Local Authority Social Services Departments Research Articles

Building capacity for social care research – ways of improving research skills for social workers

ABSTRACT Recent literature in social work/care continues to highlight limited levels of research involvement by practitioners coupled with low confidence and knowledge of research skills. This article reports on findings from a study to develop a better understanding of the challenges of building capacity to undertake social care research in the South of England and opportunities for building research engagement and capacity. It focuses on research skill gaps identified in current training pathways and qualification routes from the perspective of practitioners working in social care. A qualitative approach was undertaken. Participants were practitioners working in local authority social service departments. Participants completed an online questionnaire (n = 22), with a subsample (n = 6) being interviewed. A semi-structured interview schedule collected positive and negative views of research experiences and of using research evidence. Logistical and research skill enablers and research skill barriers were extracted as themes from the data and are described. The authors then discuss possible initiatives that might assist in helping to improve social work practitioner research skills and embedding research into practice.

Policy on the rebound: trends and causes of delayed discharges in the NHS

The Community Care (Delayed Discharges, etc.) Act, 2003 was aimed at reducing the number of patients whose discharge from hospital was delayed, incorporating financial incentives based on a model from Sweden. The Act permitted NHS hospital trusts to charge local authority Social Service Departments for delays they were deemed responsible for and was accompanied by grants aimed at supporting improvements in the transfer of care. This study aims to assess how far the subsequent reduction in delays has been due to the operation of the Act, and to evaluate the extent that the legislation increased efficiency across health and social care. Analysis and interpretation of a range of official routine health statistics plus unpublished performance data. Setting Data on patients delayed in hospital in England from 2001-2002 to 2006-2007 and trends in hospital activity. Trend analysis of health statistics and performance data relating to delayed discharges and other relevant indicators. Results Although there has been an overall reduction in delayed discharges, this trend predates the implementation of the Act. Overall, bed- days lost to delayed discharges accounted for only a small proportion of all bed-days - 1.6% in 2006-2007, and over the period studied the causes of the majority of delays were attributed to the NHS (68%). These findings indicate little evidence to support the policy of charging social services to improve public sector efficiency. The focus on reducing delays should be set in the context of the wider health economy. There are a number of pressures to reduce the time patients spend in hospital including fewer beds and increasing numbers of admissions, plus a rise in emergency readmission rates is noted. There are few good data available to monitor the impact of earlier discharge, such as on the quality and availability of post-discharge care.

The Order of Chaos: Exploring Agency Care Managers' Construction of Social Order within Fragmented Worlds of State Social Work

SummaryThe paper explores the experiences of a small group of agency care managers, based in local authority Social Service Departments (SSDs). Utilizing a method influenced by ethnomethodology, it considers attempts by agency staff to construct order in their disparate worlds of work. It was discovered that organizational and legal procedures are especially significant in personal attempts to acquire order. In addition, conformity to established norms, including the ability to gain peer acceptance and support (both inside and outside the SSD), were also of importance. Despite some improvements, however, forms of personal order were rarely achieved (or achievable), due to an array of chaotic influences. They included the abundance of convoluted and ever changing organizational and legal procedures; limited discretion and access to training; and brief, and superficial, relations with colleagues and clients. It is argued that agency social work provides more intense exposure to the uncertainty and change that epitomize care management. Such temporary employment may also help to further fragment state social work, and increase the superficial relations and hazards that encompass market-driven public sector employment. It is concluded that agency work needs to be contextualized within broader trends—most notably globalization and marketization.

To market! To market! A new dawn for community care?

The public sector in Britain has been subjected to over a decade of major reform aimed at breaking up public service monopolies, at containing costs while at the same time opening services up to greater consumer choice. Health and social services have not been exempt from this revolution in the organization and management of public sector services. The long-standing policy of care in the community is being subjected to market principles and the introduction of a ‘contract culture’ very similar to the NHS reforms introduced in 1991. This paper reviews the origins of these developments in the doctrines of ‘new public management’, a movement which has proved attractive to policy-makers in many countries. Local authority social services departments have been identified as the lead agency for the development of a mixed economy of care following a review of community care policy by the government's health adviser, Sir Roy Griffiths, and a subsequent white paper. This paper examines the limited empirical evidence available on how managers and providers are meeting the challenge bestowed upon them, and concludes that most authorities are moving ahead cautiously if at all. Only a handful of authorities studied have embraced the reforms with any degree of enthusiasm. The paper concludes with an assessment of the reforms from two perspectives: a pessimistic one and an optimistic one. There are many worrying features of the reforms, not least among these being a lack of clarity over their intended purpose. Tensions and contradictions are plentiful, which places in jeopardy the certainty of the reforms in becoming user led rather than provider driven. A more optimistic scenario is that the changes are leading to a loosening up of services and practices which have often suffered from sclerotic tendencies, paternalism and sometimes complacency. If the reform process is skilfully handled and not rushed and if the ends are clearly established and communicated then users and carers could prove to be the principal beneficiaries.

