A Quality Strategy For Social Care
Contents
Chapter
Page
Foreword by Mr John Hutton (Minister of State for Health)
3
Introduction
•
•
•
•
4
5
9
9
9
The modernisation imperative
Tackling inconsistency, promoting excellence
Delivering excellence at local level
A more skilled and competent workforce
Section 1. Tackling inconsistency, promoting excellence
– the Social Care Institute for Excellence
Setting standards
•
Improving regulation
•
The Social Care Institute for Excellence
•
Establishing the knowledge base
Producing authoritative guidelines
Dissemination into practice and
The structure of SCIE
Questions
for consultation
•
Section 2. Delivering excellence at local level –
accessible and individually tailored services
Quality in local services
•
The new quality framework
•
Leadership
Accountability
Continuous improvement
Creating partnerships
Rewarding excellence
Assessing performance
•
Questions
for consultation
•
10
10
11
12
14
17
17
20
21
22
23
23
25
28
30
34
34
35
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A Quality Strategy For Social Care
Section 3. A more skilled and competent workforce
High-quality staff
•
Social work
•
Professional training
Post-qualification training
Future funding
Management training
•
Department of Health Leadership
Development Initiative
Broader workforce planning
•
Questions
for consultation
•
36
36
37
38
39
39
Conclusion
42
Summary of questions for consultation
44
Annex A
Fair Access to Care
Long-term Care Charter
Best Value
Quality Protects
Beacon councils
Social Care Awards
Performance assessment frameworks
46
46
46
46
48
48
49
50
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A Quality Strategy For Social Care
40
41
41
Foreword
Foreword by Mr John Hutton, Minister of
State for Health
Social services, like other key public services, must be able to respond
positively and creatively to rising public expectations. People want social
services to be more accessible, more consistent, and more convenient. They
want them to protect vulnerable children and adults and ensure the safety
of those entrusted to their care. They want them to promote independence.
And they want them there when they need them.
To rise to this challenge we need a new vision and culture in social services.
Social services have serious responsibilities in law, and a duty to carry these
out to the highest possible standards. We need to redesign radically our
approach to delivery, planning, and managing social services, by improving
protection and extending choice, control and flexibility to those who need
these vital services. Some of this work is already underway. But more needs
to be done.
This Quality Strategy offers a way forward: new ideas, new institutions,
new ways of working. Radical proposals – but for a clear purpose.
So I hope people who use social services, those who work in social services,
and those who care about social services will join this new national debate
about the future of one of our most important public services.
Second best will never be good enough. We want everyone who uses and
works in social services to expect only the best.
This is a consultation document and we would welcome your views.
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A Quality Strategy For Social Care
Introduction
The modernisation imperative
‘There can be no greater reward for all of us than seeing social services better
valued in the eyes of the public. That will only be achieved by modernisation. As
people see the culture of social services transformed from a limiting to a
liberating force for some of the most vulnerable in our society, these services will
achieve the popular recognition and respect they deserve.’
Alan Milburn (Annual Social Services Conference, 29 October 1999)
1.
Social services provide vital care, protection and support for millions of
people in every part of our country – rural and urban, town as well as
country. Crucial functions in any decent and caring society.
2.
Yet social services are constantly being criticised. Some of this criticism is
misplaced. Some of it is not. Sometimes the criticism is that services are
not of the highest quality. Staff are frequently untrained or inadequately
trained. Services are often bureaucratic and inflexible, insufficiently tailored
to meet individual needs. Getting access to services can also be a problem,
with health and social services not always operating in partnership, and
with boundaries getting in the way of better care. And some of the most
serious and justifiable complaints are about inconsistencies and variations
in services between one part of the country and another – often between
neighbouring councils. All of these concerns need to be tackled head on,
and solutions found, if social services are to meet rising public expectations.
3.
Many local authorities and other care providers are responding positively,
and with imagination and enterprise, to these concerns. Many are
innovating with new models of delivering services, and promoting
individual choice and independence through direct payments and other
exciting developments. But this is not happening everywhere. It needs to.
4.
Some of these concerns are already being addressed by Government. New
legislation will improve the regulation and inspection system, which will, in
turn, raise standards in care homes and other settings. The Health Act 1999
cleared the way for closer partnerships between health and local authorities,
which will lead to more integrated service delivery. Best Value (see Annex A)
and stronger performance management will also improve efficiency and
effectiveness as well as local accountability. The Government, however,
considers that more needs to be done.
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A Quality Strategy For Social Care
5.
This Quality Strategy proposes a number of solutions to these outstanding
issues. It builds on the White Paper Modernising Social Services (Department
of Health 1998) and proposes the next steps forward in ensuring that social
services deliver care of the highest possible quality and standard. In
particular, improving the consistency of social services, the skills and
competencies of the workforce, and the accessibility of social services are key
areas where more action needs to be taken.
6.
None of these reforms will produce results overnight. But it is the
responsibility of Government to set a clear course of travel that provides a
focus for raising the quality of social services right across the board. In doing
this we are setting out a positive and radical vision of what social services will
look like in the future.
7.
Social services can be a powerful force for good in our society. But if they are
to fulfil this role, they must be of the highest quality – not just in some parts
of the country, but everywhere. This is the starting point for all of the
proposals that follow.
Partnerships
8.
The way in which social services are delivered will also be crucial in
supporting the drive for higher quality. As long as patients and users have to
undergo repeated assessments, often undertaken by several different agencies,
and have to move between one organisation and another as part of a complex
navigation around the care system, services cannot be described as being of
the right quality. All too often, this is the normal experience of those who
need the support of the health and social care system. The current system is
too fragmented, with too many organisational boundaries getting in the way
of what should be our principal objective – seamless services where the needs
of patients and users come first at all times.
9.
In future, social services will therefore need to be routinely delivered in a variety
of new settings, such as GP surgeries. They will need to work alongside other
professionals, such as GPs, nurses, community health teams and housing
agencies. Service teams will need to be closely integrated across local authorities
and the NHS; budgets will be pooled together and care will be provided as part
of a fully integrated and effective service.
10.
To achieve this level of service delivery will require a major re-design of the care
system. The essential legislative framework to facilitate this closer working is now
in place. The NHS Plan has set out how we expect closer partnerships to
develop in crucial areas such as intermediate care for older people, and how closer
working can be rewarded and encouraged. These changes provide a positive
5
A Quality Strategy For Social Care
framework within which closer integration between health and social care
services can take place, benefitting service users and patients equally.
11.
It is important to remember what social services set out to do. We want to
ensure that social services:
promote independence, by supporting people to achieve their
•
potential
strengthen
families, by supporting parental responsibility
•
improve the life chances of children in need, including children in care
•
are a dynamic, positive force in tackling inequality and promoting
•
social inclusion.
12.
We must focus on what people want from services. There is now a strong
body of evidence pointing to the qualities people value in social services:
high standards at all levels in service delivery throughout the whole
•
workforce
responsiveness, speed and convenience of service delivery
•
appropriateness – services tailored to individual need, with respect
•
for culture and lifestyle
services that build on peoples’ abilities and enable them to participate
•
fully in society
services that involve the user, so that choices are informed and
•
respected
strong safeguards for those at risk
•
and services which are provided in partnership
coherent and integrated services, where agencies work in partnership
•
and informed staff can guide people through the health and social
care system
multi-skilled teams who can respond more quickly to a range of
•
health and social care needs, not address each in isolation
an
imaginative approach to how and when services are provided, and
•
where services are located, delivering services in new ways and
alongside other care workers.
13.
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A Quality Strategy For Social Care
This evidence must be used to inform the drive for improvements.
Developments such as direct payments, greater access to information,
particularly electronic information, and a culture that emphasises human
rights, will all change the relationship between services and people who use
them. Staff will be working with people who are informed and know what
they can expect. Users’ expertise will be respected. Such empowerment can
only lead to better outcomes.
Box 1. What is important to users of long-term suppor t
services and their carers?
•
•
•
•
•
•
choice about where to live and how to spend their days.
having a say in their treatment, care and support and in the type and
timing of services.
access to paid employment or other meaningful activity.
support to get out and take part in social activities and in running
the home.
sustaining family relationships.
feeling safe and secure in the home and neighbourhood.
Services that reflect these aims need to be:
• responsive and flexible, so they can fit with individual circumstances
• of good quality – staff must have the necessary basic and specialist
skills, and work carried out in the home must be of a good standard
• integrated – staff, rather than users, should negotiate the boundaries
between and within services.
Sources: A New Era for Community Care? What people want from health, housing and social
care services. (King's Fund 1999); Outcomes of Social Care for Disabled People and Carers
(SPRU 1999).
Box 2. What aspects of services are important for
disabled children and their families?
•
•
•
•
•
•
•
high quality – parents need to be confident their children are in safe
hands.
user centred – services that take account of the wishes and feelings
of children.
individual – services that are delivered according to individual need.
sensitive – services that recognise the needs and worries of parents.
flexible and responsive – in how, when and where services are
delivered.
open and accountable – the availability of information is crucial to
parents.
integrated – key workers must ensure good collaboration between
health, education and social services.
Sources: Models of Service Support for Parents of Disabled Children. What do we know? What
do we need to know? (Child 1999); Supporting Disabled Children and their Families (Rowntree
1999); What Works In Services for Families with a Disabled Child? (Barnados 1996).
