Podcast Episode: How to encourage innovation in the regulated environment
Category: Social work (general)
What follows is a transcription of the audio recording. Due to differences between spoken and written English, the transcript may contain quirks of grammar and syntax.
CW - Carole Wilkinson
CW Good morning everybody. It’s very nice to see some familiar faces and some old friends here this morning. I was reflecting as I was coming here that this is probably quite a good piece of timing in terms of thinking about risk and regulation in the light of what has been happening in the airline and aviation industry in the last few days (Icelandic volcano eruption) and we might want to see what we can learn from that as we go through this.
I’ve been asked to think through and talk with you some issues around regulation and innovation. What I hope to do it stimulate argument, debate and even some disagreement and the structure I want to follow is I’ll just talk to you for about 40, 45 minutes probably and then we’ll begin to get into some discussion around some of the issues that I raise and I will during the session throw out some questions for you to think about.
All of us here work or have worked in the public sector and I think between us we have many years of public service between us and we chose to become public servants and to remain in public service because, and I quote the Chief Constable of West Yorkshire who was writing in The Times on the 12th of April, ‘of a sense of vocation and to make a difference to society or to the quality of people’s lives’. And when we joined public service I think we all signed up to a set of principles and certain values which included service to individuals to our communities, selflessness, honesty, integrity, openness, accountability. And what I want to do with you this morning is explore some of the issues, dilemmas and tensions of working in public service, the impact of regulation on services and on professionals and perhaps suggest some ways that we might respond. Inevitably I don’t have all the answers and there are lots of things that I’m sure you’ll come up with as we go through the session this morning.
But throughout the session I want to start by asking you to keep in your minds 3 questions, what is our purpose, what are we trying to achieve and how do we know we’ve achieved our purpose?
So in this first part of this session I’ll focus on issues, dilemmas and tensions and in so doing I want to discuss trust in professionals, accountability and responses to mistrust. I’ll then take a look specifically at social care in the sector, explore some workforce issues, identify what I think and others think are some of the gaps and weaknesses and say something about what we may have learned so far from regulating individuals. As I said earlier, I’ll throw out during the discussion some questions for you to think about, and you maybe choose to discuss some of those. If you wish to frame your own questions, fine with me, and then I’ll end with some final thoughts and some key messages and some suggestions for the way forward. Some of what I say will be familiar to you. Some of it might feel a bit pessimistic but I think most of you who know me know that by nature I’m optimistic and pragmatic so I hope that we’ll think around some practical ideas and solutions and some things that we might want to take forward.
But let’s start with some with some positive messages. I always think that starting with some positive messages is a good place to begin. And I drew for this initially on Professor Onora O’Neill’s Reith lecture in 2002 where she states that professionals and public servants seek to serve the public conscientiously and mostly to good effect. And we know from surveys on job satisfaction across the range of workers that social care staff, next to hairdressers, are high on the list for expressing job satisfaction. I think they come something like second on a whole range of workers and professions. And what they say when they say they enjoy their jobs is they’re helping people to maintain their independence, they’re helping people to live better lives and in so doing they really feel they make a difference. And I suspect if you went back to your workplaces and asked your care workers they’d say those sorts of things. And similarly others working in care services, nurses, teachers will express individual satisfaction with what they do. They might not express satisfaction with their organisations and that is I think a very interesting tension that you’ll often have workers talk very positively about the work they do as individuals, the work their team does but then be quite critical or rude about their organisations.
Surveys of service users and NHS patients also tell a good story of staff being valued, being responsive and being there when they’re needed. And we’ve now got a variety of award ceremonies in Scotland which have sprung up showcasing good practice and innovation. They’ve introduced the wider public to committed practitioners and to a range of interesting services. How far some of those are innovative services I think is probably questionable but they certainly demonstrate that people are doing good work.
The Inspection Agency’s recent Overview Report of Performance Inspections paints a mostly positive picture of services and departments doing well and delivering good quality services. So there is much in social care for the sector to be proud of. It has got a history of innovation and good practice including user involvement and collaborative working and I’d argue it’s probably better than education and the NHS in those areas. It’s successfully delivered very complex and groundbreaking policy agendas like community care and criminal justice and in early years. So there’s lots of things that we can feel positive about. And our core values are at the heart of public service, respect for individuals, protecting confidentiality, which I think probably harder to achieve in this modern age with social websites and email and an intrusive press. And we strive hard to provide and encourage independence and autonomy for individuals.
