Social Work Practices with Adults: commissioning, accountability, and lessons

SOCIAL WORK PRACTICES PILOTSWITH ADULTS:

COMMISSIONING & DEMOCRATIC FACETS

Jo Moriarty, Jess Harris, Jill Manthorpe, Shereen Hussein, Michelle Cornes

BACKGROUND

Already outlined by Nicky

13 November 2014 Accountability at arms-length seminar 2

PILOTS ANNOUNCED IN NOVEMBER 2010


The practices, which would carry out councils' statutory functions in relation to adults, are designed to reduce bureaucracy for social workers, give them more day-to-day control over cases, improve staff satisfaction and make more flexible use of resources. Putting decision-making and power in the hands of social workers will mean better, more personal care for individuals. Social workers –the people who really know their clients – will have flexibility to create services around their clients. These pilots will explore how the government can encourage social workers to develop fully independent groups contracted to local authorities

CONTEXT

•Wider policy aim to expand public service mutuals

•Adult social care already heavily outsourced•Generally agreed that

competition has helped control prices but less successful at driving up quality

• Includes numbers of people financing their own care


THE PILOTS

NE Lincolnshire

Suffolk Birmingham Surrey

Stoke Shropshire Lambeth


AS OF MAY 2014

• Complicated Care Trust origin. Moved from NHS/LA Care Trust into focus CIC. Staff already TUPE’d (Transfer of Undertakings (Protection of Employment Regulations)NE Lincolnshire

• Sensing change owned by council, plans to be independent by April 2014. Staff TUPE’dSuffolk

• Activ8 taken back in house. Staff TUPE’dBirmingham

• First point community interest company. Staff TUPE’dSurrey

• JMC healthcare community interest company back in house. Mix of staff – some owners/managers, some TUPE’d)Stoke

• People2people social enterprise has been given funding to 2015. Staff TUPE’dShropshire

• Topaz community interest company funded until 2015. Agency social workers move to self-employmentLambeth


VERY IMPORTANT

• Information on sites was public knowledge

•Some accounts identify particular pilots

•BUT

•All information presented here is not identifiable to a particular pilot, person, or organisation

•Abbreviation SWPwA refers to Social Work with Practices for Adults


METHODS

A quick overview


DESIGN & METHODS (1)

•Case-control follow up design

•Outcome and process evaluation

•Mixture of qualitative and quantitative survey data collected between September 2011 and December 2013• Staff, managers, NHS, voluntary sector, users and carers (details at

end of presentation)

•Compared experiences at start (T1) and 18 months later (T2)• 50 interviews T1• 79 interviews T1


DESIGN & METHODS (2)

•Survey sent to practitioners in:•Social work practices with adults (SWPwAs)•Other staff in local authority•Staff in three comparison sites not involved in SWPwAs•2978 replies in total (details at end of presentation)•Response rate 42% at T1 and 39% at T2•Resulted in standardized information on burnout (Maslach

Inventory) and job demand-control (Karasek’s Job Content Questionnaire), time allocation, views on SWPwA and other information


FINDINGS

Focus on a selection of findings related to the discussion today


DIFFERENCES

•Different arrangements •Outsourced from within local council or contracted with existing

voluntary organisation or transfer of Care Trust work

•Different structures•Community interest company – comparatively recent development

and some differences to being a registered charity

•Wide differences in scope and activities undertaken between different pilots

• ‘Messy’ in research terms but reflects reality


MAINSTREAMING START UPS

•Received some start up funding and access to advice paid for by Department of Health•For example, access to SCIE

& other consultants

•Challenge when developing something outside structure of ‘new’ pilots or pioneers


FUNDING

Important to consider what support will be provided and how much

‘Christmas Eve’ shopping analogy Funding timescales are

always very short term


There was approximately £10,000 taken for IT support. There is something like £15,000 taken for database support.

There was a lump sum taken for accountancy support from the council. I don’t know exactly what that all adds up to. But, thankfully, we’ve been left with an adequate amount of money. I think

we’ve actually needed the time to use it

ADVICE FROM THE OTHER SIDE OF THE FENCE

Organisations bidding for contracts may be tempted to under cut unavoidable costs

Contract departments need to set ‘fair’ rate Risks of organisation failing

Need to control costs


But maybe, we went too far the other way to prove that we weren’t being

given any special resources ... We were all buying our own kitchen

equipment and changing the toilet seats and all the rest of it and

cleaning … We did everything. It was, in some ways, it was too much.

.

INFORMATION TECHNOLOGY AND RECORDING SYSTEMS

Challenges of linking with local council IT systems Access to individual records

and how to record information

Wider issues of how to gain benefits from new technology

Very difficult to measure community development


Trying to be creative, we thought okay, we are going to ask if we can have Skype or similar for reviews … We were told we couldn’t have Skype because of the risks … It’s taken us ages really to get an [alternative] system … We still haven’t been able to set it up properly

ACQUIRING NEW SKILLS

Culture change in moving from a large organisation to a smaller one

Opportunities to learn through University of Bristol and SCIE meetings

Most learning from each other and from the LA commissioners


What we’ve really had to do and learn how to do … was about the HR side. Stuff that as a worker in the council, you don’t ever have to consider … HR say, ‘Right, these are the

forms you’ve got to fill in when you are shortlisting people for jobs and you have to read through them and you mark them and this and that and the other and hand them

back. We’ve had to develop our own HR system. So that’s been a real learning curve

THE LOCAL/NATIONAL DIVIDE

•Considerable sums spent on legal advice•Participants thought this

could be better provided if they had had access to national resource•Contracting out needs

resources• For instance VAT, human resources

(HR), responding to complaints, avoiding legal challenge

• Few SWPwAs controlled any money


MAKING THE COGS RUN SMOOTHLY

Identifying training needs

Budgets, financial

advice and accounting

Information systems and equipment


LEADERSHIP

Enthusiasm and commitment of individuals was a key theme Within the SWPwAs

themselves

Among those whose role in council was to help the SWPwAs work

How to channel this more widely?


