Liverpool’s Society for the Prevention of Cruelty to Children in the 1880s

After the foundation of the Liverpool Society for the Prevention of Cruelty to Children, Alan Brack’s (1983) history of it covers the early years of its successful development into a conventional charity of ‘good works’ of the period. Local worthies were supportive, and significantly Mr William Cliff, who had bought the children’s shelter for the Society in 1884 to provide ‘temporary refuge…to protect them from violent fathers (p. 25). He continued to provide finds from his own pocket.

The committee included a Gladstone (from the family of the prime minister of this period who came from Liverpool), a Bibby (the family had a shipping line and a ‘edible oils’ business), two Rathbones (merchants, philanthropists and among the famous women Rathbones: Eleanor, who campaigned for family allowances and Elfrida, an important educationalist) and two of Liverpool’s then three members of Parliament (p. 19). Agnew, the founder, continued as chair, a male and female inspector were appointed, to investigate allegations of cruelty, as well as staff for the shelter. And a secretary was found, Major George Leslie, who had been the army recruiting officer for Liverpool, whose release from the army was made possible by Mr Cliff’s funding his salary.

By the end of the first year 378 cases were dealt with, 202 of which arose because of the cruelty of parents under the influence of alcohol, but often because of the conditions in which they were obliged to live.

One case is quoted at length:

…great neglect on the part of both parents, of their five children, aged 12, 10, 4, 3 and 10 months. On the home being visited, it was found that the mother was at work, and the father idle, sitting on a box in front of the fire, a strange woman lying drunk on the sofa, and the home (one room in which the family lived entirely), and children in an abominably filthy condition. This family improved, fell back again, and changed their quarters repeatedly; still, on the whole, ground was lost rather than gained, so a caution was administered by the Committee [This must have been a fearsome experience; we are told that a third of the Committee were magistrates. But the family was lost sight of]…till one day the Inspector happened to meet the mother in the street, when she was drunk and filthily dirty. The home was found to be very dirty, the children verminous, a most filthy, dissipated-looking woman, nearly nude, lying on the floor. She raised herself to a sitting posture, but was unable to stand, being stupefied through drink. Both parents were now cautioned by the Committee as to the shocking state into which, by their neglect, they had allowed the children and home to get…[A]s matters did not improve, and the drunkenness continued, both parents were prosecuted, the father being sent to gaol, with hard labour, for one month and the mother for six months…[another child was born, the father had a work injury, the mother died and a housekeeper was resident, but a School Board report led to further contact]…the condition of the home and children became so shocking that the father and the woman were sentenced to six months imprisonment with hard labour. On being again seen on their release, the father was found sober but the woman was so drunk she fell off a seat with the child (1 and a half years) in her arms. Owing to further neglect and ill-treatment of the children, the father and the woman were again sentenced to six months hard labour. One girl was taken into domestic service and the three other children committed to the Industrial Schools and one to Dr Barnardo’s Home…(pp. 28-31).

For social work history, what is interesting about this case and the development of the Liverpool Society for the Prevention of Cruelty to Children, is the different practice perspective to the agencies that we have previously explored: the Poor Law, the charity organisation movement and (a little later) health social work. There is the same diagnosis: concern about alcohol misuse, ‘idleness’, poverty and poor living standards. And, at least with the Liverpool Society, there is also the wish to support better family standards (more on this later), thus preventing child abuse and neglect. But there is no sense here of ideas of ‘treatment’ and ‘understanding the family’ that were developing in the family visiting and underlying ‘diagnosis’ in the charity organisation movement. The focus is on child protection and mistreatment, rather than seeing this as interacting with poverty and social conditions. There is also no sense of providing charitable help, or improving health conditions. The Poor Law relieving officer would look at the workhouse or perhaps ‘outdoor relief’; the COS better financial management.

Development of societies for prevention of cruelty to children

News of the formation of the Liverpool Society spread. Baroness Burdett-Coutts, a leading philanthropist, got a friend, Hesba Stratton, a writer of morally and religiously improving children’s books, to visit Liverpool to check it out. Hesba wrote a letter to The Times of London:

…Some years ago the Rector of Spitalfields stated…that hundreds of children of his parish were systematically ill-treated and starved for begging purposes. Cases of flagrant and excessive cruelty were brought before the magistrates…In Liverpool a society for the prevention of cruelty to children has recently started…In none of these cases, however, did the committee feel it necessary to resort to legal proceedings, firm and kind remonstrance with the parents having prevailed. Subsequent visits are made to the dwellings of these children and they are not left to fall out of sight. Prevention is better than punishment and the knowledge that society exists will help passionate and brutal persons to control their violent tempers; and children thus protected from their tyranny will not grow up brutalised or enfeebled in mind or body (p. 43).

Following this sort of move, Agnew supported similar societies, which were successfully established in Birmingham and Bristol. He also sought support in London. Eventually, a congregational Minister, now magazine editor, Benjamin Waugh, became involved and formed a national society.

In the meantime, Agnew moved to Hull for business reasons, and also visited Glasgow and Edinburgh, promoting the idea of child protection. He formed the idea that a national society would be desirable. He suggested to the Liverpool Society that they should cover the north and a London Society the south of England. Waugh, in London, was using his promotional skills to campaign for legislation, successfully in only a few months. The Liverpool Society welcomed this, and used it to seek the help of the Liverpool police. There were similar moves elsewhere.

But Waugh’s national society became pre-eminent, and the next few decades led to conflict between the two societies, with Waugh seeking Liverpool’s merger into the national group, while the Liverpool Society wanted to remain independent. Agnew supported the idea, but his committee did not.

Partly, this was about Liverpool chauvinism: the political, social and financial power of its supporters in this major port city allowed it to remain independent. Another issue was Waugh’s assertive personality. But the main difference was the Liverpool preference for ‘remonstration and persuasion (p. 59)’ rather than prosecution before a magistrate; the national society was more inclined to that. Eventually, the Liverpool area was divided between them, with the Liverpool society operating in the extremely poor northern parts of the city and the nearby town of Bootle, and the national society covering the southern areas.

The voluntary sector and the welfare state

This worked reasonable amicably for many decades, but eventually in 1954 they agreed to a merger. The reasons were complex; the Liverpool Society had not found itself financially able to support the successor to its Islington shelter, the area of the City of Liverpool and therefore the potential workload had massively expanded since its foundation, and the new local authority children’s departments founded in the welfare state reforms of 1948, were increasingly significant in dealing with child protection and family casework. This meant that the societies for the prevention of cruelty had to develop new roles and working methods.

We can see here some of the complexities of voluntary sector provision of social services in a modern welfare state, and of relations between voluntary organisations which may come to represent different approaches to the issues that they share. And also, the politics and society of the UK is strongly centralised, and central-local relations are an issue not only for government and politics, but also for voluntary organisations. Local links may be valuable, but national coordination of policy and practice also has its worth. Various models have grown up to manage central-local relations, but there is always the tension between local loyalty and national strategies.

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Brack, A. (1983). All they need is love: The story of the Liverpool Society for the Prevention of Cruelty to Children (1883-1983). Neston: Gallery Press.

Wills’s residential care issues

This third post about David Wills’s Throw away thy rod (1960) deals with the chapters about ‘issues’ in residential care. It’s still about schools for ‘maladjusted children’ in the 1950s, but applicable in some respects to all residential care, but you have to extend your thinking to the issues that might arise for a broader population; I’ll pick up that point in the next post in the series.

Sex in residential care

A prime example of thinking broader is the chapter on sex (pp. 95-105). Wills devotes a good deal of this to 1950s attitudes to single-sex schools. First, there is the question of sexual exploration by pre-teen children. He is accepting of this, if it happens, but prefers pre-emptive education, such as parents in the home might give; this is ‘why has he got a willy?’ territory. In this period, the late 1950s, co-education was widely accepted before 11 years of age, but there were mixed views after that.

Certainly, as teenage years loomed, quite a lot of people thought that the distractions (or worse!) of girl-boy relationships (or worse!) should be delayed as long as possible. Wills thought that keeping maladjusted boys and girls separate meant that they would not learn to develop appropriate relationships with the opposite sex. Pedagogically, he sought a ‘rational and moral attitude to sex, and adequate motives to live up to that attitude (p. 100)’.

He also accepted there were practical issues:

Practically, we want to see that our girls don’t have babies. Segregation (if complete), will prevent conception, but it will also prevent the formation of the attitude which makes segregation unnecessary (p. 100).

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What can young people do if they are affected by poverty in their lives? You might think that young people are mainly affected by the position of their parents, but not so, or at least not entirely so. according to an article about recent Finnish research (Rajala & Isola, 2026). It’s available on the Internet, but not published yet, so you can read it by clicking on the doi number in the reference at the end of this post.

Research on 84 young people in poverty

The researchers analysed 84 written texts written by young people aged 15-21 years in a project to get autobiographical writings about people’s current experience. The focus was about their experience of poverty in Finland, and it shows that they actively resist the impact of poverty on their lives. Young people wrote an average of 50 pages on electronic devices.

Their material is helpful for social workers everywhere, because shows us what specific constraints that poverty imposes on their lives. You might think that, being in a very rich country with a strong welfare state, Finnish youngsters might not have much to worry about, but there are several main pressures that pose a risk to all young people everywhere:

• They’re not got there yet; they are in transition from dependence on their parents and other family social supports towards the independence offered by their own jobs and developing careers and social structures of adult life;

• They have less access therefore to a stable income, savings, education and social networks;

• They have less autonomy than people who are established in adult life;

• They have little political representation and influence over policy and social changes that shape their lives. People are generally not listening to or giving importance to their plight.

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Previous research listed in the article has focused on food insecurity, unemployment and other aspects of a marginalised position. Nordic research has shown that young people in poverty have lower quality goods and food, and may be excluded from participation in a social life because of limited income.

But this research shows it’s more than that: it’s the emotional experience of having to manage being in poverty. It’s also about finding ways of making an impact on the constraints in your life that come from poverty,

Young people’s ‘agency’

The research starts from various models of ‘agency’, that is, the amount of influence that people have on what happens to them. Ruth Lister’s analysis suggests that poverty is not a passive condition, and identifies four kinds of agency that young people have:

• Getting by is the kind of personal action that young people do everyday. Examples are helping parents with household chores, caring for younger family members, reducing living expenses like electricity or food by rely on the family home going to public institutions like libraries or hanging around in shopping centres; giving up expensive hobbies, trying to earn money informally and avoiding social events or situations that cost money to avoid the shame of not being able to participate.

Examples of this is the study are

It’s about stressing, crying, and making a monthly budget that still stretches. It’s about carefully planning expenses and often not even being able to have fun because you’re too worried about how you’ll afford food for the next week (p. 9).

Sometimes I skip hanging out with friends so that they won’t find out that I’m poor (p. 10).

• Getting out is still personal, but it’s more ‘strategic. It may involve focusing on studies, getting part-time work, saving money for education. Finding organisations and people in their social circle that will help them with this is crucial.

Examples of this in the study include:

Doing well in school has always been the most important thing for me because I have seen it as the only way out of poverty. Because of this, my grades have also caused me immense pressure…(p. 11).

Another example shows the importance of retaining some degree of self-reliance; here, the young person is ‘projecting’ her agency, looking forward to what she can achieve:

Poverty means struggling to stay afloat. I am doing everything I can to get into higher education and, after school, to work in a job that will lift me out of this trap. I’m in a privileged position, because I know that I have the possibilities to succeed (p. 11).

• Getting back (at) society for their situation is ‘every-day political activity’, such as minor theft, misusing social security benefits and other kinds of ‘counter-conduct’ against society.

An example of this from the study is:

I decided to take what I could get—and if I couldn’t get it, I would take it anyway, by force if necessary—it’s something I still regret to this day, even though I know that a big grocery store won’t collapse over a single stolen lipstick (p. 13).

But often, this was not such overt acts of defiance, but more expressing opinions about the failures of social support and social indifference to their plight.

• Getting organised is a more strategic form of political activity, such as becoming involved in volunteering and other activism locally; in Finland, young people have often organised themselves around helping in food banks and other anti-poverty projects, perhaps through faith groups, post-school groups or youth projects.

And an example of this:

I want to start a fundraising campaign to donate money to the poor and disadvantaged so that they can live a slightly better life in this society and the world (p. 14).

Another model of analysis (from Emirbayer and Mische) looked at what how poverty constrained their agency. This analysis particularly identified many acts as being about emotional or physical survival than agency in the sense of having influence.

Examples of this include:

Poverty feels like something I have to constantly hide. I try to maintain a facade of a picture-perfect life. I feel that if my friends knew about my poverty, I would no longer be invited to gatherings…(p. 10).

This indicates the ‘emotional labour’, perhaps stress, of managing your image with others when you’re poor.

I need to go to the dentist, get new glasses, take care of my dog, see a doctor, pay the bills, and cover my train fare to school… but with what money? (p. 10).

This suggests the constraints of financial pressure which mean that the young person cannot meet needs that they have identified for themselves.

The researchers note that much of this ‘agency’ consists of ‘acts of survival’ rather than where young people try to achieve progress in their lives by their own volition.

They say:

…young people’s accounts highlight a balancing act between personal resourcefulness and structural uncertainty…a constant calibration of spending, social behaviour, and emotional energy, shaped by the pressures of insufficient resources and stigma. The prominence of self-exclusion as a strategy, and the considerable emotional labour required to ‘keep up appearances’, emphasize that agency is relational and embedded in social expectations (p. 15).

The importance of relationships and social networks and the pressure of social expectations suggests, in turn, that organisations and people in the social networks of young people need to ‘listen’ to hear what young people would like to work on and find ways of facilitating it.

Social workers and other professionals trying to help could support young people’s efforts to manage their affairs and think through how they manage their social exclusions, while getting some beneficial social involvements, for example through activities such as volunteering.

It is striking, though, how few of the young people could see ways in which their society demonstrated its concern and positive response to their situation. Perhaps the rich successful welfare state is not a good place to have to manage poverty because it fails to find ways of giving marginalised people a sense of being able to have an impact on the things that are marginalising you.

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Rajala, T., & Isola, A. M. (2026). Agency of young people experiencing poverty: The implications for poverty-aware social work practice. British Journal of Social Work (2026) 00, 1–22 https://doi.org/10.1093/bjsw/bcag159

David Wills’s principles for shared responsibility in residential work

In this post on David Wills’s Throw away thy rod, we move to the principles he espouses in the main part of the book. The focus is on residential care practice with maladjusted children, a term he didn’t like. This group of young people were later called ‘children with emotional and behavioural disorders’; I’m sure he would think this is not much better.

Nowadays people often refer to young people with ADHD or who are ‘neurodivergent’. These are specific technical medical/psychiatric terms, which may be applied too frequently to people who experience a troubled life. Without careful and specific medical diagnosis, I prefer just to think of them, perhaps in an old-fashioned way, as ‘troubled people.’ They may be troubled in their minds, but they may also be affected by things that have happened to them during their lives that did not emerge from their own bodies and minds, but were done to them by other people.

