Going through the motions?

Are social workers’ skills being downgraded
amid mountains of paperwork and a tickbox approach to clients, asks
Frances Rickford.

There was a time when those who chose a career
in social work would tell you proudly that they wanted to work with
people rather than settle for a better paid and easier “pen
pushing” job. Now, although poor pay and stress still characterise
the profession, social workers employed by local authorities seem
to be spending a growing proportion of their time pushing pens – or
at least bashing a keyboard instead of directly engaging with
clients.

Both in children and adult services, carrying
out assessments is now a key part of the social worker’s job. Many
complain about the volume of paperwork and the erosion of
professional discretion that goes with it. “This isn’t what I
trained in social work for” is an often heard lament in local
authorities. But is box-ticking necessarily a bureaucratic waste of
time? Is it an administrative function, like doing market research,
or are social workers’ skills and experience important and
necessary to conducting a needs assessment? And even more
important, is it the most effective use of their time – especially
when social workers are in short supply and many departments are
unable to fill posts?

Harry Brown (not his real name) is an
assistant manager of an adult services team in the West Midlands.
He qualified as a social worker in 1982, and feels the job he
trained for now hardly exists. “It is getting more and more
difficult for a social worker to work creatively. In the first
place, they have less scope to make their own decisions – instead
they fill in the forms and their managers decide whether or not to
offer a service.

“The forms themselves are getting longer and
longer, but they are still inappropriate in many cases. The
community care assessment form is nine pages long and the review
form has gone to a booklet form. It’s good for someone in
residential care, but not for someone living in the community. It
just doesn’t ask the right questions. The social workers in this
team probably spend about 60 per cent of their time completing
forms. And now we’ve been told they’ve got to write up some of the
information on the computer as well.”

The result, according to Brown, is that the
quality of the relationship between social workers and their
clients has been seriously damaged to the detriment of both workers
and service users. “In the early 1980s when you were allocated a
case, part of your job was to befriend that person. You’d know you
would be staying with the case for a while and you would involve
yourself in it. Now you go in, fill out the form, get the service
and pull out. Social workers have no meaningful relationship with
many of the people they’re working with.”

But as well as the growth of form-filling,
Brown reports that social workers discretion – and, he claims,
effectiveness – has also been hampered by inflexibility within the
service. Resource constraints are one problem: “We’re not providing
a service for a lot of people who need one because there’s no
finance.” But also because in the world of service level agreements
and tightly managed contracts, their hands are often tied.

“At one time when we had more of our own
residential homes we could arrange for someone to go in perhaps for
a day or two. Or if someone lived opposite a home and needed meals
brought over, you could arrange that. You could look at people’s
needs in a holistic way. Now there’s no flexibility. It’s almost
pointless having discussions with service users about their needs
because we’re not allowed to do anything creative to meet
them.”

Brown’s account is supported by Imogen Taylor,
professor of social work and social care at the University of
Sussex. From feedback from students on placements, researchers and
visiting practitioners, Taylor has major concerns about the impact
on social work in adult services of the demands of an increasingly
formal and prescribed assessment process.

“Practitioners are forced to tick boxes to
generate the services that are needed so it becomes a game they
have to play. And it possibly also means they have to emphasise the
pathology and complexity of a situation to get a service.

“The other big question is the implications
for the relationship between practitioner and service user if
procedural requirements dominate. If practitioners are limited to a
certain amount of time they can spend with the service user, as is
now the case in some authorities, that is an even bigger concern.
Of course there are limited resources and we have to make sure
those resources are used to greatest effect. But one of those
resources is practitioners’ time, and the time they spend filling
out the form is not spent directly engaging with service users.

“We encourage students to use the assessment
form constructively, working with the service user. But
opportunities for real participation by service users are limited
when practitioners have to focus so closely on the form itself. The
form becomes the tail that wags the dog.”

But if the assessment procedure for community
care services is experienced by many as cumbersome and unhelpful,
in children’s services it seems to be perceived as both a necessary
and skilled part of the social worker’s job.

June Thoburn, professor of social work at the
University of East Anglia, believes the social work task in
children’s services is as skilled as it has ever been.

“If local authorities are using social workers
in inappropriate ways they will lose them all. The professional
workforce and local authority social services employees are two
different things, and social workers are now being employed all
over the place – to do social work.

“But we see here examples of creative work by
social workers in local authorities across all client groups. There
are still a lot of decisions to be made – local authority staff are
working at the heavy end and give or withhold services worth huge
amounts of money.”

According to Thoborn, assessment forms are
getting the blame for problems created elsewhere in the system. The
difficulty is the lack of social work time caused by the
recruitment crisis and staff shortages. You have to assess people’s
needs, and without enough staff you may have time to do little
else. “The frustration is that they don’t have enough time when a
problem comes up to provide the grief counselling or the anger
management work. If it gets done at all it goes over to the
voluntary sector.”

Thoburn is concerned that there is too little
long-term help for families by social workers. Family support is
now increasingly done by social work aides and assistants, she
says, but that is only safe if a key, accountable social worker is
supporting the family aide.

Thoburn defends the Assessment Framework for
Children in Need, and argues that far from being a bureaucratic
exercise, completing an assessment is a highly skilled job. “You
need lots of skill and sensitivity to do an assessment. You have to
ask very intimate questions and listen to people very carefully –
it would be incompetent to fill in one of those forms without doing
a good piece of social work at the same time, including using a
high level of discretion about how intensive the assessment needs
to be. You don’t have to fill all the boxes in if they’re not
relevant, and you don’t even have to use the form at all. It’s a
checklist, and a useful aide for inexperienced workers.”

So are social workers’ complaints about too
much pen pushing simply nostalgia for a time when resources were
more plentiful and professionals were left far more to their own
devices?

John Coughlan, corporate director of social
care in Telford and Wrekin, is sympathetic to the feelings of
people who were in the profession before the changes introduced by
the Children Act 1989 and the NHS and Community Care Act 1990, but
believes being a social worker demands as much skill as ever.

“People who were practising in the 1980s might
regret the passing of a more fluid and flexible approach, and
resources are much more pressurised now,” he says.

“But that makes it more important to ensure
that resources are used properly around clients’ needs. It is a
very skilled job to get to the heart of service users’ needs, and a
challenge to work in this pressurised process in a way which is
human and empowers the person.

“But the worst way of spending our time is to
make interventions which might be intrusive and expensive without
being clear about the purpose of those interventions.

“But if people feel they cannot engage
effectively with service users, and worry about losing their
capacity to relate to clients because their work is dominated by
court deadlines and statutory procedures, that is deskilling and as
managers we have to guard against it.”

Coughlan adds: “It is right that we work to
clear parameters. But we also have to make sure service users do
not feel they are an item on a factory conveyor belt. Spending
personal time with people, sitting down and listening to them, is
very important but not an end in itself. Without tools to help with
your work it is very easy to lose touch with what an intervention
is for – sympathy is not a substitute for progress.”