By Angela Jenkinson and John Chamberlain
The more important a service is, the more essential it is that its quality is assured. The purpose of social work with adults in need of care and support is to promote their well-being. Failing to do that can, at the worst, lead to life-threatening situations, and so the consequences of failing to provide a social work service of an acceptable quality can be grave.
Contemporary theories of quality assurance are consistent in claiming that quality can only be assured by the workers who are delivering the product or service. Recognition of this can be traced back to the experiments undertaken by the Australian psychologist Elton Mayo in the Hawthorne Studies between 1924 and 1932. These showed that when workers are involved in decision making then productivity increases. Quality assurance approaches have built on this discovery and have created systematic ways of applying it. As social work is a professional service this means the profession is systematically quality assuring itself.
The authors have written a complementary guide to quality assuring social work in adult social care for Community Care Inform Adults which looks at the meaning and importance of quality, how to assure it and test it, and social workers’ role in quality assuring their own and others’ practice. Find out more about Inform Adults and how your employer can subscribe.
However, there is very little literature on quality assurance in social work with adults and, in 2013, the Centre for Quality Assuring Public Services at Kingston University wanted to find out how social work with adults was quality assured in the London boroughs. We asked to interview each of the quality assurance leads and, of the 33 boroughs, 30 responded. The high response rate was indicative of the value that each borough placed on quality assurance.
How councils currently quality assure social work
Overall, there was clearly a commitment by the London boroughs to quality assuring social work in adult social care, but responsibility of the profession for its own quality assurance system seemed to be embryonic. The principal means by which the profession quality assured its own practice were through professional audits and professional supervision, with audits seen to be the more effective of the two. Twelve quality assurance leads said that audits alone were the most effective means available.
Overall, 21 boroughs relied on audits as a means of quality assurance and these were focused on safeguarding practice and, to a much less extent, on Mental Capacity Act-related work.
Twenty-six of the 30 boroughs provided professional supervision by a fellow social worker (the other four provided supervision but not necessarily by another social worker). Five quality assurance leads said that professional supervision alone was the most effective means of quality assurance. Eight said that audits and supervision combined were the most effective. And 11 of the boroughs had social work standards against which to judge social work practice.
There was no discernable pattern in the responses of the boroughs on the issue of the profession itself quality assuring social work. At the time, only five boroughs had a professional social work lead permanently in post and another nine were in the process of appointing one. Only four boroughs had professional governance systems of any kind in place, or quality assurance structures run by the professional body rather than by management. There was no overlap between those boroughs which had social work standards, a professional social work lead and a professional social work governance system in place. The responsibility for quality assurance was seen as lying with line management posts in 10 of the boroughs and with dedicated non-operational posts in 20.
Crucially, there was no consistent use of any agreed specification of social work. A qualitative analysis of the responses found that the need emerged for a specification for social work as a first and critical step in quality assuring practice. This is consistent with quality assurance theory. The interviews indicated that a specification could be derived from a number of sources including the law, the local authority, the profession and the service user, each with a particular contribution to make.
Four-step guide to quality assurance
To assist the profession to quality assure social work, the centre has produced a guide for Community Care Inform Adults. Drawing on established models, the guide sets out a clear four-step approach to quality assuring social work in adult social care, consisting of specifying, controlling, testing and improving quality.
First, managers responsible for quality assuring social work with adults are advised to work with social workers to produce a written specification for social work that sets out its concept, characteristics and standards. The specification is at the heart of guaranteeing quality. It is the articulation of the customer’s requirements of a service, and quality is the satisfying of these. The nature of social work is such that satisfying customer requirements means meeting the statutory rights of adults in need of care and support to have their well-being promoted. The guide sets out a proposed way of producing such a specification.
Second, managers are advised to seek to control quality against the specification. Quality control in social work is mostly done through having the correct policies and procedures in place which must flow directly from the specification. Some pitfalls of using these as performance targets are identified in the guide.
Third, managers are advised to test quality. Supervision is useful as a means of testing quality of professional practice but it is limited because it is used for many other purposes. Audits are also useful as a means of testing quality but may be limited in that they are a managerial, top-down process. Case reviews can overcome these limitations. They are case discussions between professionals. The guide advises managers to design and co-ordinate a system of testing the quality of practice through regular meetings of social workers where they professionally review cases.
Fourth, managers are advised to recognise that the responsibility for continuously improving quality rests with the professional social work body and requires maximum worker involvement. There should be a professional governance system similar to shared governance and practice councils, with the remit of case practice, education and research.
Managers must also recognise that improving quality is contingent on the customer voice being heard. There must be an ongoing dialogue between social workers as the professional body and clients and carers. A process should be designed which facilitates this and which, pivotally, accesses client and carer experiences of their rights being met or not.
Angela Jenkinson is an honorary research fellow at Kingston University, and was previously head of quality assurance for adult social care at London’s tri-borough partnership and at Hammersmith and Fulham council. John Chamberlain is a visiting fellow at Kingston University and was previously assistant director for adult social care at Hammersmith and Fulham council.