I am reminded of a young migrant from Ukraine that I know. I experience the way he behaves as frustrating, and he has been diagnosed and is being schooled as being affected by ADHD. But I’m also aware he has experienced terrifying bombing around his childhood home, and several forced relocations across Europe. I also watched my similarly-aged grandson reacting to how he was, and successfully managing the boundaries of the playing that they were doing together. Divergent he may be, but not hopelessly abnormal or impossibly difficult if you responded appropriately to him, as I think David Wills would have liked me and my grandson to be able to; frankly my grandson was better at it.

Will’s writes about residential work with children and refers to children throughout. Because this part of the book is about ‘principles’, much of it can apply to residential work with adults, too. His principles are often seen as a generalisable practice, both with young people and with adults, and his ideas are one of the sources of therapeutic community practice, alongside the work of other people that I cited in the earlier post. Sometimes, therefore, in writing this post, I adapted his convention by referring to ‘residents’, and on occasions remind you that what he says may well be applicable to adults too.

The residential environment is a ‘substitute home’

The account in Throw away thy rod starts (pp. 32-43) from treating the residential institution he was working in (it was a school) as necessarily a substitute home (p. 33). This is true for all people who are placed in residential care. They may have other places they call home, but for the moment this place must be their home in place of whatever others there may be.

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Some history on cruelty to children

We’re looking at a text on maladjusted children in the mid-20^th century in Social work history in 20 books, so alongside that, in Social work history bites, I decided to explore another bit of children’s social work history, and pulled out Alan Brack’s (1983) history of the Liverpool Society for the Prevention of Cruelty to Children from the shelves. Brack wrote several histories of the area, and I see I have a signed copy. This may be because it acknowledges funding from a couple of charitable trusts I administered at the time for its publication by a local history press in the area; I can’t now remember.

It has a Beatles-ish title: All they need is love from the Liverpool pop group reflecting its Liverpool subject. ‘All you need is love’, the Beatles song, was issued as a single in 1967 and came from the television film The magical mystery tour, which I remember as a BBC Christmas treat of that year.

Another chapter has a Liverpool musical connection (‘Walk on, walk on… is Ch. 7). This is from a Rodgers and Hammerstein song (‘You’ll never walk alone’) sung after the death of the hero on stage during the second act of their musical Carousel. Actually, you might see him as an anti-hero, since he ill-treats his girl-friend and is aggressive with his daughter, possibly appropriate to a history of a society for the prevention of cruelty to children. The song is poignantly repeated in the finale years later in four-part harmony by the prom choir of the dead man’s now-teenage daughter’s school; not a dry eye in the house. It was later taken up by another Beatles-era pop group, Gerry and the Pacemakers, and has become the anthem of choice of fans at the Liverpool United Football Club matches.

Agnew brings back the idea from the USA

Brack’s book is partly an encomium to T. Frederick A. Agnew, a Liverpool businessman who discovered a ‘society for the prevention of cruelty to children’ on a trip to New York. The page of the book with Agnew’s picture also quotes his description of his discovery.

A lady visiting the poor of New York…found a child whose groans and cries horrified the neighbourhood…The lady applied in vain to the police and the courts; she was told by one and all that there was no redress. So she addressed a complaint to Mr. Burgh, the Secretary of the Society for the Prevention of Cruelty to Animals and reported tha[t] an animal was being barbarously treated. Mr Burgh at once sent an Inspector who was completely taken aback when he found the animal was a child. Mr Burgh entered into the humour of the thing, [I don’t suppose he thought it funny; I suspect ‘humour’ here is the archaic usage meaning ‘emotional feeling engendered by the situation’] brought the child and its mother into court, when to his astonishment and the astonishment of all New York, the mother was convicted and punished (p. 11).

The lady tried again with another child, but Mr Burgh would not chance his arm a second time, and said his Inspectors were not trained for work with children and helped to found a New York society for protecting children.

It is this idea that Agnew brought back to Liverpool, to found its own society, after he inquired in Chicago later on his trip and was told that a society for animals and children combined had not worked out too well there. He passed the idea, with literature from across the USA, onto the Liverpool Central Relief Society (whose later history we looked at before in Social work history bites since it later led on to the formation of the Liverpool Council for Voluntary Aid). And to his friend, the philanthropist and local Member of Parliament Samuel Smith, who was also a financial supporter of Dr Barnardo’s national ‘child rescue’ society.

They met by chance a few weeks later, when Smith was going to a meeting of the ‘Liverpool Society for the Prevention of Cruelty to Animals’ (founded in 1809 as ‘the Society for the Suppression of Wanton Cruelty to Brute Animals’) to support the creation of a dogs home. Smith suggested that, instead, this could become a home for children. And they set off for the Town Hall to see.

‘I felt very nervous,’ said Agnew, ‘for of course the whole thing was highly irregular’, but to my great delight Mrs Forrer, the President of the society for protecting animals, said openly: ‘I’m here for the prevention of cruelty and I can’t draw the line at children.’ Her sentiments were echoed by…the society medical adviser. ‘Mr Smith has not in the least exaggerated the sufferings of children; I know the town well and I know that such a society is much needed’ (p. 12).

So Agnew was prevailed upon to promote the idea at a separate meeting, called by Liverpool’s Mayor for 13^th April 1983. Fortunately, there had already been commentary in the local press by the vicar in a nearby rural area about cases of child cruelty; and local discussion about the fact that the situation was worse in a teeming, overcrowded post city. Agnew envisaged an association of voluntary workers, who would report local cases (p. 13). He successfully sought cooperation from the local education providers, magistrates, police and the board of Guardians [of the Poor Law, with its workhouse]. There was a large, mainly supportive meeting, where it was said that others had shrunk from the task:

…from a feeling of its hopeless magnitude…if once we begin to draw aside the veil which covers home life in the lower parts of our towns, we should expose a mass of hideous misery, an evil too great to be coped with at all (p. 14).

‘Laissez faire’, child protection, the privacy of family life and ‘mothers’ work’

The meeting supported setting up the Liverpool Society for the Prevention of Cruelty to Children. Later, the local press wished them well, but raised what is often a difficulty with social work developments, a concern about interfering with the ‘privacy of family life’ and there was also anxiety that situations would arise where children had to be compulsorily removed from their parents (p. 18). Two lady letter-writers to the local paper opposed giving such powers to the state:

It would work entirely against the poor and not at all against the rich, and…add to the burdens and sorrows of the poor by denying their rights to the security of those ties of natural affection which God has given to all (p. 18).

We see here the impact of ideas of laissez faire in 19^th century industrialising society, being applied not only to economic activities but to social welfare. In reply, Agnew argued that the aim was not to exact punishment, even though he accepted that the only way to stop persistent cruelty might be to prosecute offenders.

The ladies also made a forceful point about the role of women. The proposals were for an agent who would be:

…a man [emphasis original] of good sense and good feeling…Against this we protest with the whole force of our hearts. You seek to protect little children from ill-usage, and you are going to put this mother’s work into the hands of men…Men already have too much power over the lives of women and children…the agent should be a competent woman, the directors at the head of it should be women, not men, or with some men amongst them…Plenty of women could be found who would be more fitted for such work and would move the machinery with far more benefit to children than any man that could be selected (pp. 18-9).

So although a general committee of influential men was appointed, a women’s committee was also proposed, and six women volunteers were found immediately. And the group set about fundraising.

Based on his American experience, Agnew suggested finding premises for a shelter, which was opened by the Mayor with remarkable speed on 2^nd October, barely six months after the initial meeting, and letters flowed in reporting cases of cruelty.

Outcry: a man imprisoned for chastising his own child in his own home

The first case, Helen Harrecan, caused an outcry, not all of the response being on the side of the Society. She had been savagely punched by her father, who was brought to court and sent to prison for three months. The objectors to this complained that it was wrong to send a man to prison for ‘chastising’ his own child. And in his own house. But there was also sympathy for the child.

In the first 8 months. 211 cases of cruelty to 378 children were dealt with, 50 of violence and 106 of cruel neglect; 210 of begging, vagrancy and exposure (homelessness) and 12 of immorality. Children were found who were so filthy that their clothes had to be burned immediately, some starving children died. 202 cases were ascribed to ‘drink and its consequences’.

The police welcomed the society, because there was little sympathy with their difficulties in dealing with family cases. If they prosecuted a woman with a child for persistent begging, sympathetic magistrates often let them off with a caution, and often criticised the police for persecuting women in this position.

The availability of the shelter led to increased demands. Mothers sometimes brought their children to protect then from drunken fathers’ violence, the police brought children found homeless or wandering, or begging. The shelter was better than the only alternative, the bridewell alongside drunks, thieves and sex workers. Children were often returned to parents with a warning and the homeless sent to the workhouse, or one of the children’s rescue societies.

But the pressures were such that a larger house had to be found, and it was bought with a donation from a businessman in memory of his recently deceased daughter. The Islington Square building (there is an Islington in Liverpool near the City centre) appears on the back cover of Brack’s book, with the single word ‘Children’ emblazoned on its portico

More in the next Social work history bites.

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Brack, A. (1983). All they need is love. Neston: Gallery Press.

A recent Swedish study (Isaksson, et al, 2026) provides an interesting analysis of the process that young women went through after experiencing sexual violence of various kinds from their peers. Often this happens in their early interpersonal relationships and can have lasting harmful effects. It’s a very common experience: one in four young women in Sweden experience some degree of sexual violence in relationships. The researchers analysed what 12 young women said about how they processed this in their thinking and emotions, and in their relationships. What they said gives us clues about how best to be helpful in ‘enabling recovery’.

This is not yet published, but available to read online: click on the doi number in the reference at the end of this post.

The study is focused on ‘enabling recovery’ and it strikingly makes clear some things that you can do to help. In particular, a helped can cull from this account of the recovery process, how to be in your relationship in ways that enable them to move from leaving their experience hidden, towards thinking through how to make progress in the life that they want to achieve.

Sexual violence often creates a sort of detachment from their previously existing life and relationships, and the process of recovery is a movement in thought and feeling that offers meaning and purpose again in life.

An initial phase in the process is ‘striking insight’. Previously, the experience of the violence was hidden, invisible to the woman’s perceptions and feelings. There was sometimes a ‘sense of silence’ around the abuse (p. 5). Sometimes the insight builds up, or jumps out when sharing thoughts with another person, either a friend or professional. It is not that it is ‘forgotten’, so much as perhaps ‘put away’ from the foreground of your life; it may be about ‘putting a name to it’.

Some examples:

It just came crashing down on me like…well… a bolt of lightning. That was the first time I thought he had raped me (p. 3).

…I was seeing a midwife for something else…//…and then she asked if I’ve ever experienced sexual violence and it hit me—like, yes, I actually have…// I burst into tears, and it was chaos. Up until then, it was as if my mind was a total blank (p. 4).

A useful way of dealing with this stark realisation of ‘wrong’ was to create a ‘haven for rest’. The researchers describe the complexities of this idea; it is both internal stillness, but also places and activities in which that stillness may be cultivated:

…a sanctuary, a place of stillness where one can dwell in tranquillity. This place can be found both inside oneself and together with others. A haven for rest is described as a place that allows one to escape from intrusive thoughts, fear and embodied memories. Stillness can also mean being active and can involve movement, while simultaneously being described as a form of rest in the present moment, where thoughts and emotions coexist in harmony, experienced as a sense of comfort and well- being. Stillness also provides a break from intrusive memories, fear and loneliness…The ability to create moments of stillness is crucial, as they are a way to gather strength and provide distance from the ongoing reality (p. 4).

Examples given by the women studied included activities such as crafting, dancing, caring for a pet, walking by the shore, writing a diary. If this could be done in a trusting relationship, it was often helpful.

Relationships that allowed the women to experience a sense of protectedness and safety, without judgement, were important: the researchers describe this as ‘existential safeness’. Some examples:

…having a secure network around me made a big difference, too. People I could spend time with, so that I didn’t end up isolating myself at home… instead, I went out into the world and dared to do things, even though I was afraid that something might happen or having a hard time feeling safe (p. 5).

It’s helped also to have a sense of obligation for things you had to do, like preparing for the birth of a baby, which gave the women a ‘reason to strive for survival.

Another important aspect of the process was a woman being able to ‘share her story in a safe place (p. 5).’

…painful memories can be expressed and the suffering caused by the abuse is recognised without judgement (p. 5).

The researchers found that sharing experiences helps to organise thoughts and can sometimes uncover hidden memories. These memories gradually emerge when sharing them and this offers new perspectives on what happened, but it also provides an opportunity to take control of the narrative (p. 5)

I needed to take charge of history, and the more I talked about it, the more it became apparent what had really happened that I’d suppressed for many years (p. 5).

This did require the ability to share thoughts and emotions and put them into words, to develop a language to describe what happened and how it felt.

…because when you put these fuzzy words on it made it more manageable, like I understood and had control over the situation (p. 5)

There were also things not to do, if you are providing the safe space for someone to go through this process. The researchers say:

…if the story is questioned and the listener lacks the capacity to create a safe space, it evokes a sense of being violated again. Each time the story is shared, it involves re-experiencing the violence. However, feeling validated when sharing one’s story fosters a sense of strength and capacity, thereby breaking the silence.

The researchers felt that these ideas expressed something about what enablement, and enabling recovery means. It’s not just being present and empathetic, creating a safe space, it’s about helping people to find their own language and way of expressing what happened to them.

As the researchers say, every experience of sexual violence is individual and it is experienced in a unique way. It is important to recognise the individuality of this experience, even if, as a professional, you have heard stories like this before. This isn’t narrative, ‘stories’; it is processing a unique event in your life.

The researchers also point to the importance of the social and political environment for responding to sexual violence. Often, young women are expected to adapt their movements in the world to the fear or risk of being raped, and this leads to their feeling that they are to blame or are responsible for what happened to them.

So young women are surrounded by general social, historical and individual beliefs about sexual violence, and how other individuals’ responded to the idea of it. Recovery, through the mechanisms described by the women who were interviewed, cannot be enabled, when she feels that people around her view her as an object available for others’ use. If she cannot review and work through her experience in the ways suggested, she may remain alienated and isolated in potential future relationships. Young women can no longer identify themselves with the person they were before experiencing the violence, or imagine how they can be a new and secure person in the future; they feel they are in a relationship void.

Thus, the ‘enabling recovery’ processes are really important for them to begin thinking about how they want to be and behave in their future lives.

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Isaksson, J., Palmér, L., & Lundvall, M. (2026). Enabling recovery following peer‐perpetrated sexual violence: lived experiences of young women in Sweden. Scandinavian Journal of Caring Sciences, 40(3), e70304. https://doi.org/10.1111/scs.70304

Accounts of residential practice by David Wills

David Wills’s Throw away thy rod, which I am using to illustrate developments in thinking about residential care in the middle of the 20^th century, refers to ‘living with…’ difficult children; not ‘putting them away’, not ‘treating’ them, definitely not ‘punishing’ them. The argument claims that being loving, open-minded, reasonable adults participating with young people (and by implication other troubled people) in a well-managed living situation, is a good way of enabling them to develop both the motivation and also the life skills to become well-functioning human beings in other social environments.