‘This isn't very typical I'm afraid’: observing community care complaints procedures

The new complaints procedures which local authority social services departments have been required to introduce represent an important mechanism for managing the change of culture associated with recent community care reforms. They also represent a new genre in mechanisms of redress for welfare recipients. This paper reports the findings of a study which has observed considerable diversity in the ways in which local authorities are interpreting the nature and purposes of the new procedures and, in particular, the functions of review panels established under those procedures. Variations in the composition of panels, in the style of review panel proceedings, in perceptions of the panels' powers, and in the ways that complaints and complainants are constituted are all discussed. Attention is drawn to four competing interpretations of the review panels' role and to the need for these to be clarified and prioritised.

Social Theory, Performativity and Professional Power—A Critical Analysis of Helping Professions in England

Social Theory, Performativity and Professional Power—A Critical Analysis of Helping Professions in England Drawing from interviews and ethnographic research, evidence is provided to suggest a sense of "anxiety" and "regret" amongst state social workers and case managers working on the "front-line" within local authority social service departments. There have been a number of theoretical approaches that have attempted to ground the concept of "power" to understand organizational practice though Foucauldian insights have been most captivating in illuminating power relations and subject positioning. In order to theoretically interrogate the relationship between social theory and professional power, we draw from the neo-Foucauldian work of American Social Philosopher Judith Butler—especially regarding Butler's (1990, 1993 and 1998) powerful work on "performativity" and its relationship to social work. We also attempt to examine the "distances" between the social work role and social workers narratives through an examination of notions of "anxiety" and "regret" in the face of the professionalisation of state social work.

Effective partnership working: a case study of hospital discharge

The process of discharging patients from hospital provides a critical indicator of the state of partnership working between health and social care agencies. In many ways, hospital discharge can be seen to epitomise the challenges which beset partnership working. For patients who have care needs which continue following their discharge from hospital, how well health and social care partners are able to coordinate their policies and practice is critical. Where arrangements work well, patients should experience a seamless transition; where things go wrong, patients are all too often caught in the middle of contested debate between health and social care authorities over who is responsible for what. In 2002, growing concerns over the numbers of mainly elderly people who were experiencing delays in being discharged from hospital led to the announcement that a system of 'cross-charging' would be introduced to target delayed discharges which were the responsibility of local authority social services departments. The government's proposals were widely criticised and were the focus of much antagonism. The intervention of the Change Agent Team (an agency with responsibility for providing practical support to tackle delayed discharges) marked a turning point in the presentation of the policy and in supporting local implementation efforts. This paper examines partnership working between health and social care by exploring the specific issues which this case study of hospital discharge provides. The analysis highlights the importance of understanding the dynamics of partnership working on the ground. It also underlines the need for a new relationship between central government and local agencies when old-style models of command and control are no longer fit for purpose. A new approach is required that addresses the complex and multiple relationships which characterise the new partnership agenda.

Patterns of re‐referral to social services: a study of 400 closed cases

ABSTRACTThe last 10 years have seen considerable government focus on effective initial assessment processes in the UK. This has been given added impetus by research that found that more than 97% of referrals are closed without allocation for long‐term work. Yet there is little research on referrals that are closed and no British study of patterns of re‐referral for such children. The current study looks at 400 consecutive referrals to three local authority Social Services Departments in London that were closed rather than being allocated for long‐term work. It investigates how many children were re‐referred in the 27 months after closure and identifies factors statistically associated with re‐referrals. The study found that a third of closed cases were re‐referred (36.5%), with most re‐referrals happening relatively rapidly. A small proportion of families accounted for most re‐referrals: 8.5% of families had 52% of subsequent referrals. There was very wide variation between local authorities in the number of referrals and re‐referrals received. Other factors associated with increased likelihood of a re‐referral were: previous referrals, neglect, parental capacity issues (particularly drug misuse) and parent/child relationship problems. The implications of the findings for practitioners, policy‐makers and researchers are discussed.

The Disintegration of local authority social services departments

Social services departments have been an integral feature of local authorities in England for delivering social services since 1970 with a distinct identity, a largely uniform set of social service functions and similar organisational structure. This model of a unified social services department has survived major structural reorganisations in local government, the community care initiatives and social services modernisation agendas. This paper reviews recent government initiatives to promote closer collaboration between health and social services and identifies the different models now in place or being put into place. These include formal partnerships, integrated management, integrated care trusts and the example of fully integrated health and social services trusts. The paper considers whether such developments along with the establishment of new children's trusts will finally mean the disintegration of local authority social services departments, whether the Seebohm vision has been abandoned and what future there is for social care within local government.

