Rural social work in Scotland

Colin Turbett (social work author)

April 2019

Acknowledgements

This Insight was reviewed by Helen Allbutt (NHS Education for Scotland), Sally George (Orkney Health and Care), Ed Lowe (Comhairle nan Eilean Siar), Richard Pugh (University of Keele) and colleagues from Scottish Government. Comments represent the views of reviewers and do not necessarily represent those of their organisations. Iriss would like to thank the reviewers for taking the time to reflect and comment on this publication.

Key points

- Rural social work lacks academic interest, research and a strong literature base in Scotland. There is stronger international evidence and research.

- Particular social work skills and knowledge are required to meet the needs of rural communities.

- Practice should build on the assets of a typical rural community, including people and place, familiarity and shared knowledge and a tradition of mutual aid.

- Practice should address issues of disadvantage, with hidden poverty in the midst of beauty and wealth; remoteness and isolation, transport difficulties, and a lack of service choice with few specialist ones.

- Practice should be based on generalist and ecological styles of practice. This includes strong networking built on local knowledge, continuity and trust, and managing relationships across professional and non-professional settings.

Introduction

The idea that social work in rural areas in Scotland might best be based on different approaches to those used in urban areas (where the vast majority of the population live) has received scant attention in recent years. There is a dearth of research on which to plan services that fit with such a notion. However, given the Scottish Government’s emphasis on community engagement, this is of interest.

This Insight looks at the particularities of the rural context, the policy framework, and goes on to describe approaches that can be used to help social workers living and working in rural Scotland. These form a major part of Scotland’s landmass and are home to a number of Scotland’s local authorities and Health and Social Care Partnerships (HSCPs).

Rural Scotland

Today’s transport systems have largely eradicated remoteness in the sense it meant a century ago – there are now few places that are more than a day’s travel from Edinburgh and Glasgow. However, differences between rural and urban living are still pronounced. The Scottish Government looks at this in terms of a continuum, with intensely populated urban areas like Glasgow at one end, and sparsely populated islands at the other (table 1).

Scottish Government six-fold Urban Rural Classification

1. 1. Large Urban Areas

Settlements of 125,000 or more people.

1. 2. Other Urban Areas

Settlements of 10,000 to 124,999 people.

1. 3. Accessible Small Towns

Settlements of 3,000 to 9,999 people and within 30 minutes drive of a settlement of 10,000 or more.

1. 4. Remote Small Towns

Settlements of 3,000 to 9,999 people and with a drive time of over 30 minutes to a settlement of 10,000 or more.

1. 5. Accessible Rural

Areas with a population of less than 3,000 people, and within a 30 minute drive time of a settlement of 10,000 or more.

1. 6. Remote Rural

Areas with a population of less than 3,000 people, and with a drive time of over 30 minutes to a settlement of 10,000 or more.

Table 1: Scottish Government Rural Scotland Key Facts (2018)

98% of Scotland’s land mass is defined as rural. It is inhabited by 17% of the population; a figure that is growing due to movement from cities to accessible rural locations. Just under 6% live in remote rural areas. Geographical location on this continuum will help shape a person's identity. It will also determine choices available to them, with affordability a factor. From both these factors, stem social advantage and disadvantage. Proximity to an urban area that can be accessed easily will result in a completely different life experience to one at the remote rural end of the continuum. Table 2 below identifies the communities of significance – the 18 local authorities in Scotland who have significant rural, and in particular, remote rural populations.

Percentage of population in rural areas by local authority

Local Authority

Accessible rural

Remote and very remote rural

Aberdeenshire

35

13.4

Angus

26.1

0.7

Argyll & Bute

4.2

43.0

Clackmannanshire

14.6

0.0

Dumfries and Galloway

24.2

20.9

East Ayrshire

20.6

8.0

East Lothian

23.8

2.0

Highland

9.5

37.9

Moray

29.8

11.8

Na h-Eileanan Siar

0.0

72.4

North Ayrshire

4.9

4.3

Orkney Islands

34.0

66.0

Perth & Kinross

33.2

12.9

Scottish Borders

36.1

10.7

Shetland Islands

0.0

70.4

South Ayrshire

17.5

4.0

South Lanarkshire

9.2

1.6

Stirling

26.6

6.9

Scotland

11.2

5.9

Table 2: Scottish Government: Urban Rural Classification 2016

Social work and other public services provided in rural areas with sparse populations are especially expensive to provide. Cuts, as a consequence of austerity measures, are felt proportionally harder if services are not extensive in the first place. This is true of not just statutory services, but important third sector ones such as Citizens Advice and Women’s Aid.