So all of that should suggest that we ought to be experiencing a very vibrant sector with confident practice and very innovative services and yet; I’d like to explore that, ‘and yet’ with you a little bit. As Baroness O’Neill in her Reith lecture pointed out professionals increasing find their reputations and their performance doubted, as she stated, ‘we increasingly hear we are no longer trusted, that the public no longer finds us trustworthy’. And yet she says that there’s no evidence to support this lack of trust. We say we don’t trust professionals but yet she would argue well actions speak louder than words because we want operations and we’re cross when they’re delayed; we rely on the Police if trouble threatens and as I said earlier, users of care services speak very positively of their experiences and of receiving help. So she wonders whether it’s something to do with what we tell pollsters that we don’t trust professionals rather than in fact we really don’t trust professionals. I think probably the picture’s a bit more mixed. I mean she was probably talking in 2002 and I think it may have shifted a bit, I’m not sure whether people would wholeheartedly say they rely on the Police to respond, I suspect that’s variable and I think we know that calls for social services’ help will vary how people feel about the consequences which may be sanctions not help. So I do think there is a trust verses mistrust dilemma.
But what Baroness O’Neill does say was even if we’re not sure if there is a crisis of trust or not we certainly know what the remedy is and it lies in prevention in sanctions in making governments, institutions and professionals much more accountable for what they do and I quote her, ‘and in the last 2 decades the quest for greater accountability has penetrated our lives, like great drafts of Heinekens reaching parts that supposedly less well developed forms of accountability did not reach’. And what she says is accountability is meant in the public sector is a form of detailed control, legislation, regulation, memoranda, circulars, guidance, advice, instructions. And what she says is happening is this new accountability culture is aiming for evermore perfect administrative controls of institutional and professional live. And what this does is it requires conformity from procedures to form filling, provision of information in specified formats and success in reaching targets. And it’s got quite sharp teeth too as I’m sure those of you in this room know well enough. Performance is monitored, inspected, audited, subject to quality control and all of this it could be argued has replaced older systems of accountability and taken away professional autonomy and discretion and obstructed the proper aims of professional practice and in consequence has led to defensive practice.
And we know too from the events in Selecta that these teeth are very sharp, that demands for heads to roll, individual professionals to be punished and organisations to be publicly criticised and condemned. Just a few examples, Haringey over baby Peter and Victoria Climbie, Doncaster for a series of child protection failings, Aberdeen City for mismanaging public funds, Edinburgh City for Caleb Ness and I could go on and I’m sure you could add to that list. But does all these requirements for conformity, for audit, for inspection, for regulation make us more accountable to the public or are we just more accountable to Auditors, Regulators, to departments of governments and to those who fund us? And I’ll pose a question to you, who do you, who do we feel accountable to?
And even when we have all these forms of measurement and control we know that there are inconsistency between the measures and targets. We also know that what gets measured is easy to measure and I’m sure you’ll have from time to time in your workplace got really frustrated about the sort of information that you’re asked for and whether it’s telling anybody anything. So there is a question about whether all this information does actually tell us what is good quality care and what makes a difference. One of the ones I know I always used to feel very irritated about was the collection of data about homecare, you know, how many hours does somebody receive homecare, what it tells you is how many hours people receive homecare, it doesn’t tell you anything about the homecare, doesn’t tell you, you know, whether it’s delivering, but it’s easy to measure, you can count the hours.
COSLA as we know has complained about too much inspection and regulation, though local authorities themselves, as I have discovered, often feel pushed into adding their own burden so on top of all the other government inspired regulation they carry out their own audits and inspections. Does it help them improve or are they just doing it to protect their backs or do they feel they have no choice?
And the worry is that this new climate of accountability leads professionals to respond to what they’re required to respond to not what amounts to being a good Social Worker or a good Care Worker or a good Manager and it leaves the intensives for arbitrary and unprofessional choices.
I’m now going to turn to another critic of the regime, John Seddon, now I know John Seddon is not everybody’s taste and in that sense it’s quite enjoyable to actually use him because he usually gets people going and some of you may well have heard him speak but actually for the purposes of this morning I’m going to focus on what he views as what’s wrong with current practice and not his solution. So that might reassure you, I’m not going to spend a lot of time talking about his systems approach. But you all probably know those of you who’ve read his work or heard him, that he’s very critical of the obsession of targets, performance measures and inspection regimes. ‘There is now’, he states, ‘an ever growing industry telling us what to do, telling others what to do, inspection for compliance.’ Much of it, he would argue, based on opinion not knowledge. As I indicated earlier the view is that regulators look and measure what can be measured and get responses that earn the required tick, the star, the good rating. He does not accept the new Labour arguments that market choice and performance targets drive improvement. What in fact he argues is that targets lead to cheating and what’s become known in the NHS as gaming and there is some evidence from the NHS in England that this is happening. Trust massage waiting time figures or design access to services to meet timescales set by the Department of Health.