Access, Ethics and the (Re)construction of Gender: The Case of Researcher as Suspected ‘Paedophile’

This paper presents an account of an access encounter, and uses this case to reinforce the potential for access meetings to provide a rich source of ethnographic data. The paper originates from one of the authors' experience of negotiating research access in a UK local authority social services department. In response to a summary research proposal sent in advance that expressed interest in social work with men, a gatekeeper expressed his concern during an initial meeting that the author might be a ‘paedophile’ wanting to make contact with others of a similar persuasion. This encounter, and the issue of sexual abuse that it introduced, highlights a number of ethical, epistemological and gendered tensions for ethnographic work, which this paper attempts to negotiate. Some of the potential implications of this specific access meeting are discussed, and set within broader methodological and empirical contexts.

Social Care and the Modern Citizen: Client, Consumer, Service User, Manager and Entrepreneur

Since coming to power, New Labour has embarked on a programme of modernization. Few areas of state activity have been more visibly subjected to New Labour’s modernization agenda than the personal social services. Local authority social services departments have largely ceased to exist as separate organizational entities. However, modernization has also required that the relationship between state and citizen be reconstructed. This is evident in New Labour’s vision for adult social care which envisages a move towards individual budgets. The individualizing nature of such schemes may be thought hard to reconcile with the discourse of integration and partnership prominent elsewhere. However, a key linking concept is that of ‘person-centredness’. It is often assumed that this simply means that public services become more flexible to meet the needs of ‘the person’. This paper uses the example of direct payments to demonstrate how modernization also requires flexibility of ‘the person’. It would appear that inherent in New Labour’s project of modernization is the assumption that the modern citizen should be both managerial and entrepreneurial. What were once public responsibilities are being transferred to the individual. The implications for the users of adult social care are discussed.

The Tension between Mainstream Competence and Specialization in Adult Protection: An Evaluation of the Role of the Adult Protection Co-ordinator

With the implementation of No Secrets (Department of Health, 2000), the question of how far to specialize in adult protection has been raised for social services departments. Related issues include the extent of specialization within the vulnerable adult client groups as well as between adult protection specialists and other workers. This paper draws on an evaluation of the role of the adult protection co-ordinator across two local authority social services departments (the case study) who share adult protection policies, protocols and procedures but where the specialist role has only partially been implemented and has evolved in different ways. It identifies a number of critical considerations for the local implementation of national policy, including the particular model for adult protection specialization, working relationships with district management and care management, decision making and accountability, adult protection case management and the development of mainstream competence in adult protection.

Policy Swings Over Thirty-Five Years of Mental Health Social Work in England and Wales 1969–2004

Thirty-five years ago social work in England and Wales was reeling in the wake of the Seebohm Report (1968) and local government reform that had brought about the unification of personal social services under new local authority Social Services Departments (SSDs). Over three decades later, social workers working in the fields of childcare, mental health, learning disability, older people and physical disability once again are increasingly working in separate settings. The Department of Education and Skills has acquired responsibility for children's services. While responsibility for community services for older people and those with physical disability is retained by social services, mental health social workers are again often working in healthcare settings, albeit in community mental health teams managed by new health and social care partnerships. This article considers, through a review of the policy and professional literature, the main political and workforce contexts of mental health social work in England and Wales between two main periods, 1969–1990 and from 1990 up to the present time (2004). It does this to illustrate how policy swings and trends during the periods have influenced social work practice, with a particular focus on mental health.

Good enough decision‐making? Improving decision‐making in adult protection

This paper examines decision‐making in adult protection based on arrangements operating in a local authority social services department and discussion generated in a specialist training intervention. The paper seeks to identify ways in which approaches to decision‐making can be made both more effective and more user centred. The need for good information for efficient and effective decision‐making is highlighted, along with the need for user involvement for the production of positive and valued outcomes. The paper looks at how user centred arrangements can be put into practice and discusses the potential for advocacy, outlining possible approaches for adult protection casework. With local authority social services departments struggling to implement No Secrets (2000), with adult protection a key social care competence and with the implementation of PCP and similar approaches a priority (Valuing People, 2001), it is important to improve decision‐making in adult protection in ways that are not only time and resource efficient, but place service users and their advocates at the centre of related processes.

Progress Towards Partnership? The Development of Relations between Primary Care Organisations and Social Services Concerning Older People's Services in the UK

This paper will present evidence from the interim results of a large scale longitudinal project designed to track the development of partnership working between the new primary care organisations (Primary Care Groups and Trusts) entrusted with the commissioning and in some cases provision of health care, and local authority social services departments, regarding health and social care services for older people in the UK. Drawing on theoretical work concerning the role of partnership working in the governance of welfare, the author uses a framework originally devised by the Nuffield Centre for Health at the University of Leeds to analyse the interim data, and to draw conclusions about the feasibility of current policy pushes towards partnership working and service integration around health and social care for older people.

