Efficiency, effectiveness and the misrepresentation of social

work: designing humane services

Sue WhiteProfessor of Social Work (Children and

Families)University of Birmingham

.... Services have become so standardised that they do not provide the required range of responses to the variety of need that is presented. This review recommends a radical reduction in the amount of central prescription to help professionals move from a compliance culture to a learning culture, where they have more freedom to use their expertise in assessing need and providing the right help (Munro 2011)

What went wrong?

Real Problems (which persist, internationally)....

A Nugget of Pure Green?

It should look more like this.....

And one of our successful exports....

Assumptions of Policy Responses

• People need extrinsic motivation to do a good job

• Strong top-down management is the key to quality and performance;

• Standardisation of processes and explicit targets drive quality – ‘doing simple things right’,

• That errors are a result of professionals failing to share or record information

• Efficiency is privileged over ‘reliability’

• Confidence privileged over trust

• Managing institutional risk is the policy priority

Social work is politically charged and this creates the problem of hubris.....

Strong but wrong solutions – BLAME

The ‘Front Door’ of Children’s Services

Team leader: There are 50 contacts in your inbox . . . you are under pressure because you have to clear them by the end of the day . . . and the question of whether you are more likely to close them in these circumstances? Well yeah . . . so, really we are looking to close cases not open them . . . that’s why we work to the highest thresholds.

... Looking back, something will always be found which would seem to provide advance knowledge of impending catastrophe. But to be sure that this evidence is decisive, we need to know how often it was present in other cases but did not lead to calamity. Designing on the basis of retrospective correlation is a recipe for disaster, intrinsically linked with magical thinking, but unfortunately in the domain of child protection it is the norm (David Wastell, Managing as Designing in the Public Services, 2011).

What about the human factors?

DR SCHWARTZ: I cannot account for the way other people interpreted what I said. It was not the way I would have liked it to have been interpreted.

MR GARNHAM: Was it not known to you at the time that that is the way social workers and police officers would treat the opinion of a person as eminent as yourself?

DR SCHWARTZ: In the past, when we have had problems like this, we have had discussions directly, and I would have explained why I reached my conclusion with regard to scabies. I would have hoped that they would have heard what I was saying about other aspects about which we were concerned.

(Victoria Climbie Inquiry, 2001, http://www.victoria-climbie inquiry.org.uk/Evidence/Archive/Oct01/121001latestp3.htm: emphasis added)

“Whoever I talked to made it a lot more complicated, actually, because I thought that whoever I talked to would come in and see her and it would be very straightforward. But it was not” (Dr Dempster, Junior Doctor)

Dr Dempster followed up the conversation with the following letter:

“Thank you for dealing with the social issues of Anna Kouao [Kauao was believed to be Victoria’s mother and Victoria was known by Kauao as Anna]. She was admitted to the ward last night with concerns re: possible NAI[non-accidental injuries]. She has however been assessed by the consultant Dr Schwartz and it has been decided that her scratch marks are all due to scabies. Thus it is no longer a child protection issue. There are however several issues that need to be sorted out urgently:

1) Anna and her mother are homeless. They moved out of their B & B accommodation 3 days ago.

2) Anna does not attend school.Anna and her mother recently arrived from France and do not have a social

network in this country. Thank you for your help.” (cited in Laming 2003: 251).

Signal and noise

She has however been assessed by the consultant Dr Schwartz and it has been decided that her scratch marks are all due to scabies. Thus it is no longer a child protection issue. (SIGNAL)

There are however several issues that need to be sorted out urgently (NOISE)

Knowledge sharing in complex organisations

Social hierarchy, accessibility, psychological safety and trust

Knowledge is both ‘slippery’ (difficult to codify) and ‘sticky’ (difficult to share across cultural or institutional barriers)

This will not respond to simple exhortations to ‘share information’!

So, systems must be Designed for the Right Species

• Information processing• Emotion/moral judgement• Group think, bystander effect (thanks to Paula

Doherty)

Designing systems for the right species can be easy

SituationBackgroundAssessmentRecommendation

So what has changed post-Munro

Centrally – absolutely nothing at all

Locally – tentative steps towards bolder design aspirations....

Research, Accountability and Outcomes

• Munro stresses the need for different models for judging service effectiveness

• Inspectorates are still working within a output-focused paradigm• Resources are sucked out of provider agencies by excessive and unfunded

data demands• Proxies for success (e.g. Narrowly specified activities which stifle

innovations for providers; indicator sets, payment by results)• Interrogate claims that interventions are evidence based• Children, young people, families and providers can help identify indicators

Get the design wrong and you end up trying to sweep with this....

‘Quality Culture’ and the Learning Organisation

Argyris ‘defensive routines - sustain established patterns and are so taken–for-granted they are difficult to spot.

‘To retain their power, defensive routines must remain undiscussable. Teams stay stuck in their defensive routines only when they pretend that they don’t have any defensive routines, that everything is all right, and that they can say ‘anything’ . But how to make them discussable is a challenge (Senge, 1990: 255).

An example?

Increase in numbers of care proceedings is the result of

‘‘better understanding the effect of neglectful parenting due to drug and alcohol problems and the physical damage to ...brain development it can do with very young children’’ (President ADCS)

• Where did these brains come from?• The (still unsettled) evidence from neuroscience does

not point to the unique fragility of the infant brain, but far more to its resilience and plasticity (e.g. Bruer, 1999; Rutter et al 2010)

• Neuroscience is operating as a ‘trump card’ –neuroscience shows we’re right to intervene!

• Moral dimensions of professional decisions are not debated

• This new developmentalism is evident elsewhere in Europe – appealing to both ‘left’ and ‘right’

We have to get bolder, more critical, more confident and more

modest all at once!

We need to bring methodological expertise and honesty to challenge the next version of command and control

PAYMENT BY RESULTS

“Everything should be as simple as it is, but not simpler.” (Albert Einstein)

The trickiest thing is not seeing if the performance indicators are moving, it’s knowing if what we’ve done is making any difference. Yesterday we had the teenage pregnancy stats. Across the country in 2007 teenage pregnancy rose by 2.6% and in Downton it dropped by 15%. What’s that the result of? It could be the result of our work, it could be a statistical blip, it could be less young women got legless and didn’t have unprotected sex over the course of that year. Could be anything, totally random reasons, could be a butterfly taking off in the Amazon jungle, I don’t know (Director of Children’s Services) (Loveless 2012)

Local services can innovate and acknowledge complexity – over to you!