“Signposting: “the act of telling someone which organization they need to go to to find the help they need.”

Cambridge Dictionary [1]

“‘Signposting’ indicates that the client will not be supported by the local authority and there is no universal service that will help them. Details are therefore given of other organisations (for example, in the voluntary sector) that might be able to provide assistance.”

Department of Health and Social Care [2]

“Signposting: A social care sat-nav to nowhere.”

Mark Neary [3]

Signposting is a tricky old term, isn’t it? It sits at, and exposes, the crossroads we find ourselves at in terms of social care and social work practice. A recent “rapid realist review” into “signposting services for people with health and care needs” concluded that “the tension between efficient (transactional) service provision with brief referral and effective (relational) service provision, which requires a detailed understanding of individual service user needs, remains unreconciled. This tension is underpinned by competing narratives of whether signposting represents ‘diversion of unwanted demand from primary care and other urgent care services’ or ‘improved quality of care through a joined-up response that encompasses health, social care and community/voluntary services’”. [4]

There’s much to unpick in that conclusion, and in the term itself and what it represents.

There’s nothing wrong, as such, with direction. With knowing where to go, or which way to turn. In everyday life, signposts stand at junctions, at forks in the road or path, giving useful information about distance and destination. They help us when we’re lost. Offer guidance and a choice.

Knowledge is power, and people should have access to “the information they need to take control of their care and support and choose the options that are right for them.” [5] So why don’t I think signposting in health and social care is A Good Thing? 

Why does the term make me go hmmm?

Diversion of unwanted demand

Council’s reports about, and plans for, adult social care – and especially for ‘transformation’ – refer to “effective triaging… and signposting to other services where possible to manage demand for services”.  “The single front door will be able divert and sign post a greater number of people to alternative services.” 

So, the first reason why references to, and the concept of, ‘signposting’ makes me go hmmm is that the benefits are often stated in terms of the ‘system’. This is about process, ‘efficiency’ (not that it is) and cost-reduction (not that it does), not people, wellbeing and better lives.

I’ve already written about the term demand, but I’m interested here in the way signposting is used in relation to ‘demand’, and the key question – demand for what? Because I think this is where we encounter a critical question: what exactly do we mean by adult social care? 

Councils report “over 23% of people being supported at the Front Door with community intervention and signposting and therefore not reaching Adult Social Care prematurely”, and how “signposting at the initial point of contact where appropriate [is] helping to delay entry into adult social care services.” 

The “core purpose of adult care and support” should be “to help people to achieve the outcomes that matter to them in their life.” [6] We use the terms ‘care and support’ and ‘adult social care’ interchangeably. The statutory guidance defines “care and support” as “the mixture of practical, financial and emotional support for adults who need extra help to manage their lives and be independent’. [7] And the Care Act 2014 defines “adult social care” as including “all forms of personal care and other practical assistance for individuals who, by reason of age, illness, disability, pregnancy, childbirth, dependence on alcohol or drugs, or any other similar circumstances, are in need of such care or other assistance.” [8]

Both definitions refer to the need for support, not services. And the statutory guidance is clear that the Care Act 2014 signifies a shift from existing duties on local authorities to provide particular services, to the concept of ‘meeting needs’”.

So, another reason that ‘signposting’ makes me go hmmm is that it continues our perception that social care is all about assessment, eligibility and getting a service. It perpetuates our sorting office approach. That way for a life. This way for a service.

“Information will be used to direct users to specific community services to help maintain independence and improve quality of life, or through to adult social care as a direct referral.”

And yes, signposting is frequently mentioned in the same breath/paragraph as ‘independence’, ‘prevention’, or ‘strengths-based working’ – all those other tricky words that should equate to wellbeing, social justice and rights-based, relational practice, but are all too often code for ‘go away’.

Efficient (transactional) service provision with brief referral

“Triage is the front door to Adult Social Care. They take the initial contacts that are sent through from the call centre and gather more information in order to signpost clients or transfer them through to the appropriate team… Triage is a short term and fast paced team.”

