Social workers get a bad press and are sometimes put in impossible positions.Mark Gould examines their plight on the eve of a major restructure and integration of social care with the NHS

Social work looks like the job from hell.When it works well it is invisible. When it goes wrong, as a litany of tragedies culminating in the death of Victoria Climbie testifies, the most vulnerable people in society suffer. And social workers receive a ritual media mauling.

In October, health minister Jacqui Smith will use the annual Association of Directors of Social Services conference to outline details of a recruitment drive to address the UK's acute shortage of social workers.

The past two years have seen a 50 per cent rise in care orders, the arrival of nearly 5,000 unaccompanied refugee children, and shortages of foster parents and care home assistants. The closure of many long-stay residential homes for elderly people has raised the spectre of a coming winter of bedblocking and NHS crisis headlines.

Councils in London and Birmingham report vacancy rates among social workers of 40 per cent and 26 per cent respectively.

All this is against a backdrop of massive structural and regulatory changes to meet the quality and performance targets of the NHS plan, which will see the integration of social services into the NHS.

In June, chief inspector of social services Denise Platt warned the ADSS that 'turbulent' times lie ahead for the marriage of health and social services. But she insisted the government wants to 'encourage social workers to be proud and positive about what they achieve rather than - as often seems the case - being timid and defensive, seeing change as a threat, a loss not a challenge'.

Gail Tucker, chair of the British Association of Social Workers, agrees that integration and joint working is happening, if not at senior organisational level then 'at the grassroots'. But she is not convinced the NHS has much to offer.

'Take the example of the man who died after waiting for nine hours for treatment [at Whipps Cross Hospital, London]. That sort of thing is not an uncommon story.

If there are still difficulties about delivering health services at the sharp end of accident and emergency then the NHS has not got anything to teach social workers.'

She is concerned the government push for change is leaving little time to take stock. 'Combining the professions should cut down bureaucracy and make things more fluent. But there is a feeling among many people that we have just been bombarded by continual change for about a decade.

'Keeping up, even just keeping on top of reading about what is happening, has been a phenomenal struggle and that is when social workers are experienced in the business of managing change. If you bring about change you have to have a period of consolidation to assess the success of the change you have just brought about.'

One universally welcomed change is the reform of social work training, with the creation of an all-graduate workforce.

Ms Platt told the ADSS this arose from concerns that newly qualified social workers 'did not feel equipped' for the new agenda.

Mike Leadbetter, director of social services for Essex county council, who will become president of the ADSS in October, agrees that, as in the NHS, human resources are the biggest obstacle to achieving quality improvements. 'Social worker shortages have been in the news, but what is less publicised is the serious lack of care home staff in residential homes and a lack of foster carers.'

Most people understand the need for reform: 'Some people are experiencing a difficult cultural shift. People have strong feelings about change. But they do not always realise that It is a national agenda and not someone having a go at individual departments. I have to tell people that the grass is not greener elsewhere.'

Part of the problem for social work is its public perception as people who fail children. 'Social services staff get heartily sick of not being able to get across the good news stories in the media.'

And, he adds: 'It is up to people like me and social workers and staff to show the other side of the coin.' But, 'if you screw up you screw up and people should know'.

Next month, the Laming inquiry will deliver its verdict on failures by health and social services that allowed eight-year-old Victoria Climbie to be tortured to death by a couple supposed to be her carers. An ADSS insider fears 'it will be another excuse for grinding axes against social workers'. Whatever happens, a major reconfiguration of children's services is in the offing.

The National Society for the Prevention of Cruelty to Children wants the reconfiguration to include a national strategy 'to end child killings'. Director Mary Marsh says 'great strides' have been made in reducing the child death toll due to accident or illness, but the homicide rate in England and Wales has remained 'largely unchanged' for 25 years.

She says 1,250 children have been killed since 1975, 'mostly at the hands of violent parents and carers'. The NSPCC wants an independent children's commissioner for each of the four UK countries - Wales already has one. This call was also made by Professor Ian Kennedy in his report on the Bristol inquiry.

A recent survey for the ADSS and the Local Government Association revealed most local authorities are plundering elderly care budgets to plug gaps in children's services. Mr Leadbetter says: 'To an extent you can ration services for the elderly using a prioritisation matrix for old people, but if a child comes through the courts they have to be looked after.' The new structure will encompass social services, education and health.

'People are coming together to look at shared configuration and delivery of children's services.

There are some simple things that can be done to look after kids.

Schools could be opened up in the holidays. What about offering school meals from 7am so kids get a decent breakfast?'

Will the new coalition create friction? 'There are worries on all sides. From our point of view there are fears that social work could become medicalised. But nurses and social workers should be proud of their professions and be strong enough in partnership to be relaxed about their roles.'

On a practical front, many social services managers are worried about resources this winter given the closure of long-stay residential homes.

It is hoped that health minister Jacqui Smith's recruitment drive will offer light at the end of the tunnel. But one manager summed up the perception among social services staff that they are the NHS's poor relation, asking sceptically: 'I wonder if they will start trawling the world for social workers like they have done for doctors and nurses?'

Hard times in social work Social services departments have come in for fierce criticism for failing vulnerable people in their care.

October 1999: Harrow social services guilty of 'significant shortcomings'following the death of 13-year-old Aliyah Ismail from a methadone overdose.She was working as a prostitute while officially in the council's care.

February 2000: Welsh first secretary Alun Michael orders major shake-up at Caerphilly county borough council after it was revealed a child at risk was imprisoned in a filthy bedroom.

July 2000: Dorset county council severely reprimanded in an independent report for failing to protect a 12year-old boy who was 'systematically tortured'by a couple who had convictions for sexual assault of a minor, and actual bodily harm of a two-year-old.

January 2001: Haringey social workers at all levels criticised by Lord Laming in the independent inquiry into the life and death of Victoria Climbie who suffered multiple injuries and died of hypothermia at the hands of her aunt Marie Therese Kouao and her boyfriend Carl Manning.

July 2001: Department of Health orders an inquiry into allegations that vulnerable children were allocated to fictitious social workers because Devon social services staff were so overstretched due to sickness and recruitment problems.

Social services: the shape of things to come The National Care Standards Commission will regulate service provision.

The General Social Care Council will regulate the profession, register workers, publish codes of practice and regulate training and continuing professional development.

The Social Care Institute for Excellence, a not-for-profit company, will disseminate information about best practice.

The Social Services Inspectorate will continue to review the performance and quality of local authority social services departments.