How one council boosted social work’s quality and status

In recent years, performance management in social work has become associated with unnecessary bureaucracy and cost, a negligible impact on quality and poor morale among practitioners.

However, one council says that it has designed and implemented a system that has delivered precisely the opposite over the past two years.

Hammersmith and Fulham’s quality assurance programme assesses social work practice with adults, and its management, against 50 standards.

Senior managers say it has driven significant improvements in safeguarding practice and court work, produced £1m a year in savings, reduced paperwork, strengthened  morale at the front line, and provoked a significant reorganisation that has effectively separated care management from social work.

Impact at the front line

One of seven social work services reviewed through the process so far is the learning disability team, which is integrated with the NHS.

An initial quality assurance review, in December 2010, identified a number of problems, including a lack of face-to-face contact with service users and inadequacies with safeguarding. Unsurprisingly, morale was low, says the team’s social work manager, Milli Miller (pictured, below).

[Update your safeguarding knowledge at Community Care’s forthcoming conference on supporting adults at risk.]

“It made me question what I was doing as a manager,” she adds.

However, she says that practice has now improved, particularly in safeguarding, thanks to support from the quality assurance team.

One clear example of this is the fact that the team were given support to take three cases to the Court of Protection. Despite the team having no experience of court work, the judge accepted social workers’ recommendations in all three cases.

One of the social workers involved, Angela Wilkey (pictured, right), says: “I found [the support with court work] very helpful.” “I’m not worried about going to court now,” she adds.

She also praises the training she received as a result of the 2010 review, including in safeguarding and applying Fair Access to Care Services eligibility criteria.

Through support to reprioritise her work, she is now getting more face-to-face contact with service users, while supervision has also improved.

“We have it more often than we used to. It’s now a good tool where you can express yourself and clarify issues that are not clear to you.”

Miller adds: “Before in supervision, I would be more instructing the social workers. No I will ask them what they are doing in the case and how they are going to take things forward.”

She is also investing more time in preparing for supervision. “Before each session, I will go through the cases and see how they have gone. It’s about getting the best out of [the practitioners].”

Increasing challenges for practitioners

The quality assurance programme was introduced in November 2009 to address a number of challenges.

The implementation of the Mental Capacity Act 2005 in 2007 and the deprivation of liberty safeguards in 2009 had introduced fresh practice demands, including an increase in court work and the need to satisfy the requirements of the Court of Protection.

In addition, expectations about safeguarding adults were also increasing.

Head of community assessment and social work Ann Stuart (pictured, left) says social work skills had been eroded on the back of the community care reforms of the early 1990s that established care management as a core role for practitioners.

“I felt that social work skills were declining because of community care. I wanted to bring back social work,” she says.

Though quality assurance frameworks in adult social care provision are nothing new, Hammersmith and Fulham’s is distinctive in a number of ways, says Angela Jenkinson, the council’s head of quality assurance for adult social care.

One of these is its academic basis in quality management theory. Though Jenkinson has a 20-year background in adult social care, including managing provider services, she also has an MBA and has lectured in public services management at Kingston University since 2000.

Defining social work

This helped shape the development of the programme. Jenkinson, Stuart and assistant director of adult social care John Chamberlain developed a conception of the function of social work against which the standards were built. This was to “support vulnerable adults in making decisions which enhance their independence or to make decisions for vulnerable adults where they lack the capacity to do so”.

Fifty standards were established, five of which were identified as critical: those relating to risk assessments, safeguarding, capacity, supervision and courtesy to service users.

Another distinctive factor is that Jenkinson and her two colleagues in quality assurance work alongside the teams they are reviewing, rather than at arms-length in a commissioning unit, as is common elsewhere. This means that the process is less remote for the teams, service managers have buy-in and there is ongoing

support to implement action plans, say Jenkinson and Stuart.

“When we are reviewing a service I always say that every social worker can talk to me at any point,” says Jenkinson (pictured, right).

“When you look at the quality of the service, some people will feel that it’s going to be a criticism of them personally,” says Stuart. “We’ve worked very hard with staff to make it clear that they have the opportunity to have their say about the work that they do, the systems they use and their management.”

However, she insists that the process is also independent: “I don’t see the outcome of the review until it’s completed and presented to me.”

How quality reviews work

The reviews are conducted by Jenkinson, her two colleagues, who specialise in mental capacity and safeguarding respectively, and independent experts, who are all qualified social workers.

Each team is scored against all 50 standards, drawing on 12 sources of evidence, including financial information, surveys of users, carers, social workers and managers and, significantly, an in-depth analysis of one case per social worker on the team.

In each case, the social worker, supervisor, service users and any informal carer is interviewed and the case record reviewed, providing a deep and rounded insight into practice.

The team’s scores translate into an action plan for improvement, agreed between the quality assurance team and the service manager.

Jenkinson says the robust nature of the process means that the results carry credibility with the teams. “As it’s so evidence based, it’s hard to argue against the findings.”

The frequency of further reviews is based on a team’s performance.

Splitting social work from care management

“The biggest outcome for me was to separate care management and assessment from social work as I believe that social work needs space to flourish,” says Stuart. “It’s difficult to do that while doing care management.”

This means that the former physical disabilities, older people’s and hospital teams have been replaced by a social work team and an assessment team. The former handles safeguarding, Court of Protection work, mental capacity issues and other long-term work, while the latter handles care management and has a minority of social workers for complex assessments.

The split has not just given social workers more time to focus on long-term work and statutory practice, but has generated efficiencies. Having one assessment team means more consistent application of FACS criteria, for instance.

It also feeds into another key outcome from the review process – a recognition of the need to protect a professional space for adult social workers and strengthen professional identity.

Improvements in safeguarding and supervision

The council now also has clear expectations about the volume and quality of supervision received by practitioners, and all managers are being trained in line with the supervision standard.

In addition, a social work governance board has been set up to review cases and look at service development. In future, this will be co-chaired by a frontline social worker and each team will elect representatives. Stuart, who is the council’s professional lead for social work, says she does not know any other local authority with a similar board.

Improvements have also been seen in many areas from the quality assurance process.

In November 2009, case audits indicated that 55% of safeguarding was carried out at an adequate or above level; by October 2011 the figure was 76%.

Face-to-face contact with service users has also been improved including by cutting back on paperwork. The overview assessment form, for instance, has been reduced by several pages, says Stuart.

As for the £1m a year in savings, Jenkinson adds: “We didn’t set out to make savings. We set quality standards not efficiency standards. But it’s my belief that if you get the operations right, it will necessarily be the most cost effective way to run services.”

She is now keen to share her experience with other councils. This will happen first with Kensington and Chelsea and Westminster, the two main boroughs with which Hammersmith and Fulham are forming a “tri-borough” arrangement which will see adult care managed under a single director.

From a frontline perspective, Wilkey adds: “I would say that it’s a unique service. I have worked in another borough and had no experience of anything like this.”

For more information on the programme contact Angela Jenkinson at a.jenkinson@kingston.ac.uk 

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What future for adult social work? 

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