The policy context

Changing Lives (2006), the most recent review of social work in Scotland, mentioned the rural setting only in passing in its main report, but did explore some of the issues in its separately published literature review (Asquith and colleagues, 2005). This was surprising given the relevance of the remote rural context in two major Scottish child protection inquiries in the years leading up to its publication: the Clyde report (Clyde, 1992) and the Eilean Siar report (SWIA, 2005). See also Turbett (2011) for discussion on this theme. These reports certainly made an impact, resulting in legislative, procedural and organisational change across the country, however, the particularities of the remote rural settings somehow got lost. Since then, although rural social work has been largely unrepresented in social work literature in Scotland, the rural context does feature in wider policy frameworks.

Community-orientated practice and community empowerment is encapsulated in the Community Empowerment (Scotland) Act 2015. Parts 2 and 3 of this legislation are concerned with public involvement in the planning and delivery of local services, by definition, lending opportunity for community social work approaches. Such planning and participation matters are enhanced for Scotland’s populated island communities by the provisions of the Island (Scotland) Act 2018. These are measures designed to make sure that the needs and particularities of such communities receive proper attention by policy makers and planners. While these legislative changes were driven by a requirement to address land ownership, management and environment issues (eg physical planning issues), the provisions are wide ranging and do not exclude public participation in community planning issues concerning social provision.

This paper acknowledges the absence of specialised services and shared resources in rural communities. Personalised budgets, a key policy approach of self-directed support, might be used imaginatively and creatively to enable needs to be met through collective approaches that make good use of resources that are available.

Social problems in rural areas

Scottish Government’s Rural Scotland Key Facts highlights the impacts of rural life for the disadvantaged:

- Fuel poverty is four times greater than for the rest of Scotland

- Less affordable housing

- Costs of car use (often essential) are higher

- Sparse or non-existant public transport

- Essential services like GP services and shops are ‘not within reasonable distance’

While unemployment, at 5%, is similar to other areas in Scotland, low pay is a significant issue: Dumfries and Galloway, Moray, Clackmannanshire and Highland have the highest proportion of low paid workers (eg earning less than the ‘living wage’) in Scotland. Tourism, agriculture and related activities are major employment sectors, much of which are seasonal. There is a particular lack of employment opportunities for disabled workers, with few tailored training programmes in comparison to urban areas (Poverty Alliance, nd). The introduction of Universal Credit to replace existing basic welfare benefits has exacerbated claiming difficulties in rural areas: the requirement to claim online is problematic for many and the alternative of doing so through the nearest job centre may also be very difficult for access reasons. Indeed, the impact of these issues may well be driving some young people with literacy problems who have no family support into invisible poverty and total dependency on friends and food banks (this is under-researched in Scotland but discussed in an English context in Citizens advice, (2018)). The question of rural poverty is referred to in the Scottish Government’s Every child, every chance: tackling child poverty delivery plan 2018–22 (Scottish Government, 2018). Other policy initiatives such as that concerning rural housing are designed by government to address some of these issues (Scottish Government, 2016).

Isolation in rural communities is a general problem but one particularly recognised as an issue for those with mental health conditions. Beneath the brief mention in Scotland's mental health strategy 2017–27 (Scottish Government, 2017) lie issues of loneliness and social isolation, as well as distance from services and helping networks. The wider issue of access for minority groups to services in rural communities is discussed in the Scottish Government’s research paper Review of equality evidence in rural Scotland (Scottish Government, 2015a). Some experiences are good, such as access to primary health care, but others such as access to specialist services, are not positive. Discrimination and racism are under-researched issues – the last serious work was a number of years ago (Turbett, 2011) but one group, Scottish Gypsy Travellers, continue to report very poor experiences (BBC Scotland News, 2017; Iriss, 2017).

Rural Scotland has an ageing population driven by several factors in remote rural areas which have been widely reported (eg Third Force News, 23rd April 2018). These include a reduced birth-rate, outward migration of the young and, in some areas, inward migration of retiring people from other parts of the UK. The care sector has warned that Brexit-driven reductions on inward migration may significantly reduce the workforce available to provide the services that will be needed in years to come (STV News, 2019). This will increase the burden on unpaid carers who are consequently denied work opportunities (and educational opportunities) that will impact on their own health and wellbeing, as well as the local communities who might be denied their labour and economic contribution through earnings. This will impact particularly on women (Independent, 2018). In Scotland, rural areas (apart from the North East) are already prominent (9% plus of the population) in numbers of unpaid carers (Scottish Government, 2015).

Growing issues of low workforce density, scarcity of providers and recruitment and retention challenges in rural areas are all referred to in the National health and social care workforce plan part 2 (COSLA, 2017) and the Workforce skills report 2016–17 (Scottish Social Services Council, 2017). In the Highland HSCP area, a scheme has been launched to home-grow qualified social workers through using vacant posts as training posts for the secondment of existing staff from other disciplines (NHS Highland, 2018).