Efficiency is prized in our industrialised, Chronos time approach to ‘care’. 

Job adverts emphasise speed. “You will ensure that all cases are progressed efficiently through the system within this fast-paced environment.”

Local authority ‘transformation plans’ aim to “maximise efficiencies”, ensuring “streamlined and efficient processes” and making adult social care “as efficient and as cost effective as possible”.

As such, ‘front door teams’ aim to “signpost enquiries to other organisations”. “A multidisciplinary social care team at the first point of contact… is able to more effectively signpost and screen demand.” “Without Adult Social Care specialists working within the front door, the team could not effectively triage and signpost people.”

Efficient (transactional) service provision with brief referral.

We’re basically encouraging people to come and tell us their story so we can pass them on somewhere else to tell their story again. And again.

And to be honest, we’re not really that interested in stories. In what really matters to you. Because listening to stories takes time. And “within 24 hours of contacts being received they must be logged, written up and a decision made by a Social Worker about the type of response required and threshold.” “The Single Point of Contact only holds cases for 72 hours.” “We will try to meet your needs as soon as possible by signposting over the telephone.”

We mainly just want to know which boxes to tick and which ‘activity’ in The Community – or which service in The System – we can redirect you to.

We have checklists and screening forms and scripts to follow. I just looked at one ‘screening tool’ that has over 100 questions. Intrusive, irrelevant questions, especially when once you’ve answered them you get told you’re not eligible there’s nothing more we can do come back when things get worse here’s a leaflet telephone number website goodbye.

“The state, pre-occupied with itself and the assessment, the prescription, the link worker and its godforsaken Mary Poppins bag of tricks approach to services to suit all needs, fundamentally misses the point of our uniqueness, quirkiness, deep-routed personal wants that cannot ever be reimagined for us by people paid to momentarily know us and assess and prescribe for us.”

Rob Mitchell [9]

The review of signposting services I referenced above observed that “only a small number of service users potentially benefit from signposting-only services. Many users have complex health and social care needs that require intensive and repeated support.” I’d obviously rewrite that – something along the lines of “only a small number of us potentially benefit from signposting-only services. We all have (to adopt Rob’s language) unique, quirky, deep-routed personal wants that require someone we trust to spend time alongside us to listen and learn and hold the space and help us to find our own way forward.” I think the language of users and complexity and needs is all part of the problem, but the fundamental point is that this transactional, transitional approach DOES NOT WORK for most people. 

For most of us.

A ‘sign’ of success

“Received a total of 40,000 referrals over the 2021 calendar year and we were able to successfully signpost/ refer on 50% at this first point of contact.” 

“25% increase in calls signposted to local community services by front door provider.”

Possibly the thing that frustrates me most about the concept of signposting is that we view it as a positive outcome. Or indeed as an outcome at all. We have KPIsⁱ relating to redirection. “Target: Re-direct 75% of all initial contacts (Access & First Point of Contact)”. We report ‘performance’ in terms of the number of “clients” we have “signposted to other services”. We measure ‘success’ by the percentage of people we divert elsewhere. 

“Around 4,000 calls a month answered by contact centre. 53% signposted at front door.”

Even though we have no idea what happens to them next.

‘Official statistics’ suggest that the outcome of 37.3% of requests for support from “clients aged 18-64” and 25.6% of requests for support from “clients aged 65 and over” in 2023-24 was “universal services/signposted to other services”. [10] As the ‘People at the Heart of Care’ white paper explains, “‘universal services’ are defined as any service or support for which national eligibility criteria (following the Care Act 2014) are not relevant. It includes the provision of information and advice. ‘Signposting’ indicates that the client will not be supported by the local authority and there is no universal service that will help them.” [11] 

Clear? 

Mark Neary’s “social care sat-nav to nowhere” interpretation of signposting feels painfully astute here.

The definition of signposting I quoted at the start of this post stated that “details are therefore given of other organisations (for example, in the voluntary sector) that might be able to provide assistance.” [Emphasis added]. Might. Maybe. We don’t know for sure.