How many of you fly RyanAir? RyanAir traditionally lands you and then has this great fanfare in which it tells you that it’s arrived ahead of schedule. Of course it always, a bit like the rail network as well, sets its targets and its schedules to add another quarter of an hour, half an hour, so that it arrives on time. It also as it happens tends to travel between smaller airports where it’s unlikely to be delayed by lots and lots of air traffic. So there is something about - and I’m sure you’ve read the stories of accident and emergency departments - actually having people in corridors and in certain places so that they can meet their targets.
John Seddon says people cheat. He also thinks that the current system is based on a rather gloomy view of public sector managers that he thinks were opportunistic; subject to inertia and that we lie and cheat. So there’s something - this whole system is based on not actually trusting public sector managers to manage and to know what they’re doing. The problem we’ve got of course as I’ve just said is that there are a few bad apples that reinforce this view. What on earth were the Senior Managers and the Board of the NHS North Staffs Trust doing in creating the system they did which ended up with insufficient staff to provide care for people and a failing hospital? And I guess this view of public sector managers as not being very trustworthy has not been helped by the current debates about salaries and I started by quoting a Chief Constable, I don’t know if anybody, if you read his article in The Times, but he actually wrote an article in which he argued that he was paid too much and that he didn’t deserve to be paid that much. He was in it for public service and most public servants would do the job because they believe in public service, they don’t come and do the job because they’re going to be paid £100k plus. I’m sure he upset a few people on the way by saying that but it was quite interesting.
So, to quote John Seddon, ‘we think inspection drives improvement, we believe in the notion of economies of scale, we think choice and quasi markets are levers for improvements, we believe people can be motivated with incentives, we think leaders need visions, managers need targets and information technology is a driver for change.’ These are all wrong headed ideas, but they have been the foundation of public sector reform and I think that’s interesting in the light of the stuff coming out of the Conservative Party at the moment about the big society and this notion of public sector, public servants setting up their own services and if we give them incentives, you know, they’ll go off and set up their own little businesses and provide better services. He argues that the regimes perennial mistake is to legislate without knowledge. And I think that’s an interesting concept and we might want to think a bit later on about regulation based on knowledge based on knowledge as an alternative. And we also remember the discussions about evidence based policy and I wonder if it ever happens or if it’s disappeared. Sometimes it feels like it’s the other way round and its policy based evidence. ‘But’, Sneddon argues, ‘there’s nothing wrong with the new regulatory regimes if they support development, improvement and change’, and I’d be interested to hear from you if you think the current regulatory regimes in Scotland do that. But he would say that in fact bureaucracy and red tape have driven public services in the wrong direction. And he’s not just concerned about the cost but he thinks that the changes in sending services in the wrong direction have sapped morale and particularly have sapped the morale of managers and of the workforce and I’ll come back in a minute to talk about morale.
And what about the contract culture, it could be argued that the contract culture works against small providers in both the voluntary and the private sector. It threatens business sustainability and it has the potential, I think, to stifle innovation and it could be argued that the current regulatory arrangements betray a lack of trust in this contract culture. Not just from those contracting services but from regulators too. And a little personal anecdote, in my previous existence I got drawn in, rather late as it happened, to the discussions that COSLA was having with the private sector care provider, Scottish Care, about the new contracts and about setting quality criteria. I attended the meeting with a colleague from the Care Commission and we were there to actually help them think about devising quality criteria that didn’t duplicate the regulatory requirements and didn’t add burdens, but actually Liz Norton and I felt like we were sitting in a room holding the coats, and I felt like I was back in the 1970’s, you know, it was public sector good, private sector bad and these 2 groups of men, as it happened, in their suits, going at each other because basically they didn’t trust each other and they couldn’t agree. And I still think that there is a sense, particularly in the private sector, but the voluntary sector might agree, that there is a lack of trust, a lack of belief that they’ll deliver and in the private sector, of course, a belief that it’s all driven by profit. You may disagree with me.
