, 2008). Subsequently, Kant introduced the idea of a categorical imperative (CI). A CI maintains a person’s motives for their actions and they therefore should be acceptable as a universal law. Thus people should act on motives that can be used by everyone in a moral society and lead to respect for people (Darwell, 2002 cited in Reiman, 2009). From this it is seen that people should be treated as an end, for example a choice or desire, rather than a means (object) to our own ends. He believed that everyone should be treated with respect regardless of their characteristics or behaviour (Banks, 2001).
Kant talks about respect for the individual person and promoting self – determination. Biestek (1961) produced 7 principles that over time have become highly influential to social workers looking at values and ethics within their practice. 5 main principles have been used:
Individualisation; Recognition that each service user has unique qualities, good and bad.
Purposeful expression of feeling; Recognition that service users need to express their feelings (especially negative ones) freely.
Acceptance; The social worker should be able to work with a service user without passing judgement and accepting Individuals for who they are, including their strengths and their weaknesses.
Non – judgemental attitude; Social workers should be able to not pass judgement or assign guilt to the service user. It is about judging the service users behaviour
User self – determination; the social worker should be able to guide the service user, depending on their on their capacity, to have freedom in making their own decisions and choices (Adapted by Banks, 2001).
Utilitarianism focuses on a consequentialist approach as it focuses on the consequences of the action, rather than the actions themselves. (Scheffler, 1994 cited in Reiman, 2009). Decisions should be made on the results and consequences it could have on society rather than on a personal and individual basis, and to promote maximum good within society. The right action produces the greatest balance of good over evil – the principle of utility. (Banks, 2001). Utilitarianism is based on a theory developed by Bentham and Mills who looked into two branches of utilitarianism; hedonistic and ideal utilitarianism. Bentham explored hedonistic utilitarianism, where good was matched with happiness. Mills explored the idea of ideal utilitarianism. This focused on good being about virtues, truth and knowledge, not just happiness. (Banks, 2001). The theory promotes the greatest good for the greatest number of people. When making a decision it is imperative that the consequence is considered. Therefore as a social worker, it would be beneficial to look at the consequences of the forthcoming action and evaluate what would be most beneficial and least harmful to the service user.
In the late 1980’s, the Government recognised that an improvement in access to community services was required. The Government were committed to providing more support for people with long term needs by assisting and supporting individuals to manage their conditions and providing services they require in the community rather than in long-stay hospitals.(Oliver, 1996) Morris (1993) conducted a study that looked into disabled individuals who needed day to day services. He found that disabled individuals were starting to feel a sense of hopelessness and helplessness when trying to access statutory services. Historically, social workers assessed and told service users what services they needed. Through the personalisation agenda, and the introduction of direct payments, service users told the social worker their needs. For the first time, the social worker had to accept the service user’s self-assessment and then use the assessment to see if the highlighted issues were eligible under Fair Access to Care (2003) legislation. Direct payments were introduced in 1997 and social workers had to translate service user needs into a monetary value to enable them to purchase their own service. The aim was to give individuals control over their care and their lives. Direct payments evolved into personalised budgets and have further evolved into a more individualised budget / service plan. The need for change and equality of service provision has been recognised as more views are being voiced by people with disabilities. In line with Beistek’s theory, service users are using purposeful expression of feeling and self-determination to enable the social workers to know their wants and needs. This has resulted in changes which could reduce the potential for conflict in the future.
A further challenge is budgetary control. Service users often want services that are financially unavailable to them. Although ethics state that service users should be encouraged to have self- determination, be treated as a whole and the social worker should promote and provide information regarding their care (BASW, 2012), the service users choice cannot always be guaranteed. Utilitarianism would suggest that this is because if service users always received the services they wanted, the social worker would not be promoting the greatest good for the greatest number, instead would be taking a more Kantian approach of promoting moral good. These two philosophical approaches cause conflict within themselves.
The Mental Capacity Act (2005) says “a person lacks capacity in relation to a matter if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of, or a disturbance in the functioning of, the mind or brain”. (s2). This leads to challenges and conflicts for social workers. If the service user had capacity, there could be conflict over the way they spend their budget which could lead to the social worker treating that individual without respect. Following the BASW code of ethics (2012), it states that social workers should respect the right to self-determination. Kant would support this view as, by the social worker supporting the individual to meet their own self-defined needs, the social worker is promoting good actions that will in turn produce good outcomes for the individual. The social worker needs to recognise that the individual has human rights and freedom to voice their views. Burton (1996) showed that there was a failure to recognise the unequal power relations between the social worker in control of provision of services and the service user who relies on the services. This therefore would undermine Beistek’s principles of self-determination as, although the service user is voicing their opinion, the social worker is not listening and this could be seen as jeopardising the principles of personalisation and the code of ethics that are imperative. The implementation of The Mental Capacity Act needs to be reviewed to ensure workers are following legislation and ethics. It should not be assumed someone lacks capacity because they have a disability.
