Chapter 9 – Deirdre Connolly (D1SOP9)
Domain 1 Standard of Proficiency 9
Understand the role of policies and systems to protect the health, safety, welfare, equality and dignity of service users, staff and volunteers.
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KEY TERMS Understanding policies and systems How policies and systems develop Role of policies and systems in protection Effect of policies and systems on social care workers
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Social care is … about all of us. It is about recognising that at any time we, or someone we care about, may need care and support to live a whole and fulfilling life and be safe. Social care policies, systems and practice seek to address the tendency at a societal and individual level to ‘other’ people who have different experiences and needs from our own, to ensure that there is high-quality, fair and equitable care and support for anyone who needs it. |
Introduction
The standard of proficiency set out in the CORU standards expects that social care staff will understand the role of policies and systems in protecting the health, safety, welfare, equality and dignity of service users, staff and volunteers (Domain 1, Standard 9). But what are policies and systems? Where do they come from? What is their role in protecting the health, safety, welfare, equality and dignity of the people who use services and the staff and volunteers involved in their care and support? And what is the effect of these policies and systems on social care workers when they are delivering person-centred care and support?
In this chapter I am going to look at these questions in detail based on research and using the lens of my own experience, first as a social care worker in voluntary services and latterly in my role developing standards, guidance and policies for social care services at an organisational and national level. By doing this, I aim to illustrate how the social care sector has changed since the early 1990s, how social care has been shaped by emerging national policies and systems that inform day-to-day practice, and finally the effect these policies and systems have on social care workers.
Understanding Policies and Systems
First, let’s take a look at policies. What is a policy? At a high level, there are social policies. These are developed by states and governments to address the social needs of people in society in areas such as housing, health, education and social services (Blakemore & Warwick-Booth 2013; Spicker 2014). While it might be difficult to see the connection between such high-level social policies and the day- to-day policies and procedures of your organisation, it is these social policies that ultimately inform many organisational policies. At an organisational level, policies can be understood as a set of rules or guidelines for an organisation and its staff to follow in order to deliver safe, high-quality care and support to people using its services.
At a very basic level, policies set out what staff members actually do in their in day-to-day work to meet the care and support needs of the people using a service, and what they aim to achieve. I will go into more detail about the relationship between social policy and organisational policy in the next section. One common example of an organisational policy, recognisable to all social care workers is a recording and documentation policy. While not universally loved, the importance of recording your work in a timely, accurate, consistent and clear way cannot be overstated (HIQA 2012).
By doing this you ensure that there is a clear overview of the person’s wellbeing before, during and after any intervention. This information can then be used to inform aspects of the person’s care and support, reflecting what is working well and not so well, and allowing you and the service user to decide together what adjustments may need to be made so that any interventions are effective. Recording and documentation is fundamental to good person-centred planning, and also to your own supervision and reflective practice.
Turning now to what is meant by systems, as referred to in the CORU standard; these are the structures that an organisation puts in place to organise its staff, its resources and its facilities to ensure that organisational policies can be implemented and the organisation can achieve its aims. Continuing with the example of recording and documentation, services should have a system in place to support staff to consistently record and document their work. Although the format may vary from service to service within an organisation, or even from task to task – for example, there may be an ICT system where staff input case notes in an online file, while staff might have a hard copy of a supervision template that they complete and store in a folder – the fundamental purpose of the system remains the same: to accurately record and document essential information and to do so in a consistent manner.
Taken together, then, the aim of policies and systems is to create a clear framework for staff in which to practise so that they know what to do and how to do it. This in turn provides a level of consistency and predictability for people using the service, which is very important. Without clear policies, and robust systems to support social care workers to implement them, it is very difficult for organisations to protect and promote the health, safety, welfare, equality and dignity of people using the service, staff and volunteers, in line with both CORU standards and other national standards.
