Quality Assurance for Social Care Agencies

A Practical Guide

Emlyn Cassam, Himu Gupta

• Publisher: Routledge
• Year: 2017
• eBook ISBN: 9781351907330
• Topic: Politics & International Relations
• Subtopic: Social Policy
• Index: Politics & International Relations

Quality Assurance for Social Care Agencies is specifically designed to enable you to set up a Quality Assurance system within a social services setting. Including practical checklists, it covers all aspects of Quality Assurance - from what is meant by Quality Assurance and how to implement it to how to monitor and maintain quality control. Examples and details of experiences are included to help you get it right first time.

1    Introduction

The aims of this book are to be practical, readable and useful. Students who wish to delve into the arcana of theoretical concepts would be better advised to search elsewhere. During the last 5 years, the authors have devised and introduced a system of quality assurance into one of the largest social services departments in the country. Here, they describe how they did it, setting out the pitfalls and rewards, the successes and surprises.

The book will be of interest to anyone who is thinking of promoting the concepts of quality either in large organisations or in smaller teams and units. The impetus towards producing a quality outcome may be generated by councillors, managers, staff, consumers, voluntary bodies, professional associations, trade unions. All may benefit from reading this practical description of what works and what does not.

Of course, no one ever admits to having no interest in quality. Everybody would say that they intend to provide a good quality service, and are often affronted when obvious failures are starkly brought to their attention — often accompanied by hurtful publicity. Councils whose youngsters complain about intolerant or irrelevant regimes in their children’s homes; proprietors of residential homes whose insensitivity denies dignity to their residents; staff whose restrictive practices force consumers into lifestyles even less flexible than penal institutions; voluntary organisation who so patronise their recipients that they have fewer rights than children; workers whose arrogance precludes their listening to what their clients are saying; politicians who promise Valhalla and deliver purgatory; all would probably claim that they are aiming at quality and ‘doing the best they can’. And when things do go wrong, always the fault lies with ‘resources’ or incompetent bureaucrats or the profit motive or the Government or training — always something beyond their control. This book insists that quality must be the responsibility of everyone, and sets out what you can do to achieve it.

Aiming for quality in the work of social care agencies is not new. Achieving it, however, is somewhat rare. Practical instructions on how to tackle the task are few and uncoordinated. Like the pot of gold at the end of the rainbow, we all cherish the ambition of reaching it, but the precise route is difficult to find. Exhortations abound and there is no shortage of Government strictures placing the full responsibility on local authorities for securing good standards of care.

In managing the mixed economy of care, ensuring quality will be vital. No agency has a monopoly of virtue on quality. So far as local authorities are concerned the recent SSI report on the management of local authority homes for the elderly made that abundantly clear. We look to you to ensure that the care provided is not simply the cheapest, nor the most convenient to supply, nor a ratification of the way things have always been done, but the package that best meets the client’s need. To define good quality is not always easy but I urge you to begin listening to your clients.

David Mellor, Minister of Health, Social Services Conference 1989

Monitoring the quality of services will become more complex as social services authorities’ responsibilities for arranging the provision of community care increase. As purchasers, arrangers and providers of care services, local authorities must be responsible for ensuring that adequate systems are in place for securing the necessary qualit of services and monitoring it over time.

Paragraph 5.14 of the White Paper Caring far People

SSDs will need to ensure that they are aware of the quality of services which service users expect. This information can be obtained in a variety of ways but monitoring existing users’ satisfaction with services, information obtained through the complaints procedure, from inspection units and from individual assessments, should be used. SSDs will be responsible for ensuring quality standards are built in to service specifications. A critical issue in commissioning care services will be the establishment of quality standards which meet the requirements of the ‘purchaser’, the service user and to which the service provider is committed. However, this does not mean that quality is solely the commissioner’s responsibility. Providers are responsible for the delivery of quality and the onus should be placed on them to demonstrate the quality standards they propose and the systems in place to assure this provision.

Paragraph 4.18 of Policy Guidance Community Care in the Next Decade and Beyond

In addition to these exhortations, experience from commercial and manufacturing ventures shows that concentration on quality not only leads to satisfied customers but increases the job satisfaction of the workers and reduces costs to the employer.