It might be useful here to introduce the concept of public value. An idea that attracted some interest having first been developed at the Harvard Kennedy Business School in the 1990’s, this seeks to recognise that there is something special about public services. You could actually draw on something from private business- because of instead of the shareholders being the beneficiaries then you could argue that in the public sector it’s the communities that are the beneficiary and that the value is the value provided to all citizens. It puts a focus on outcomes and it sees managers as entrepreneurs, recognises their expertise and does recognise the political context in which they operate. And in developing the model, More, who took some of the ideas further, says that ‘public managers should be explorers, they should propose ways forward and should then be judged on their results. Much as private sector managers aim to create value in their company by maximising long-term shareholder wealth, the judgement of value within the public sector should be made by the public’. And he goes on to suggest a system of measurement which could be instructed to measure success which would liberate managers to be entrepreneurial without having to wait for the slow and sometimes painful process of political authorisation. I think that’s quite exciting but how realistic. IS something you may want to talk about. He proposes that measurements would include things like value for money, how taxes are spend, quality of services being received, levels of customer service, but he doesn’t reach any conclusion.
Now I know these ideas have attracted a lot of political interest across the UK but I’m not sure how far they’ve been developed. And some people might argue that in fact these are things that we already measure and we’ve already got some sense of measuring public value. How do we feel about the major judgement being that of the public? I think that’s an interesting question in the light of some of the people and communities that local authority, social services departments work with and it led me to think about the tensions the sector faces between national and local, local and community and community and individual.
So to summarise, we live in a climate of mistrust of public services, public servants and professionals and the response to that has been to seek control, to impose sanctions, to make organisations and individuals more accountable to inspection and regulatory regimes. The critics would argue that this is far from bringing improvements, what it’s done is inhibited and restricted professionals, made them responsive to what the regulators want and can measure. And I would ask the question, might it be better to be more accountable to the public, to our communities than to regulators?
I want now to turn our focus to social work and social care, as I said earlier we are noted for innovation and good practice but somehow this gets lost in the discussions about what went wrong. Liz Kendall and Lisa Harker in their opening chapter in the volume Welfare to Wellbeing argue that social care has lost its strategic focus, it’s become overly concerned with process rather than outcomes, it’s tented to be crisis driven rather than preventative and its mistakes gain a very high profile, particularly those in child protection. And I wondered whether in fact we are singled out as a service and profession and I don’t have an answer to that, again you might want to think about that. And what we might learn from others e.g. the oil industry or the aviation industry. I remember a master class run by Lord Brown in the then Scottish Executive when he was Chief Exec of BP and he talked about how BP was managing risk at the time and he emphasised the delegation of responsibility for risk down to the local level but you could not centralise and control risk from the headquarters of BP, particularly when BP was a global industry. You had to give management of risk to the local oil fields, to the local managers. I thought that was quite interesting.
And the other one that I think some of you may well be aware of and have been part of discussions, particularly if you were involved in some of the work around the 21st Century Review which is the air traffic control industry’s approach to risk. Air Traffic Controllers have apparently developed a culture which encourages the Traffic Controllers to learn from near misses and mistakes and encourages them to report them. So apparently at the end of shifts they talk about what’s happened and their management allows them to actually be open about what’s been happening and about the near misses. And apparently that culture, I am told, has been passed down from Chief Executive to Chief Executive so that it’s continued even though there’s been changes of Chief Executive and I know the Practice Governance Group in 21st Century Review has actually had people from the air traffic industry to actually talk to them about the learning from mistakes and about how you develop that culture.
But going back to our criticisms because of this focus on crisis and on being reactive what Kendall and Harker argue is we’ve now created a profession, a workforce and a sector that lacks confidence and influence and there’s a perception that our voice in national debates or our contribution to social policy is not as great as it might be and we are much less visible than the NHS or education. Now I think the general election at the moment might well be changing that, which is interesting if any of you were watching the debates last night and I have owned up to saying that I watched them a bit and then I kept switching back to the football because I wanted to see if Liverpool were winning or not. But I did hear some of the debate about Carers and it is interesting. I don’t think in previous general elections you’d have had social care being talked about, but it’s only I think a first step.
The challenge of a voice for social work is not new, it goes back to the Barclay Report and some of you may have been around long enough to remember the Barclay Report. The Barclay Report was a review of social work several decades ago. But it’s interesting if you go back to that you find common themes and concerns and thoughts expressed. It struck me when I re-read it how relevant it was and I’ll just quote you one of its messages, ‘in spite of all the complexities and uncertainties surrounding the functions of Social Workers we are united in our belief that the work they do is of vital importance in our society, as it is in other modern industrial societies. It is here to stay and Social Workers are needed as ever before’. And if you go and read the 21st Century Review or England’s Social Work Task Force you’ll see those thoughts echoed. What you’ll also see if the same messages about Social Workers arguing too little contact time with clients, too much admin, too much bureaucracy. So over the decades the messages and the complaints don’t seem to have changed.