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This third post on the contents of Cherry Morris’s edited book on social case-work (note the hyphen) is both backwards- and forwards-looking. We looked at the book in general and the chapter on moral welfare a few weeks ago. Now, for the final post, I’m picking up on ‘Family case-work (pp. 59-76)’ by Dorothy (D. M.) Deed, and on ‘Child care (pp. 165-88)’ by Clare Britton.

The writers

We have not met Dorothy Deed before in Social work history bites, but we have met her social context: Liverpool, that centre of working-class poverty, social service and social work education. At the time, she was ‘training supervisor and assistant secretary at the Liverpool Personal Service Society’ (LPSS - more on this organisation below) and ‘special tutor in practical work in Liverpool University’s Department of Social Science’. I take it this means she was big in student supervision and practice placements in the area.

On the other hand, we have met Clare Britton before, several times. First in her role as ‘tutor in charge’, as the contributors’ list here has it, of the childcare course at the London School of Economics (LSE), that hotbed of professional social work’s development. There she worked alongside Kay McDougall (in charge of the mental health course, the pre-eminent British training in psychiatric social work, for the 1950s and ‘60s the editor and private owner of the pre-eminent generic social work journal, Case Conference, and in 1970 the person who led the creation of the British Association of Social Workers. And soon also Eileen Younghusband, leader of the first British generic ‘applied social studies’ social work training course, frequent chair of committees promoting social work development, including the foundation of the National Institute for Social Work, and eventually ‘Dame Eileen’, a leading establishment academic of the 1960s.

Eventually, Britton married the eminent psychoanalytic psychiatrist, Donald (D. W.) Winnicott, and many of her later publications are as ‘Clare Winnicott’. As a duo, they were influential in social work thinking during this period, and she later became the social work grand panjandrum at the Home Office, at that time the government department responsible (through Clare) for social work education in childcare.

Backwards to family social work, forwards in childcare.

Deed’s article is the backward-looking article, starting from the work of the London Charity Organisation Society (COS), citing Sir Charles Loch, its eminence gris twice (we explored his practice text in Social work history in 20 books and his self-justifying late theoretical publication is also cited) and not a lot from the 1940s, compared with the other chapters.

The idea of family casework was substantially to disappear, as did the Association of Family Caseworkers, never to be seen again after the foundation of the British Association of Social Workers. Deed’s article relies only on voluntary sector family work, limited because she does not consider its role in social work in other settings.

But family work has a substantial professional presence and history in the high-status voluntary organisations of American social work, and was to become the ideology underlying the Seebohm reorganisation of the British social services only 20 years later in 1971. So why is it not more important at this point?

This quirk (a quirk, if like me you are looking at it with hindsight) probably arises because of the uncertainty in the 1950s about what the role of the voluntary sector would be. Both authors mention it somewhat anxiously, because it appeared to have been displaced by the post-second world war reforms that created the British welfare state. It renewed itself through community work and radicalism in the 1960s. Those reforms generated an expanding state social work profession over the next 30 years, and family work became its underlying practice; but there was as yet little sign of this in Deed’s thinking or in Britton’s welcome to the new era.

Britton, on the other hand is writing (probably sometime early in 1949) about the local government children’s departments, created in those welfare state reforms only just before in 1948. In discussing their work, her chapter is inevitably focused on hope for the future.

Deed on family case-work

She starts:

Family case-work is the most comprehensive and the least specialized of all forms of case work. It covers a particularly wide field and deals with an infinite variety of problems…being by nature designed to deal with all the multiple problems which can arise in any family. The family case-worker is interested in these problems and is, inconsequence, particularly well-fitted to work for the welfare of the family as a whole (p. 60).

The intro discloses a set of 1940s assumptions about ‘family’. As a crucial social structure in people’s lives and the social services it is ‘comprehensive’ and ‘infinite’ only if your social assumption is that family is central social universe in people’s lives. The source of such ideas is perhaps Christian religious tradition (since Liverpool is Deed’s professional base, Catholic ideas of the importance of family are likely to have been influential on the work that came to her; Liverpool has a large Catholic population). It perhaps also reflects the recent war-time experience – a lot of top people in social work at the time had been involved in child evacuation from bombing in the major cities, and reunification of and securing renewed family life was an important factor in people’s lives.

And not only in the UK. Iacovetta (1998), in a Canadian history that also applies to the USA argues that after the war’s disruption, there was a ‘domestication’ of expectations of family life, as the basis for a secure lifestyle. She, and others, argue that in part this was a middle-class imposition of social ideas about the role of women on working class families, and that a renewed emphasis on family ideals in an individualising social work practice during the 1950s was one instrument of this.

We can see the editor’s judgement about the role of family case-work within social work, perhaps relying on its American pre-eminence, in its positioning in the book. It is Chapter 3, after the first two general chapters, before the rest of the contents, which describe a range of specialised agencies.

Deed continues with the organisation of family work:

The organizations dealing with these family problems have always been voluntary bodies called into being by citizens of different towns to meet a definite need, and because of this they have been free to experiment…(p. 60).

Her example is the London COS, and its management of poverty, poor conditions of life and indiscriminate charity encouraging ‘the clever and plausible beggar, the lazy and the dissolute (p. 60)’. In the 1950s, after the 1930s economic depression, war and the welfare state reforms, it is astonishing to see this reiteration of these outdated COS tropes. She notes the development of local guilds of help across the country and the development of visiting.

The COS view (also common in other welfare organisations) that its visitors should look at the wider social situation, and in particular support a family’s responsibility for each other is one of the sources of the importance of ‘family’ in social work practice. In this, of course, social work is reflecting a common view of many faith groups and political and policy stances. There is a modern question mark: traditional family structures are less important to many people nowadays. But the evidence generally is that most people still see caring by family members as important, other things being equal.

And, certainly, family was important in Deed’s day, because of the pressures on families and post-war ‘domestication’. Picking up the current position of the COS, she notes it has become the (London) Family Welfare Association, and transmogrified into a general family social work agency, a bit like the American family agencies. Many of the British big cities had developed such an organisation, often associated with their Council of Social Service. We looked at the development of CSSs earlier in Social work history bites (now in the 1960s councils for voluntary service, and often becoming ‘voluntary action’).

Liverpool’s Personal Service Society

But in Liverpool, where Deed was, it was a separate social work agency, the Liverpool Personal Service Society (locally known as ‘the PSS’), which emerged with some difficulty just after the first world war, a painful birth midwived by the Liverpool Council for Voluntary Aid, whose policy, we saw when we looked at its history in Social work history bites, was not to run services in competition with its members’ finances.

The PSS’s first leader, Dorothy Keeling wrote a memoir, The crowded stairs (1961) describing the poor queuing to be seen in the old building near the Town Hall in Liverpool during the economic depression of the 1930s. Strikingly, I thought, she says the most poor mothers were always fat, because all they ever ate was bread and potatoes to keep the stomachs full. When I was on the executive committee in the 1980s, it still had the lengthy gloomy winding staircase, but had devolved into a variety of mainly innovative social work projects.

Keeling went on to become an important pioneer of Citizens Advice Bureaux (CABx). She was succeeded by a variety of social work illuminati, notably Wally Harbert, who became one of the leading early directors of social services in the 1970s, and a writer on social work and social services, and Sheila Kay, an important poverty campaigner who died young in the 1980s; her admirers founded a Trust in her name to support people to take social and youth work training. For most of the last years of the century, Robin Currie used the contract culture which invaded charity financing in the 1980s Thatcherite revolution to get government money to run a wide range of community projects across Merseyside.

Voluntary workers in the 1950s

But Deed’s work was primarily family case-work, aided by (mainly lady) volunteers who did a lot of the legwork. As with Keeling’s CABx, marriage guidance services and Cruse, the widow’s organisation which grew up in the 50s and has become a bereavement counselling service, many organisations still, and to this day, rely on carefully trained volunteers. Deed mentions that ‘…expert help of various kinds is frequently available…by means of panels of individual volunteers able and willing to give expert guidance on a variety of problems (p. 65)’. The lack of specialised responsibilities was also an asset:

Family case-work

The family case-worker is unhampered by any special terms of reference, and …many clients are passed on to her by specialist workers…the general case-worker is always there and the client may return at any time should fresh difficulties of any kind occur (p. 65).

The work she describes involves family relationships ‘…her mother was said to “interfere” too much (p. 66)’, requests from officialdom to improve family organisation. Child care problems, being ‘…a natural outlet for her pent-up maternal emotions hitherto seldom let loose without detriment to the child’, marital difficulties ‘…a sense of insecurity, springing from an unfortunate marriage, had influenced this mother’s attitude towards her child…(p. 66-7)’ and volunteer legal advice, probably from the CAB, helped marital decision-making.

Presaging the future arguments for merging social work agencies into a generic service, Deed suggests:

One of the most important functions of a family case-work agency [is]…the co-ordination of work carried out by different agencies for the same family (p. 67).

Part of the issue here seemed to be that several ‘case committees’ in different agencies did not allow for flexibility in the work of different agencies. This was a characteristic of organisation also inherited from the COS district model of social work visiting. They persisted until well into my time as a social worker, to the 1970s, and allowed for the involvement of ladies of good works (and occasionally male politicians) in social work services’ decision-making. And was sometimes necessary in those days of a largely untrained workforce.

Deed discusses a variety of case examples, which appear similar, but call for different responses. In particular she notes the problems caused at the time from ‘…inadequate accommodation due to post-war housing difficulties…(p. 71)’, which case-worker’s could not deal with. So, like the families involved, complex family management issues had to be dealt with. I can connect with this: for some years, as Deed was writing and afterwards, my family, ‘bombed out’ of their home in the 1941 London ‘blitz’ were living in a couple of rooms, in a shared house with a variety of relatives and their families.

Britton on child care

Unlike Deed, Britton is able to start from the new Children Act, 1948. It is, thus, a ‘new era’ for ‘homeless children (p. 165)’ in which efforts would be made to understand individuals through case-work, and also a new field of activity and employment for social case-workers that would enable a better understanding of deprivation.

It is from this future vista that, probably covering a editorial format, she looks backwards to the Poor Law and the volunteer services in family visiting provided by the COS. The aim of public health provision to have a better standard of living, and high standards of physical care, for children (p. 167) have led to better education. The Children Act provides for continuing the voluntary organisations’ contribution through government grants to charities, while also providing a consistent local government service network. The growth of child guidance since it started in the 1930s, encouraged a stronger use of scientific knowledge from psychology about children, which should also be used ‘…to relieve, rather than repressive measures to crush, the offender (p. 167). She also marks the learning gained from wartime child evacuation measures.

New legislation only marks the stage reached when it is passed, clearing obsolete ideas.

The task is to translate public sentiment into personal relationships which the child can assimilate and understand…If the next few years are to be regarded as a period of experiment, then along with human sympathy and understanding which must be brought to the work, an objective outlook must develop which will enable facts to be faced however much they disturb theories or upset plans. And facts must be recorded if anything is to be learned from them (p. 169).

A statement of the classic form of social work for a new direction of practice in public sector social work.

As with Deed, she sees the importance of cooperation between a variety of services concerned with children, but she focused on the child:

…[W]hen a child loses his own home, however poor and inadequate it was, he feels a sense of loss. He may do all kinds of things to hide his feelings, and in an attempt to deal with them may go to all lengths of difficult and delinquent behaviour. If the boarding-out officer cane talk to him about his own home, recognizing and taking for granted that he minds leaving it and feels lost and afraid, then she may prevent some of the most desperate happenings from taking place. For the most important thing about adult understanding and recognition of difficulties it that the child need not then go to all lengths to prove his point (p. 170).

And also on the child’s mother and family. (I remind you, as you read this quotation, that the book explicitly states that case-workers are always, in the conventions of the day, ‘she/her’ and clients, in this case including children, always ‘he/his’).

And you see in this quotation another assumption of the period, that the service would primarily be concerned with ‘boarding-out’. This is the bureaucratic term, inherited from the Poor Law, and still in use in government guidance when I joined the service in the 1970s, for fostering children with carers. This would be the main function of social workers, as ‘boarding-out officers’ rather than as ‘child care officers’ as they became known, because the main problem was seen as orphaned or otherwise homeless or parentless children, not, as it became, a broader service for child and family social work.

Britton might have hoped for, but could not yet quite present child care as, such a broader service, but as public health and social conditions advanced in the 1950s, orphan children completely disappeared from child care services’ responsibilities.

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Britton, C. (1950). Child care. In C. Morris (Ed.). Social case-work in Great Britain (pp. 163-88). London Faber and Faber.

Deed, D. M. (1950). Family case-work. In C. Morris (Ed.). Social case-work in Great Britain (pp. 59-76). London Faber and Faber.

Iacovetta, F. (1998). Parents, daughters and family-court intrusions into working-class life. In F, Iacovetta & W. Mitchinson (Eds.). On the case: Explorations of social history (pp. 312-37). Toronto: University of Toronto Press.

Keeling, D. (1961). The crowded stairs: recollections of social work in Liverpool. London National Council of Social Service.

This post deals with two recent reports on end-of-life care in British social care and healthcare services from the people (Ombudsmen – a word stolen for this purpose decades ago from the Nordic languages) who deal with complaints about all sorts of official services. To complain, you already have to have gone through all the official complaints procedures and fit their criteria for what the law says they can investigate. But without going to law, the Ombuddies are as far as you can go, and they can force apologies, compensation, reconsideration and the like out of official bodies.

The UK Ombudsmen and what they do

There are two ‘Ombudspersons’ (the writers in these reports are both women) who deal with public complaints about government services. One is concerned with local government and the other covers Parliament and the national government. They are independent and report ultimately to Parliament in general, not to whatever the present government is. The first also deals with social care (because it’s mainly within the purview of local government bodies), and the second with the health service (at the higher levels mainly about national policy and guidelines, but with local bodies also involved because they throw up individual cases of ‘maladministration’).

The Ombudsmen only rarely publish specialised reports, the regular grind of reports is about individual cases. (You can get a regular download of their decisions – go to their websites listed at the end of the post). The last specialised report I remember reading with any interest was years ago on continuing healthcare funding, still a bizarre procedure (for paying some people’s care costs if they are for health issues and not paying them if they involve only personal care) raising all sorts of overlapping health and social care issues.

They have overlap problems, too, when dealing with other areas of health and social care which in the case of these two recent reports has led to these simultaneous reports on ‘end-of-life care’ (their print designers have cut out the hyphens in end-of-life care – is this a coordinated government print decision? – who knows? People’s end of life is usually without hyphens, end-of-life care, the omnibus term referring to services, usually has them). Both reports are about communication problems in a difficult area of services where health and social care (and public and private) overlap.