The foundations for effective and rewarding rural social work

Rural social work has a long history with a rich literature, much of which has originated from the USA, Canada and Australia – areas where distance and remoteness are on a scale we cannot experience in Scotland (Martinez-Brawley, 2000; Brownlee and Graham, 2005; Lohmann and Lohmann, 2005; Collier, 2006; Pugh and Cheers, 2010). In the UK, such studies are hard to find, practice being dominated by models and perspectives that reflect urban settings and academic institutions. However, attempts to redress the balance have been made (Pugh, 2000; Turbett, 2010). There are common themes that run through all of these works which will be discussed.

The first relates to the possibilities for social work practice that follow from the nature of rural communities and the interdependence between community members and those who provide them with human services. The small size of place can be uncomfortable – the perception that everyone knows everyone’s business, but is also an asset that can be built upon within the context of a community social work model (Turbett, 2018). Neighbourliness can be called upon for support of the vulnerable – it will often be found operating on a quite informal basis, especially with isolated older people (questions arising about confidentiality are dealt with later). A social worker’s knowledge of both formal and informal community assets will depend on practice knowledge and wisdom gained on the ground, rather than handed down from the employer. Workers need encouragement and space to gather such knowledge and it should never be the preserve of managers alone. Networking is part and parcel of this process. Rural settings offer real opportunity to build strong working relationships with colleagues in other disciplines such as education, police, health (across the whole range from GPs to health assistants) and voluntary sector. The opportunity to talk and discuss issues freely with social care colleagues (from care-at-home assistants to specialists) is also vital and systems built around a silo mentality and vertical communication systems, such as. through managers, never work successfully in a rural environment (Martinez-Brawley, 2012).

In the past, generic practice (working across specialisms) seemed to fit statutory rural settings. However, this has almost disappeared in rural Scotland. The long held notion of ‘generalist practice’ however is very much alive. This rests on the worker becoming skilled at choosing a methodology and strategy that addresses an issue using the resources available. The lack of specialist resources to which service users might be referred in a rural neighbourhood, requires the worker to be inventive and creative. Generalist practice will thrive in a team, however small, that celebrates this culture and finds it rewarding; it will not work in a managerial environment where work is judged on computer generated measurable outputs. Although it will, as an essentially upstream method, reduce downstream statutory referral levels (Smale and colleagues, 2000). It will also depend largely on the exercise of discretion by the worker – knowing how and when to apply practice gained wisdom rather than employer-driven prescriptive procedure and process (Lipsky, 2010; Schwartz, 2010). Generalist practice is a component of the community social work model of service delivery described briefly in the last paragraph (Turbett, 2010, 22–27).

The notion of ‘community’ has already entered the discussion in several places. It is worth examining this in a little more detail to locate its foundation in theory such as ‘why are rural communities typically different from urban ones?’ Emilia Martinez-Brawley is one of the foremost theorists on rural social work internationally. Among her works are two papers on social work in remote Scotland (Martinez-Brawley, 1986 and 2012). She draws upon the work of the 19th century German sociologist, Ferdinand Tonnies, whose book Gemeinschaft und gesellschaft (translated as Community and society) does much to explain the inherent differences between urban and rural settings. In a rural community relationships are close, loyalty inherent, roles mutually dependant and complementary, and codes understood that govern behaviour. In an urban metropolis, there will be communities where these factors might well be present and strong, but will not apply to entire urban locations where anonymity will be the norm, neighbourhood ties weak or non-existent and identity typically determined by other factors, such as class, race and religion. This also explains how rural communities can be oppressive, socially excluding, racist and reactionary, as well as embracing and protective.

Martinez-Brawley (2000) discusses the ties that connect people with institutions and agencies. In an urban setting these will often be delivered from the outside by people whom one will have no knowledge of personally; conversely in a rural setting the service user (or patient) may well know the service providing worker and will want to connect personally. The introduction of systems into rural areas (eg NHS 24 or single call centre-based referral points for social care services) has impaired the local ties that characterise small communities. This can strengthen the role of the rural social worker in occupying an important place at bridging the gap between the user and the outside provider of a specialised service.

Confidentiality can take on a new meaning in a rural setting. Of course an individual has the right to expect that their privacy will be respected, but sometimes, by negotiation and consent, information can be shared if it will lead to increased community understanding and support. In a remote community there is little that happens that is not shared publicly. This can have a damaging effect if based on half-truths or misinformation. Gossip plays an important role – both a regulatory one to induce conformity (and deter deviant behaviours), and as a means to share information. Its effects can be damaging and information sharing by agreement can help mitigate them (Pugh, 2000). Personal behaviour and conduct can be especially important considerations in rural settings and feature prominently in the international rural social work literature. Aspects of this are discussed here, many of which might seem of little significance in anonymous urban settings.