Liam Hughes in his chapter in the volume Welfare to Wellbeing speak of social work being forced into reactive mode and emphasis is shifted to one of assessment, case management, rather than providing therapeutic interventions. And the fear of making mistakes and being publicly pilloried has reinforced this trend. I mean how often have you heard Social Workers that you come across talk about not being able to do real social work, not being able to do direct work with children, in fact in some senses forgetting how to do it. And that’s what Liam Hughes argues that this has done is it’s actually narrowed the skill base and so rather ironically instead of Social Workers and Care Workers helping individuals to reconnect to their families and communities the primary responsibility has actually been to allocate statutory resources and what that means is intervention achieves the very opposite of what workers are trying to achieve which is to empower individuals, encourage independence, instead it creates dependencies.
Now I’m conscious that practice in England has moved much further away than in Scotland and in fact I think their Task Force Report, if you read it, is seeking to regain lost ground, they’ve suddenly in England rediscovered social work and if we want to be positive we can at least say that we’ve never really lost sight of it, it may have lost its direction a bit but it’s never been - it’s never started to disappear off the map in the way it has in England.
Dom Brand undertook on behalf of the 21st Century Review an examination of the need for social work intervention. In doing so he asked the questions, what is the core purpose of social work, whose needs are being met and what’s its contribution? And his answers identified the conflicts, contradictions and tensions that surround social work. There are mismatches in how practitioners and their managers define their roles and responsibilities. In service users’ experiences and expectations and how policies and procedures shape what they do. And there were real fears coming from Social Workers about how other professionals had encroached on their territory, you know, worried about in particular what Nurses and Health Professionals are getting up to, which some Social Workers would say is really their job.
Morale in the workforce is an interesting issue, it crops up over the years and again if you go back and the Barclay Report you’ll find discussions of low morale among Social Workers, familiar complaints about not being able to do real social work and discussions about what they should be freed up from doing and much of this is repeated in the 21st Century Review and echoed in the England Task Force. And to quote the Barclay Report, ‘but it is clear from what Social Workers told us that their morale and sense of purpose is gravely effected by the role in which they are thus cast of being the last resort or as some put it the dust bin’. And very similar things were said by Social Workers who came and talked to the 21 Century Review Group in Scotland.
Dom Brand talks of a profession that has sometimes shown all the signs of being a depressed and anxious profession, often bogged down in the same sterile debate about whether or not it is truly a profession, whether it is simply an arm of the state, whether it has a proper evidence base for its work and why it does not enjoy greater esteem. He also talks of workers feeling left to do what other professionals don’t want to do and I know that’s a common theme and I - at one time I probably felt sympathy for that and I was beginning to wonder as I was doing this whether, whether that was really a bad thing or not or whether that was part of social works purpose and being there for people when nobody else was, was perhaps something we could be proud of rather than be negative about. And Dom Brand asks should we be worried about having the same old debates about what Social Workers are doing or should do, is that healthy? And I would ask, do we think its okay, is it time they moved on? And it’s interesting when you look at the debates surrounding the establishment of the National Social Work College in England where again the same gap is identified about the lack of a strong voice or identity and the need to boost the morale of the profession.
So just to summarise, some of the weaknesses identified in the profession and the sector, I would argue are, it lacks a strong voice and ability to influence debate, it lacks clarity of focus and purpose, it lacks a focus on outcomes, too much attention on processes and procedures, it lacks confidence and there’s low morale in the workforce. It lacks a culture of evaluating practice of what works, it lacks a research base. And I would ask the question, what is going on in the research community? Is social work and the care sector influencing it or is it driven by academia? And we could have a very interesting debate about a whole other regime about chasing stars in the university sector and what that’s particularly done I think for social work, education and evaluating practice. What all of this does is leave us ill-equipped alongside other professions or our critics to explain what we do, how it makes a difference and why it matters? Now I think we know that practicing social work effectively and being a Social Care Worker is very demanding work and I think this is increasingly recognised and I think it’s recognised that it requires high levels of knowledge and personal qualities and to some extend Scotland has recognised that through the redesign of a social work degree, to setting up Iriss, to actually looking at what qualifications Care Workers now need and recognising the importance of learning and development.
