It doesn’t add up…

In the current political climate many social services directors are
under pressure to rapidly improve their departments’ performance.
Councils are subject to the pressures of the government’s star
ratings for social services, and concern the ratings impact
directly on their overall comprehensive performance assessments.

A natural “knee jerk” reaction to these pressures might be to focus
effort and resources entirely on improving performance on the 11
key performance indicators that are used to help determine the
number of stars awarded. This response though is not without its
dangers and may result in some perverse outcomes.

For example, by focusing resources on improving performance on the
key indicator “C28 Intensive home care” at the expense of less
intensive preventive care such as measured by “C32 Older people
helped to live at home” (not a key indicator), there could be an
increase in demand for residential and nursing care. Before making
these difficult choices, social services departments need to check
first whether the management information on which they are being
judged is based on an accurate recording of the services they
provide.

Although management information is analysed at a national level to
determine the department’s star rating and ultimately the “freedoms
and flexibilities” the council will have, the inputting of the
original data on to a database is often left to hard-pressed
front-line professional staff. These staff might not see recording
as a priority, may not connect their role in inputting data to
performance indicators, or might not understand the implications of
star ratings for themselves and their service users. Yet inadequate
recording can seriously underestimate the extent and the quality of
the services being provided.

Therefore, directors may be able to rapidly improve their
department’s overall performance, as measured by performance
indicators, by enhancing the quality of recording by front-line
staff. The management information returned to the Department of
Health would thus more accurately reflect the quality of the work
that is actually taking place rather than simply reflecting the
quality of the data inputting.

In Suffolk, as at many other local authorities, concern has been
expressed for some time about the quality of recording in relation
to the minimum data sets (basic information held on individual
referrals, such as name, date of birth, ethnicity and the statutory
group). Incomplete data sets may mean that many clients are
excluded from the performance indicator measures. Thus the overall
quality of the management information returned to the DoH had to be
questioned.

To determine why recording was not reflecting the face-to-face work
that was taking place, a survey of all first-line managers and
front-line staff was conducted. The results of this survey provided
several possible explanations for poor or incomplete recording.
These included significant practical barriers but a number of
psychological barriers were also highlighted.

The main practical barriers given for not being able to record
effectively and efficiently included insufficient time due to heavy
workloads, computer software being too slow and cumbersome, the
need for more bespoke training and support, difficulty in accessing
computer terminals, and the office environment not being conducive
due to too many interruptions and distractions. As one staff member
said: “With the current pressure of work, interruptions by phone
calls and the amount of recording expected, I feel a computer is
needed on everyone’s desk to do my job properly.”

The survey also raised a more fundamental issue about attitudes to
recording and performance indicators that could suggest that the
psychological contract between social care staff and management has
been broken by the introduction of IT-based recording and the
performance culture. A psychological contract works like an
unwritten agreement in which both management and staff have certain
beliefs about their respective roles and obligations. The pressure
to spend more time recording on a computer, when they came into the
job primarily to work with people, sometimes created a conflict
between people’s view of their professional role and their
employer’s expectations.

The survey found that, given the work pressures, front-line staff
did not see recording as being as important as face-to-face work
with clients. A typical comment was “Recording is time-consuming
and with the volume of work coming in, customers take priority over
recording.” This state of affairs is not a new phenomena within
social care. What the performance culture has done though is to
bring inadequate recording into sharp relief and to the notice of
the council as a whole.

The difficulties around recording were reinforced by the
expectation that staff should have keyboard skills to directly
record onto the database themselves. Although not averse to
computers as such, for many longer serving staff, typing was seen
as an “admin” task. Comments were made such as “I did not come into
social work to become a computer operator.” The association between
computers and the introduction of performance indicators was
acknowledged by a minority, but few front-line staff had much real
sense of what performance indicators had to do with them.

Psychological contract theory suggests that there can be mutually
beneficial “trade-offs”, which form the basis on which any
organisation motivates its staff, introduces change in working
practices and ultimately fulfils its goals.¹ Using
psychological contract theory in relation to recording and the
resulting production of high quality management information in
social care, suggests the need for a framework of policy and
practice that takes into account both the needs of the organisation
and the defined role of social care staff. Social care as a
professional activity can be redefined as including the importance
of recording onto a computer database as part of the performance
culture. But as a trade-off, organisations need to offer not only
resources but also an acknowledgement of the psychological shift
that is required.

Suffolk Social Care has already taken steps to set up a team to
assist in inputting data and is consulting widely on the use of its
database and other aspects of the practical “speed bumps” that get
in the way of accurate recording. However, to ensure that the
performance culture is more fully integrated into mainstream social
care, with the commitment to recording that this implies, steps
will need to be taken in all authorities to convince professional
staff of the benefits to their customers of using performance
indicators, and working to set targets and desired outcomes as such
a culture demands.

High-quality recording will only produce improved performance
indicators if the services are of a high quality. However, the
transformation in the mind set and behaviour of social care staff,
in relation to recording, needs to take place now so that directors
can feel confident that they get the “star rating” their
department’s services deserve.
Paul Schofield is a performance review manager for Suffolk Council
social services department. paul.schofield@socserv.suffolkcc.gov.uk

References

¹ J Coyle, “Consequences of the
psychological contract for the employment relationship: A large
scale survey”, Journal of Management Studies, 37 (7)
903-931, 2000