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A Quality Strategy For Social Care
14.
The active promotion of the Government’s agenda on valuing diversity is
intrinsic to any quality strategy. Services that discriminate or exclude
potential users from their communities are not, by definition, excellent
services.
15.
The agenda for change in social services is further stimulated by the
Human Rights Act 1998, which comes fully into force on 2 October 2000,
and by the Government’s commitment to enforceable civil rights for
disabled people. Both require a change in approach to one that respects
and affirms human rights, and emphasises autonomy, integrated service
settings and social inclusion.
16.
Many workers in social services are already providing an excellent service.
However, this is not the case everywhere. Our aim is to improve quality
throughout. Sometimes cultures can grow up which tolerate second best;
we want to change this, so that quality is encouraged and sustained at all
times. Second best will never be good enough. Our White Paper
Modernising Social Services placed the users at the centre, and reformed
systems and structures. This Quality Strategy is about the people who
deliver the service: frontline workers and their managers.
17.
There are obstacles in the way of the provision of high-quality social care.
There has not been enough reliable information on cost-effective ways of
providing a high-quality service. The skills and training of social services
staff have not kept pace with the demands placed on them, and, at local
level, an inadequate framework for quality improvement has meant that
local authorities have been unable to drive up the quality of social care.
18.
Delivering high-quality social care services is essentially a local
responsibility. The Quality Strategy will set a national framework to help
raise local standards, but this will only be achieved through local policy and
implementation.
19.
Our Quality Strategy therefore aims to enable local authorities to deliver a
better-trained workforce, who can provide flexible, user-centred services
tailored to individual needs. To make services accessible, new local
partnerships across all health and social care services must be forged, so that
existing barriers and blocks are eradicated. Services must be of a
consistently high standard across the country – regional variations in
quality will no longer be acceptable.
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A Quality Strategy For Social Care
Tackling consistency, promoting excellence
20.
We will set in place a national framework to promote excellence. We are
already establishing the National Care Standards Commission and General
Social Care Council. Both of these bodies will help to raise standards.
21.
We are now proposing the creation of a new institution to accelerate the
drive for quality – the Social Care Institute for Excellence (SCIE) – whose
work will inform management, practice, regulation, training, inspection
and review. SCIE will draw together and disseminate what works best in
social care, in order to ensure that social services are no longer a
‘postcode lottery’, lessen the present lottery of care in social services and
to promote greater consistency across the country.
Delivering excellence at local level
22.
The new quality framework will be the mechanism through which local
councils will drive up the quality of social care and be fully accountable for
its delivery. Instituting a new quality framework will mean the creation of
coherent structures and processes – both across local councils and within
social services – and clearly defined lines of accountability.
A more skilled and competent workforce
23.
If social care is to be more responsive, greater attention must be paid to
staff development. Social care staff comprise the single greatest asset
services possess. To make the most of this asset, staff training and
development must be thoroughly overhauled, in order to equip the
workforce for our modernising agenda. Improved training, recruitment and
job retention will have benefits not only for service users, but also for local
councils and for social services staff.
24.
As well as laying out the changes needed within local councils to prioritise
Lifelong Learning, we will consult on the reform of professional social
work and post-qualification training, and on the future development of
other Government-sponsored training initiatives.
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A Quality Strategy For Social Care
Section 1
Tackling inconsistency, promoting
excellence – the Social Care
Institute for Excellence
Summary
•
•
•
•
We will improve consistency by setting standards for social care, and drive
our modernising agenda through the establishment of a Social Care
Institute for Excellence (SCIE).
SCIE will draw together and spread evidence of what works best in social
care. SCIE guidelines will be used in inspections and reviews of social
services.
SCIE’s work will be central to modern social care. It will help local councils
and other service providers take decisions about changing the ways services are
delivered, and help practitioners make better decisions.
SCIE will be innovative in the way it works, making maximum use of
electronic means to publicise and exchange information.
‘Consistent action must now be taken to set enforceable standards of conduct
and practice’
Modernising Social Services (Department of Health 1998)
Setting standards
25.
We will improve consistency in the quality of services by setting standards
for social care.
We will set national minimum standards for regulated services.
•
All standards will reflect what people say they value in services.
•
Local service standards will tell people what they can expect from
•
services and provide a way of measuring improvement in quality.
26.
Through the National Service Frameworks (NSFs), the Department of
Health will set national standards and service models, to be implemented
jointly by health and social services. They will put in place strategies and
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A Quality Strategy For Social Care
service improvements to support implementation, and establish local
performance measures against which progress within an agreed timescale
can be monitored.
27.
The Social Services Inspectorate will set standards for how the local
authority is carrying out its social services functions. These are specific to
each inspection and can be used by local authorities for their own audit
and review.
28.
The Department of Health will provide a framework that local authorities
can use in setting local service standards and criteria, through initiatives
such as Fair Access to Care and the Long-term Care Charter (see Annex A).
Improving regulation
29.
The Government, through the creation of two national bodies, is already
establishing a new regulatory framework for social care, with the aim of
improving protection and driving up standards both in the workforce and
in service delivery.
•
•
Our Care Standards Act establishes a single National Care Standards
Commission, which will be responsible for ensuring that all regulated
care services in this country are provided to national minimum
standards laid down by the Secretary of State.
The Care Standards Act will also create the General Social Care
Council (GSCC), which will increase the levels of safety offered to
service users, their carers and the general public, by regulating the
social care workforce for the first time. The GSCC will also be
responsible for the regulation of professional social work training.
Box 3. How will the General Social Care Council and
National Care Standards Commission make a difference
to users and carers?
•
National codes of conduct and national minimum standards will
mean that users and carers can be more confident that they are
receiving a consistent quality of service.
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A Quality Strategy For Social Care
The Social Care Institute for Excellence
30.
One of the main reasons for inconsistencies in the quality of services across
the country is the lack of reliable evidence about what works best in social
care. There is simply not enough rigorous information on ways of raising
the quality of service, and what information exists is poorly disseminated.
We are therefore proposing to create a new Social Care Institute for
Excellence (SCIE), so that knowledge about what works becomes an
effective force in improving quality.
31.
This will support the implementation of Best Value and assist local
decision-making about the best ways of providing services, taking into
account the wide variety of local circumstances and the necessity to set
local priorities. SCIE’s work will be aimed at achieving a consistent quality
of service; how this is done in practice will rest with local policy-makers
and decision-takers. We are aiming for an environment that promotes
innovation and creativity. There will be different ways of responding to
local needs whilst maintaining good quality local services.
32.
SCIE’s development and dissemination of the knowledge base for social
care will be crucial to the training of social care workers and to the
monitoring and regulation of social care services. As knowledge about what
works in social care develops this can be used to inform the standards
against which services are inspected. These activities will be strengthened
by the existence of sound evidence from which practice and services can be
improved and evaluated.
‘We must unlock the potential within the public service to drive our
modernising agenda right across Government. There is great enthusiasm
and determination within the public service to tackle the problems that
face society, to do the job better.’
Modernising Government (Cabinet Office 1999)
33.
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A Quality Strategy For Social Care
There is no doubt about the commitment within social care to improve the
outcomes for and experiences of service users, but change at a local level
has to be supported by an active programme to spread this knowledge. We
want to ensure that:
this commitment to improve quality is harnessed
•
knowledge is translated into practice
•
unacceptable variations in practice are reduced.
•
34.
SCIE will stimulate change. It will be a major lever in creating a culture
throughout social care that prioritises quality, evidence-based knowledge
and a commitment to continuous improvement by asking:
What is it that social care does?
•
How can we make this better?
•
How can we measure our success?
•
35.
SCIE will do this by:
establishing and developing the knowledge base
•
producing authoritative and accessible guidelines on effective and
•
efficient social care practice and service delivery
ensuring dissemination through creating effective partnerships across
•
the diverse range of organisations involved in the research, training,
monitoring, regulation, commissioning and provision of social care.
36.
SCIE will need to work with the large number of organisations that have
expertise in social care and build partnerships with the NCSC, GSCC, SSI,
TOPSS and other major stakeholders including employers and training
providers in social care. Recognising that individual need crosses
boundaries, SCIE will make links with similar organisations in other
sectors, particularly health, housing and education. In particular SCIE
can work with others to inform new arrangements for closer working
between health and social care services. A defined knowledge base will be
vital in ensuring that social care can work confidently and effectively
alongside partner agencies.
37.
Local councils will ultimately be held to account for the implementation of
SCIE’S guidelines. How this is achieved will depend on local policies and
strategies. Local councils’ progress will be monitored through the
performance management arrangements already in place.
Local councils can make use of SCIE’s work on best practice and cost
•
effective solutions in their Best Value reviews.
Social Services Inspectorate inspections, and Joint Reviews, will use
•
SCIE’s guidelines.
SCIE’s guidelines will inform the National Care Standards
•
Commission’s work to regulate and inspect social care services.
13
A Quality Strategy For Social Care
Figure1. Supporting the quality agenda.
Social Care
Institute for
Excellence (SCIE)
National Care
Standards Council
(NCSC)
• knowledge
• guidelines
• national minimum
standards
Social Services
Inspectorate (SSI)
Audit commission
Staff
• better services
• better outcomes
for users
• evaluation
• inspection
• review
Employer
•
•
training
General Social Care
Council (GSCC)
• codes of conduct
• regulation of social
work training
National Training
Organisation for
Personal Social
Services (TOPSS)
• occupational
standards
development
Establishing the knowledge base
38.