What Dom Brand in his report does is he summarises some of the knowledge and the qualities that workers need; ‘they need to be able to apply core values as the basis for their decision making; they need to have a capacity for tolerating uncertainty; to be mature individuals with a clear sense of identity; have good emotional intelligence with an ability to establish relationship in situations of challenge and risk; have clarity in assessing and responding to complex situations, relationships and in dealing with risk; be flexible and creative; have intellectual curiosity and accept a multiple and sometimes competing set of accountabilities’. Now you can actually see that if that’s how you see your Social Workers and your Care Workers that some of the things I’ve been saying there is a little bit of a mismatch.
Let me just say something briefly about accountability and the professional Social Worker. I think several authors comment, the Barclay Report, Dom Brand and Pinko and his Alternative Report to the Barclay Report, Social Workers operate within political democratic structures and as such they’re accountable to their leaders, to their organisations, to their managers for how they exercise their professional judgement and for the use of resources. And Social Workers have for a long time had to work in this situation and have been responsible for allocating and rationing resources. You know I would argue its part of the job; it’s the reality and if Social Workers moan about it, you know, you have to say get real. But how far do these different levels of accountability create tensions and dilemmas? What’s the balance between accountability to employers, to service users, to the local community and to national priorities and again that’s a question you might want to come back to me. It seems to me there’ll always be tensions between professionals and those who employ them and that’s not confined to Social Workers. If you work in local authorities then you’ll have come across Architects, Planners, Solicitors, Doctors in the NHS who are constantly having to deal with this tension of being a professional with a set of professional values and working in accountable structures.
Barclay argues that we should be much clearer about the individual responsibility of the Social Worker, and then trust them to get on with the job. Give them support, ensure they have the protection of senior managers, but also give them greater delegation and discretion. Pink would probably disagree, he saw the role of Social Workers are much narrower, he didn’t care for notions of Social Workers working in communities and community development. He probably wouldn’t have met with much favour here in Scotland I suspect. But he does raise issues about how far Social Workers can manage the tensions between individual and local and Brand echoes this. And I think the 21st Century Review looked at how Social Workers and workers might do this and that was one of the reasons for setting up the Practice Governance Group.
Most critics of regulatory regimes argue that elaborate controls are not the way to deal with professionals. What you should be doing is setting down formal recognition of responsibility, trust them and give them support and protection, particularly protection of Senior Managers and that’s the way forward. It would be interesting to know whether you think Scottish Government’s recently published Guidance on the Role of the Chief Social Work Officer and of the Social Worker has gone any way to meet this sort of demand. And I think there is a very interesting issue about how far both local political structures and national structures can take the sort of steps back that that model implies.
Professor O’Neill argues that accountability is necessary and even desirable but current - what she calls ‘fashionable’ methods actually damage not repair trust. What she argues is that if we want greater accountability without damaging professional performance we need what she calls ‘intelligent’ accountability and what she means by this is attention to good governance and fewer fantasies about total control. ‘Good governance is possible if institutions are allowed some margins for self governance of a form appropriate to their tasks within a framework of financial and other reporting’. She goes on to say, ‘such reporting I believe is not improved by being wholly standardised or relentlessly detailed and since much that has to be accounted for is not easily measured it cannot be boiled down to a set of stock indicators. Those who are called into account should give account of what they’ve done, of their successes and their failures to others that have sufficient time and experience to assess the evidence and report on it. Real accountability provides substantive and knowledgeable independent judgement of an institution or a professional’s work’.
So to summarise, what seems to be being argued is of course we need accountability but unless it focuses on the right areas, calls to account on successes and failures, allow managers some scope to talk about these and leaves professionals free to practice, intervention will not be effective and new ideas and ways of working will be stifled. So a question for you, can we build our new regulatory regimes around this notion of intelligent accountability? It would mean trusting managers and professionals and creating opportunities to talk about near misses, failings as well as successes.
