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Listen
Growing Support
4 Integrated support for vulnerable families
Quality assurance and workload management
A focus on action
Clinical and professional supervision
Education and training
Quality assurance and workload management
1. Senior social work managers in each of the local authorities we visited had clear and specific expectations of what effective professional practice and case management should look like. They were not able to say definitively how far their expectations were currently being met in the areas for which they were responsible but thought that practice was likely to be variable with weaknesses attributable to workload pressures. In none of the local authorities were these expectations written down or available to staff, in the form of practice or operational standards. In the absence of clearly visible professional standards for their organisation, operational staff thought that management was concerned with productivity rather than quality. There were no consistent systems for quality assurance.
2. First line managers had more of a sense of strengths and weaknesses in local performance. But their perception of standards was intuitive, based on observation of some aspects of practice and content of supervision rather than any systematic attention to quality assurance. There was evidence in one local authority that some line managers had read some case records, but this was not common across the local authority fieldwork sites. Local managers did not have sufficient information to benchmark their teams' performance against that of other area teams in the local authority or say how consistent performance might be across the local authority. They knew about different local issues and pressures affecting responses and performance in different parts of their local authority.
3. Practitioners in local authorities and health services thought that senior management in their organisation was preoccupied by organisational and financial issues rather than management of the services. There had been management reviews and reorganisations in each local authority area within the last year. In some authorities there had been more than one reorganisation of senior management leaving frontline staff confused and uncertain about lines of accountability and decision making, and demoralised and cynical about effectiveness. In efforts to ensure effective financial management, control of resources was very centralised and few local managers were aware of how much their services cost. None had devolved control of financial resources other than small local budgets for limited financial assistance.
4. In health services strategic planners and senior managers also lacked information about the quality of local professional practice, and any systems for measuring this. We were struck by the differing perceptions of management and frontline practitioners about the quality, quantity and effectiveness of health care services.
A focus on action
5. We found that too often agencies and practitioners focused narrowly on their core function without taking account of the family's wider needs and the impact of other professionals.
6. On the whole however, where health, education and social work services were working together to support families, too much time and effort was spent on duplicating 'assessment' and 'monitoring' rather than remedial input. There was little evidence of focused work towards change with clear goals and regular review and evaluation of the effect of agencies' intervention.
7. Joint planning and liaison on a regular basis was limited to those cases in which there was a formal framework for inter-agency planning and review. These were cases in which there was an inter-agency child protection plan, children subject to compulsory measures of supervision, or looked after away from home by the local authority. There were no means to ensure joint planning between the professionals in cases that fell short of these thresholds.
8. We found evidence that in order to obtain social work intervention other services were increasingly making referrals framed in terms of risk to children and child protection. Framing referrals in this way may subject a larger number of families to the stress of compulsory intervention, with its attendant problems, than is warranted.
Clinical and professional supervision
9. All the local authority social work services have well established arrangements in place for supervision of field social workers. The frequency and content were tailored appropriately to the developmental needs of newly qualified and experienced staff and most reported that they were satisfied with the content and quality of supervision by first line managers. Supervision addressed review of casework, agency responsibilities and management requirements and staff development. Formal supervision was regular and reliable, although often liable to disruption in all the authorities.
10. We found some evidence that the introduction of nurse specialists in some areas had given health visitors greater access to clinical supervision. But these practitioners had few regular opportunities to review complex cases. Arrangements for clinical supervision were patchy and irregular. In some areas clinical supervision was based on peer review and support. Clinical supervision by supervisors was available on nurses' request and many staff were hesitant about appearing unconfident.
11. Many staff working directly with both parents and children most often, such as family aides, respite carers and childminders, home support workers and child care staff in family centres, were the least qualified and most junior in professional networks, with least access to training and supervision.
Education and training
12. Across health and social work services professions, but most consistently amongst field social workers, practitioners said that their pre-qualifying training had not equipped them to practice autonomously with confidence, and meet their agency's requirements with vulnerable children and families, particularly those with complex needs and problems. Paradoxically, other agencies perceived newly qualified and less experienced practitioners as more likely to work actively with families with complex needs. Children's Reporters described newly qualified social workers as more likely to maintain regular and frequent contact, more persistent in engaging families and more creative in identifying sources of help and providing emotional support for families. They suggested organisational constraints and workload pressures on more experienced staff were contributing to 'burn out' and cynicism.
13. All agencies highlighted the need for some mandatory element of shared training at pre-qualifying and post-qualifying level for health and social work staff working with children. We found some successful examples of joint training and inter-agency practice forums.
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