Reflecting on my own experiences of policies and systems, a great deal has changed since I began my career in social care nearly thirty years ago. Before I did my degree in social care in the late 1990s, I worked in the access service of a Dublin University providing academic support services to students with disabilities. Then I worked as an information and research officer in a small charity supporting people affected by HIV and AIDS. While the overarching objective of my role in each of these services was clear – for example, researching and providing information in an accessible way – how I was expected to work on a day-to-day basis was less clear. There was a brief job description, but no formal induction or introduction to policies (such as they were), no supervision, and little in the way of procedures or systems. Though there were occasional team meetings, the size of these services meant that the line managers simply took it for granted that everyone knew what they were supposed to do and would learn from each other on the job. And, in general, we did know what to do, and just got on with it. I did receive occasional feedback, usually from another staff member and sometimes (but rarely) from a manager, but it was all very ad hoc. Although I was fairly confident that my work was meeting the needs of people using the service – at least, they seemed happy with it – I was working very much in isolation. It was very hard for me to fully grasp the wider context of what I was doing or how my work fitted into a bigger picture. In fact, looking back, I’m not sure there was a bigger picture! It is very hard for any social care worker to develop in their role in these circumstances.
It was only when I started my degree in social care that I began to see this ‘bigger picture’ more clearly, to understand what informed and shaped social care more generally, and to gain an understanding of where my work, in particular, sat within this wider paradigm. My studies allowed me to break down social care practice into its key components, to see the relationship between wider social issues and the lived experiences of people and why some needed support from social care services. I also began to see how social policy informs legislation and how both inform organisational policies and systems and social care practice on the ground (as discussed from a variety of perspectives by others in this book).
TASK 1
Read Chapters 4, 13 and 16 for a few examples of how legislation has influenced policy at both national and organisational levels.
How Policies and Systems Develop
As I touched on in the previous section, social policy informs the development of many of the day-to day policies and systems within social care services. But where do social policies come from?
One such policy with which we are all familiar is Children First National Guidance for the Protection and Welfare of Children, the national guidance for the protection and welfare of children. First developed in 1999 by the Department of Health and Children, it has gone through several iterations, the most recent version published in 2017 (DCYA 2017). While Children First articulates in detail the responsibilities for statutory social workers and An Garda Síochána, as set out in the Child Care Act 1991, it also states clearly that it is the responsibility of all those working with children to keep them safe. Although the policy has developed over the years, the objectives of Children First have remained unchanged since 1999. They are: to raise awareness of child abuse and neglect; to improve the response to concerns about a child; to ensure that people working with children understand their responsibilities in this regard; and to enhance communication and coordination of information between disciplines and organisations.
Practical Example 1 Reflecting on My Practice
As previously discussed, my own awareness of policies and systems began in college.During this time, I started working in a residential service for people with intellectual disabilities.In this service, there was a strong focus on meeting the psycho-social and physical needs of the people living there, and a clear commitment to their wellbeing. The service had practical procedures in place to be followed by staff when providing care to each person – everything from planning daily activities, to family engagement, to medication administration. However, as a staff member in that service, I felt little connection to the wider organisation and had no real sense of continuity between services. There were some organisation-wide health and safety policies, and systems for recording staff hours, but care planning, incident reporting, and adult and child safeguarding policies, all common policies in services today, were not in operation uniformly across the organisation. Instead, each residential or day service developed its own local policies and procedures based on the presenting needs of the people using the service, often in response to an incident. These policies and procedures, and the systems that supported them, were generally useful and created a practical framework for staff to work within at the time. However, as they weren’t connected to any social policy, legislation or strong evidence base, when the needs of the people using the service changed, these policies didn’t necessarily meet these emerging needs. And, because staff had put time and energy into writing these policies, and had embedded systems to support them, they were difficult to change.