On the other hand, if the service user didn’t have capacity, it could cause conflict between the social worker and the paid carer and/or unpaid carers. If the service user lacks capacity, how would the social worker or the carers be able to assess what was best for the individual? A social worker would have to uphold and promote human dignity and well-being as well as empowering the individual. (BASW, 2012). These ethics and values are supported by Beistek’s theory. Workers need to treat the service user with respect, be non -judgemental and accept the situation the service user may be in. The social worker therefore would only be able to act upon their assessment which should include the carer’s views on what is best for the service user. Utilitarianism, an alternative argument, would argue what’s the greatest good for the greatest number? What would benefit the service user more? The social workers views or the carer’s views? The outcomes need to ensure that the maximum people are happy. The social worker could reach the maximum happiness and reduce conflict by using empowerment. The social worker would respect the needs and preferences of the service user, via the carers and family members as well as recognising their own prejudices to ensure the correct services are offered. The Community Care Act (1990) promotes care in the community and people staying within their own home, allowing the individual to use their personal budget and have carers to promote independence. There is evidence to suggest for example, individuals who have fractured a limb, fare better when they recuperate in their own homes. (Pignolo, Keenan and Hebela, 2011).
Accommodation is a major concern for many service users (Davis and Wainwright, 1996). One aspect that could cause conflict is the practice of placing young people in young disability units, properties that are specifically designed for people with learning disabilities. Although this could be seen as a solution for people to interact and have support, there is a potential conflict as the individual cannot choose where they want to live and may live a distance from family/friends. If placed in a purpose built establishment, the individuals are classed as being housed by the local authority and therefore do not get to choose alternative locations (Oliver, 1996). The dilemma for the social worker is the need to take the individuals views into account whilst balancing their needs and wants, particularly if the service user lacks the capacity to make the decision.
It is unlawful for anyone to sign a tenancy agreement on behalf of an individual who lacks capacity. A capacity assessment needs to be undertaken to ensure the service user understands how to maintain that tenancy. In order to proceed, an application needs to be made to The Court of Protection. This could lead to conflict as the social worker and housing department need to uphold the law, however many families feel they have the right to sign a tenancy for their disabled family member and find it difficult to accept that this is not the case. According to BASW (2012), the social worker needs to develop professional relationships with the service user and the family, uphold the reputation and values of the profession as well as recognising diversity and treating the individual as a whole. Utilitarianism would recommend looking at what benefits the whole family, rather than just the service user. Challenges arise when the service user lacks capacity. Using the utilitarian approach, it could be said that the service user shouldn’t be given a tenancy as it doesn’t promote the greatest good for the greatest number. This view is in conflict with BASW codes of ethics. It could be seen as unethical practice and lead to further conflict. Beistek would support the view of BASW in using the specific value base that service users should be allowed to freely express their feelings, both positive and negative, and the social worker should listen and make a decision in an accepting and non-judgemental way. However, Kant would say that although the consequence of not getting a choice in where the service user lives is a negative outcome, the intention of placing them in a home, with other people to socialise is a good moral judgement that is solely benefitting the individual.
Another potential conflict could be older disabled individuals being forced into care. The Sutherland Report (1999) claimed that older disabled people were being forced into institutional care too early due to the lack of alternative care at home. Sixsmith and Sixsmith (2008) provided evidence that by 2008 there had been a shift in care provision and that the Personalisation Agenda meant that people were remaining in their home for longer and receiving appropriate services. However there is a further potential for conflict when accommodating people, with disabilities, to stay in their homes. Individuals may want to grow old at home but is this possible for people with significantly reduced mobility? Many homes are inaccessible to wheelchair users and those with significant mobility impairments (Burns, 2004). There is a Government scheme whereby disabled people can apply for a disabled facility grant to have their homes adapted, and certain individuals have to re-pay the Government, therefore the Government is not financing expensive care packages. The role of the social worker would be to negotiate, support and empower the service user to have their needs met in the most appropriate, desired way. According to Kant’s theory, having a loan is the moral good as people will be able to remain at home for longer, promoting happiness and community care. This would be supported by the values of BASW which states social workers need to treat the service user as a whole and respect their right to self-determination. In contrast to Kant’s theory, Utilitarianism would consider weighing up the consequences of removing the service user from their house and into an adapted and safe environment. I.e. a care home could be seen as an easier option for disabled people to receive care. This view could cause conflict because the social worker is going against the wishes and desires of the service user. Utilitarianism looks at the best outcome for society rather than on an individual level. Therefore, by moving individuals out of the house into the care home may provide maximum happiness for society, although it disregards the individual’s views and opinions. This is a criticism of the model as many service users could potentially not have their needs met in a manner that is acceptable to them due to the focus being on the benefit to society. This could be particularly true e.g. for people with English as a second language or who follow a religious faith. However, Beistek would agree with Kant in promoting self-determination.
A key theme running throughout this essay is respect for the individual person as a self – determining being. Both Kant and Beistek promote this and therefore appear to be the social philosophical models best tailored towards social work values and ethics. There are clear conflicts between traditional social work and the personalisation agenda for people with disabilities. These conflicts have been reduced with the introduction of HCPC ethics. If the social worker consistently uses these theories whilst working with conflict and challenging service users then the BASW ethics will be maintained and the service users will receive the best appropriate service available within Fair access to care criteria.