The readiness is all. Planning and training for post-disaster support work

Having acknowledged the world-wide impact of the terrorist attacks in New York on 11 September 2001 attention is drawn to the number of recent peace-time disasters that have happened in Great Britain. Local authority social services departments have been suggested as being best placed to be the lead agency in co-ordinating responses to such disasters. This paper describes how Buckinghamshire social services is working in partnership with its local voluntary counselling agencies to establish and maintain a trained team able to respond to disasters if needed. Contemporary theory relating to post-traumatic stress disorder, the imprint of death, psychic numbing and survivor guilt is cited and illustrated. The team has not yet been involved in a major disaster but examples are given showing its responses to various smaller scale, local disasters. It is acknowledged that counselling and de-briefing after disasters are not necessarily beneficial and therefore some critics of its provision are quoted. Lessons distilled from practice wisdom are provided. Responses to disasters are more likely to be effective, and least damaging to those involved, if potential helpers are trained as a team and are fully aware of the likely impact of such events.

New managerialism, social service departments and social work practice today

Global economics, demographic change and the rise of neo-liberal-ism have contributed to the new managerialist ethos of public sector organisations. In consequence, Local Authority Social Service Departments have been reformed and now operate by means of management approaches borrowed form the private sector. It is argued here that this new organisational and managerial context is reshaping the very nature of social work. Previous methods have given way to a managerial-technicist practice that fails to place due emphasis on the non-rational component of the human condition and the process of caring. This approach is compared to the earlier reflexive-therapeutic, socialist-collectivist and individualist-reformist perspectives, as identified by Payne (1997). The paper concludes by noting the uncertain future of Social Service Departments as well as social work itself.

Nursing Homes in England and their Capacity to Provide Rehabilitation and Intermediate Care Services

The numbers of older people living in residential and nursing home care in the UK have risen exponentially since the early 1980s when the closure of long–stay geriatric wards and changes in social security funding of care home places led to a rapid expansion of the care home industry. While the implementation of the 1990 National Health Service (NHS) and Community Care Act shifted the responsibility for the commissioning and funding of these services to local authority social services departments, the provision of most health services (such as general practitioner care, physiotherapy and specialist nursing services) to nursing home residents remains the responsibility of community–based NHS practitioners. Recently, the attention of policy–makers in the UK has been focused on the need to improve the throughput of the acute sector. Older people who have received treatment but are not yet able to return to their own homes are to be transferred into intermediate care facilities, often by using nursing home beds, with the aim of supporting short–term rehabilitation outside of the acute sector. This paper presents evidence from a study of health service provision to older people living in nursing homes in England. It examines whether nursing homes have the capacity to fulfil the rehabilitation and intermediate care function envisaged by policy–makers. It concludes that shortfalls in the provision of NHS services to nursing homes and difficulties faced by nursing homes in paying for health services themselves may hinder the rehabilitation potential of intermediate care placements in nursing homes.

Increasing the depth of field: The Voluntary Sector Pathway

There is a danger in discussion about social work that it becomes seen as a monolithic activity, one which is the monopoly of Local Authority Social Services Departments. Voluntary sector social work is, inevitably, a casualty of this view: overlooked within accepted definitions of social work and marginalised within the teaching and placement organisation of the DipSW curriculum. The Voluntary Sector Pathway, an option in the second year of the MA/DipSW course at the University of Nottingham, inverts this situation, promoting the longstanding and unique contribution of the voluntary sector to social work. Voluntary sector placements provide the culmination of a learning experience which places the sector at its heart. This article has its roots in a workshop run at the JSWEC conference at Derby University in the summer of 2001 on the theme of partnership. This provided an opportunity for the authors, joint co-ordinators of the Pathway, to reflect, together with Voluntary Sector Pathway students, on their learning. The workshop was conceptualised, planned and delivered in partnership with three students from the 1999-2001 student cohort - Jane Gorst, Jonathan Lung and Alice MacGregor - with input from a number of other students on the Pathway. It describes the work of the Voluntary Sector Pathway and considers its effectiveness in preparing students for practice in a range of settings. In the light of forthcoming changes to social work education, we consider the lessons to be learned from this unique Pathway.

Integrating Primary and Social Care in Barking and Dagenham

By bringing together the management of the local authority social services department and the new primary care trust, an alternative to the ‘care trust’ model has been tested in this London borough. A senior manager here describes the background, and outlines both the achievements and the difficult issues that remain.