I am passionate about social work and social care and doing the best for our

communities and I think it’s better served outside of local authority

control than inside of it. And we save money by doing so, which has got to be a good thing for the community as well

ASPIRATIONS AND REALITY

Intended outcomes

•Assessments would be quicker and less bureaucratic

• Savings would be made when compared with standard LA

•Would improve service quality

•Could build up better relationships with service users & carers

Reality more nuanced

•Most budgets not devolved so impact more muted

•Complex systems made it hard to identify costs

•Clearer for specialist SWPwAs

•Over time, social workers felt they were not spending enough time with clients


STAFF COMPARISONS

11/09/2014 Kingston University, Social Work Seminar 22

•Many of the SWPwA staff viewed working in a new organisation positively • They had made a positive choice to move

•SWPwA staff had lower levels of burnout (but started out this way)

•SWPwA staff had greater levels of autonomy (but started out this way)

•Work satisfaction high but also experienced uncertainty about pilots’ futures

ROLE OF COMMISSIONING

‘One key finding of this study is that the quality of commissioning is important to an enterprise such as a SWPwA’ (p 135)


TIMESCALES AND PRESSURES

•Local and national election cycles

•Funding cuts

•Most participants thought timescale for evaluation was not long enough•Would a longer timetable

have made a difference to outcomes?


READ ALL ABOUT IT…

•Final report •275 pages long•6 page summary too!

•Updates on: http://www.kcl.ac.uk/sspp/policy-institute/scwru/res/roles/swpa.aspx

•Follow @scwru on twitter


http://www.kcl.ac.uk/sspp/policy-institute/scwru/res/roles/swpa.aspx

DISCUSSION

Some aspects for us to discuss


RECOGNISING COMPLEXITY & ENCOURAGING DEBATE

‘All evaluators now understand that what works in Wigan on a wet Wednesday will not necessarily work in Thursoon a thunderous Thursday’ (p xvi)


SOME SIMILAR THEMES

•SCWRU study of social care practice with carers

•Challenges of complying or going under•Risks to traditional roles in

campaigning or advocacy•Balance between ‘innovative’

and established organisations•Value of local authority

support


TAKING LESSONS FORWARD

•Outcomes depend on the measures of service quality that will be used• Continuity of support? Specialist services and so on

•How can local democracy relate to outsourced services (for example, large regional voluntary sector or private sector)?• One SWPwA already doing work in another LA outside region; another wanting

regional work

•What does/should remain in house?• None of the pilots took on responsibility for hard financial choices. Only one did

safeguarding

•Hard to answer some of the policy ‘holy grail’ questions, such as reducing costs/bureaucracy or improving integration• Could SWPwAs be a challenge to integration?


AND FINALLY…

Before we move onto the discussion


THANK YOU …

• Practitioner, manager, consultant, voluntary sector group representative, service user and carer participants, staff at Social Care Institute for Excellence (SCIE) , colleagues from University of Bristol, members of Project Support Group, and other stakeholders

• Thanks, too, to the local authorities that volunteered to act as comparison sites for our surveys, to Rose Marie Bennett who assisted with interviews and to members of the Social Care Workforce Research Unit’s User and Carer Advisory Group

• To you for listening


ACKNOWLEDGEMENT AND DISCLAIMER

•This research was funded by the Department of Health’s Policy Research Programme. The views expressed in this report are those of the authors and not those of the Department of Health


SOURCES

Slide number Source

1 Image from SCIE Social Work Practices website: http://www.scie.org.uk/workforce/socialworkpractice/

3 Speech extract from Community Care, image ITV news

4 Mutuals Taskforce report: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/61776/Public-Service-Mutuals-next-steps.pdf

6 Update on pilots from Community Care with information on staff added: http://www.communitycare.co.uk/2014/05/28/next-steps-adult-social-work-practice-pilots/

13 SCIE Social Work Practices website: http://www.scie.org.uk/workforce/socialworkpractice/


SOURCES (2)

Slide number Source

18 Photograph of Gray’s Inn

23 LGIU report on commissioning: http://www.lgiu.org.uk/outcomes-matter-effective-commissioning-in-domiciliary-care/

25 Final SwPA report available at: http://w4ww.kcl.ac.uk/sspp/policy-institute/scwru/pubs/2014/reports/Social-Work-Practices-w-Adults-FINAL-EVALUATION-REPORT-2014.pdf

28 Fragmentation and competition: http://www.ingentaconnect.com/content/tpp/vsr/2014/00000005/00000002/art00007


INTERVIEW PARTICIPANTS

Stakeholder interviews # at T1 # at T2 Total

Pilot lead/manager 9 8 17

Social worker, pilot 10 11 21

Host commissioner/lead 11 7 18

NHS 5 5 10

Voluntary sector 11 9 20

Consultant to LA 4 1 5

Service user & carers n/a 38 38

Total 50 79 129

11/09/2014 Kingston University, Social Work Seminar 35

SURVEY RESPONSES


Staff survey # at T1 # at T2 Total

Host 988 771 1759

Comparison 548 399 947

Pilot 109 163 272

Total 1645 1333 2978

Social Work Practices with Adults: commissioning, accountability, and lessons

Healthcare

Transcript of Social Work Practices with Adults: commissioning, accountability, and lessons