This national policy is connected directly to your organisation’s child protection policy. It underpins any child protection and welfare training you receive and the system you use for recording, documenting, submitting and following up on child welfare and protection concerns. Additionally, any adult safeguarding policy in operation in your service has also been shaped by the principles first described by Children First and now reflected in the National Standards for Adult Safeguarding (HIQA & MHC 2019). Children First is a clear example of how a high-level social policy, enshrined in legislation, can shape social care practice on the ground.
Role of Policies and Systems in Protection
What role do policies and systems have in protecting the health, safety, welfare, equality and dignity of people using or delivering social care services? Looking back at Ireland’s historical approach to protecting the safety and wellbeing of people using social care services (as well as health and mental health services), we are all too aware of the failure to protect people who need care and support when services are hidden from view, as illustrated in the 2021 final report of the Mother and Baby Homes Commission of Investigation (DCEDIY 2021), or where there are inconsistent policies and fragmented approaches, as outlined in the Department of Health’s report on the response to COVID-19 in nursing homes (DoH 2020).
Research shows that the provision of social care services in Ireland, up until the late 1990s, was largely hidden from public view (Connolly 2019; Linehan et al. 2014; Raftery & O’Sullivan 1999). Despite ongoing calls in the social care sector for legislation and external monitoring, the role of the state remained at one remove, with very little co-ordination or oversight of the work of the many services in operation across the country. Although the development of guiding legislation for children’s social services began in the 1980s, resulting in the 1991 Child Care Act, and regulations for disability services were approved in 2000s (Health Act 2007), the establishment of bodies to assess compliance with the legislation and regulations only happened in 1999[1]The Social Services Inspectorate (SSI), established in 1999, was subsumed into the Health Information and Quality Authority (HIQA) on its establishment in 2007.[2] in response to high-profile reports of abuse and neglect2 (Connolly 2019; Jones & Smey Carston 2016).
Although these external oversight systems are often put in place in response to an incident or a failure to protect people (Koornneef 2010), as can be seen here in Ireland, such systems have also been established in response to the increased demand for accountability by social care services themselves (Featherstone et al. 2012). It is generally accepted now that services and individual staff members must be able to evidence that the work they do is having a positive impact on the lives of people using their services. It is also increasingly necessary that services can prove that the work they do represents value for money (Martin et al. 2010).
In my own work, I saw this increased demand for organisational governance structures and professional accountability when I started work as a housing support worker at a national housing and homeless and advocacy organisation in the early 2000s. This demand was driven in part by organisational expansion and in part by the expectations of central governing and funding bodies such as the Dublin Regional Homeless Executive (then the Homeless Agency) and the Health Services Executive (then the Health Board). At this time, the organisation was keen to develop consistent cross- organisational policies and systems and to train staff to use them effectively. All of this was aimed at improving quality across the organisation, improving outcomes for people using services and, crucially, being able to demonstrate effectiveness to funders, both statutory funders and the general public (whose donations funded a significant proportion of its activities).
Looking again to the example of Children First as a guiding policy, at the time the organisation was working on the development of a child protection policy aligned to Children First, as well as child protection training that was contextualised for staff working in housing and homeless services. The policy and training worked together to ensure that children who might be more vulnerable to abuse and neglect due to their housing circumstances, or the problems that their parents were facing, were supported by staff who knew how to recognise the indicators of abuse and neglect, and how to respond to these in an appropriate and timely way.
Management in the organisation were keen to involve staff members in this process, not only to ensure that the policy and the training reflected the diverse circumstances of children’s lives, but also to promote staff buy-in and the implementation of the policy in day-to-day practice. In my role as a housing support worker, I worked with families who were moving from homelessness into housing, supporting them to address a range of issues that were negatively impacting their wellbeing and their ability to sustain a home. The organisation recognised my knowledge and experience in this area and so I was asked to get involved in developing both the policy and training, as well as in delivering the final training package to staff.
- The Social Services Inspectorate (SSI), established in 1999, was subsumed into the Health Information and Quality Authority (HIQA) on its establishment in 2007.