The local government and social care one, entitled ‘No second chances’ focuses on the reality (commonplace in palliative care professional thinking) that you don’t get a second chance to improve your care and treatment, when the person you’re caring for dies – you’ve got to get it right first time. This is sort-of coordinated with a (less-snazzily produced – are they more serious or do they need a zippier designer?) report from the Parliamentary and Health Service Ombudsman focused on ‘Conversations that matter most’.

They do these specialised reports when they are seeing so many similar complaints that they really have to say to local and national government and service providers: ‘Hey look, you really need to get your acts together on this.’

No second chances – the social care report

The report lists (p. 3) the relevant law, and two sets of guidance published on setting priorities for care in people’s last days and hours and the national ‘palliative and end-of-life care framework’.

The report starts off from the repeated problems they were seeing:

• Not assessing someone’s capacity to decide properly – not ensuring their wishes and preferences are at the heart of decision making

• Care that isn’t personal enough – including failures to respect wishes;

• Basic care needs not being met – such as food, drink, pain relief and medication;

• Poor record keeping – missing or inaccurate records that lead to confusion;

• Services not working well together – confusion between care homes, GPs, pharmacies and other services;

• Poor communication with families and loved ones – not keeping them informed, or communicating without warmth and empathy;

• Difficulties around visiting – including disputes between family members;

• Problems with charges after someone has died – unclear or unfair billing practices.

Examples of the problems come out in cases:

• Sunaya could not receive care at home any longer, and a temporary stay in a care home was made permanent without explaining that she was now receiving end-of-life care and involving her (or her relative by the look of it)in deciding where she should go.

Effectively it did the bureaucratically easy thing, rather than involving and caring thing.

• Brian had live-in carers from an agency that claimed to provide palliative care. This quotes the report on one of them:

A third [carer] screamed for Brian’s wife for help after Brian fell – despite his wife being unable to hear without her hearing aids – then left Brian on the floor for more than an hour. They called […his daughter] at 4am rather than district nurses, and after Brian died, began handling his body rather than giving the family time to process his death.

In the complaint’s findings:

The provider’s claim to offer palliative care was misleading – palliative care is a specialist service beyond what a domiciliary care provider offers. Contact with Brian’s family was superficial, and there were no regular care plan reviews during a time when his needs were changing rapidly…At an already devastating time, Brian’s family had to deal with chaotic, inadequate care from workers who caused additional distress rather than providing the support the family had paid for.

• A care home for Victor:

…When his granddaughter, Celia, was finally able to visit, she found his room in a poor state with stains on the walls and a dirty toilet. The clothes in the room didn’t belong to Victor. She was concerned about his care, including staff refusing to give pain relief and not properly looking after a wound. She also felt a staff member was rude and focused on funding rather than her grandfather’s needs

There was no clear link between medical advice and Victor’s medication charts. On at least one occasion, Victor was in pain and didn’t receive pain relief. The home recorded he had a wound but had no care plan for it and no evidence of how they cared for it. There was no nutritional plan, meaning there was nothing to show how the home ensured Victor ate and drank enough.

• Olive went into a care home, too:

…She had no close family, but her second cousin Chloe, and Chloe’s daughter, discovered she was in a care home and started visiting regularly and sending gifts. Although solicitors acted as Olive’s financial deputy, Chloe and her daughter were named in her records as family contacts…Over a year later, Chloe discovered Olive had passed away only when one of her gifts was returned. She and her daughter made enquiries and found Olive’s grave – unmarked and overgrown. The care home had never contacted them.

The findings:

Chloe and her daughter didn’t learn of Olive’s death for more than a year. They were deeply distressed to find her grave unmarked, and felt the funeral hadn’t reflected Olive’s wishes. The home’s dismissive response to their complaint made their distress worse.

There were many more similar cases. The Ombudsman’s conclusion:

• Communicate with warmth and clarity – with the dying person and everyone important to them

• Meet fundamental standards of care – and deliver care with compassion

• Follow the law, guidance and your own policies – and if you depart from them, have good reasons, explain them, and record them

• Encourage staff delivering care to seek help promptly – if they’re unsure about something.

Fairly basic guidance for professional health and social care services, you would have thought.

Conversations that matter most - the health service report

The healthcare report has a much more extensive superstructure of discussion about end-of-life care than the social care report, which mainly focuses on examples of what they found during investigation. Here, the recommendations focus on three areas (p. 6):

• Confident, skilled, compassionate communication with patients and families at the right time…

• Clear outcome measurement that includes patient and family voices…whether end of life care is improving must be informed by how it is actually experienced by patients and families.

• Effective information sharing between teams and care settings…As the NHS works to shift care from hospitals to the community, this longstanding policy aim becomes increasingly urgent.

And there is discussion with recommendations about how to improve the systems that deal with end-of-life care; so a fuller account of issues than the social care report.

The case studies show that it is not only care homes and services that failed in effective communication, so did professional healthcare provision

• Mr O was referred by his GP for investigations for cancer, but was not told any outcomes. Later he saw his GP about pain management. The report says:

The Trust knew the cancer had spread weeks earlier but delayed informing Mr O, meaning he only found out because the GP unintentionally disclosed it. Hospital records confirmed that the Trust did not tell Mr O directly until a month after the tests had identified the spread of the cancer. This delay denied Mr O additional time to prepare for the end of his life.

• Mr Y also had investigations for cancer:

We found no evidence that the Trust ever had a discussion with Mr Y about his long term prognosis if the planned treatments were unsuccessful, and how this would affect his life expectancy. We found that the Trust should have known, around three months before his death, that Mr Y was approaching the end of his life… The Trust did not explore Mr Y’s preferences for end of life care, such as his wishes about dying at home or in hospital. It did not do enough to clarify whether he wanted his family involved in decisions …The missed opportunity for advance care planning and discussion of Mr Y’s preferences with him and his family added to their distress and prevented them from preparing for his death.

It was clear that less experienced clinicians were not trained or helped adequately to have difficult conversations with patients and their families.

Families felt that their participation was not valued:

Families described times where they felt dismissed or not properly listened to, particularly at emotionally difficult moments when empathy would have made a significant difference: ‘There were comments around the fact that I was a nuisance… It was obvious anyway, that I was not welcome.’

• In Mrs B’s case:

The first clear recorded discussion of a possible cancer diagnosis did not happen until almost two weeks after the first scan results were available. The Trust missed numerous opportunities to share information with Mrs B’s family and keep them informed of the likely diagnosis and prognosis. Mrs B’s daughter and her family assumed it was something minor from which Mrs B would recover. She said they felt let down by the fact that the Trust knew what was happening but they did not.

There was also poor communication between teams and services:

We found that the Trust failed to share critical information about Mrs R’s condition promptly. The referral contained no mention that Mrs R had been admitted with bowel obstruction caused by progressive cancer, or that she was likely approaching the end of life. The referral also made no mention of the syringe driver that had been fitted. The care centre said this information was essential, as its staff were not prepared or equipped to manage patients with syringe drivers. On the day of admission, the care centre noted concerns about the appropriateness of the referral and raised a formal incident report about the syringe driver. Although the discharge summary contained this information, it was only shared after Mrs R had arrived at the care centre, rather than when the referral decision was made. Had this been communicated earlier, it is likely the centre would have refused the referral. We also found that earlier communication may have avoided the second hospital admission, and Mrs R could have chosen to receive palliative care at home with minimal medical intervention.

The impact of the reports

Reports like this tend to come and go, and I haven’t seen much press interest since they came out. But what, in their different ways, both reports make clear is that the end of life is emotionally powerful for the people involved. Uniquely, more than having a serious illness or requiring really complex surgery, both the patient/service user and a range of helpers need involvement, and it’s easy to leave someone out.

This is particularly true, in my experience, in NHS facilities with their tendency to focus only on their patient (and refusing to speak to anyone else on grounds of confidentiality, which just excludes carers and community links), talking only about the actually health condition that this particular professional is focused on, and completely ignoring the major part of people’s lives and relationships that the condition affects. When the patient is abbreviated to ‘p’ in the records and relatives, absent from the record at all, are called ‘mum’ or ‘daughter’, rather than having a name, address and mobile phone number, both common features of health records, they’re liable to miss the point of something universal like end-of-life care.

It’s also clear from some of these cases, that social care employees and others (mostly not social workers it seems, more’s the pity because they are trained to take on this sort of thing) have only a hazy idea of things to do with mental capacity, legal responsibilities like ‘power of attorney’, the idea of ‘next of kin’ (a completely arbitrary non-legal status, but a lovingly filled-in space on many healthcare forms)

And the complexities of successive families. I once dealt with a man who had three ‘wives’ in his life, one present with children, one past and divorced, with grown-up children, one past and in strict legality only a cohabitation, but with teenaged children. All wanted involvement in his end of life. The care home, also involved, could not imagine how their system would record so many complicated and interacting relationships, let alone their staff be expected to remember and deal with them sympathetically.

People moving towards the end of life need to know and make decisions, so far as they can, about their care and treatment. It’s an emotional time and this needs to be done carefully and empathetically, sometimes repeatedly. The idea is real in some care homes and other services that what the dying person gets should be what the service usually provides, even if nowadays they are paying quite a lot for it. And there needs to be careful thought about the various relatives and helpers who are involved, respecting their own emotions, too. This is something that all services should be checking on all the time.

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Local Government and Social Care Ombudsman (2026). No second chances: What complaints teach us about end of life care. Coventry: Local Government & Social Care Ombudsman.

Parliamentary and Health Service Ombudsman (2026). Conversations that matter most: improving communication in end of life care. Manchester: Parliamentary and Health Service Ombudsman.

Websites: Local Government and Social Care Ombudsman: https://www.lgo.org.uk/

Parliamentary and Health Service Ombudsman: https://www.ombudsman.org.uk/

David Wills and residential work

And so, in this series of posts in the Social work history in 20 books, we come to residential work and the books of W(illiam) David Wills (1903-80). You might say: ‘who?’, and so does Wikipedia, which does not have an entry about him, although some of his books are mentioned in passing there (his earliest are still available in Routledge reprints).

Why David Wills? He wrote, starting in the 1940s (1941, 1945, 1960), a series of atmospheric books which achieved great popularity and reprinting for many decades afterwards. Their style is an amazing, almost stream of consciousness account, mixed in with personal philosophising around the meaning of his Quaker faith, of life in various residential projects for troubled youngsters that he was involved in during the 1930s and ‘40s; and later – it was a lifetime’s endeavour. One, The Barns experiment (illustrated) for example, is about an attempt to care in a residential setting for children evacuated from major cities to avoid bombing in the second world war whose behaviour was so difficult they could not be placed with families.

In these books, he expresses both his personal struggles with how to work in a way that reflected his beliefs and philosophy, but also many of the issues that societies faced as they moved away from institutions as a way of providing for difficult people. He built up a philosophy of residential care practice, later called ‘planned environment therapy (now a lost piece of jargon)’ which saw control and punishment as failing strategies in residential care, to be replaced by love. Social workers and others have returned to these books again and again to understand what it feels like to be made frustrated and angry by the people you are trying to help, yet to continue to treat them with love and humanity.

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The gap in posts last week was because of a visit to Japan to speak at the annual conference of the Japanese Society for the Study of Social Work. There will be a paper published later, so I can’t deal with the content here.

But there is a brief report on the International Federation of Social Workers site:

The Society has a journal in English, the Japanese Journal of Social Welfare, freely available on the Internet, which can help you to keep in touch with Japanese social work (previously the Japanese journal of social services, whose first edition from 1997 I was given by Shiro Abe, then President of the Society, when I was first in Japan in 1998; I gathered from colleagues at the conference that he, now a centenarian, is still alive). I discussed some articles on the development of Japanese social work from that edition in this Substack in 2024.

The conference was hosted by the Japan College of Social Work, a renowned institution of social work education. The College, celebrating its 80th anniversary this year (see the logo above), is part of a thriving Japanese social work education sector; the photo below is of its triangular, treed, suburban campus.

We are both baby boomers. I am somewhat younger, because my father was in Asia for the war, and could not get back quickly, so my birth was a little more delayed after the war than the College. The College has boomer status because of its immediate post-second-world-war founding by the American administration of Japan in 1946 - a renewal of earlier developments in social work lost in the 1930s. This was part of what seems to have been a worldwide mission on behalf of social work in the 1950s, stimulated by American hopes that welfare would be one of the strengths of democracy in the Cold War.

The College has an online brochure in English, where you can read about its wide range of learning and research activity.

Hansen’s disease in Japan

Near the college, whose suburban campus is near a major clutch of hospitals, is the National Hansen’s Disease Museum (this links to the Japanese website - other languages, choose from the bottom righthand corner of the Japanese page). You may only be familiar with the ancient and biblical name, leprosy, in English. Perhaps you know this is an easily curable disease, and also hard to catch. But, like many countries (there is a similar museum in Louisiana, USA, whose history section starts off from stigma), Japan had a record of institutionalisation through isolating patients in very marginalised colonies on the outskirts of both history and Japanese life; the Museum is built on the site of one such institution. The Leprosy Prevention Act, which had led to the isolation of sufferers due to fear of infection and stigma, was only repealed in 1996 (yes, I typed that right). The photo is of a memorial statue depicting patients at the entrance.

The Museum represents the nation’s commitment to preserve ‘the living testimony of patients and former patients of leprosy and to appeal to [the] society not to repeat the same mistakes’. There are heartrending exhibits about the impoverished lives of patients and their families in these isolated institutions. The website of the equivalent American museum is also informative.

Tokyo’s social welfare history

I also visited again the Edo-Tokyo Museum, recently restored, which has interesting reconstructions of ‘the life of the people’. Edo was the earlier name of Tokyo, before it became the capital city in the 19th century. One side of the museum had the earlier history, the other the Tokyo period. The picture at the head of this post is of a street scene model depicting the Edo period. Enthusiasts for social work museums will be pleased to know it has a display about the early development of social work as a response, partly, to liberationist movements, and there is also a display about Tokyo’s official social welfare services (below):

I was reminded during this visit that, wherever you go, there are resources for the history of social work around us in many more general museums and in the history of the organisations that continue to serve social workers and the people they work with.

Most social workers working with people with mental ill-health will have come across ‘hoarders’, as they are sometimes called. And have thought that they should (or have been asked to) do something about it.

We see them around where we live, too. Two people on my various routes to the bus stop seem to have piled up loads of stuff in their front rooms, one of them notably stacking stuff from floor to ceiling even in the porch, presumably from then on inwards. Research cited in the paper I’m discussing this week suggests that it’s not that unusual, perhaps 2.5% of the population.

This interesting paper on how ‘hoarders’ feel about ‘forced clearances’ (Parker, et al, 2026; available pre-publication on the Internet, click on the doi number in the citation in the references to this post to read it) explains what happens in a more organised way than those of us who occasionally get asked to do something.

