Recent research confirms that the mass of bureaucracy weighs heavily on social workers, with serious implications for personalisation, writes academic Bob Hudson
Two pieces of research recently published in the British Journal of Social Work shed some interesting light on social work decision-making:
Title: Barriers to Retaining and Using Professional Knowledge in Local Authority Social Work Practice with Adults in the UK, BJSW volume 38, pp1370-87, (2008)
Authors: McDonald A, Postle K and Dawson C
Title: Social Workers in Community Care Practice: Ideologies and Interactions with Older People, BJSW Advance Access, May, pp1-20, (2008)
Author: Sullivan, MP
These studies explore the basis on which social workers make decisions about whether or how to support service users. Both use a qualitative approach to explore the way social workers’ “belief systems” are constructed, and the implications of this for their practice. The studies share the same broad conclusion – that the profession has institutionalised a bureaucratic frame of reference, and needs to reconsider the basis of its practice.
McDonald and colleagues pose the question: “what do practitioners use to work with and make sense of complex cases?” Their study is based upon the views of 20 experienced fieldworkers, each of whom was asked to choose and describe a complex case from their recent practice which had caused them difficulty. This is an interesting approach that improves upon the typical method of inviting reflection on a constructed vignette. The researchers were particularly interested in sources of knowledge, the value base and its source, the skills employed and the means of support.
Sullivan is similarly interested in how a practitioner’s ideological frame of reference affects practice – if, for example, social workers are collectivist or committed to self-determination, what are the consequences of this when a social worker meets a client? In Sullivan’s study, data were collected through semi-structured in-depth interviews with 40 fieldwork staff in two contrasting locations in England.
McDonald et al report many practitioners displaying a high level of stress when discussing their cases, often using the language of battle and conflict. They found barriers to the retention and use of professional knowledge at three levels:
● A structural level, where a rigid hierarchical system did not encourage the use of practitioner knowledge.
● A management level, where practitioners experienced supervision concentrating on workload management rather than professional issues.
● A practitioner level, where staff struggled with gaps in their knowledge and used defensive or procedural practice rather than working proactively and creatively.
The interesting question is why these barriers existed and persisted in staff educated (some quite recently) to use professional knowledge and skills. The authors resist the simplistic view that practitioners had forgotten or wilfully ignored everything they had learned rather they conclude that instead of relying upon their knowledge, practitioners were fearful of blame for their actions and had become dependent on a raft of procedures and routines. In effect they conclude that staff have become institutionally captured by the dominant bureaucratic/rationing regime.
This conclusion lines up with Sullivan’s findings. She reports that practitioners’ principal justifications for their actions originated from a conviction that finite resources had to be allocated equitably – eligibility criteria were seen as the means of ensuring objective assessments, and professional practitioners served as the neutral means of implementation. This attitude was found to be only slightly more apparent among those who had not obtained a full professional qualification.
Sullivan argues that this demonstrates how readily a new form of “practice wisdom” can become established as part of the worker’s repertoire of understandings. This is then introduced to users during initial short assessment visits and can effectively block the client from introducing his/her own views. In addition, Sullivan found that preferential treatment was accorded those older clients who showed gratitude. This paternalistic model of care is the precise opposite of what the government is anticipating with its personalisation agenda.
The findings from these studies confirm evidence from elsewhere that practitioners do not rely heavily upon social work knowledge in their interactions with service users, but rather look for organisational “permission to act”. Although for both studies the samples are relatively small and the data a little old, there are enormous implications for social work in the era of personalisation. The findings raise questions about how professional social work will accommodate the personalisation agenda.
Last year’s Interim Workforce Strategy from the Department of Health refers to some need for radical change in the social work profession, and it is likely that this is a reference to the new focus on “brokerage,” which is widely seen as vital for ensuring that individual budgets work effectively for those who receive them.
Official interest in the idea can be traced back to the 2005 green paper on adult social care, Independence, Well-being and Choice,which talked about the introduction of “a care navigator/broker model” where a “care broker” is someone “who might help the individual formulate the care plan, negotiate funding and help organise and monitor services”.
Subsequent official publications have been blunt, with the Transforming Social Care circular from the Department of Health stating that: “The role of social workers will be focused on advocacy and brokerage rather than assessment and gatekeeping.”
While the political rhetoric surrounding personalisation speaks seductively of social workers returning to traditional values and practice, the evidence from the two studies reported here suggests that the profession will not easily and smoothly glide into the resumption of what seems to be, simplistically, perceived as a golden age of professional practice. It is not simply that many practitioners no longer have any experience of a therapeutic approach, but also that the bureaucratic/rationing paradigm is now so dominant that it will not be easily susceptible to change. To say that the key issue is “culture” is to state the obvious but to underplay the complexity of breathing life into the current rhetoric about transformational change.
Traditionally, workforce planning and development has been seen as a backroom function in adult social care, one that crunches numbers and calculates rates of recruitment and retention. This is no longer the case. It is now clear that Putting People First can never be effectively implemented without a social care workforce that is sympathetic to the policy principles and skilled at putting them into practice. As the findings of these studies imply, this will require a much more proactive strategy co-ordinated across a complex web of stakeholders than currently exists. Much will ride upon the final workforce strategy due to be published soon by the Department of Health.
● The articles cited can be found in the British Journal of Social Work.
● Department of Health (2005), Independence, Wellbeing and Choice: Our Vision for the Future of Social Care for Adults in England.
● Department of Health (2008), Putting People First – Working to Make it Happen: Adult Social Care Workforce Strategy – Interim Statement.
Professional knowledge Where practitioners focus upon the minutiae of putting care services together, then professional knowledge will be devalued.
Procedures The heavy procedural emphasis relegates the importance of working with uncertainty – the hallmark of a mature profession.
Risk and choice Practitioners who are unused to exercising judgement will find it more difficult to work creatively with other professions.
Training The new personalisation agenda has to be urgently reflected in existing training opportunities.
Interagency working Practitioners will need to radically reappraise their conceptualisations of risk and choice.
Putting People First The role of social work will need to change greatly if it is to be consistent with the expectations of Putting People First.
Bob Hudson is visiting professor of partnership studies at the school of applied social sciences, University of Durham
Published in the 9 April edition of Community Care under the heading ‘Captives of bureaucracy’