The knowledge base for social care is fed from a number of sources:
the views and experience of users
•
evidence from research
•
Social
Services Inspectorate and Audit Commission reports
•
the views and experience of managers and practitioners.
•
39.
At the moment, much of this valuable information is not available in a
form that stimulates changes to policy, service delivery, training or practice.
Research reviews are needed to assess all available evidence in a particular
area, and synthesise key findings. Such reviews would apply rigorous and
robust standards to the quality and relevance of research.
40.
The Social Care Institute for Excellence would be responsible for:
identifying and prioritising the need for reviews of research
•
promoting and commissioning reviews of research to underpin
•
quality services
drawing up standards for research review.
•
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A Quality Strategy For Social Care
41.
Such a programme of research reviews would be complemented and
strengthened by secondary analysis of Social Services Inspectorate, Audit
Commission and Joint Review reports.
Box 4. Research into policy and practice: childcar e
The Department of Health Messages from Research series synthesises
findings from a number of related bodies of research. These findings
have been influential for a number of years in determining childcare
policy and practice.
• The research findings summarised in Child Protection: Messages
from Research contributed to the new guidance on Working
Together.
• Caring for Children Away from Home influenced Quality Protects
(see Annex A), the objectives for which are strongly linked to
research findings.
• Research underpinning the Looking After Children system
contributed to the development of a framework for planning and
review of looked after children.
Similarly we can only know what works in adult social care through a
rigorous synthesis of relevant research. All fields should also look beyond
national boundaries in order to draw lessons from international
experience.
42.
Ownership of the research agenda for social care needs to be broadened, to
strengthen the contribution from the field and to encourage research
activity at a local level, where it is directly relevant to services and practice
needs. Increased knowledge and skill in the use of research would enable a
positive contribution. SCIE could have a role in working with local
partners and other research funding agencies to co-ordinate the
development of a more practice-led agenda.
43.
On 1 April 2000 the Department of Health signed a strategic alliance with
the Higher Education Funding Council for England. This aims to ensure
that both parties work together to secure capacity, infrastructure and projectlevel support for health and social care research and development, which will
deliver the evidence base needed to underpin quality social care services.
44.
At the same time, reforms to the funding of NHS Research and
Development were announced. Among other changes, these offer the
opportunity for NHS research and development funds to be used on
partnership issues in social care, across local authorities. In these and other
15
A Quality Strategy For Social Care
ways the Government is seeking to ensure the strengthening of the
evidence base in social care to underpin quality improvements. The report
of the Better Government for Older People programme “All our Futures”
similarly recommends that the spread of learning into practice should be
promoted.
45.
The scope of SCIE’s work is therefore broad. At the moment there is no
recognised mechanism to bring together evidence from research, user/carer
experience and recognised good practice. SCIE’s task will be to review and
evaluate all available evidence in a particular area, and synthesise key
findings.
Figure2. Developing knowledge and guidelines
Synthesis
Assessment
Test against
New Knowledge
• User/carer views
• research evidence
• SSI Inspections
• Joint Review
• Audit Commission
•
•
•
User/carer views
manager &
practitioner
knowledge
• translate into pratice
• build into training
and development
• make accessible
• disseminate
policy intention
monitor &
review
new findings
Identify
additional
research
16
A Quality Strategy For Social Care
IMPROVED
OUTCOMES
Producing authoritative guidelines
46.
Robust and effective guidelines about what works will be based on
knowledge about user/carer views, cost effective use of resources and
outcomes for individuals. All major stakeholders in social care – users,
carers, service providers, managers and practitioners – will be involved in
setting guidelines, to ensure their sensitivity and their relevance.
47.
Social care is a diverse service; if we are to drive up standards throughout
the range of provision, the work of a Social Care Institute of Excellence will
have to be relevant for all sectors and the entire workforce. This means that
knowledge and guidelines have to be geared to the correct level of practice
and to address a range of subjects – from models of service delivery, to
organisational arrangements, to practice interventions. SCIE will not limit
itself to providing guidelines for best practice, but will also develop
decision-making tools and evaluate innovative models for social care
delivery.
Box 5. Users’ definition of a quality homecare service
•
•
•
•
•
•
•
Staff reliability
Continuity of care and of staff
Kindness and understanding of care workers
Cheerfulness and demeanour of care staff
Competence in undertaking specific tasks
Flexibility to respond to changing needs and requirements
Knowledge and experience of the needs and wishes of the service
user.
Source: Older People’s Definitions of Quality Services (Joseph Rowntree Foundation 2000)
Disseminate and make information accessible
48.
SCIE will have a proactive communications strategy to ensure the use of its
guidelines in practice. Information is a powerful way of empowering users
and SCIE’s work should be produced in a form, which makes it easily
available to users and members of the public.
17
A Quality Strategy For Social Care
49.
The Social Care Institute for Excellence should have a major role in
creating new ways in which intelligence and information can be shared. In
particular, the Institute should explore the use of new technology so that
social care becomes a leader in modern information provision. A reliable
high-quality knowledge base must incorporate mechanisms for constant
updating. SCIE will be leading the field in using new information
technologies to produce information that is not only instantly accessible
but also constantly updated.
Box 6. Electronic Library for Social Car e
The Department of Health has funded the National Institute for Social
Work to take forward the initial development of an Electronic Library
for Social Care (eLSC). This will be similar to the National Electronic
Library for Health (NeLH), enabling the eLSC to work closely with the
NeLH and in ‘virtual branch libraries’. The eLSC is designed for use by
practitioners, and by users and carers. It has a service users’ and carers’
‘floor’, with the aim of providing information about social care and an
opportunity to collate and disseminate the knowledge and expertise of
users and carers.
50.
The eLSC (see Box 6) is an example of a system that practitioners, users
and carers can interrogate and explore. Other ways of promoting
information exchange include establishing online learning zones. Links to
related topics, for example in health, housing and education, will be
crucial. We are seeking views on how best to promote access to electronic
information, and how best to structure the information.
51.
Dissemination of knowledge about best practice will be backed up by
systematic and rigorous review, and must also be accompanied by
structured development programmes at a local level. New knowledge must
inform training, so that changes in service and practice are sustained. SCIE
will have a strong role in working with the national organisations for
training (GSCC,TOPSS) and the providers of social care training to
communicate its findings and guidelines.
52.
We can learn from existing initiatives (see Box 7) to improve the
dissemination and use of research in practice and service delivery, which
show the benefits of co-operation between academic institutions and the
field. These networks could develop in a number of different ways
according to local circumstances, but all with the aim of using knowledge
to change practice.
18
A Quality Strategy For Social Care
Box 7. Research and practice collaborations
The Centre for Evidence Based Social Services, (CEBSS), Making
Research Count and Research in Practice are collaborative ventures
between universities and local authorities. All aim to improve the
dissemination of research findings, to assist practitioners to learn how to
evaluate and use research findings, and to ensure that research findings
are available to Social Services Departments when reviewing and
changing service delivery. Membership is voluntary, and the growth of
these initiatives is testimony to the enthusiasm in the field for this sort
of approach.
Box 8. How will a Social Care Institute for Excellence
make a difference to users and carers?
SCIE will ensure greater consistency between services offered in local
areas, and better quality of services. Users and carers can expect that the
best possible decisions are made about service delivery, and about
individual care.
SCIE will do this by pulling together the knowledge about what works
in social care, and producing authoritative guidelines. It will ensure that
this reaches all parts of the social care workforce through new technology
and good communication.
The structure of SCIE
53.
The organisation and structure of SCIE will be commensurate with its
purpose and functions, namely to establish its authority and credibility
within the field. Its structure will enable it to work in partnership with a
range of personal social services and other bodies, including for example
national health service bodies.
54.
The Government is considering the following options for the organisation
of SCIE, and wishes to consult on them. Key questions are how to ensure
sufficient stature and credibility to discharge its functions, and whether
SCIE should be solely funded by Government or able to attract additional
resources for, for example, its own research and development programme.
19
A Quality Strategy For Social Care
•
SCIE could be a not-for-profit voluntary body with appropriate
governance structures, working to a Service Level Agreement on the
basis of core sponsorship by the Department of Health (i.e. a Section
64 grant), and also able to generate its own income from an
independent programme of work. Such an organisation would
appoint its own chief executive and board of management, who
would have responsibility for overall direction, financial management
and probity. Voluntary status would confer greater independence
than an NDPB, which would work at arms length from government.
•
SCIE could be formed as a non-departmental public body (NDPB)
funded by Government, which would require legislation. NDPBs
have a degree of independence from Government, and work within
annual objectives agreed with ministers. They are able to attract
funding from sources other than Government. An NDPB employs
its own staff, who are not civil servants. The chair and the board are
appointed by ministers, and the chief executive by the board. NDPB
status would demonstrate the importance ministers attach to this
task, and confer authority on the organisation.
•
SCIE could be set up as part of the new National Care Standards
Commission or General Social Care Council. A rationalisation of
functions along these lines could facilitate a more integrated
approach to raising standards across the social services sector; would
limit the number of new players in the sector; and should deliver
efficiency savings. If the SCIE was set up in this way the benefits of
authority and autonomy set out above would also apply. It could,
however, lack the distinctiveness of a separate body with a clear focus
on best practice. It would share a common board and governance
arrangements with its parent organisation. The Government is
interested in views about whether a more integrated approach would
be positive or potentially confusing.