Forced clearances happen when landlords or the local council or health authorities are asked to clear the house, often on health or public nuisance grounds. The study comes from a doctoral thesis which is also available on the Internet, if you want to read about it in detail: Thesis here.

Like social workers in mental health, housing providers and public health services often get called in to ‘do something’. One current worry is about older people who seem to accumulate a lot of ‘stuff’. Is hoarding a sign of dementia? you sometimes get asked. One elderly woman I got involved with had a very cluttered kitchen; some people who knew her thought this was untypical. Talking with her about her cooking, I found that she was having memory problems and dealt with them by leaving stuff out of the cupboards. Memory problems are not necessarily dementia; for her, this was a fairly rational way of dealing with her worries about forgetting things. When you asked her, she actually had a very organised kitchen; it was just unusually visible.

But there’s no evidence that ‘hoarders’ progress; that is, they don’t get worse. They’ve always been collecting sort of people, and have achieved mountainously as life goes on. I have one friend, who has had high-flown jobs, who never allows people in her overfilled house, but is otherwise valued by a wide circle of friends.

But sometimes, hoarding comes from the life disruptions of mental illness. My first involvement as a social worker was receiving a referral for an older woman, who had experienced a lifetime of hospitalisation for ‘schizophrenia’, and was now living in a (very poor-quality – the Council that owned it should have been ashamed) one-room flat. She was socially isolated and heard voices, but it didn’t disturb her too much, and she was living a basic life alone as a result of her lifetime illness. She often replied to her voices by writing chalk messages on the shared-staircase wall – irritating for the neighbours.

One problem was that she had stacks of newspapers and magazines, piled high on every surface, including the bed. This meant that she slept on the only vacant armchair, so she was not only alone and lonely but also tired. Worse, when she had meals, she covered up the dirty plates, cutlery and leftovers with newspaper, and just had the next meal on top.

I got her to agree to our home care service helping her to clear stuff away. But I think I was too pushy, too much in a hurry, and she would have known from past experience that this young man would have had legal powers, making her more compliant than she should have been. Most of the stuff ended up back in the flat, therefore, although most of the health risk problems were gone for a while. What I did was not strictly a ‘forced clearance’ but undoubtedly came about because of my pressure on her, and probably felt pretty forced. Like many formerly mentally ill people who are alone, however, she managed to carry on the very limited life that her illness left her for long periods of time; I think my intervention probably enabled her to carry on without annoying the neighbours too much for a further period.

She had many of the characteristics of the people interviewed for the ‘forced clearance’ research. People were a problem, usually to their housing providers and they are a ‘self-neglect’ concern under the Care Act 2014 and possibly required assessment under the mental health legislation for compulsory action. The researchers interviewed nine people ranging…

3 years and 4 months to 74 years and 4 months … and there were seven females and two males. Participants’ ethnicity was White British (n = 4), Mixed White (n = 2), British Caribbean (n = 1), White Welsh (n = 1) and White Scottish (n = 1). Participants described experiences of clearances which were completed by organisations and family members…(T 1).

Three themes came out of the interviews:

1. power imbalance in the situation, including feeling criminalised for their mental health difficulties and seeing clearance which they didn’t want as the lesser of two evils;

2. the trauma of the clearance. For example ‘losing belongings is like losing myself’ and this trauma on top of the other traumas in their life experience;

3. picking up the pieces, for example the experience of the clearance weighs heavily on the mind and the ‘shield’ of things against the outside world had to be replaced in some way.

Some quotations from the people interviews make the point:

…it was a standardised letter which said that if you don’t clear it, this is antisocial behaviour, we’ll force a Community Protection Notice and you will be fined…and taken to court…

If I didn’t agree to the house clearance, the housing association would have forced it on me anyway…and charged me for it…it would have taken years and years to pay off cause I’m on benefits…technically I agreed to it, but I had no choice.

Having had the experience, they also faced the possibility of future consequences: it might happen again. Interviewees felt the pressure of trying to maintain their house.

…losing it is, it feels like my own personal death. It’s horrific…it’s horrible because it feels like they have, part of my soul is with them and I don’t know what’s happened to it…

…it’s not just that I’ve lost something. It’s, I’ve lost part of myself and how can I continue breathing and living? It’s a really weird feeling and kind of a shock like I am still here, but how?

This is similar to my own experience with another man, never married, who lived in his parents’ house after their death, having been eased out of a teaching job some years previously probably because of his increasing strangeness. I met him doing volunteer work for a local mental health charity, and he was able to show me interesting property inherited from his parents; important memories. We took some time to get to know him, but, looking back, I think probably not enough time really to get true consent to improving his position.

And also valuable if they were sold, so his security was at risk if someone found out they were there. He also slept in part of a narrow childhood bed, surrounded by towering masses of his hoards. But he had the same unhygienic way of managing his eating as the older woman I described before. Our volunteers helped him throw some of this away, and organise his garden. But again, stuff had to be thrown away just the day before refuse collection, or he would retrieve it, so he never really said ‘yes’ to throwing things away, and a few weeks later complained to the police that things had gone missing. Although I don’t think they had.

But I think it also exacerbated his fear that that he would lose the property that represented his parents’ lives. I came away from my experiences of this issue feeling that we need to take a lot more care and spare more time to help people deal with the consequences in their feelings and their lives when something like this has to happen.

Stay with people through the process and through the aftermath when you have to force people to deal with something that is so important to them. And realise that going through this process and taking away the shield against the world that their ‘stuff’ provides may add pressure to them which makes their mental health worse again.

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Parker, H., Waddington, L., & Gregory, J. D. (2026). Exploring experiences of forced clearances in people with hoarding difficulties. Psychology and Psychotherapy: Theory, Research and Practice, 00, 1–15. https://doi.org/10.1111/papt.70082

1950s social case-work and moral welfare

My previous post in the Social work history bites looked at the general information in Cherry Morris’s edited 1950s text on social case-work (note the hyphen). I promised to look more closely at the chapter on ‘moral welfare’. This topic is not well-documented at all as you can tell from the illustration at the head of this post of the chapter’s bibliography. Or, nowadays, people don’t understand what it was and what was involved. Hence this post on the history, which is fortunately well-covered in the chapter.

The topical reason for doing this is the issue of ‘forced adoption’. Young women who had ‘illegitimate’ babies at the time felt forced into giving up children for adoption, that they wanted to bring up in their own care. Of course, neither the children nor their mothers were ‘illegitimate’; it was the law and social attitudes that made them so. The Church of England and the Prime Minister, Sir Keir Starmer, have recently apologised for official involvement in this, and Britain is not alone here, similar apologies have been given elsewhere in the world.

The instrument for much of this was the 20^th century specialisation of social work in ‘moral welfare’, now disappeared from the social work lexicon. What this rare specialised account of moral welfare shows is:

• a history of an exceptional level of negative judgement of sexual ‘misbehaviour’ according to very traditional religious (Christian) mores, and

• a focus on adoption (particularly) and foster care (perhaps) seen as preventive of further immorality.

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During the period when this account was written, a new adoption service was beginning to grow up, from very informal arrangements for adoption. As this service emerged, a tension grew up. This tension was between the needs of children’s mothers and the needs of an adoption service, mainly run by church organisations for moral welfare and some other voluntary bodies until the Adoption Act 1958 (well after this chapter was written) put the whole system on a more organised footing..

The chapter is in two parts, with a short section of definition first. The early part (pp. 144-51) recounts a history of moral welfare as a social work service; we could see this as the then-current (in the late 1940s) cultural traditions of the specialty. The second part (starting from the section ‘case-work’ on p. 152) contains information about the kind of clientele and services that moral welfare workers worked with.

Defining social work in moral welfare

The introductory material on definition makes clear at the outset that this service and professional practice is closely linked to the Christian churches:

Moral welfare work is undertaken on the basis of a religious interpretation of life and for the most part is organised by religious bodies. In this it differs from most other forms of social work (p. 144).

But it also has other differences from the Anglophone approach to social work as social problem-solving. The next sentence:

It is also closely associated with work of an educational kind [so with connections, probably unknown to these writers, to social education/pedagogy, a European social work model], but in other respects it conforms to the principle of case-work already outlined [i.e. in the introductory parts of the book we looked at last week].

Then its objectives and clientele:

This case-work is mainly concerned with the rehabilitation of young people and adults whose sex behaviour and personal relationships have led them into conduct damaging to themselves and to other people. They may be adolescents who are making dangerous experiments, unmarried parents and their children, those involved in extra-marital relationships, or the victims of a broken home life./In practice, it is difficult to isolate sex immorality from other forms of misconduct, and so the worker is often concerned with the wayward, the weak, the delinquent and the criminal.

It is clear then that the focus on sexual behaviour regards it as misbehaviour. Moral welfare, conceptually, deals with immorality. And the extent of that concern is breathtaking: not just unmarried mothers seeking some resolution of bearing an illegitimate child (abortion was illegal at this time), such as adoption, but people who were living ‘over the brush’ as they used to say in a Yorkshire town I worked in (cohabiting and having children as though they were married), having affaires or having broken homes (the implication is broken because a marriage has broken up). There is no mention of homosexuality, perhaps because this was unimaginable (and for men also illegal at this time). Not mentioned at this beginning, but turning up later in the chapter, was a concern for ‘broken homes [or marriages]’ and the increases in illegitimate children during recent wars, which moral welfare workers also dealt with.

One of the most striking things about this chapter, to me, was that moral welfare workers saw themselves as most closely related to probation. This is partly because the new local government children’s service was barely up and running at the time this chapter was being written, having started in 1948. But it is also because probation was not a universal service at this time. In many areas, probation officers were part-timers, often recruited from former volunteers, so other voluntary services, like moral welfare services, saw themselves as reasonable substitutes when dealing with alcoholic, homeless or criminal and inadequate husbands.

The rest of the introductory material, therefore, notes that moral welfare work often overlapped with other welfare provision. Agency boundaries were less clear than we now expect. The focus is on the moral welfare worker seeing people ‘at a time of crisis in their personal life, whose primary need is for security and affection, and she depends on winning their confidence (p. 145)’.

Social casework relationships models of practice are what connects moral welfare work with the social case-work covered in other chapters of this 1950 book. It is important to remember, though, in everything that the writers say, that the fundamental justification for this work is a judgement on the people they are dealing with. They have defined it as sexual immorality, they regard it as socially reprehensible and close to criminal behaviour.

Attitudes to moral questions have varied over the centuries. Early pioneers experienced:

‘…opposition and apathy. A speaker in the House of Commons said that Josephine Butler [the 19^th century heroine of this work] was as bad as the prostitutes [sex workers] on whose behalf she was fighting. Until recent years the illegitimate child shared the public condemnation and ostracism of his unmarried mother, though curiously enough his father escaped all blame. Today, when extra-marital and pre-marital relationships on the part of women as well as men are regarded with sympathy and even approval, the victims of their own irresponsible conduct are said to be unfortunate, or “unlucky this time”…Moral welfare work is concerned, therefore, not only with case-work amongst those who suffer through their own misconduct or that or others, but with educational work which builds the foundations of all true personal relationship; it coordinates “thought and action in relation to the place of sex, marriage and the family in the Christian life” (p. 145)’.

This last quotation is drawn from the Constitution of the Church of England Moral Welfare Council. Moral welfare work, on this account, reads very judgementally. The reason for this lies in the history of its development, as well as in the social attitudes of its workers.

The history of moral welfare work

Moral welfare is concerned with two problems, prostitution and illegitimacy, but these were dealt with separately in the early days of the 18^th century, when infant mortality was high due to social distress. A ‘foundling hospital’ was opened in 1739, by a naval captain, Thomas Coram, in London to take homeless children off the streets, ‘for the purpose of admitting every illegitimate child brought to its gates’. The agency still exists, in its historic buildings undertaking work in adoption, foster care and other children’s social work, and you can visit its museum: its website says its 18^th century interiors and exquisite art make it perfect venue for weddings and social events. Indeed, I’ve been to many meetings there. The art is because famous artists donated work (the composer, Handel, donated music manuscripts) to support the trust, and there were visiting days when the foundling children could be viewed by the cognoscenti.

Following up on this, in 1758, a Magdalen Hospital was opened as a ‘place of reception for penitent prostitutes’. Unmarried mothers in the 19^th century had the choice of surrendering their child, or the Workhouse, as we have seen in previous history bites posts. In 1898, a diocesan home for girls moving with their first babies from the workhouse was founded in Kent, in the countryside south of London. A lady with experience of female convicts said in a speech that want of this help meant that many young women spent the ten best years of their lives in the workhouse. Many other similar homes were opened across the country:

…with the object of fostering maternal instincts, training the girls and reinstating them in society…(p. 146)

…usually staying for two years, and nurseries attached to the homes often kept children until they were 2, 3 or even 5 years old. No concern, then, with the girls as mothers or continuity of care for their children with a stable carer.

There was no legal adoption (until 1926/7) and most of the girls were placed as domestic servants in middle class homes, with their babies being placed in foster homes. Both Dr Barnardo’s Homes and the Church of England Children’s Society, both child rescue societies, ran boarding out schemes like this nationally. Many workhouse unions followed suit, as we have seen in various history bites. The Children’s Society was originally called the ‘waifs and strays society’, and it became a catchphrase. My mother in the 1950s always called people who were a bit disorganised in life ‘a waif and stray’.

Various organisations were set up ‘for the protection of young females’ and this was called ‘penitentiary work’, with a Church Penitentiary Society being set up in 1852 (p. 147). By 1881, there were 28 ‘houses of mercy’ and 11 refuges. note that the mothers must be penitent as part of their care. An 1881 report says:

The statistics of the penitentiary at Highgate (in north London) prove incontestable that the terrible sin against which we contend is steadily increasing and the victims are of a tenderer age’. Although ‘sisterly love’ was the prevailing treatment, evidently the discipline was ‘extremely severe’ (p. 147).

The double standard for the treatment of men and women led to many refuges and training homes, and eventually to the White Cross League in 1883:

…to promote purity among men, a chivalrous respect for womanhood, the preservation of the young from contamination, rescue work…and a higher tone of public opinion (p. 148).

I’m going to deal with Josephine Butler in a separate post, but she worked (mainly in Liverpool, but across the country and Europe), provided a home for young women, and eventually for professional training for workers in this field. When I worker in Liverpool in the 1980s, one of the social work professional courses was housed in ‘Josephine Butler House’. She campaigned against the 19^th century Contagious Diseases Act, which oppressed women generally and sex workers in particular, allegedly to prevent infection among the armed forces

During the First World war, 1914-18, rates of venereal disease and illegitimacy rose rapidly, and led to a Royal Commission which established free treatment for venereal disease, the original source of today’s sexual health clinics in every National Health Service area. This led to both state and voluntary services to assist young women, including a visiting service, and became the basis of moral welfare work. The intention was ‘preventive work’, and some areas provided health visitors or welfare officers and official ‘mother and baby hostels’ (p. 150), while others relied on continuing provision form moral welfare services.