The Government too seems to be taking its own strictures seriously. Whatever people may think about the content of the Citizen’s Charter and the Patient’s Charter, or the rights of parents vis-à-vis their children’s education, the concept is surely right. It is pleasing to see that (albeit slowly), the Government is taking steps to make some of the services over which it has more control more responsive to users e.g. Social Security and the Prison Service.

What then has been inhibiting social care agencies from putting quality ‘up front’?

Disregarding the basic lack of understanding (which this book seeks to address), the prime reason is that some of the people vital to a comprehensive quality service have other issues higher on their agenda. Aiming for quality is fine, providing it does not get in the way of:

•  some local and national politicians being able to keep down the costs to the charge payer or taxpayer;

•  management stretching resources to meet preferred client need, or at least concentrating as a priority on those areas where there is the greatest danger of debilitating publicity. (And we have enough problems without upsetting the unions, don’t we?);

•  professionals, whose perceived task is to give people what they appear to need rather than what they would actually choose;

•  those trade union negotiators who have no doubt where their loyalties lie when a choice has to be made between allocating extra money to benefit their members or to improve the standard of services.

Another inhibiting factor is the fear of losing control over what we want to do, the pernicious belief that we always know better than anyone else. Why should we have to do what somebody else wants, especially as we do not trust their values? What can the private sector (who have only been lured into social care by the prospect of making money) teach local authorities brought up on decades of municipal benevolence and public-spirited professionalism? Or, what lessons can protected town hall bureaucrats give to dynamic business entrepreneurs? What can either offer to dedicated, underfunded voluntary groups?

Even within departments or agencies suspicions have to be overcome. What are the hidden agenda? Is quality assurance merely a management device to discipline and control staff? Will it be used without consultation to change current ways of working? Why should staff co-operate if the end-results may reflect badly on them? What guarantees are there that deficiencies in personnel and training will be identified and rectified — or even the inefficiences of management? Where does it fit in with our equal opportunities policy? Will it just be an additional burden, an extra chore? What will it mean for me?

And councillors too may be wary. Why should they approve a system which will identify unmet need and consumer dissatisfaction? Is this a ploy by the officers to bounce the council into spending more money? What will the group make of it — and the chairs of other Committees?

Amongst these doubts and worries the voice of the consumer can be lost.

To overcome the inertia of the status quo and the fears of those deeply entrenched in their defensive postures is a complex and lengthy task. There is no quick fix. The introduction of a quality assurance system in Norfolk’s Social Services Department was slow, evolutionary and painstaking — no big bang, no conversions on the road to Damascus — just an emerging vision which developed over 8 years. Many false trails were enthusiastically followed, including the chimera that inspection units on their own could raise standards; we found out in the very early days that merely to identify deficiencies did not necessarily mean that anything would be done about them!

Indeed, we are indebted to Clive Bone (of Clive Bone Associates) who recently pointed out to us that our experience was similar to that of Admiral Rickover who was in charge of the American nuclear submarine programme. We quote: ‘Admiral Rickover was working in an environment that had first-class inspection facilities and comprehensive standards; yet in a 1962 Conference Paper ‘The Never Ending Challenge’ he wrote that:

•  only 10% of the work was delivered to programme;

•  30% of the work was 6 months to a year late;

•  50% required rework on receipt;

•  only 10% of the welds met the standard.’

This was happening in the most technically advanced nation on Earth, the nation that invented modern production engineering as it is understood today, and the nation that taught the Japanese about quality! In other words, Admiral Rickover was confronted with the inherent limitations of the control approach to quality. He saw that it was vital to ensure that the organisation which was to supply a product or service had a system of internal organisation to make sure that things were done right first time. Quality control — standards setting and monitoring — does not achieve this and can lead to too many controls and bureaucracy, which in turn leads to a lack of ownership by the workforce.

In this context it may not be irrelevant to consider modern-day Russia and Japan, the former decried for the quality of some of its products, the latter applauded. Yet no one could fault Russia for the theoretical standards it sets for its industries. And how many people realise how little emphasis is given by Japanese industry to external inspection? If quality is built into the production line, external inspection becomes almost superfluous.