Questions for consultation
•
•
•
•
•
20
A Quality Strategy For Social Care
What are the most effective ways of disseminating research findings
and promoting their implementation into practice?
How can the use of electronic information in social care be
promoted?
What encourages the use and exchange of electronic information?
What type of role should SCIE play and who will be the other key
partners?
Which option for the organisation of SCIE best suits its purpose?
Section 2
Delivering excellence at local level
– accessible and individually
tailored services
‘
Summary
Quality is a local responsibility. Our Quality Strategy can only deliver if there
is radical change at a local level. This will be achieved by a number of means:
•
•
•
•
•
•
•
implementing Best Value (see Annex A), which will drive continuous
improvement in the way services are provided by local authorities
the introduction of a framework to ensure continuous quality
improvement, which emphasises the importance of staff development and
training together with high standards of practice at all levels
actively fostering a culture within social services that emphasises Lifelong
Learning
creating a sound evidence base from which to drive service change
generating and cementing creative partnerships between all sectors and
across all fields, to develop innovative and flexible services
the imaginative use of information technology
regular and rigorous assessment of local councils’ performance in achieving
these goals.
‘The Government is setting directions and priorities for modernisation, but it is
local authorities who are responsible for the day-to-day delivery of social services.
There will be clearer responsibilities for local government in showing how well
they are serving local people.’ Modernising Social Services (Department of Health
1998)
21
A Quality Strategy For Social Care
Quality in local services
55.
Social services are criticised for their inflexibility, lack of responsiveness to
people and their particular circumstances, and lack of coherence and
consistency, so that users are passed from pillar to post. In some places
services are seriously failing their communities. Where services are failing,
there are characteristic problems at local level:
lack of leadership from councillors and managers
•
ineffective
systems to monitor and account for quality
•
little investment in staff
•
the results and recommendations of external review and inspection
•
not implemented
lack of partnerships with health and other local services, or with users
•
of services and with carers.
‘Effective social services have good leadership from councillors and
managers, and their staff deliver quality and competent practice,
consistently. They learn – from their own and others’ good practice, and
from external scrutiny and review – in order to achieve a high level of
performance’.
Modern Social Services: A Commitment to Improve (8th Annual Report of the
Chief Inspector of Social Services 1998/9) (Department of Health 1999)
56.
Best Value sets a challenging agenda for local government and will be the
driver for change and improvement at a local level. Councils now have a
duty of Best Value to deliver services taking into account quality and cost.
Councils with social services responsibilities therefore have a statutory duty
to ensure Best Value across the range of social care services delivered by
many different providers. Best Value Performance Plans are an important
way in which the local authority is held accountable to the people it serves.
57.
Social services are already undergoing change: some councils have
combined social services with other local government functions, and
flexibility under the new Health Act will also lead to new ways of
delivering services. In addition, the new political structures in the Local
Government Bill currently before Parliament including the Government’s
proposal to abolish the requirement for Social Services Committees in
council which adopt the new structures, will lead to further changes. Such
changes rightly respond to the differing needs of local communities.
22
A Quality Strategy For Social Care
The new Quality Framework
58.
The Government plans to ensure the delivery of excellent social
services at local level through the introduction of a new quality
framework to reinforce and support Best Value by providing the means
through which quality in social care services is assured. This will mean:
formal arrangements for local councillors to fulfil their
•
responsibilities through Best Value for continuous improvement in
the quality of local social services
clear lines of accountability at local level – the quality of care will be
•
the direct responsibility of the director of social services
a full commitment to staff training and development through the
•
introduction of Lifelong Learning.
The aim of the new quality framework is to address current problems,
anticipate changes in the way services are delivered, and ensure Best Value
and accountability for quality in social care.
Leadership
Excellent local councils will have:
• vision and strategy – clear statements of value and goals, and of
changes necessary to achieve them
• formal arrangements to ensure that councillors fulfil their
responsibility under Best Value for the quality of local social care
services
• a commissioning strategy that includes Best Value principles and
concentrates on outcomes as well as outputs.
59.
Delivery of social services is part of local councils’ corporate responsibility
for the economic, social and environmental well being of the community.
Policy and strategy for quality in social care should be developed in the
context of the council’s overall commitment to Best Value for their
community and in a way which encourages widespread input and
ownership across the council.
60.
Councillors’ leadership in promoting change and the drive for
improvement is essential. It is the job of councillors, in partnership with
officers, to develop a vision and strategy for social services to which the
whole council is committed. Best Value reviews (see Annex A) will
challenge and compare how services are provided. The duty to consult and
agree goals for services with users, potential users and other stakeholders
will be a powerful and transparent force for change.
23
A Quality Strategy For Social Care
61.
Councillors have profound responsibilities for the quality of social care
services available in their communities. This applies both to directly
provided and commissioned services. Best Value principles highlight this.
Councillors have an obligation to be aware of what is current best practice,
and on that basis to challenge what is happening in their social services
department.
62.
Councillors with responsibility for social services should take an active
interest in arrangements for developing quality social services. Specifically
they will need to have knowledge of:
the local implementation of General Social Care Council codes of
•
conduct
National Care Standards Commission reports on local care services
•
performance management arrangements
•
staff development and training
•
how the new partnership flexibilities in the Health Act are being used
•
how partnerships are delivering more integrated services for users
•
(particularly in intermediate care)
how lessons learnt from complaints, external review and monitoring
•
are being incorporated into practice
how national regulatory standards, and knowledge-based guidelines
•
from SCIE are being implemented
results of user satisfaction surveys (see Best Value, Annex A).
•
63.
The direct experience of users is a touchstone for improving quality.
Councillors with a scrutiny role should receive regular reports on quality
from the users’ perspectives, and take a strong interest in the
implementation of quality improvements.
24
A Quality Strategy For Social Care
Accountability
Excellent local councils will ensure that:
• clear accountability arrangements and robust business planning are
in place
• measures are agreed across the council for dealing with poor staff
performance
• the use of information technology is geared to business planning
objectives, and supports performance management
• risk assessment procedures are developed with other agencies, and
ensure that people who pose a high risk are living safely in their
placement
• recruitment procedures guarantee that all necessary checks are
undertaken
• commissioning practice ensures that services the department uses
apply good practice in recruitment
• quality control mechanisms are in place to safeguard vulnerable
children and adults
• the council is able to demonstrate that all revenue and capital
resources are being use to maximum effect, in support of the
council’s objectives.
64.
The ultimate accountability for quality lies with councillors, reinforced by
the new provisions in the Local Government Bill, which will ensure more
efficient and transparent decision making. Once Councils have adopted a
new constitution under the Bill responsibility, and therefore accountability,
will lie with the executive and in many cases a member of the executive will
have direct personal responsibility for social services.
65.
There should, therefore, be clear accountability for quality to councillors via
the director of social services. Modernising Social Services states the
Government’s intention to retain the legal requirement for a director of
social services, who must be accountable to the council chief executive and
have direct access to councillors on social services matters. The new quality
framework makes the director responsible for the quality of services
provided to fulfil the council’s social services functions. The Director of
Social Services has a wider role and will need to work effectively within the
council to implement council wide policies and on cross cutting issues to
deliver Best Value, joined up services.
66.
The director of social services must have authority and credibility within a local
authority and its partners, and, where activities and functions are dispersed,
clear and demonstrably effective lines of accountability must be in place.
25
A Quality Strategy For Social Care
67.
The Department of Health will issue guidance on the role of the director
of social services, and is seeking views on the possible status of guidance
and what it should cover.
68.
Social services directors manage within and across many organisational
boundaries. Some services are within their line management; some may be
outside their line management and managed either by another council
department or jointly with a particular agency. Other services are
commissioned from wholly external providers. Clear accountability
arrangements must be made.
to councillors – directors must have a sufficient level of seniority to
•
ensure direct access to the head of paid services (or chief executive)
and to the executive councillor or councillors with responsibility for
social services. Directors must be in a position to provide advice and
information directly to councillors on the scrutiny committee for
social services.
within council line management – so that accountability is ensured
•
whether staff are directly managed by the director of social services or
by other senior council staff.
for
quality and professional development – so that social services staff
•
are supported to deliver social work, social care wherever they are
based.
where
external agencies are providing services – contracts must make
•
sure that quality and standards are written in for all services
delivered, and that accountability is clearly defined, and adherence to
these terms is closely monitored.
69.
Managers need to be able to deal with poor performance. This requires
quality control systems, so managers know whether correct procedures and
guidelines are being adhered to. Managers also need the ability to identify
bad practice, and need to be supported in taking action to rectify it.
70.
Procedures for dealing with poor performance and bad practice need to be
agreed across the council, taking into account the particular nature of social
care and the vulnerability of some service users. Directors need to ensure
that procedures that protect children and vulnerable adults are embodied in
the personnel procedures of the council. When directors of social services
bear personal responsibility for the quality of social care, they will require
corporate support. We are interested in views about what mechanisms (if
any) are necessary should this responsibility be compromised.
26
A Quality Strategy For Social Care
Box 9. New technology
New technology can assist the development of high quality
management. Quality Protects (see Annex A), for example, has detailed
IT-based tools for developing high quality casework, with in-built
systems for review and monitoring. Effective use of IT, which supports
departments’ overall business objectives as well as supporting operational
activities, will be crucial to performance management. A sound
information base means that information can be shared to promote
partnerships and joint working at planning and operational levels.