The evacuation of children from major cities to avoid bombing in the second world war revealed poor child care standards, both among urban families in poverty and in the visiting and official ‘boarding out [foster care]’ supervision, which led to the Children Act 1948 providing for a comprehensive local social work service for children, still, at the time this chapter was being written, in its early stages. Earlier children’s legislation in 1933 had made better provision for ‘training’ for young children in approved schools and some provision for ‘maladjusted’ children. Also, early experiments in ‘child guidance’ (after 1929) had made better official community psychiatric provision for children and adolescents.

As a result, some of the focus of moral welfare shifted to placement and adoption of mainly illegitimate children. Provision for formal adoption only dated from the operation after 1927 of the Adoption of Children Act 1926, requiring formal consent from the parents and an organised system for placing children. Previously, very informal provision had led to loose arrangements, sometimes through professionals (often a local family doctor) or through families and friends. In many areas, the only available agencies for achieving this was the church moral welfare organisations, but because these were religious organisation, adoption became in reality often an arrangement for finding babies for parents unable to conceive their own children. As the chapter says:

Statutory facilities, in any case, are likely to remain inadequate for many years, and there are still gaps in legislation which allow some children in need to go unnoticed by the authorities…There are those over the age to be dealt with by statutory powers, and others for whom help is sought more readily from the welfare worker of a voluntary organisation rather than from an official employed by the State (p. 151).

The role of the Poor Law Relieving officer had been in existence until 1948, so long-time concerns about dealing with ‘officials of the State’ were still apparent when this chapter was being written.

Moral welfare case-work

The people who come to a moral welfare worker may be in real distress, such as the parents anxious about their child, the utterly ashamed expectant unmarried mother, the jealous husband, the distracted wife. Others hide from themselves in their own uncertainty…the well-dressed young woman living with a man to whom she is not married, the self-righteous father who wants his daughter brought under control and the self-confident girl who has all her plans nicely made and expects the moral welfare worker to find a home for her baby after it is born. An unmarried mother may be a child under the age of consent [for sexual intercourse], she may be a woman nearing middle-age who has been made love to for the first time in her life. She may be a pleasure-loving, thoughtless, selfish and irresponsible girl, or one giving love to a man she knows she cannot marry (p. 152).

These examples suggest the 1950s attitudes to women and men facing such difficult situations. They may need practical help making arrangements or advocacy for services that will meet their needs. Though somewhat accepting, these attitudes are also judgemental, and this must have been felt in the casework that moral welfare workers offered.

Adoption is ‘only one way of helping the illegitimate child (p. 155)’. But, while previously practice stressed developing the mother in the care of her child, this sometimes did not give enough attention to the welfare of the child, who might have been better provided for through adoption. The mother must make her own decision, ‘but the worker can help by seeing the situation objectively (p. 157)’ [in other words, perhaps to persuade her in favour of adoption]. It is important to try to keep the confidence of all the people involved in the situation, the mother, the mothers’ parents who are often providing her home, the needs of the child, people who blame the father and mother for their behaviour.

The moral worker will help to balance these attitudes, and also maintain effective relationships with other agencies who may be able to help.

What we can see in this brief discussion of moral welfare practice is the need to balance a range of factors, without a strong focus on the needs of the mother of an illegitimate child.

It may not be surprising, then, that the wishes of those mothers were given little importance: they were seen as ‘immoral’, troubled and perhaps troublesome, among conflicts around them about the right moral and practical courses of action, in a service with a history concerned with responding to ‘bad behaviour’. And a service whose task might have been seen as ‘preventive’ in protecting the illegitimate children by shifting them to apparently more secure and less troubled adoptive and foster care.

That’s maybe what led to an experience that this was ‘forced adoption’. The history of moral welfare and the reality of its role in an undeveloped caring service for children and young people suggests that ‘forced adoption’ was sometimes, perhaps often, a reality in 1950s British social work provision.

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Reeve, B., & Steel, E. (1950). Moral welfare. In Morris, C. (Ed.) Social case-work in Great Britain (pp. 141-162). London: Faber and Faber.

Regular readers may remember that I get a magazine from the International Monetary Fund (anyone can get them to send it quarterly in various languages, or you can read it on the Internet).

I find it often sparks social work thoughts, hence this post in my Social work bites series. And it is often historical too. This quarter, one of the articles starts off with the Medicis (the aristo Florentine banking family of the Renaissance period), does a quick flip through the Nazis and then zooms in on the US and China now.

One of the messages I caught in passing was how economic power increases disproportionately as a hegemon (an individual or usually a nation, think USA and China, with significant power over others) approaches complete control of an economic asset or sector. If you produce 95% of an asset like oil, or rare minerals needed to run computers, your power increases disproportionately. The article (Clayton, Maggiori & Schreger, 2026) says:

At 95%, a target economy [you or me] has almost no viable alternatives and must accept whatever terms the hegemon demands. At 85%, there is enough of an alternative to give the target meaningful options (p. 23).

Think not only proportions, but also ‘choke points’ like the Straits of Hormuz for oil tankers.

This quarter’s edition is mainly about this sort of thing, it’s called ‘geoeconomics’ – this is about how the economic system affects national security and vice versa. The ghastly realities are that ‘geoeconomics is the use of financial and trade relationships to achieve geopolitical and economic goals, p. 22)’. And the point is that everynation does it (mostly) and at the level of everyday life a lot of businesses are forced into it because their own economic security depends on their economic control of other people’s lives. If you’re homeless, with nowhere to sleep tonight, you lose control over a lot of human and social issues that affect your life.

Apparently, this subject emerged from a study of the German economy published just at the end of the second world war. It showed that Nazi Germany structured its economy to make sure it had leverage over its neighbours in the interwar years. There’s an index the researcher, Hirschman, gave his name to, alongside someone else, which measures the economic power of nations (and firms) over others.

Mainly this has interested politicians, but just now, as another article notes (Lipsky, 2026), it’s been rediscovered, although for many people in business, it’s the way you live. Poor and less powerful countries have always been aware that the big boys on the international stage (I say ‘boys’ advisedly) can do something to their benefit that slaps you down. And the Covid-19 pandemic and Russia’s invasion of Ukraine makes it only too clear. And it’s only too clear for people who are on the margins of any economy, like the people social workers often spend their time helping.

During the post-Cold war period,

‘…the US and Europe had the luxury of often separating economic policy from national security…Wall Street and Washington could operate on a disconnect…Today, the ability to silo economic and national security policymaking is gone. The US is rediscovering geoeconomics and doing so within a system that also serves as the beating heart of global finance…the reality is that for most of US history, geoeconomics was the norm. The past three decades was the exception (Lipsky, 2026, pp 26-7).

The impression I get is that people in the US government rather enjoy the economic power it has, and are happy to use it whatever the economic or other consequences for other nations, and the people , such as migrants, or the people who need government services. Most nations, therefore, have to bear in mind in everything they do, that it will probably have effects, good or bad, in the economy, and they have to organise to combat economic problems arising from their preferred social policies. This seems to be true for governments, and that may be why it’s difficult to do governing these days. And this is true for most people who live precarious lives, so it’s difficult for governments to provide services for them.

As another geoeconomics article makes clear:

Governments have good reasons to use economic polities for geopolitical purposes. Sanctions, embargoes, tariffs and other such methods can coerce adversaries without the threat and use of force…[But] Coercive economic policies typically impose costs on the country that uses them (Frieden, p. 32).

The costs include:

• reduced economic efficiency – you can’t use just-in-time supply chains if you’re restricting access to another country’s resources;

• specialisation – if you don’t bother with things that you don’t produce efficiently, like weapons, other countries gain economic power over you;

• innovation – it’s expensive to invest and develop things to turn them into economic value, but if you don’t, you increasingly become irrelevant to what people want;

• credibility – if you treat other countries badly, your promises become less useful to you and to them.

As another article in this quarter’s magazine explains (Singh, 2026), it’s good to be ‘plurilateral’, get in tune with other people in the same boat as you and help each other out – the more the better.

Another article notes that nationalisations, globally, have gone in waves. In England, we tend to think of nationalisation as a socialist policy, mainly used after the last war for the government to gain control and manage the economy directly, after the wartime and earlier experience of economic depression. But the indications are that nationalisation depends on cost and chaos. As we’re hearing about the water companies at the moment, they’re too expensive for the government to take over, but it’s easy for it to take over the railways because they’re in a mess and not making any money. The post second world war splurge of nationalisation was mainly because the cost was cheap and, post-war, many of the enterprises taken over were not in a good state. At other times, it’s more economic to use private resources to invest.

As in the care home sector. In the 1980s, there were a lot of problems in the UK about the quality of care homes. Some of that has been dealt with by private investment, but now we’re finding that the investors are taking money out of the system and we can’t find care homes for young people who need them. All the concern about the care home sector for older people is currently because it’s not providing the right kind of care for older people in the right setting; only homes that will make a profit from people who can pay (a lot) will provide good care. And even then, it requires getting low-paid migrants to do the caring work, because the system does not pay enough to employ enough of the right kind of people to do the job.

That’s about economics, and it’s also about global economics, because the British care sector is exploiting the labour force from poorer countries.

The other thing that I notice about this sort of thing internationally and with people who receive social work help is the attitude that economic power breeds. What happens to most of the people that get slapped down happens because the people with power are not that bothered, The company, or the bureaucrat that runs things doesn’t really bother all that much if it goes wrong for you.

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Clayton, C., Maggiori, M. & Schreger, J. (2026). Understanding geoeconomics in a volatile world. Finance and development 65(2), pp. 20-5.

Frieden, J. (2026). The cost of geoeconomic coercion. Finance and development 65(2), pp. 30-3.

Lipsky, J. (2026). Geonomics, rediscovered. Finance and development 65(2), pp. 26-9.

Mulder, N. (2026). The new wave of nationalization. Finance and development 65(2), pp. 38-41.

Singh, N. K. (2026). The middle power moment. Finance and development 65(2), pp. 14-15.

More on 1980s Asian social development ideas

In this third post drawing on the text of edited papers from a 1988 Asian conference, I focus on a group of papers concerned with broad conceptual ideas about development. I’m choosing to look at this as evidence of a critical analysis of Western social development ideas towards the end of the 20th century.

I suggested last week in covering some of the chapters on value conflicts between development and Asian social values that there was at the time perceived to be a tension (at least) between Eastern and Western concepts of development. This is taken forward both in some empirical work in the papers and in more general texts.

It seems that the writers fairly universally want to contest the economic, technocratic industrialisation and resource extraction model of development in use, preferring a stronger focus on the social. but it’s not there yet. This may be because this is a bunch of psychologists, and the main aim is to say that we have to think more about the quality of human life here. I think sociologists might be looking at structural issues in social life as well, even though all would probably agree that it’s worthwhile distancing people from poverty. China, under communism, seems to have been very successful at reducing the proportion of their population in poverty. But what were the human social consequences of the way they run their now developed economy. Better than business-dominated Western economies?

I have reproduced the dust jacket here, since it contains the same graphic in a different form to the binding - who knows what it means? Answers: in comments if you have any thoughts.

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Introducing 1950s casework (and ‘forced adoption’ and T. S. Eliot)

At least two previous owners have marked their names on the flyleaf of my frazzled copy of Cherry Morris’s (1950a) book on social casework (still social ‘case-work’ in the conservative styling of Faber and Faber, its publisher and indeed published in ‘mcml’ as the title verso has it, also in Faber’s classic style, as my poetry bookshelves demonstrate).

It was the first of three books on social welfare published by that redoubtable company (I think the only three they produced - I’d be intrigued to learn how that came about), known as an important purveyor of poetry, with its Nobel prize-winning poet/editor, T. S. Eliot. The firm’s archivist notes:

In addition to poetry and verse drama, T. S. Eliot’s ‘list’ covered a range of non-fiction, from literary criticism to religion; and he was responsible for monitoring foreign-language publications (Brown, 2020).

Actually, at the time he was monitoring more or less everything, but was later allowed to step back from the more general list in view of his stratospheric eminence as a poet. The three social work edited volumes (I’ve mentioned the two others in various previous posts in Social work history bites and Social work history in 20 books) were on groupwork and community work, but Morris’s volume, the first, has greater historic importance and had a more significant impact on the field.

I’ll deal in this post with the three general chapters on casework and social work education, by famous social work illuminati of the period, and return in the next post in Social work history bites to some of the more specialist material.

In particular, I’m going to spend some space in the next post on the currently controversial ‘moral welfare’ chapter. Moral welfare of the period is not well-documented, and is currently important because it was significantly involved in ‘forced adoption’ of illegitimate babies in the post-war period; another recurring issue in history bites, and which the Church of England recently apologised for their practice and the Prime Minister today as I write is going to apologise in Parliament.

Post-war upheaval

We’ve met Morris before in Social work history bites for her 1950s elegantly bound appeal for funding for the social welfare provision at St Thomas’s Hospital, London (the one with the great views from the wards of the Houses of Parliament) where she was once head of the almoner’s department, and conveyed some of the London history of almoning as medical social work was then called).

But I first knew her name as the editor of this book, which during the 1950s was the only general text on social work, and still in use, but a bit outdated, when I became a social work student in the 1960s. She contributed only a brief introduction (Morris, 1950b) explaining why the book was necessary.

It was, she said, a time of upheaval, new legislation for social work and demand for training. So a committee funded by the London Family Welfare Association (the successor to the Charity Organisation Society - COS) was set up to organise the book, with the great and good of British social work as a guiding voices( well, actually London, there’s a committee member and contributor from Leeds, and a senior academic from Hull – not a contributor).

Morris claims a ‘middle way’ in social work, as in politics and religion. The book seeks to synthesise state services (then expanding massively) and the voluntary services (then apparently to be in the background), strengthen psychological knowledge as compared with material needs) and a ‘liberal tradition’ in the English ‘way of life’ (she means socially liberal – the book is devoid of political analysis, except by omission. Morris opines:

Deep too, is the belief that the State, however powerful, is the servant and not the master of the individual citizen and, moreover, that it is the privilege of ‘ma, proud man’ to develop his own idiosyncrasies…To reconcile this belief with an acceptance, for the general good, of a large measure of compulsion inevitable in a modern socialized State is possible but is never easy. It demands of social workers…a constant awareness of the conflict and of the necessity for maintaining a balance between the satisfaction of material needs on the one hand, and on the other that freedom which alone the spirit of man can live (p. 9).

Her introduction ends with a note for this emphasis on ‘man’ rather than citizens and people, which contemporary readers might require to read:

Throughout the book, as a matter of convenience, the convention has been observed of speaking of the social worker as ‘she’ instead of the more accurate ‘he or she’ (p. 9).