This book will show the steps which need to be taken in order to ‘build quality into the system’. Wherever possible, examples will be given, many based on the authors’ experiences with Norfolk County Council

Norfolk began grappling with problems of quality in 1982, and in 1987 the Social Services Committee had the foresight to set up a Quality Control and Staff Development Section to be headed by an Assistant Director. This section incorporated the functions of training; inspection of all the Department’s activities; advice on setting standards and interpreting legislation; homes registration and the inspection of statutory and independent homes to common criteria.

This section was to be fully integrated into the system of quality assurance. For example, Homes Registration Officers were involved in the drawing up of the Revised Guide to Registration and consulted homeowners about what should be included. They were to participate in training courses and seminars for the independent sector and, when required, would offer support and advice to isolated proprietors. In our view that was a far more effective way of raising levels of care than any threats to consider deregistration.

Norfolk evolved the vision of assuring the quality of all its services, not just of residential care. The tasks of the Unit inspecting residential homes are similar to those of staff who monitor home-care, occupational therapy and all aspects of fieldwork and day-care. Quality is an attitude of mind which should permeate throughout all the Department’s activities, and it would be incongrous for residential care to have a different system from the rest of the Department.

We hope that this book will not be a disappointment to those who think that, by setting up an Inspection Unit, their quest for quality is complete. In our view, quality cannot be inspected into an organisation. Indeed, the present predilection for inspection could divert attention from the real issues surrounding quality unless they are put firmly into their proper contexts.

Much of what will be described could seem to some readers as nothing more than principles of sound management. So be it. Perhaps in essence that is what is lacking in many social care agencies. This book will attempt, however, to put these principles into a process which gives a high premium to consumer satisfaction, and ensures that staff are set objectives which are achievable.

Vested interests abound in the delivery of social care. In their time, professionals, managers, party political factions have held sway. More recently, it has been the day of the auditor and accountant. An emphasis on quality will at last put the consumer back in the picture. And, you never know, that might in the end prove agreeable to everyone.

Checklist of main points in Chapter One

1.  Quality assurance is the responsibility of every person in an agency. This book sets out what you can do to achieve it.

2.  Concentration on quality not only leads to satisfied users but it increases the job satisfaction of the workers and reduces costs to the employer.

3.  To achieve quality, it is necessary to put it higher on the agenda than other cherished interests.

4.  To do what the user wants, it may be necessary to lose some bureaucratic control.

5.  There is no quick fix.

6.  Setting standards and inspecting whether they are being achieved will not by themselves achieve quality.

7.  Much of a quality assurance system can be described as good management.

2 From little acorns

The system of quality assurance which is to be described in this book began its life 9 years ago. To many, it was an unwanted baby, to be tolerated only because its parents were apparently respectable. During a disturbed and disturbing adolescence, not even its begetters were sure of what they had spawned, or whether their offspring would reach maturity.

This chapter logs the faultering steps which brought us to where we are today. Much of our thinking was empiric. Some was filched from elsewhere, including a clandestine visit to a ‘bootiful’ turkey-processing plant! Those readers who are confident that they have nothing to learn from the historical groping of others — or are just impatient — are welcome to pass on to Chapter 3!

In 1982, the management of Norfolk Social Services Department realised that it has a serious problem. It had no idea whether the services it was offering to the public were of a high enough quality. Management information consisted primarily of the volume, size and relative cost of various activities — but not whether they were effective or whether they were what the consumer wanted. True, the Department had detailed policies and procedures, which were constantly being revised by a team of social work consultants, but our performance review largely consisted on whether we received letters of complaint (and sometimes praise!) or what appeared in the local press, radio or television. When trying to evaluate if policies were being carried out, senior ma...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgements
• Foreword
• 1. Introduction
• 2. From little acorns
• 3. What is this thing, quality assurance?
• 4. Creating the right climate
• 5. Aims and values
• 6. Setting the standards
• 7. Setting up the assembly line
• 8. Monitoring and inspection
• 9. Consumer satisfaction
• 10. Review of the system
• 11. Postscript
• Appendix 1: Mission statement — Wiltshire County Council
• Appendix 2: If you need to complain… We need to listen — Norfolk Social Services
• Appendix 3: Statements of philosophy and policy for the provision of services — Norfolk Social Services