I just want to touch very briefly on the regulation of individual workers. In some of the earlier literature one of the weaknesses identified was lack of sanctions for individual professionals. This was long seen as influencing how they were perceived by other professionals, their status and their confidence. So argument goes, introducing regulation would improve standards, raise status and increase public confidence and I guess through that actually encourage workers to practice more openly and feel free to try things out. Now the regulation of Doctors, Nurses and Health Professionals is well established and understood both by the professionals themselves and I think to a large extent by people who use health services. The individual professionals accept it and own it but I have to say in Health it is a membership driven system. Its weaknesses are seen as the profession regulating the profession and the profession looking after itself and giving little voice to patients and users. But following the high profile cases like Harold Shipman’s, steps are being introduced to shift the balance to separate the processes of regulation and sanction and to give greater weight to non-professionals. But I did wonder whether regulation of Doctors for instance over the years has stifled them trying out new medical interventions, my thoughts were, no I don’t think it has. I don’t think new medical procedures haven’t come on because the Doctors have been worried about what might happen to them if they get it wrong.
Now we know that regulation of Social Workers is relatively new and I think it’s much too early to draw on detailed evidence and there’s no doubt that regulating a wide-ranging workforce is challenging and it’s always going to lead to debates about proportionality. I just want to focus briefly on Social Workers and some of my thoughts about introducing the new system. Despite being told over many years that the profession wanted and supported regulation but didn’t immediately embrace it and didn’t grasp its implications or its benefits. So we often seem surprised by some of its requirements, particularly if they were subject to a complaint. Having said that it is a very small percentage of complaints that led to removal. But what was coming to light was poor practice and complaints that often revolved around communication, limited information being given, service users not liking decisions and in a sense that I think showed that certainly some clients were not trusting their social work. And of course this trust and mistrust gets tangled up in their organisations. I did ask myself the question, did I think this new system of regulation of workers had made them fearful of trying out new things and I don’t think so but I’d be interested to hear if you said so. I can’t imagine a worker embarking on a piece of work and saying, ‘if I do this will it affect my registration?’ It might make them think about their wider activities and how they behave in an out of the workplace and that seems to me no bad thing but has it made them feel more valued, give them a stronger identity and make them more confident? I doubt that yet. But what the experience has highlighted and this won’t surprise you I don’t think, is the important part that management practice and organisational culture plays in professional conduct. When the regulatory bodies, Care Commission and Inspection Agency in the Council compared notes we found the same organisations were raising concerns for us. So if a workers conduct was in question they were likely to be working in organisations whose services were of concern and overall performance wasn’t good. Is this a case of too much regulation, focus on meeting demands of the regulators or not enough attention to what really matters?
What I do think we need to focus on and be careful about is duplication of activity, multiple checks on individuals, adding to the burden of regulation, because that, I think, has the potential to stifle innovation, to inhibit change and that’s particularly, I think, going to be testing in a tight financial climate. But we shouldn’t see the regulatory system in isolation from how workers are trained, developed and supported to undertake their duties. And we could have an interesting debate about how we regulate the education and training of workers and whether we’ve got it right. It has been designed to ensure we deliver practitioners, particularly Social Workers who can practice safely and effectively and we’re beginning to see some evidence of that because employers were starting to tell the Social Services Council that the students coming out of the courses were of better quality, better educated and felt a bit more competent than in previous years.
I now just want to move on finally to some thoughts and key messages and think about where we go from here. Both the England Social Work Task Force and our own 21st Century Review set out a clear vision for where we need to be and what they argue is we need a workforce and a sector that’s confident about its values, purpose and identity, works in partnership with service users, works cohesively with other professionals, demonstrates impact and effectiveness, is committed to continuous improvement, is understood and supported and is well led. The 21st Century Review in particular focussed on the need to develop individual practitioners as leaders. So its concept of leadership was not just about the people at the top or even the people in the middle, it was everybody. So a Homecare Worker was just as much a leader in their work area as a Social Worker as a Team Leader as the Director of Social Work or the Chief Executive. But we need to build a knowledge base and skills and the same messages again about creating a confident professional sector. And I want again to pose two questions here for you to think about, do you think social work and social services and the care sector has an identity and do you think it’s a universal service? It seems to me we are moving increasingly in the direction of being a universal service and that might be an advantage because in a sense I think some of our ‘being pushed to one side’ is because we’re not seen like education or health or something where the majority of the population comes in contact with. But if you think about it with the growing numbers of older people and people with disabilities and I think with the early intervention strategies, wider numbers of children and families coming into contact, I think, increasingly you could see us moving to be a universal service. And maybe if this was better understood and articulated we’d cease to be a ‘Cinderella’ service, or to feel like ‘Cinderella’s’, and we’d develop an identity and make an impact.