71.
Quality management tools and techniques need to be used with the
discrimination necessary to ensure their application both to the task and
content of social care and to the Best Value framework. The Cabinet
Office, DETR and IDeA has jointly published a Guide to Quality Schemes
and Best Value. Decisions about strategies are for individual authorities to
make, but authorities will want to share and compare their experience. The
Government is interested in views about what type of quality assurance
systems provide the most security for users.
72.
Under the new quality framework the director of social services will have a
number of specific duties and responsibilities.
They will report at least annually to the relevant councillor forum on
•
the quality of social care services provided and commissioned by the
local council. They should set up quality assurance systems across the
council’s social services functions and receive quarterly reports.
They will take action to ensure adequate safeguards are in place to
•
protect vulnerable children and adults.
Directors of social services will be the focus for the purposes of
•
performance assessment by the Department of Health and the
proposed annual performance review meeting.
Box 10. How will the new quality framework make a
difference to users and carers?
For users and carers, a new quality framework guarantees the quality of
local social care services.
27
A Quality Strategy For Social Care
Continuous improvement
Excellent local councils will ensure that:
• staff respond to the diversity of users’ background, cultures and
ethnicity, and consultation is used to identify how services need to
change
• services recognise the civil rights of disabled people, and fully
comply with the requirements of the Disability Discrimination Act
• the potential of diversity within the workforce is maximised
• lessons – from mistakes and successes – are disseminated, learnt and
applied
• knowledge-based practice informed by research evidence is
supported and applied in everyday practice
General
Social Care Council codes of conduct, National Care
•
Standards Commission minimum standards and Social Care
Institute for Excellence guidelines are implemented
• information from performance assessments, inspections and Joint
Reviews is used to promote innovation, learning and change
• the organisation at all levels is clear on standards and priorities and
how success or failure will be gauged
• there are clear mechanisms for keeping staff and other service
providers up-to-date with practice development, research findings
and active participation in research and learning networks.
73.
The new quality framework will drive change at all levels in social care
organisations through a shift to a culture of continuous improvement. This
means being open to challenge the way things are done, using knowledge
to drive change, staff taking responsibility for the quality of their practice,
and investing in training and development.
74.
A service focused on excellence will use information from a variety of
sources to make continuous improvements in quality. It will learn from
staff, users of the service, from external audit and inspection and from
complaints, mistakes and successes. It will use evidence-based practice. It
will also look outwards to see what can be learnt from other areas of care
and social support, for example housing and health, and it will be aware of
developments not only in other regions but other countries.
75.
Users’ views are a crucial way of testing and assessing for quality in services.
Service users’ views must be actively sought, and there must be specific
targeted efforts to ensure that service users who have previously been
excluded by reason of race or disability are now included in the
consultation and assessment processes. Input from users and carers
28
A Quality Strategy For Social Care
stimulates staff to question current practice and make changes. Training
and development programmes will need to ensure that this dimension is
included.
76.
Staff who deliver services are also a vital source of information about what
works and what does not. Their evaluations, from what happens in
practice, must be central to service improvements, to spreading good
practice and to the developing knowledge base for social care.
77.
Ensuring quality in social care means creating a culture that values Lifelong
Learning – the acquisition and upgrading of skills and knowledge
throughout life. This will play a crucial role in driving up quality. A focus
on Lifelong Learning and continuous staff development will:
identify training and development needs
•
support change
•
and so drive up quality.
•
78.
Such a focus, in a workforce in which the majority of staff are not
professionally trained, requires imaginative and concerted changes in staff
development and training, and a recognition that this is an investment in
quality. The establishment and support of local learning networks for social
services staff is one way to provide important opportunities to learn from
others and reflect on their own practice.
79.
Modern public services value their staff, are open to innovative ideas
generated by them, and act on those ideas. A culture that resists its
workforce’s attempts to innovate, or that stifles creativity, is no longer
acceptable.
80.
Councils themselves can only gain from a commitment to Lifelong
Learning and the drive for quality within social services: improving training
means better job satisfaction, better job retention, improved recruitment,
and building up a better reputation for providing quality local services.
Box 11. How will Lifelong Learning help users and
carers?
Local communities and individual users and carers can be confident that
local service development and the skills and knowledge of those
providing their care are keeping up to date with information about best
practice. A commitment to staff development means that all staff
working in social care will be able to undertake their tasks safely and
competently.
29
A Quality Strategy For Social Care
Creating partnerships
Excellent social services departments will ensure that:
• local partnerships are actively used to explore and develop new ways
of delivering services
• priority is given to partnership and maximum use is made, for the
benefit of the local community, of the new flexibilities in the Health Act
users’
and carers’ views are recorded, and feedback is given about
•
action taken
• users and carers are fully involved in the development of Long-Term
Care Charters; local Charters are both honest and challenging
• children are listened to, and their wishes and feelings respected
• the views of the wider local community, including potential users and
other stakeholders, are actively sought through a variety of means.
81.
Local councils can take the lead in building strong and effective alliances
with all sections of the local community, other public agencies and the
private and voluntary sectors.
82.
Within any local area there is a range of potential partners with whom
social services can work to improve quality. Partnerships will create new,
shared ways of delivering services that are individually tailored, accessible
and more joined up. They are the key to better integrated services for users
and will become one of the main ways through which services are delivered.
Such partnerships are with users and carers, between health and social care,
across the local authority e.g. with housing and education and with private
and voluntary sector organisations, whose potential contribution to local
service provision should be explored. The focus, particularly for health and
social care, should be on extending and deepening partnership working.
83.
As the NHS Plan makes clear, if people are to receive the best care, then the
old divisions between health and social care need to be overcome. This will
be achieved through greater use of the powers in the Health Act 1999.
Primary care trusts provide a unique opportunity to foster closer working
between health and social services, by making the health and social care
system easier to understand and simpler to use.
Individually tailored services
84.
30
A Quality Strategy For Social Care
As direct payments extend, so users will gain greater control over their
services. Increased partnerships with service users will ensure that services
are better designed and that users have a say in their management. In some
places this is happening already (see Box).
Box 12. Examples of innovation – individually tailored
services
Bristol Unitary A joint scheme between the Family Placement Team
Authority Social and the Disabled Children’s Service for deaf children
Services
to have a chance to spend time away from their
families with deaf carers who share the same culture
and sign language.
Royal Borough
of KingstonUpon-Thames
Community
Services
Developed in partnership with a local association of
disabled people, their Independent Living Scheme is
open to people with physical and/or sensory
impairment, or other health needs, HIV/AIDS,
Mental Health problems, and Learning Disabilities.
There are currently 40 people using the ILS, which
promotes independence, enabling people to take
control of their lives. Regular practical support is
provided to scheme users in order to assist them in the
management of their care packages.
More accessible services
85.
Information technology opens up choices to users and carers. It can
transform some of the relationships between social services departments
and their clients, and make a move away from ‘telling people what they
need’ to ‘offering them choices so they can decide what they want’.
86.
IT systems have also been developed in some authorities to enable users
and carers to access information without the need to contact local authority
staff. These computer systems are not restricted to social services
information; one of the successes has been the integration of the local
voluntary sector providers with the statutory ones. Thus people needing
respite care, for example, may be shown a variety of options on the screen,
while people receiving direct payments may be offered lists of experienced
staff and organisations from which they can interview and select their own
care staff.
87.
Looking to the future, technology will soon be a major component of
social care – for performance management, for information, for users, for
assistive technology to help keep people in their own homes – and so a key
to improving quality.
31
A Quality Strategy For Social Care
Box 13. Examples of innovation – more accessible
services
Luton Unitary
Authority
88.
In the spirit of community care, a joint partnership
and joint training between Social Services and
Housing, who have worked together to formulate an
agreed protocol for joint assessment of housing and
social care needs that offers integrated and easier to
access services for the community. This will make
things much simpler for people requesting services.
Working alongside other professionals, being knowledgeable about and
making connections with other agencies, working strategically within a
network of local organisations – all this will result in more accessible
services for users.
Joined-up services
89.
For users, successful partnership working adds value when it means that
they don’t have to act as their own broker between different services, and
they know quality is assured. Partnerships that work depend on changing
how staff see their role. This will be done by:
staff development aimed at enabling people to work across
•
boundaries
making co-operation part of the job by setting clear objectives
•
holding managers to account through joint objectives.
•
90.
Partner agencies will be working within their own framework to account
for and promote improvements in quality. The duty of Best Value sets the
imperative for the delivery of quality services, whether commissioned or
provided by councils with social services responsibilities. The new quality
framework for social care, like clinical governance, provides a way of
continuously improving the quality of services. Similar principles underpin
both:
active involvement of users / patients
•
clear accountability arrangement for quality
•
a
change in culture to a more active and sustained approach to
•
quality and to staff development.
91.
Together, clinical governance and the quality framework for social care
provide a means through which quality can be jointly assured. Further
work may need to be done to make effective working links between these
quality frameworks.