And do all those ‘calls’ and ‘referrals’ we re-route even get as far as taking that next step? While we may record handing people a leaflet or dictating another number to ring as a satisfactory conclusion to our ‘front-door process’ (‘no further action’, ‘involvement ended’, ‘case closed’, job done), we’re effectively saying off you go, you’re on your own, start again. And how many people don’t, can’t, start again?

“When someone gives me a telephone number as a means of access and tells me to ring it myself, I don’t ring it. They don’t know about the anxiety. That you’re already overwhelmed in that space and then to have to do that and explain it all again and do it all again. It’s like, just leave it. I’ll just sit in this problem. I can’t be bothered.”

Issachar John [12]

Success for who exactly? 

Connecting

The “rapid realist review” I referenced earlier suggested that ‘signposting’ could represent “the improved quality of care through a joined-up response that encompasses health, social care and community/voluntary services’”. Maybe. But the way we talk about signposting, and the practice approach it refers to, suggests otherwise – as I’ve hopefully demonstrated above.

I think this comes back, as things generally do, to purpose. When we see the purpose of adult social care in terms of ‘washing and dressing’ and ‘service delivery’, and the purpose of our ‘front door’ teams as being to ‘divert’ people from these services and ‘manage demand’, and we view ‘prevention’ in terms of ‘reducing demand’ and saving money, and ‘independence’ as managing without support, then signposting fits right in.

But that all changes if we view the purpose of social care as being about “weaving a web of support and relationships in our local communities that we can all draw on to live our lives the way we want to, with meaning, purpose and connection, whatever our age or stage in life”. [13] As connecting the threads, tying the knots, untangling the messy bits, and mending those parts that are torn. 

Because here, instead of referring on, we introduce. Warm handshakes instead of cold handoffs. We “pull for help” [14] instead of pushing away.

And we invest in people and relationships, not pathways and procedures. Invest in our own relationships with people and families. With colleagues and communities. Invest in connecting people not to services, but to other people to find friendships, relationships, love and peer support. Invest in co-creating the conditions for people and communities to thrive. 

Social work and social care should be right at the beating heart of communities, the core of a pulsing, shifting, growing network of connections and relationships that benefit us all. 

Signposting sits in a social care world where we put process and efficiency before people and efficacy.

Our focus in our better, brighter future must be to connect, not redirect. 

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References

[1] Signposting, Cambridge Dictionary

[2] People at the Heart of Care: adult social care reform white paper, Department of Health and Social Care, 18 March 2022 

[3] Parley Vouz Health & Social Care? (An A to Z of Carespeak), Mark Neary, Love, Belief and Balls 

[4] Signposting services for people with health and care needs: a rapid realist review, Anna Cantrell, Health and Social Care Delivery Research, Volume 12, Issue 26, August 2024

[5] Care and support statutory guidance, Department of Health and Social Care, GOV.UK, 18 February 2025 

[6] Care and support statutory guidance, Department of Health and Social Care, GOV.UK, 18 February 2025 

[7] Care and support statutory guidance, Department of Health and Social Care, GOV.UK, 18 February 2025 

[8] Care Act 2014

[9] P is for Social Prescribing, Rob Mitchell, in The Social Work, Cats and Rocket Science Guide to Rights-Based Practice: An A-Z, from Advocacy to Zones of Influence, Edited by Elaine James and Rob Mitchell, Jessica Kingsley Publishers, 2025

[10] NHS England. (2024, October 31). Adult Social Care Activity and Finance Report, England, 2023-24, NHS England, NHS Digital, 31 October 2024

[11] People at the Heart of Care: adult social care reform white paper, Department of Health and Social Care, 18 March 2022

[12] Your Care and Support: Doncaster – Adult Social Care Local Account 2024. Adult Social Care Making it Real Board. City of Doncaster Council, January 2024

[13] How to build public support to transform social care, Social Care Future, October 2023 

[14] The Liberated Method – Rethinking Public Service, Changing Futures Northumbria, 2023

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i. Key Performance Indicators