At the outset of a relationship with a service user, particularly older ones, it can seem rude and counterproductive not to answer some personal questions that will help the service user ‘place’ the worker as an individual (Pugh, 2000). This will pay dividends as a successful encounter will ensure a worker’s good reputation goes before them (in line with the informal systems referred to in the last paragraph). Trust in the worker will follow on a professional service based on care and consideration – the essence of relationship based social work – but with the added dimension of high visibility and public knowledge of the worker’s role and reputation in the small community. The negative aspects of rural life, for example, intolerance and racism, can be challenged by the practitioner and their team, but only through hard won respect and after they have become established (Turbett, 2010).

Rural social workers who live and work in the same place can also encounter issues that will be largely absent in urban areas – that of ‘dual’ relationships, defined as encounters and relationships with service users outside of the professional setting (Pugh, 2007).

This can be trickier than it sounds – ‘If I bump into a service user do I ignore them so as not to draw attention to our professional relationship? Do I take slight if they ignore me? How do I avoid mutual embarrassment?’ All this requires thought and if required, prior negotiation and agreement between both parties to manage effectively (Turbett, 2010).

Other aspects of dual relationships include the ethics of user and worker transactions that extend beyond the professional social work one, for example, any type of financial exchange. It is clearly acceptable to be served in a shop by a service user, but private purchases may be problematic and should be avoided. Another ‘dual’ relationship to be wary of is a personal relationship outside of work, especially a sexual one.

The Scottish Social Services Council codes of practice provide some rules on this type of issue, but do not extend to every type of relationship which might occur in a small community. A question that should always be asked is one of power: am I gaining from this encounter because of my authority or position? If the answer is yes, the transaction should be avoided as it transgresses codes of practice. It should be borne in mind that getting this wrong might mean a disciplinary procedure, and whatever outcome that might involve.

Importantly and invariably, it will also damage the social worker’s reputation in the community and impair trust and working relationships with other agencies, as well as current and future service users. The evidence shows that rural social workers, outside of work, will be judged by their behaviour, and should be mindful about their personal conduct (Pugh, 2000; Turbett, 2010; Pugh and Cheers, 2011). For example, professional objectivity should never be prejudiced by knowledge of an individual gained as a fellow community member – local knowledge should be used appropriately and transparently.

With social workers both living and working in the same community, relationships between worker and service user can also affect the worker’s family. While respect for personal integrity can overcome issues, problems might ensue. For instance a young person subject to social work support sharing a classroom with the worker’s child. This might require thought and negotiation, but safety should always be the paramount consideration.

What rural social work can teach the wider profession

Most Scottish social workers in remote and rural settings work to service delivery models and processes designed for urban areas, but many adapt these to local situations, which are the starting point for a community-orientated approach. The considerations demonstrated in this paper can be developed by teams to create a rural social work culture. This represents good and creative social work designed around the needs and strengths of small communities.

Leading US rural social work teaching academics have written that if you can work in a rural location you can work anywhere because you will have learned how to innovate and deal with widely differing client issues (Lohmann and Lohmann, 2005). In that sense, properly applied rural models exemplify a community social work model that can be applied in any setting if community is identified as an entity, and partners seek to achieve change and resolve issues affecting the personal lives and welfare of less advantaged members. In recent years, the traffic in expertise has been all one way, from generalised urban social work practice to rural, with a noticeable decline in interest in the latter as a consequence. With all but one university campus (Dumfries) based in Scottish cities, this is perhaps inevitable – a contrast to the generation of interest by rurally located campuses in the USA, Canada and Australia whose academics, over the years, have turned out numerous texts that influence practice in those countries. In contrast this Insight demonstrates that rural social work, much of which is based on practice wisdom and experience of fruitful social work practice, should be celebrated by practitioners and enabled by managers. This will enable services that are meaningful to communities and rewarding to those who deliver them.

Implications for practice

Effective rural practice should include:

- Generalist (including community and ecological practice) social work approaches to building capacity and upstream responses to issues that might produce downstream referrals. For example, carer issues and resources for the socially isolated.

- Strong local networking involving front line workers in different agencies (eg health, education, police) and community activists (including potential activists).

- Opportunities to develop practice wisdom based on the building of experience of a locality and its inhabitants.

- Opportunity to build understanding and knowledge of social issues affecting rural areas.

- An appreciation of ‘dual’ relationships’ and managing encounters and relationships with service users outside of the professional setting.

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