So here are some key messages from me what I think we need to do:
Build and strengthen the identity of the sector with a focus on purpose and what we are trying to achieve. This I think would give it a louder and stronger voice in national and local arenas and debates; build and strengthen the identity of the workforce; reinforce the values and principals by which we practice. And I think actually you could use regulation to do that, not rely on regulation only to do that, but use it; build a confident workforce through a focus on learning and development. A confident workforce with a strong identity will I think learn to work effectively with other professionals across boundaries.
I think it is lack of confidence that gets Social Workers tangled up in encroachment from other professionals. It was interesting, in my past I’ve worked with Hospital Social Workers who I think were pretty good at being clear about what they did because they worked in a multidisciplinary setting they learnt how to stand their ground, make their case, argue what it was they could offer to Consultants and to Nurses and I think that was quite powerful and I think this would actually assist workers to practice in a climate of change. I think it’s really important that we learn through case discussion audits, routinely looking at cases and we learn from other professions and businesses and from other countries. And whilst I think we can learn from other countries I want to inject a note of caution here because I think we need to be careful, and I was talking to somebody earlier about this, about not transposing simply what other countries do because we like it and I think that’s the danger. People get very excited about what’s going on in America, what’s going on in Scandinavia and simply think you can move it. You can move it as long as you understand the cultural context and the example I’ll use is the one I was using earlier this morning in my chat with somebody, is Social Pedagogy, some of you may know that children in Scotland are pushing this model and in particularly in pushing what happens in Denmark and across Scandinavia. Now they start from a very different attitude to children and to their Childcare Workers. If we were to bring that to Scotland we need to do quite a lot of work to actually change how we think about our children and we need to value our Childcare Workers, our Residential Childcare Workers more.
In thinking about learning from cases, I just wanted to mention briefly some work that SCIE (Social Care Institute for Excellence) has done. It’s been looking at a systems approach to serious case reviews and it argues that what you should do when you’re looking at what’s gone wrong in serious cases. They were looking at child protection cases, to understand what at what factors in the work environment support good practice, what creates unsafe conditions and to put the focus on learning and what they argue is - they feel very frustrated about all these reports on child protection mistakes that express amazement when things go wrong. It’s almost as it they think people start their working day by wanting to get it wrong and what SCIE says is you need to start from the basis that people don’t start out to get it wrong and the decisions they made at the time seemed to them to be the right ones to make. They turned out not to be the right ones but it’s not that they started their working day saying ‘lets get it wrong’. It argues this system for better explanations of why things go wrong and perhaps more importantly, going back to where I started, more importantly about why it goes right more often than it goes wrong. So it actually asks you to take a slightly different approach to looking at cases. And ultimately what the SCIE approach says is if you look at cases, right, what you’ll see is changes required at all levels not just the front line. So just pointing the finger at the front line Social Worker and changing that won’t change things.
We need to build a research and evaluation base. We need a better understanding of what works and what makes a difference. This will strengthen arguments and clarify purpose and improvement will come with collecting knowledge and with using it. We’re at a disadvantage at the moment because we don’t have sufficient research and practice evaluation that helps us stand up and account for what we do and that’s where I think we’re in a weak position compared to say the NHS.
We need to shift the focus to outcomes, to what we’re trying to achieve, how we know this and again I think this will give the sector a voice.
And finally I think we need to focus on the health of organisations, quality professional practice will flourish in an environment where workers feel supported. They’ll feel able to try out new ideas if they feel the culture of their organisation, the management and leadership in their organisation is giving them permission to do that and is by definition is giving them permission to maybe not always get it right. It was very interesting when the Council embarked on a piece of work around the continuous learning framework and we focussed initially on what was the learning and development needed for individuals. After the first round of consultation workers came back and said, ‘what makes a difference to how we can practice is whether our organisations allow us to practice how we’re managed’, so it is about what the culture of the organisation is. So health of organisations is very important and this also means I think developing and supporting managers and leaders.
So let me leave you with four final questions and a piece of advice from John Seddon. So the questions first:
In all of this debate about professional accountability and autonomy, and I haven’t spent much time talking about the growing movement towards citizen leadership and user involvement but I hope it’s been running through - do you think there’s a tension between increased client autonomy and professional accountability?
How far do you think the current social care system allows professional judgement, experimentation, trying out new ideas and what works?
How far do you think its organisational structures and organisational health, not regulation that inhibits innovation? Where would you put your money?
Does choice act as a lever for improvement or is it regulation that is a lever for improvement?
So those are the four questions I’m leaving you with.
And the piece of advice from John Seddon, ‘if you’re worried about whether your service is subject to problems and might not be getting it right, go and look for yourself don’t ask for a report’.
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