In Essex, 70% of assessments are now signed off by the social worker carrying them out, freeing up managers’ time and leading to a much quicker service for clients.
By Tristan Donovan
A social work approach that thins out bureaucracy, empowers practitioners, frees up managers’ time and delivers higher-quality assessments appears too good to be true.
But Essex County Council’s self-confirmation of assessments system appears to have done exactly that. The local authority isn’t the only one saying it.
Think Local Act Personal, the cross-sector partnership that seeks to aid the implementation of personalisation, liked the approach enough to pick it as a case study for others to learn from for a project on reducing bureaucracy in personal budgets.
The basic idea is that frontline social workers in adult services who meet certain standards are given the power to sign off care packages and assessments, and that the task of vetting these reports is handled by a centralised unit rather than individual teams. Essex has been using the approach for about two years now and the results are impressive.
70% of assessments signed off by practitioners
Practitioners now sign-off about 70% of assessments themselves, the time managers spend reviewing and approving their work is down by two-thirds, and assessments are completed faster.
Shaun Lancaster, project manager – safeguarding, placement and development at Essex, was one of the people who helped create the system.
“The idea for it started four or five years ago,” he says. “All assessments were being quality assured and would go to a budget holder to assess. This was representing a significant amount of time for managers. We estimated that 50% plus of team manager time and 30% of service manager time was involved in the quality assurance process.”
The answer was a major rethink of how the checking and validation of assessments was handled. The council moved the task of quality assurance of assessments and support plans into a county-wide team called the central confirmation and validation team (CCV Team).
In addition experienced social workers, who had completed a package of relevant training, would be able to get a ‘self-confirmation passport’, allowing them to approve their own assessments in all but the most complex cases, in which case the CCV Team would need to sign it off.
“We took the opportunity to say that managers do not have to quality assure 100% of cases and that the staff are able to be accountable for the quality of the assessment work and care packages,” says Lancaster.
Quicker service for clients
“This meant we could have a smaller group of people doing the quality assurance in a shorter amount of time. In addition, we were getting improved response times for service users and more consistency across the county in how we responded to care packages.
“Managers can do more development work too. It frees up a great deal more development time for them and gives them the ability to be a point of reference for staff again.”
The training social workers need to do before being allowed to sign off their assessments is comprehensive. It covers everything from Essex council’s corporate governance and the Mental Capacity Act to the database system, safeguarding of adults and children, assistive technologies and basic occupational therapy.
“You do basic OT so that we can assess for OT-based equipment,” says Christina Collins, a senior social worker in the council’s working-age adults physical impairment and learning disabilities team.
“This is better for the person being assessed because you go out there and actually you can do it all in one hit. If it’s a simple piece of equipment with no other risk that you need an OT for you can include that in the support plan.”
As well as completing all the training, social workers also need to have three consecutive assessments or support plans gain approval from the CCV Team.
“You get three of those and you’ve done your training, then you get your self-confirmation passport,” says Matthew Ansell, senior social work practitioner on the CCV Team.
Trust in social workers
“The county is saying ‘your work is good, we trust you to confirm your own reviews’. We’ll keep an eye on them and discuss any practice issues with the workers, but unless there is a cause for concern, which is very rare, they can sign off their own reviews.”
The CCV Team’s job is to vet the work of social workers without self-confirmation rights, carry out occasional checks on the work of those with the passport, and quality assure the assessments and plans for the more complex cases that practitioners with the passport carry out.
Ansell says one of the positive aspects of the approach is that the 15 social workers and occupational therapists on the CCV Team do not have direct contact with service users.
“Because we don’t know the service user we’ve got no preconceived ideas about what we should be seeing,” he says. “Sometimes from a practice point of view it is good to have someone take a step back and say whether we need to put something else in or say maybe we could do something less intrusive here.
“For example a report might say the son gets in the shopping in one bit, but later says the son didn’t get the shopping because he is in hospital. We would send that back to the worker and say we need to know what the situation is in terms of the son fulfilling those basic needs.”
Ansell says the CCV Team might also suggest alternative ways of offering support to having a carer coming in to do the shopping, such as getting shopping delivered. But while the CCV Team checks the work of the frontline practitioners, Ansell says “we’re not there to police people”.
“We keep things good humoured and professional,” he says. “That is really important because when you are giving constructive criticism you’ve got to be professional, polite and nice about it – very few people like criticism whether it’s constructive or otherwise.
“I was in frontline [practice] and it’s easy to get caught up in situations and it’s really good to have someone look at what you’re doing and say ‘that’s really good, no problem’ or ‘let’s have a bit of a chat about it’.
“It compliments what frontline workers and their managers do. I am a practitioner at heart – I wouldn’t want to do this unless I felt it improved professional practice.”
Collins says the move to the self-confirmation systems has been good news for social workers in Essex.
“I think it acknowledges their professionalism again,” she says. “It makes sure all the work is completed so that it’s of a higher quality. People are more accountable so they think more about what they are doing and what they are signing off.
“Essex trusts the work that they do, that’s the message it gives to staff. It’s no longer Big Brother, it’s we trust what you’re doing.”
Lessons learned by Essex
- Time needed to be invested in getting rules right for when practitioners should sign off their own assessments, and when they should be sent for quality assurance to build management confidence;
- Time also needed to be invested in getting the training programme right for staff to be qualified in signing off their own assessments;
- Teams needed to be restructured with more experienced staff moved into the central confirmation and validation team.
Picture credit: Rex/Darren Greenwood/Design Pics Inc