32
A Quality Strategy For Social Care
Box 14. Examples of innovation – joined-up services
Royal Borough
of Kensington
& Chelsea
The Council, practising with a good parent model, is
committed to provide a needs-led service tailored to
each individual care leaver. The service starts with
foster and residential carers preparing young people
for independence by teaching self-care skills. The
specialist Independence Support Team (1ST) becomes
involved to help with care planning for the young
person (16 yrs) and shares their innovative materials
called 'Get Ready', jointly produced with First Key.
Continuing the preparation for independence, 1ST
provides direct personal support to a young person
(18-21 yrs) through a range of partners from
education, employment to housing so to access semiindependent accommodation to secure a young
person's future.
Sefton
Metropolitan
Authority
As a result of the partnership work between Sefton
Health and Social Services, Sefton residents were able
to access the care they required during the winter
months. Sefton Health authority and Sefton Social
Services co-operated in a programme of support to
nursing and residential homes to ensure that they were
ready for the extended holiday. They made appropriate
social, primary and community care help available to
residents with health problems over the holiday. This
reduced the inappropriate use of A&E and hospital care.
London Borough Joint ownership, joint training, an integrated
of Camden
assessment system and joint funding combining social
and health care elements are the facets of Camden’s
Co-location of social services staff with community
nurses in the borough’s five health centres and two
large district hospitals. The seven teams located within
health settings provide one site for all access to
community care services. For Camden’s people, Colocation facilitates communication between the two
agencies, leading to faster and more satisfactory
responses for patients/users.
33
A Quality Strategy For Social Care
Rewarding excellence
92.
The Government wants to celebrate success by rewarding good services.
People working in social care do a difficult job, and make a highly
significant contribution to the life of our communities. Doing this well
should be recognised. The Beacon Council Scheme (see Annex A)
recognises good overall performance, and particular excellence in a specific
service. Social Care Awards (see Annex A) recognise innovation, best
practice and value for money in social care services. They aim to raise the
profile of social care workers and what they do.
Assessing performance
93.
Best Value (see Annex A) sets a challenging new performance framework
for the whole of local government. The Government has defined Best Value
as the duty to deliver services to clear standards – covering both quality and
cost – by the most economic, efficient and effective means available. For
social services, as for all local authority services, improvements in quality
are intrinsic to securing Best Value.
94.
The Best Value performance plan means that targets and performance against
them will be in the public domain and subject to local debate every year.
95.
The quality of social services will be subject to internal and external
scrutiny. We have described how the duty of Best Value will drive
continuous improvement, and how the director of social services will be
accountable for quality to councillors. The delivery of this Quality Strategy
will also form an integral part of Department of Health performance
assessment arrangements.
96.
The White Paper Modernising Social Services requires a new approach to
social services performance assessment (see Annex A), and the key
components of the new arrangements are now in place. Quality underpins
all performance assessment activity, and will form a significant part of the
discussions at the annual performance review meeting. Focus should be on
progress with changes necessary to deliver improvements at a local level.
The Quality Strategy identifies the key elements for improvement in
quality. The performance assessment process will gather evidence,
particularly through Joint Review and inspection, of councils’ progress in:
clear accountability for quality
•
safe personnel procedures and recruitment
•
a staff development plan
•
becoming a learning organisation
•
good quality control.
•
34
A Quality Strategy For Social Care
Box 15. How will local government performance
assessment make a difference to users of social services
and carers?
Users and carers can be confident that through the arrangement for
assessment of councils’ performance, the Government is aware of
strengths and weaknesses.
Users and carers are always consulted in the course of inspection and
joint reviews. Under Best Value, councils will have to consult and listen
to users and will be able to compare their own performance with others.
They will also carry out annual surveys of user satisfaction.
Questions for consultation
•
•
•
•
•
How far does the new quality framework reflect the key components
that should make up a quality framework for social care?
How might the principles be extended and applied within all sectors
of social care?
Are the principles outlined to underpin the role and accountability of
the director of social services sufficiently robust?
What should be the status of the proposed guidelines for directors of
social services, and what should they cover?
With the increasing importance of partnership working between
health and social care, how should we best make links between the
new quality framework and clinical governance to ensure a consistent
approach to quality?
35
A Quality Strategy For Social Care
Section 3
A more skilled and competent
workforce
Summary
Delivering excellence requires a new focus on workforce training and
development. We need to increase the level of training and be sure that it
equips people to deliver the sorts of service we want in the future. This
chapter consults on:
•
•
•
•
the reform of social work education
post-qualification training
the future direction of government funding for training
workforce planning.
‘We will raise standards in the one-million-strong social care workforce; we will
introduce a new national training strategy, which will improve training levels across
social care.’ Modernising Social Services (Department of Health 1998)
High-quality staf f
97.
The modern social care workforce needs to be:
better trained
•
confident
and flexible, so that staff can work across boundaries and
•
in partnership with users
continuously updating its knowledge and skills
•
clearly linking training and development to career progression, either
•
through increased practice skills or ensuring that staff have some
preparation and skills enhancement prior to taking up supervisory or
management positions.
98.
The Government is setting a clear framework of expectations for workforce
development. We are working with the employer-based National Training
Organisation for Personal Social Services (TOPSS) to develop occupational
36
A Quality Strategy For Social Care
standards for the whole of the workforce. Dedicated funding towards
specific initiatives is available via the Training Support Programme (TSP).
Lifelong Learning establishes a framework for the acquisition and
upgrading of skills throughout life.
99.
The primary responsibility for training lies with employers in all sectors,
who should work effectively with TOPSS and take the lead in training and
developing all their staff. This investment is a crucial component in
delivering quality by building an informed, confident, responsive and stable
workforce. Not least, such investment will help to make the social care
sector an attractive employer in an increasingly competitive labour market.
100. TOPSS has already developed a training strategy for the social care sector,
and is now planning its implementation. Proposals for the resourcing of the
strategy therefore need to be considered between employers in the various
sectors as part of their ongoing management responsibility for the service.
Employer (and employee) responsibility for training and development lies
at all levels within social care organisations:
at a strategic level, to work with TOPSS and devise a staff
•
development strategy for their organisation
at an operational level, line managers need to identify development
•
needs, plan how they should be met, implement that plan and
evaluate the action which arises from the development
at an individual level, staff must play an active part in their own
•
training and development.
Social work
101. Social work has a specific contribution to make to the Government’s
modernising agenda, with its emphasis on rights and responsibilities,
citizenship and participation. In the future, social workers will be working
in a variety of settings, and are as likely to be working alongside health or
other care professionals as in social services offices. The profession will
develop its ability to:
work with excluded people and restore them to mainstream services
•
assist people to identify problems and their solutions
•
balance the needs of individuals with the needs of their families and
•
wider networks
work
creatively with other professionals
•
identify conflict and negotiate solutions.
•
37
A Quality Strategy For Social Care
102. Effective practice will be underpinned and updated by knowledge,
combined with the ability to apply it flexibly according to the particular
circumstances, to respect and work in partnership with users and their
families, and to analyse the situation and communicate with all those
involved.
103. Recent Social Services Inspectorate inspections have shown that social
workers need to rediscover some of these core skills of assessment, so that
decision-making and care planning are based on a sound analysis and
understanding of the person’s unique personality, history and
circumstances. Social workers’ own skills need to be seen as a resource to be
used and offered in the assessment.
104. This requires a clear definition of the future role of social work, refocusing
to ensure that best use is made of the skills and experience of qualified
staff. It also calls for a radical consideration of the future structure and
content of social work training.
Professional training
105. The mechanisms for delivery of professional training in social work have
changed only slightly over the past thirty years. However, the social care
sector and the needs of its clients, as well as the general social environment
and the profile of the workforce, have changed markedly. In particular, a
future strategy for social work training needs to take account of:
the continuing fall in applications for social work courses, which
•
gives rise to concerns about the calibre and sufficiency of the
workforce in the medium term
the increasing complexities of the task and the need to fit the future
•
social work workforce to deliver higher quality services to a modern
agenda for social care.
106. Professional training must play its part in meeting these challenges. In
1998, the Department of Health commissioned JM Consulting to look at
this issue. Their reports are being published on the Department of Health
website for consultation, you can find it at:
www.doh.gov.uk/scg/training.htm. The report found that while many of
the criticisms reflect broader issues, there is a need for significant upgrading
of several aspects of the qualifying education with greater focus on field
experience based on a ‘national curriculum’ for social work training.
Centres of excellence should be developed and consideration given to ways
of encouraging participation in training.
38
A Quality Strategy For Social Care
107. The report advocates development of a three year undergraduate social
work qualification. Whilst creating a graduate entry to the profession may
have a role in the long term, we are concerned about the effect on supply
of newly qualified social workers, including in year one, and that a rounded
view can only be taken in the context of a strategy for the whole of the
social care workforce. We welcome the views of local councils (as
employers) and others before deciding on the most effective way of tackling
problems on which the JM Consulting report focuses.
108. We will reach final decisions on the way ahead in the light of the responses
to consultation on this document and the JM Consulting report and
involving TOPSS(E), CCETSW and the Advisory Group to the GSCC.
Post-qualification training
109. It is also no longer acceptable to assume that a qualification gained at age
25 or 30 will equip professional staff for the challenges they face twenty
years later. We will set out to encourage a step change in attitudes to and
participation in, post-qualification training. Registration for professional
staff would ensure that knowledge and practice is regularly updated.
Supervisory positions could be made dependent on the attainment of postqualifying training.