Social casework’s role and practice

The first two contributions are by Kay McDougall and Una Cormack. The first looks at the role of casework as part of social service, the second at how it is practised. These two writers were at the London School of Economics (LSE) and Oxford, respectively, prestigious academic homes for social work education. McDougall was in charge of the prestigious mental health course, the main training centre for psychiatric social work. She has later to lead the merger of the social work professional associations in 1970. Cormack was tutoring at the Oxford ‘Delegacy’ for social training, in effect an external training centre outside the traditional structure of Oxford University (which usually avoids direct contamination by social work). At the time of writing in the late 1940s, Richard Titmuss was about to be appointed to the LSE as the first professor of ‘social administration’ (later, social policy), the founding father of this subject, which was to incorporate social work for the next thirty years.

The argument of the first chapter (Cormack & McDougall, 1950) was the principle that the field of social work covered individuals in difficulties which they could not meet unaided, and such difficulties where a number of people were affected that justified ‘collective action’ (p. 17). The presence of groupwork and community organisation were noted; casework was reserved for ‘individual treatment’. The history of social work derives from efforts at social reform, for example in housing, sanitation and preventive health and the ‘relieving officer’ of the Poor Law. As these fields have developed, there have been overlaps, but:

It is naturally case-work, logically as well as historically speaking, the first, which forms, and will always form, the hard core of professional social work (p. 19).

There are specialist forms of casework, represented in the book. The authors argue at some length, suggesting that this was an important question of the day, that the work is professional, with the practitioner equipping themselves by study to help a wide range and greater number of people than could be served by people who happen to be their family friend..

Case-work developed from industrialisation and its associated urbanisation, which left people isolated from family and personal support. They draw on the work of Edward Denison, an MP of the mid-19^th century who argued for the State to take on responsibility for ‘diminishing the sufferings and increasing the happiness of humanity at large (p. 21, quoting from Denison)’. He was an important figure of this period, in fact many social work organisations in London were based at Denison House. The vision of society at this period was of disintegration, knitted together with charity ‘where each man had his place and used it to serve his neighbours (p. 23)’. Early case-workers were

…not to busy themselves with financial or material needs, but to establish a relationship, to make contact with the personality first, and offer a personal service, before going on to raise consequential help in cash and in kind (p. 23).

In reality, they faced extreme poverty and social distress that led around the beginning of the 20^th century to a perception that social change was an important part of dealing with society’s social problems. Richmond’s Social diagnosis provided the beginnings of general case-work method, but this was not strongly developed. The COS developed a range of other services represented in the modern structure of provision described in this book. Later influence came from psychology and psychiatry. These methods were consolidated from the 1920s-40s, and dislocation due to evacuation of children from cities during the second world war (a particular issue in London) and the need for psychiatric case-workers led to the present urgent need to ensure provision for individuals to enable them to become useful contributors to society. Officials in other public services can offer efficient and worthwhile services but do not offer the understanding and breadth of intervention that is possible with case-work.

The second chapter focuses on practice, seeing it as predominately an art practised using scientific knowledge (p. 34). At first contact, the aim of the case-worker is to put clients at their ease, demonstrating integrity and understanding. The client states their problem, but this may be part of a much wider range of issues that the worker will collect information to understand fully.

This leads to a social history, building a social understanding of the sources of the issues the client faces and develops a diagnosis, to be discussed in a conference or committee (but not, it seems, with clients as part of the decisions). All this constitutes part of the ‘treatment (p. 45)’, because it clarifies and prepares the client to work on the issues appropriately, and leading to tentative plans for treatment.

An important skill in treatment is interviewing, since these discussions help to make changes in clients’ attitudes and self-confidence in tackling their problems (pp. 46-8). Some interviews, depending on the approach of the agency, will take place through home visiting, to gain a realistic picture of clients’ lives and place the problems identified in the context of their clients’ way of living (pp, 48-52). Some help will be in short contacts (pp. 52-4), with clients being able to help themselves with initial guidance and greater awareness. Recording is important (pp. 54-6) to draw attention to the main aspects of the case, helping to remember the specific circumstances and needs of the client, who should understand how they will be used. Standardisation of records may in the future with research on social issues and on case-work practice.

Social work’s knowledge and education

The third general chapter in the book is Younghusband’s (1950) ‘conclusion’ to it. At this time, she was also a member of the academic staff of the LSE department, teaching on the general social science course, which was later to be regarded not as a professional qualification. She was soon to take on the management of the LSE’s pioneering course in ‘applied social studies’ the first ‘generic’ UK social work qualification, following developments in the USA. She had already written a report on social work education (Younghusband, 1947), looking at the training needs of social workers, deriving from the 1940s post-war social legislation. Chairing such committees was to become a later life pre-occupation for her, and the source of much of her influence. Others followed up the first, and in the 1970s she also contributed to the development of community work training in a similar way. The main one, for the government in 1959, was still to come. It led to the creation of the National Institute for Social Work (Training was removed from the title after a few years), and a two-year training for workers in health and welfare services, later merged into the UK’s general social work education arrangements.

Her chapter is primarily an argument for knowledge development ‘to make benevolence scientific’ (she quotes a colleague, p. 190). Knowledge is needed both of the social services and their operation and also ‘profound knowledge and understanding of people (p. 191)’. The general social science courses (which she was herself a product of and teaching on)

…have taught students about the structure of central and local government and the social services. And the practical work is planned partly so that students may see these in action (p. 191).

This has become accepted, but it is far less accepted that in depth understanding of psychology and social relations is also essential to social workers. ‘These two strands woven together make up case-work, and distinguish it from other forms of social work (p. 193)’.

She also argues for participation in interprofessional teams (pp. 194-5) and adequate involvement in the administration of services (pp. 195-8) including awareness of the legal requirements of statutory bodies (pp 198-9).

Moving on to training, she suggests that the attitude of employing bodies to ensuring such training will be crucial. She also seeks to clarify circumstances where more intensive ‘treatment’ is required, and discusses the post-war development of Family Service Units (building on pacifist initiatives during the war) to build active involvement in families’ lives.

Case-work training is offered after the general social sciences courses, but there is no clear linkage between them in the existing education system. Students do not receive an adequate preparation for their work unless it is possible to see the teaching of ‘general principles (p. 205)’ to go beyond the training available for existing specialisms, which are ‘only partially watertight’ compartments.

We see here the beginnings of an argument for the generic course which was to be the most powerful innovation of her career. In this, she is reflecting developments in the USA, where, for a variety of reasons, the separate professional associations of social workers were about to come together (in 1955), and the separation of different types of education was leading towards a commitment to generic social work education in the creation of the Council on Social Work Education in 1952.

Interestingly, this book was reviewed by Gordon Hamilton (no less, the then-current leading textbook author in the USA, about to publish her second edition) in the prestigious Social service review published from the University of Chicago. And Hamilton spends much of her review commenting on how the separation of specialities in the British textbook reflected similar unfortunate divisions in the US.

The movement for generic social work was on its way.

In the next post…

The chapter in ‘moral welfare’ and its role in what is now called ‘forced adoption’.

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Brown, R. (2020). Eliot at Faber. https://tseliot.com/editorials/eliot-at-faber.

Cormack, U. & McDougall, K. (1950). Case-work in social service. Morris (1950a), pp. 15-31.

Hamilton, G. (1951). Review of ‘Social case-work in Great Britain’. Social service review

25(3), pp. 407-8.

McDougall, K. & Cormack, U. (1950). Case-work in practice. In Morris (1950a), pp. 34-57.).

Morris, C. (Ed.)(1950). Social case-work in Great Britain. London: Faber and Faber.

Morris, C. (1950b). Foreword. In Morris (1950a), pp. 7-9.

Younghusband, E. L. (1947). The employment and training of social workers. Dunfermline: Carnegie United Kingdom Trust.

Younghusband, E. L. (1950). Conclusion. In Morris (1950a), pp. 189-208.

Worries about mental health social work

An interesting paper (Wilberforce, et al, 2020) on how service users saw UK mental health social work used a not-so-common research method called ‘best-worst scaling’. As the researchers say, a lot of research on mental health social work mainly asks the professionals, social workers themselves or the people they work with. So why not find a way of getting a clear answer from service users?

You might wonder about ‘best-worst scaling’, not something I’ve come across reading social work journals. It’s a widely used method in ‘choice modelling’; a recent paper on the method (Schuster et al., 2024) found it used in health, agriculture, transport, linguistics, and the environment; there are books telling you how to do it. It gets people to look at lists containing (a limited number of) things or ideas and choose which is the best or worst of them, eventually comparing all the items on the list. Then you can get a computer to work out what is most important to the people doing the choosing. In this case, it was lists of what mental health social workers do.

Why would you do this? The researchers point out the there’s a deal of alarm and despondency about British mental health social work, which used to be highly prestigious. It is partly that the government took away the monopoly social workers had of legal powers of compulsory admission to mental hospital, and although they are still the main players, other professions have sometimes been taking this on (Hemmington et al., 2021).

While this removed an obviously distinctive role in the mental health services system, its disadvantage always was to focus the perception of social work on the legal and official role rather than the interpersonal support that social workers could provide. Other professionals, nurses, doctors and occupational therapists all had their own function in the system and it was less clear what social work was about. Interdisciplinary services meant that many supportive jobs were swapped around among the professionals.

And social work has never been very good at helping people see what they are about. The researchers say:

…a widely reported finding is that the managerialist approaches to risk have further eroded the autonomy and professional judgement of social workers relative to other professions (p. 1325).

Various professional developments, described in the research (p. 1326), clarified some of the social work contribution. But was this clear to others workers and service user? Mainly qualitative studies:

…found many personal and values-based qualities crucial to social work across the profession, including honesty, integrity, warmth, openness, courtesy, positivity, reliability and compassion. Many have referenced qualities akin to friendship, or at least a reciprocal relationship with social workers offering a sense of equality between people of equal worth…Specific skills recognised and valued by service users include the capacity for social work to help them build empowering social relationships, and the attention to wider support needs beyond the relief of psychiatric symptoms…Other studies have noted the importance of advocacy and providing important information around rights, entitlements and service avail ability (p. 1327).

But what is most important to service users; what should social workers be giving priority to?

The best-worst method

The researchers used existing research to identify 46 statements that potentially described something distinctive about mental health social work, and came up with a final list of ten. This was put in order by an expert panel from most to least distinctive each of these characteristics were of social work, as opposed to a general services. These were made into sets of four statements and tried out on the service users. They had to choose one they thought best described good social work service and another they thought was worst. Different service users were given a variety of different sets of four statements to say ‘best or worst’ to.

There’s then a complicated statistical analysis.

And the results?

The upshot was:

…the overriding concern amongst service users was that their social worker must provide a continuous and reliable source of support (p. 1336).

This was a bit of a surprise, because policy-makers had spent a lot of angst worrying about continuity between services by using multidisciplinary teams, but they miss the point that most people want someone that is identifiably the person that they make a relationship with. And managers worrying about making sure that team is covering all the work may well not be worrying enough at making sure that a mental health service user has a secure, well-known point of contact.

‘There appears to be a positive relationship between relational continuity and quality and life…’ (p. 1336), say the researchers, and perhaps in our management arrangements we have missed it, even though a lot of previous qualitative research has emphasised the service user’s relationship with their worker. This factor also meant that mental health service uses were not impressed by workers who were unreliable about keeping appointments, and are having to repeat their story to a series of workers they haven’t met before. It’s obvious when you think about it that this adds to anxiety and uncertainty for service users.

The second most valued attribute, and the most unique to social work according to the expert panel…, was attention paid to ‘my whole life, not just my illness’. This attribute speaks to the broader perspectives of the causes and consequences of mental health problems beyond those evaluated by traditional medical approaches to psychiatric illness (p.1337).

The researchers knew that mental health service suers generally valued the ‘whole-person’ approach of social work, but had not realised what am important priority this was for the service users. The study is:

…strong evidence that whole-person approaches are territory where social workers make a distinct contribution, and that service users recognise and value this over and above nine other possible attributes (p. 1337).

Another finding was:

The least valued attribute was ‘arranging access to other services’, which was defined as being either through formal referral processes (in the case of health or local authority services), or through informal liaison with other community-based organisations, such as voluntary groups, employers and other networks (p. 1337).

Social workers do a lot of this, so should social workers be thinking this is less important than they thought? Perhaps not. The researchers say:

…it may suggest that service users need to be more involved in deciding what this activity entails and why it may help them. Some evidence has suggested that liaison activities are important to user outcomes…, but perhaps this benefit is not effectively communicated to service users (pp. 1337-8).

Why would that be? Lay members of the research team thought that long-term users of services were jaundiced about being referred on because they had tried it all and not found it useful. Some service users might have thought that the workers were trying to get out of providing the service themselves.

This is one of the common criticisms of ‘strengths-’ or ‘asset- based’ approaches to social work. These practices involve finding community, family and volunteer resources to support service users. But enthusiasts for this approach are sometimes accused of shuffling off responsibilities away from the local authority, so saving it money. Finding community assets or strengths only works when when the worker does it together with service users and stay alongside them to help them make the best of the resources. It is by no means a money-saver.

This has also been said for decades about volunteers. It’s hard work to find, train and support volunteers. Don’t think it’s going to be cheap - but it will often provide a congenial helper for someone who needs relationships in their lives.

Overall, then, it seems that the relationship-based approach to providing social work services to people with mental health difficulties is most valued by services users. That is only a surprise if you thought working with people living with mental ill-health was an easy task.

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Hemmington, J., Graham, G., Marshall, A., Brammer, A., Stone, K. & Vicary, S. (2021). Approved mental health professionals, best interests assessors and people with lived experience: An exploration of professional identities and practice. Preston: University of Central Lancashire/Sheffield: Sheffield Hallam University.

Schuster, A. L. R., Crossnohere, N. L. Campoamor, N. B. Hollin, I. L. Bridges, J. F. P. (2024). The rise of best-worst scaling for prioritization: A transdisciplinary literature review. Journal of choice modelling, 50 https://doi.org/10.1016/j.jocm.2023.100466

Wilberforce, M., Abendstern, M., Batool, S., Boland, J., Challis, D., Christian, J., ... & Roberts, D. (2020). What do service users want from mental health social work? A best–worst scaling analysis. The British Journal of Social Work, 50(5), 1324-1344.

Development vs traditional, colonial vs indigenous

In this post, I am looking at an Asian source to understand some of the debate about ‘social development’ in the 1980s: Sinha & Kao’s (1988a) edited collection of conference papers with a psychology emphasis on Asian social values and then-current ideas about social development.

The book is divided into three parts, after the editors’ introduction. There are six chapters discussing social values in different nations/cultures in Asia; six generalised national perspectives. Six further chapters are more empirical in that they discuss the interaction of national cultural social values and their interaction with particular aspects of development, , for example around marriage, ‘achievement motivation’, childrearing and the ‘self’. Finally, there are four ‘strategic’ chapters which seek to show how integration between development objectives and cultural values might be achieved.

