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SOCIAL WORK PRACTICES PILOTS WITH ADULTS:
COMMISSIONING & DEMOCRATIC FACETS
Jo Moriarty, Jess Harris, Jill Manthorpe, Shereen Hussein, Michelle Cornes
PILOTS ANNOUNCED IN NOVEMBER 2010
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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
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THE PILOTS
NE Lincolnshire Suffolk Birmingham Surrey
Stoke Shropshire Lambeth
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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’d Suffolk
• Activ8 taken back in house. Staff TUPE’d Birmingham • First point community interest company. Staff TUPE’d Surrey • 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’d Shropshire • Topaz community interest company funded until 2015. Agency social workers move to
self-employment Lambeth
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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
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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
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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
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FINDINGS Focus on a selection of findings related to the discussion today
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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
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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
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FUNDING
Important to consider what support will be provided and how much
‘Christmas Eve’ shopping analogy Funding timescales are
always very short term
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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
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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
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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
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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
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MAKING THE COGS RUN SMOOTHLY
Identifying training needs
Budgets, financial
advice and accounting
Information systems and equipment
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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?
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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
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STAFF COMPARISONS
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•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)
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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?
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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
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RECOGNISING COMPLEXITY & ENCOURAGING DEBATE
‘All evaluators now understand that what works in Wigan on a wet Wednesday will not necessarily work in Thurso on a thunderous Thursday’ (p xvi)
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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
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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?
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AND FINALLY… Before we move onto the discussion
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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
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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
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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/
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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://w4 ww.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
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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
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