110. The Government would therefore welcome views on:
how to increase the uptake of post-qualification training
•
whether the General Social Care Council should be asked to develop
•
a formal re-registration scheme for professional staff, in the same way
that the General Medical Council has recently introduced such a
requirement for doctors
whether changes are needed in terms of the nature, volume and
•
accessibility of training opportunities and, if so, how movement in
the right direction can be encouraged.
111. As with qualifying training, the Government will make final decisions on
the way ahead in the light of responses to consultation and its broad policy
objectives.
Future funding
112. Government currently supplements the training activities undertaken by
local authorities by providing specific grant monies through the Training
Support Programme (TSP). The new proposals in this paper mean that the
time is right to review the effectiveness and consider the future of this
funding stream.
39
A Quality Strategy For Social Care
113. Against that background, the Government would welcome views on the
future direction of TSP funding and:
how to ensure that the TSP works to complement local authorities’
•
activities
how to stimulate training activity in the private and voluntary sectors.
•
Management training
Department of Health Leadership Development Initiative
114. The top managers’ programme is a three-year Department of Health funded
programme focused on improving the leadership skills of directors of social
services and their top strategic managers. There are also specific initiatives for
Black and minority ethnic senior managers. This is proving to be a highly
successful programme, and is expected to make a significant contribution to
effective leadership in social care and the public services more widely.
115. In parallel with this activity for top managers, the Department of Health, in
association with the Local Government Association, the Improvement and
Development Agency and the National Training Organisation for Personal
Social Services, is developing an integrated strategic framework for
management/leadership development at all levels within social care
organisations.
116. The new NHS Modernisation Agency, described in the NHS Plan, will
operate a new Leadership Centre for Health. The Centre, will promote
leadership development. It will provide tailored support for clinicians and
managers at different stages in their careers and for those already in
leadership roles. It will be open to social care organisations.
117. Frontline managers play a key role in maintaining standards of practice by
supervising, supporting and developing staff. Their training should be a
priority. There are three core areas in which skills and competencies need to
be developed:
the management of practice (direct work with users, provision of
•
service, planning and decision making)
responsibility
for the organisation (including budget) of service
•
delivery
working in partnership and co-operating with other agencies,
•
professional and occupational groups.
118. We wish to consult on the priority and components of frontline managers’
training. Many managers working in social care will have both vocational
and professional qualifications. Management training needs to link to and
build on both.
40
A Quality Strategy For Social Care
Broader workforce planning
119. We have already described our intention to define social work more clearly,
so that best use is made of professional training and skills. We also need to
make sure that we are using the rest of the workforce to its fullest potential.
Achieving this is key to our modernising agenda.
120. Many of our policies to combat poverty and social exclusion are creating
new types of programmes to assist people. As new services both within and
outside social care develop, so the traditional boundaries between jobs and
roles will diminish. The social care workforce needs to be geared to work in
this new environment, through effective planning for the right mix of skills.
Services will be provided in different ways, health and social care staff will
work alongside each other. This requires new ways of working to provide
seamlessness and continuity for users. The right skill mix and training
(across health and social care) will be essential.
121. Many staff already working in social care maybe capable, with the right
training, of undertaking more skilled work. We also need to attract more
people into the workforce. Expectations of the workforce are changing, and
this provides an opportunity to consider new ways of structuring the workforce
through, for example, the development of a new occupational group.
122. The Government would welcome views on these issues and broader questions
on how the workforce might best be developed in the medium term.
Questions for consultation
•
•
•
•
•
•
•
•
•
Does our description of social work fit the profession’s future task?
To what extent do the recommendations in the JM Consulting report
provide a basis for the reform of social work education?
Should we aspire towards a professional workforce with a requirement
for re-registration and for post qualifying training prior to taking up
supervisory positions?
How might post-qualification training be developed in the future?
What should the objectives of the TSP be from 2001/2002 onwards?
How best can we recruit and retain professional social workers?
What should the balance be between professional staff and the rest of
the workforce in future? How can we use professionals to best effect?
Should we be developing a new intermediate occupational group as
one way of relieving pressure on professional numbers, but also as a
way of providing developmental opportunities for others in the
workforce? If so, how should the process for doing that best be
defined?
What should the training priorities be for frontline managers?
41
A Quality Strategy For Social Care
Conclusion
123. The modernisation of social services is a long-term programme, which we
began with our White Paper Modernising Social Services. This set out the
steps to be taken to promote independence, improve protection and raise
standards.
124. With this Quality Strategy we are concentrating on the quality of services
that users experience, and on the staff who deliver those services. Our goals
are to improve consistency, ensure services are tailored to individual need,
and create a better-trained and more confident workforce.
125. We believe that this Quality Strategy sets an exciting agenda for our vision
of modern social care – a service in which people will be proud to work.
42
A Quality Strategy For Social Care
•
A service supported by a national framework that sets standards, develops
knowledge and promotes its use in practice
The standards people can expect will be clearer. Improved knowledge
about what works in social care, promoted by our Social Care
Institute for Excellence, will mean that better decisions are taken
about service delivery and by individual practitioners. Users will be
confident that knowledge is being applied in practice.
•
A service in which quality is assured through the new quality framework
There will be clear accountability for the quality of local social care
services, wherever they are provided. The director of social services’
responsibility for quality will be strengthened with regular reports to
councillors. All staff will have a responsibility to continuously
improve quality of services and regularly update their skills and
knowledge. Users will be able to feel confident about safe
recruitment practice, the flexibility and expertise of services.
•
A more skilled and competent workforce
We are consulting on proposals that could have radical effects on
professional, post-qualification and management training. We also
want employers to take a new look at staff development and apply
the framework of Lifelong Learning for all their staff. A greater level
of training throughout the workforce will improve status,
recruitment and retention, and will mean that staff are
knowledgeable and able to address peoples’ concerns.
•
A service that enjoys dynamic and creative partnerships with other agencies
This will produce more innovative solutions, better geared to
individual need. Better co-operation will mean easier access, less
duplication and frustration for individuals. Working with users and
carers, services will reflect what they value. They will empower
people to take or retain control over their lives.
Expectations of public services are increasing. Services need to modernise
so that they are responsive and integrated, so that they can empower people
to take control and lead their own lives, protect, where necessary, strengthen
families, improve children’s life chance and enable people to meet their
potential.
A service that achieves this will truly be one for the 21st century.
43
A Quality Strategy For Social Care
Summary of questions
for consultation
We look forward to receiving your views. We would welcome general comments
and responses to our particular questions in the order listed below:
Section 1. Tackling inconsistency, promoting excellence
1.
What are the most effective ways of disseminating research findings and
promoting their implementation into practice?
2.
How can the use of electronic information in social care be promoted?
3.
What encourages the use and exchange of electronic information?
4.
What type of role should SCIE play, and who will be the other key
partners?
5.
Which option for the organisation of SCIE best suits its purpose?
Section 2. Delivering excellence at local level
6.
How far does the new quality framework reflect the key components that
should make up a new quality framework?
7.
How might the principles be extended and applied within all sectors of
social care?
8.
Are the principles outlined to underpin the role and accountability of the
director of social services sufficiently robust?
9.
What should be the status of the proposed guidelines for directors of social
services, and what should they cover?
10.
With the increasing importance of partnership working between health
and social care, how should we best make links between the new quality
framework and clinical governance to ensure a consistent approach to
quality?
44
A Quality Strategy For Social Care
Section 3. A better trained workforce
11.
Does our description of social work fit the profession’s future task?
12.
To what extent do the recommendations in the JM Consulting report
provide a basis for the reform of social work education?
13.
Should we aspire towards a professional workforce, with a requirement for
re-registration and for post-qualification training prior to taking up
supervisory positions?
14.
How might post-qualification training be developed in the future?
15.
What should the objectives of the TSP be from 2001/2002 onwards?
16.
How best can we recruit and retain professional social workers?
17.
What should the balance be between professional staff and the rest of the
workforce in future? How can we use professionals to best effect?
18.
Should we be developing a new intermediate occupational group as one
way of relieving pressure on professional numbers, but also as a way of
providing developmental opportunities for others in the workforce? If so,
how should the process for doing that best be defined?
19.
What should the training priorities be for frontline managers?
Please send your comments by Tuesday 21 November 2000 to:
Kasey Chan
Department of Health
Area 608, Wellington House
133-155 Waterloo Road
London SE1 8UG
Alternatively you may wish to use the feedback form on our website at:
www.doh.gov.uk/scg/qualitystrategy.htm
or email comments to:
[email protected]
45
A Quality Strategy For Social Care
Annex A
Fair Access to Care
(Modernising Social Services 1998, page 26).
Fair Access to Care:
ensures greater fairness and consistency
•
improves
the way in which local authorities define and apply
•
eligibility criteria for audit services
ensures regular review.
•
Long-term Care Charter
Better Care, Higher Standards is a national Charter. It tells people over 18, who
need care or support over the long term, what they can expect in terms of local
housing, health and social services, what standards are set for those services, and
what to do if these expectations are not met. The national Charter expects local
authorities and health services to draw up local Charters and to make local
standards public.
Best Value
From 1 April 2000 local councils have a duty of Best Value. This is a statutory
duty to deliver services taking into account quality and cost by the most effective,
economic and efficient means possible.
Best Value is a new approach to service delivery, which emphasises
continuous improvement, the key role of local people in influencing
service delivery, and the importance of making best use of partnerships
with the private and voluntary sectors and with other public sector
bodies to deliver services jointly.