It will be obvious from this simple summary that the editors saw Western development concepts as at least in tension with traditional Asian values, and sought to explore the extent to which and how this was so. The issue of colonialism is front and central in some of the papers. And the argument for incorporating indigenous values is also beginning to emerge with clarity in most of them. But this is very early in the development of the critique of colonialism and the movements towards decolonialisation and Indigenist thinking that we see in the 2020s.

An example is Enriquez (pp. 124-48), whose extensive critique of attempts by Western anthropologists to interpret Philippine indigenous values, sees the flaws as deriving from a Western inability to see the holistic and interacting characteristics of the values expressed in Philippine languages. That inability, in his view, derives from giving priority to the way of thinking required by colonial language, rather than engaging with the indigenous cultural pattern of thought. Moreover, this has led to a Western worldview that sees all Philippine traditional values as blocks to development. Enriquez argues that a fuller understanding of complex linguistic usages would reveal both resistances and progressive change as appropriate and important in Philippine cultures.

The aims of the editors, as founders of this conference is presented as seeing where congruence may arise between traditional cultural values and development ideas. In this intention, it seems that there is the beginning of a struggle towards indigenous social development, informed by traditional cultural ideas. This foreshadows Indigenist social work and social development of the 21^st century, but is here being explored.

In this post, I look first at the editors’ ideas on congruence between Asian values and development, and then some of the general accounts of development in the light of value conflicts in various countries.

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It’s getting hotter everywhere - and in care homes

I’m writing this in one of the cooler rooms in my house in what is said to be likely to be a record-breaking heatwave.

Last week, and most weeks, I visit a modern (built within the last ten years) care home nearby, where three very old women I know now reside. It is much the best care home for older people I have ever known, out of the many I’ve visited, been involved in managing and placed older people in during my 50+ years in social work. Although it is inconveniently positioned in a rural byway (we still have some in our London suburb) without public transport, so not good for visiting, up a hill hard to climb for (as far as I can see, mainly) elderly visitors.

And astonishingly for these climate-change-affected days, it is without air conditioning.

A major research paper (Hajat, et al., 2026) looks at heat adaptation in care homes and whether you can use Care Quality Commission (CQC, the UK care regulator) ratings to identify homes where overheating is the biggest problem. The basic answer (which the authors were too tactful to give in an academic paper) was ‘yes’ and ‘no’:

• ‘yes’, because there was a gradient, the poorer your rating on CQC the more likely you are to get excess deaths in a heatwave;

• ‘no’, because deathrates were raised in all care homes during heatwaves.

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I won’t bother you with the research details: it seems to this non-nerd competently carried out and is reported after 5 months peer reviewing in the respectable Age and ageing journal. If you want to know about ‘daily time-series regression analysis employing distributed lag non-linear models’ (!!!) be my guest: click on the doi number in the reference at the end of this post to read it for yourself. Straight on to the information.

Older people die in heatwaves

The starting point of the study is:

…the almost 3000 heatwave-related deaths that occurred in England during the hot summer of 2022 - including during a brief spell on 16–20 July when temperatures exceeded 40◦C for the first time in the UK - over 95% of the death toll was in those aged 65 years and over (p. 2).

The study found that:

Current risks are stronger than those reported for a previous period in England [in a previous study], indicating the increasing impact of climate change and the apparent lack of progress on climate adaptation in the care home sector (pp. 4-5).

There’s been a lot of commentary lately about how temperatures are rising due to climate change in traditionally ‘bring an umbrella’ English weather. British housing is not adapted to this, more to keeping the cold out in winter. True also in care homes, it seems.

Care homes?

Almost half a million people currently live in care homes in the UK, housed in …[about] 16,566 facilities of which around 70% are residential care homes, i.e. providing accommodation and personal care, and around 30% are nursing homes that also provide personal care but additionally the presence of one or more qualified nurses on duty to provide nursing care (p. 2).

When I first started my involvement in care homes in the 1970s, most of the older people I admitted to them went into 19^th century buildings. Mainly these were former workhouses, sometimes nicely refurbished, or the adapted mansions of Edwardian entrepreneurs with toilets down the corridor. Many lived in multi- or dual-occupied rooms in which strangers co-existed during their last days.

One of the aims of the independent but government-funded Wagner Committee (1988) on residential care, which I was a member of, was to ensure that people had their own en-suite room. This tended to be ignored in the professional press coverage of the report in favour of more professionally exciting material (the newspapers almost totally avoided it as they always do), but was crucial in the minds of the Committee members. Lady Wagner (later Dame Gillian) died recently in her late 90s, probably not in a care home.

Since then, that aim has mainly come to pass. At first, this was through refurbishment by local government of the large number of care homes built from the 1960s onwards and a process of getting rid of the mansions. A setback came about because of the trend towards small-business care homes run by GPs and nurses in converted mansions which continued into the 1990s. Later progress was achieved by the construction of the generation of care homes funded by private equity finance in the early 21^st century, which tend towards hotel-like facilities. The home I visit has a bistro where more mobile residents and guests cluster daily for tea and cakes and freely available booze. One of the residents I know transferred her stocks when care home beckoned, and unopened bottles of Baileys were contributed. There is also a private dining room (birthday parties etc.), cinema and hair dressing salon. All would have been unimaginable in the places I worked with in the 1970s

The researchers say:

Care homes in the UK are generally designed to retain heat during winter to protect against cold risks, but these measures may increase the risk of summertime overheating if appropriate (p. 2)

This is a generous description of the origins of care homes; most seem to me to be ‘designed’ (if at all) to fit in as many rooms for profit that the planning regulators will allow, to fill tightly the area available. The researchers quote various studies to show that daytime temperatures exceeded 30 degrees C for prolonged periods, especially in bedrooms. The researchers quote:

…[a]n epidemiologic assessment of mortality data from 1993 to 2003 in England observed a higher risk of heat-related death in nursing and care home residents compared to the general population (p. 2)

There is guidance for care home operators but nobody knows what effects it’s had.

Deaths in care homes, England 2022-4

The study looks at all deaths in care homes in England between 2022 and 2024, and also looked at deaths in a heatwave from 16-20 July 2022.

The greater number of deaths observed during the winter months is typical of the mortality distribution observed in England in any regular year; however,…during the 16–20 July 2022 heatwave period, there was a clear spike in deaths. Deaths during this 5-day period increased by 34.1%...in nursing homes and 13.0%… in residential care homes. Deaths in the community…exhibited a 28.1% increase during the heatwave (p.3) [I’ve taken out the statistical significance data – the changes are significant – and references to a diagram].

The study then worked out the relative risk of death during six days after a day where the temperature was 25 degrees C and a day at 16 degrees C throughout the two years. Death rose in the community, in residential care homes and nursing homes, more in the care homes and even more in nursing care homes,

They then matched these increases in the risk of death with CQC ratings for safety and for overall standards.

They say:

…there is a gradient of increasing heat risk associated with successively poorer rating…Homes rated either ‘good’ or ‘requires improvement’ [the two middle and most common grades] were associated with significantly elevated heat mortality risk in both domains, although a raised risk was evident in almost all categories (p. 4).

Statistical significance can’t be calculated in the ‘outstanding’ and ‘inadequate’ ratings because there aren’t enough homes at these ratings to test it properly. Similarly, there was not enough statistical power to compare residential care and nursing homes.

The research looked at government regions (some of which are more affected by high temperatures than others):

There was a raised risk in all regions except the North East and North West [likely to be colder], although the increase was statistically significant only in the West Midlands and London [likely to be warmer]. The increase in the West Midlands was over three times greater than in some other regions.

A study of two care comparable homes with similar outdoor temperatures found that the ‘low-temperature home’ had a more stable [day-time] lounge temperature than a ‘high-temperature’ home.

Comment

I think we should be worrying about this more and doing more about it.

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Hajat, S., Hussein, S., Li, K., Kovats, S., Davies, M., Mavrogianni, A., & Gupta, R. (2026). Heat-related deaths in social care in England: can the Care Quality Commission ratings system be used to identify care homes that would benefit most from heat adaptation measures? Age and Ageing, 55(4),

Wagner Committee (1988). Residential care: A positive choice. London: HMSO.

Just over 125 years ago, on 4^th January 1901, an eminent British philosopher gave a lecture on The meaning of social work to an audience of former students of the then University College, Cardiff. And had it reprinted in the International Journal of Ethics. Click on the link in the reference at the end of this post to read it for yourself.

I thought I’d have a look at it because the phrase ‘social work’ was, on the historical evidence of the Oxford English Dictionary, quite new then. I wondered what they were thinking about social work just then as the term was coming into use. And I found both elements of personal response to need and social change to improve social conditions. But set in the idealist framework of thinking.

Bernard Bosanquet, the idealist philosopher, was not uninformed about what most people still called charitable or philanthropic work since he, alongside his wife, the economist Helen Dendy Bosanquet, was an active member of the London Charity Organisation Society. Helen over the following ten years, was a member of the Royal Commission on the Poor Laws, and later the historian of the early phases of the Charity Organisation Society; her bulky hymn to the work of the COS is still in print.

If you look at some of his many collections of lectures on various topics of the moment, you can see that Bernard was something of a public intellectual, often talking about welfare issues of the day (and often to various branch meetings of the COS groups across the country; perhaps I’ll come back to more of them in later posts). As an idealist, Bernard was committed to the concept that social reality is the product of the human mind, interpreting perceptions of the world. This view influenced early social work, which relied on the idea that human imagination and endeavour could change the world for the better.

Social work: heart and the head; art and science

Like anyone doing a guest lecture, Bosanquet starts off with flattering his audience of Welsh graduates, and expressing his idealist values. The Welsh education system is coordinated and planned from bottom to top, not the mish-mash that the English have:

…an organized intelligence, a popular mind, supported by a duly graded system of schools and colleges, and a University, in touch with the life of the people, is an enormous social force…It is not surprising that those who are immediately connected with the centres of this great social force should to-day be turning their attention systematically to social work. (p. 291).

Thinking [academic] people, he says, inevitably come across, in their private life, the need to attend to ‘the management of a household and the social needs and duties of a neighbourhood, among rich and poor (p. 291)’.

Life becomes more interested and securely founded, because they know and understand their position in the ‘living drama’ of the community as a whole; it is no longer a background to their lives, they become part of it; they need to train themselves in learning about, seeing and feeling social forces in action, the subtle problems hidden in apparently simple lives.

This leads people:

…to realize that to introduce reforms into a district may need as much hard thinking as to remodel a scientific theory, and much more patience, courage and tact (p 292).

Single and double social work

That applies nationally, too. Social work may be single or double: it may aim to benefit society in general, but to do so will be costly and require ‘the highest standards of work’. Thus,

…Social work is thought of as something spontaneous, human, sociable; an effort to gain direct contact with the human nature of those around us. In it we devote to others not our peculiar acquired skill, but ourselves, our heart and soul (p. 293)'.

But double social work:

…has an aspect of being an art and science, a clear purpose with a reasonable [well-directed] method… We are not to make our social work victim f the foolish opposition between heart and head. It is im-possible to utter profound and serious feeling except by the instrumentality of thorough brain work (p. 293).

Social work education and what it leads to

He follows this argument for method and science in social work with an argument for higher level education in social work. When people were called upon to volunteer to deal with social issues in the recent war (he means the Boer War), they did not have the capacity. There are simple tasks, for example helping in social clubs, or delivering a benefit for an elderly person. But it is how you think about society and its needs that to the idealist is important:

…the sort of thing you have in your mind about the working class must make just all the difference. They must see where your heart is and where your hopes lie for society;… “social work,” like everything we do which is to be of any service, demands that we shall know our own minds; that we should know what we mean by it, and act consistently and with purpose (p. 295).

Social work’s aims

Social workers take many different lines, but they mostly come back to these two: they want to brighten the lives of the people, or to improve the conditions in which they live (p. 296)

This means improving the happiness of people’s lives, but this is always affected by the circumstances in which people live and the effect of those circumstances on their minds, both individually and collectively.

Every social fact, when you pursue it with a view to complete explanation, leads you up to a mind, because this is the only central point of view.

Here, then seems to be the true meaning of social work. Wherever it may start, its goal is the same: to bring the social mind into order, into harmony with itself. Social disorganization is the outward and visible form of moral and intellectual disorganization (p. 297).

Social issues and social science

What does this mean for dealing with social issues? If social workers accept that the present social order reflects the disorganisation of the social mind, does this imply the perpetuation or dependent poverty, or its ‘extirpation’. Unless we understand this, social work will be aimless: are we working to support the continuation of poverty, by paying our taxes or tithes of benevolence, or should we be aiming to rid ourselves of poverty? Similarly with health services: overstrained and disorganised hospitals need to be improved by a better system.

But present charitable support for people in poverty and in badly-run hospitals means that we encourage the maintenance of inadequate systems.

Social science has developed strongly in economics but not in recognising other important social forces and their effects on organisation. He refers to Chalmers’ work in Glasgow, based on democratic principles ‘the sufficiency of the people’ (p. 299).

This is grossly misconstrued if it is taken to mean that a respectable man can usually find work and sup-port himself. What it meant was rather this: A community of the people is a living mind. It has its affections, its duties, its obligations, its foresight, its pride and its delicacy - his constant reiteration of the term delicacy is a striking proof of his insight. It has its own innate strength, its own variety, its own recuperative power. If you wish to help it to make the most of itself, you must understand it, sympathize with it, and meet it on the right path. You must not thrust in the iron hand of the unskilled social worker, tearing to pieces the deli-cate living tissues of filial and parental obligation, of neighbourly kindness and of the standard of right conduct, foresight and honesty (pp. 299-300).

This is an example ‘…in a small compass of the way in which mind and character are central facts, and because central facts are in practice unique forces (p. 301).

A renewed role for the COS

The Bosanquets were credited with improving the social aims of the COS, after the dominance of charity benevolence under C. S. Loch’s influence.

The duty of [a COS], as I understand it, is by no means to grasp at power, or at exclusive control, but to take a stand for definiteness of plan and purpose, and endeavour to promote therein throughout all the social work, both public and private, of the neighbourhood; to organize, in a word, the mind of the district about social work (p. 304).

[F]or all social workers to “chart” the district…is an excellent beginning…Do the social workers, visitors and philanthropists, all of them know what the life of a first-class workman is, and, therefore, what they want the “poor” to become? (p. 305).

He argues for educating social workers to understand better the specific needs of the area they are working in and also identify clear aims for their work with people and in changing the social system.

Comment

You can se in his arguments the idealist philosophy in Bosanquet’s arguments: clarity of mind in both the workers, and the clearer definition of their aims and needs of the areas in which they are working. He is also expressing the beginnings of the doubts about the philanthropic approach rather than social planning as the basis for ‘social work’.

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Bosanquet, B. (1901). The meaning of social work. International Journal of Ethics. 11(3), 291-306. https://www.journals.uchicago.edu/doi/10.1086/intejethi.11.3.2376291.