This requires staff to:
• adopt new approaches to work in which they challenge and identify
new ways of doing things
• listen to what users have to say and take account of this
• understand links and connections with other services
• work in an environment that encourages innovation.
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A Quality Strategy For Social Care
Best Value Reviews
Authorities must review all their services over a five-year period in line with the
Local Government Act 1999 and DETR guidance issued under it. The Reviews
are expected to:
involve elected members (both with executive and non-executive
•
roles)
seek advice from outside the authority (including public, voluntary
•
or private sector partners)
involve
those currently delivering services (especially frontline staff)
•
question existing commitments
•
engage with users and potential users of services
•
address equity considerations.
•
Best Value Performance Plans
Best Value Performance Plans (BVPPs) are to be produced annually by 31March
by each local council. The first BVPPs, prepared by all local councils, are to be
published by 31.3.00. These give councils the opportunity to engage local people,
and others with an interest, around their record of delivering local services and
their plans to improve upon them. They are intended as the principal means by
which a local authority is held to account for the efficiency and effectiveness of
its services, and its plans for the future.
User satisfaction surveys
Under Best Value, councils are required to report on user satisfaction indicators
for all their services. They will carry out a general survey, plus a service-specific
survey for specialised services such as social services.
Further information on best value can be found on the DETR website at
www.local-regions.detr.gov.uk/bestvalue/bvindex.htm
Further information on the personal social services user experience survey can be
found on the Department of Health website at:
www.doh.gov.uk/pssuser/index.htm
47
A Quality Strategy For Social Care
Quality Protects
Many of the principles of the Quality Strategy are already being put into
practice in the Quality Protects programme, and supported by the
Children’s Services Special Grant in 2000-01.
• ‘Managing change’ is a priority area for grant in 2000-01.
• We are enhancing the development and use of management
information systems.
We
are disseminating ‘what works’ in a number of ways.
•
• QP Research Briefings aim to help frontline managers and
practitioners ground their practice in evidence-based knowledge.
Examples
of best practice will soon be available on the new Quality
•
Protects Website at: www.doh.gov.uk/quality.htm
• Four demonstration projects in diverse authorities focus on a range
of issues for services for black and ethnic minority children and their
families.
• We are helping local authorities improve their quality assurance
systems.
• We are working directly with councillors, frontline social workers
and children.
• For councillors, we have produced Think Child, a guide to quality
in children’s services, have held a series of seminars and will be
holding more during the course of 2000.
• We have commissioned research from MORI to gauge frontline
social workers’ recognition of and reaction to Quality Protects.
• We are launching a series of seminars/demonstration events in
children’s participation, aiming to hear their views on Quality
Projects and the care system.
Beacon councils
The Beacon Council Scheme aims to identify centres of excellence in local
government from which other councils can learn. To be selected as a Beacon, the
council must provide evidence of good overall performance, and the particular
services for which Beacon status is awarded must be demonstrably excellent. All
Beacon councils have a duty to spread best practice in the service for which
Beacon status is awarded. The Improvement and Development Agency (IDeA)
will co-ordinate a national programme to spread good practice.
48
A Quality Strategy For Social Care
Social Care Awards
The Social Care Awards recognise innovation, best practice and value for money
in social services. They aim to raise the public profile of social care workers and
of the work that they do.
Carers’ Awards
In its first year the Department of Health sponsored the Carers Awards, this is a
new initiative aimed to give carers the chance to nominate someone – other than
a relative – who they feel has given them exceptional help that reflects good
practice in services.
Examples of rewarding excellence
REWARD
FOR
SCHEME
Social Care
Awards
Herefordshire
Council Social
Services
St Owen’s centre student council, run by
and for people with learning disabilities,
with the help of a facilitator.
Beacon Council Wakefield
The Council's Housing and Social Care
Scheme Awards Metropolitan
Department works in partnership with
District Council Barnados to provide services for care leavers
through the 'Signpost' project. The project
has positive working arrangements with a
range of other agencies to meet young
people's assessed needs and plans. Service
users are actively involved in shaping
strategy, policy and practice for leaving care
services.
Carers Awards
Richard King,
of Greenwich
Social Services
Department,
based at the
Greenwich
District Hospital
Nominated by young carer Zoe Ansell of
Eltham, South London, who looks after
her mother and her sister. Zoe said, ‘My
eco-warrior, friend, social worker. He is a
unique and wonderful person who really
cares. Thank you Richard for being our
friend and just being there.’
49
A Quality Strategy For Social Care
Performance assessment frameworks
Performance assessment will bring together all the information available about
the performance of councils with social services responsibilities, in order to:
help them develop their own performance management arrangements
•
ensure that social care issues are appropriately addressed in Best Value
•
performance plans
ensure that the corporate management and leadership and political
•
scrutiny arrangements promote better social services that contribute
to community wellbeing
ensure that they work effectively with the NHS to address joint
•
health and social care policy and services delivery issues
ensure
they work effectively with other local government
•
departments and external agencies
assess their progress in implementing the government’s policies for
•
social care
identify and promote good practice
•
identify councils whose performance is poor and ensure action is
•
taken to improve their services.
Full details of the performance assessment framework for social services can be
found in Performance Assessment 2000/01 on the new Department of Health
PSS Performance Assessment website at: www.doh.gov.uk/scg/pssperform.
50
A Quality Strategy For Social Care
Bibliography
2000
Performance Assessment 2000-01 – a guide, Department of Health 2000.
www.doh.gov.uk/scg/pssperform.
Guide to Quality Schemes and Best Value, Cabinet Office, DETR and IDeA
2000.
Older People’s Definitions of Quality Services, Joseph Rowntree Foundation
2000.
Community Care (Direct Payments) Act 1996 Policy and Practice Guidance,
Department of Health 2000.
Children’s Services Planning consultation, Department of Health 2000.
All Our Futures – Better Government for Older People programme, Cabinet
Office 2000.
1999
A New Approach to Social Services Performance, Department of Health 1999.
Personal Social Services Performance Assessment Framework, Department of
Health 1999.
Working Together to Safeguard Children, Department of Health 1999
www.doh.gov.uk/quality.htm
Modern Social Services – A Commitment to Improve, The 8th Annual Report of
the Chief Inspector of Social Services 1998/9, Department of Health 1999.
The Local Government Act 1999 (Part 1 Best Value), DETR.
www.local-regions.detr.gov.uk/bestvalue/bvindex.htm
Health Act 1999, Department of Health www.doh.gov.uk
51
A Quality Strategy For Social Care
A New Era for Community Care? What people want from health, housing and
social care services, Christine Farrell, Janice Robinson and Peter Fletcher, Kings
Fund 1999.
Outcomes of Social Care for Disabled People and Carers, Outcomes in
Community Care Practice No.6, SPRU 1999.
Models of Service Support for Parents of Disabled Children. What do we know?
What do we need to know?, P.Sloper (Child 1999).
Supporting Disabled Children and their Families, J.Morris (Joseph Rowntree
Foundation 1999).
Better Care, Higher Standards - A Charter for Long Term Care, Department of
Health 1999.
Facing the Facts Services for People with Learning Difficulties, Department of
Health 1999.
Meeting the Challenge, Improving Management Information for the Effective
Commissioning of Social Care Services for Older People, Department of Health
1999.
Planning to Deliver: Inspection of Children’s Services Planning, SSI 1999.
The Government’s Objectives for Children’s Social Services, Department of
Health 1999.
Fit for the Future? National Required Standards for Residential and Nursing
Homes for Older People, Department of Health 1999.
Modernising Health and Social Services: National Priorities Guidance 1999/002001/02.
52
A Quality Strategy For Social Care
1998
Modernising Social Services White Paper, Department of Health 1998.
Listening to Users of Domiciliary Care Services M.Henwood, H.Lewis and
E.Waddington (UKHCA and Nuffield Institute for Health 1998).
A First Class Service – Quality in the new NHS, Department of Health 1998.
Overview: Outcomes of social care for older people and carers, Outcomes in
Community Care Practice No.5, SPRU 1998.
LAC(98) 28 The Quality Protects Programme: Transforming Children’s Services.
HSC 1998/167: LAC(98)23 Health Improvement Programmes, Planning for
Better Health and Better Health Care.
Someone Else’s Children, Department of Health 1998 CI(98)14.
Messages from Research: Caring for Children Away from Home, Department of
Health 1998 CI(98)23.
Other significant sources
People Like Us: The Report of the Review of the Safeguards for Children Living
Away from Home, W.Utting 1997.
What Works In Services for Families with a Disabled Child? B.Beresford,
P.Sloper, S.Baldwin and T.Newman (Barnados 1996).
Electronic Library for Social Care (eLsc) www.elsc.org.uk
National Electronic Library for Health (NeLH) www.nelh.nhs.uk
Training Support Programme, www.doh.gov.uk/training
Department of Health website at www.doh.gov.uk
Department of Environment, Transport and Regions website at www.detr.gov.uk
The Cabinet Office website at www.cabinet-office.gov.uk
53
A Quality Strategy For Social Care
Further copies of this publication are available free from:
Department of Health
PO Box 777
London SE1 6XH
Fax: 01623 724524
email: [email protected]
This document is available on the Department’s website at:
www.doh.gov.uk/scg/qualitystrategy.htm
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