- These cases included the Kilkenny Incest Case (1993), the Inquiry into the Operation of Madonna House Report (1996), and the HSE report on Leas Cross Nursing Home (2006).
Following this experience, I moved away from frontline work and was employed by the organisation as its standards development officer. This provided an opportunity for me to work on the development of many other organisational standards and policies, all informed by research and all with the input of frontline staff. Later, I moved on to creating systems for auditing the compliance of individual services with these standards, developed processes for services to assess their own compliance and areas for improvement, and systems for people using the services to provide feedback on their experience of the service and whether it met their expectations. These structures and systems helped to ensure that the organisation was meeting both its legal obligations and, more important, its obligations to deliver high-quality, safe and consistent support to people using the service. It is important to note that while all these systems improved the governance and accountability of the organisation, this was all internal assessment of compliance, because housing and homeless services did not fall under the remit of the external regulatory body, HIQA. And, in fact, they still don’t!
Effect of Policies and Systems on Social Care Workers
The intended effect of policies and systems is to create a framework to support staff in their day-to-day work, reduce ambiguity and inconsistency, and set out clearly what should be done in a variety of situations. Of course, social care practice is by its nature extremely complex. The work of social care workers must also be informed by their knowledge, experience and creativity. We know from research that policies and systems can in fact act as a constraint on innovative practice, and compliance with policies and systems becomes an end in itself (Boyd et al. 2017). It is important that a balance is struck and that staff are not burdened or stifled by excessively policy-driven or bureaucratic systems. Additionally, it is important to note that when policies seem at odds with the purpose of the service, or when the systems to implement them become too burdensome, staff often ignore them. This leads to staff developing their own way of doing things, which in turn leads to inconsistent care and support, ultimately impacting on the safety and wellbeing of those using the service (Brechin et al. 2000).
To illustrate some of the effects of polices and systems, I’m going to take a detour here to bring in research I undertook as part of my master’s dissertation. Specifically, I looked at how social care managers experienced HIQA’s inspection and monitoring process to understand the effect it had on their practice (Connolly 2019). Although the focus of my research was primarily on participants’ experience of preparing for, participating in and following up on HIQA inspections, the research also touched on how social care has changed over time, what this change has meant for social care workers in their day-to-day work, and what effect this has had on the safety and wellbeing of people using services. Nearly all participants talked about how they had witnessed a significant increase in the number of policies and systems in their organisation to ensure compliance with the national standards that HIQA assesses against. They found that these policies meant that staff spent a lot of time on recording and documenting the work to evidence compliance with the regulations and standards, taking time away from direct work with people using the service.
Nevertheless, my research showed that social care staff believe that external inspection, and the policies and systems needed to ensure that the service can evidence good practice for inspection, is necessary. It holds them (and their service) accountable for their work, and thus improves the quality and the safety of the services for the people using them (Connolly 2019). However, the research also highlighted a possible drawback of external inspection, whereby services are found to be ‘gaming the system’ by providing inspectors with the evidence of compliance they require, while not actually improving the services for the people who use them (Boyd et al. 2017).
Ultimately, what the external inspectors want to see, and what ensures the best possible outcomes for people using the service, are organisations where national standards, policies and systems are meaningful, internalised and lived out in day-to-day practice by both management and frontline staff (Connolly 2019; Featherstone et al. 2012; Koornneef 2010; Smithson et al. 2018).
Consider This
As a social care worker, part of your role is to create opportunities for the people using the service to be involved in the development and review of policies, and the systems that support these. By doing this you can help to ensure that these structures reflect the needs of people using the service, and are in line with best practice.
Conclusion
The thread running through this chapter is the importance of understanding what frames your work the social policy, the legislation, and the organisational policies and systems that follow from these and recognising how it affects your practice. It takes time to understand this, but as you build up your knowledge and experience, this framework will become clearer to you. It is there to guide your work and ensure that the people you are caring for and supporting receive a high-quality, safe and consistent service. Over time, you will be able to reflect on whether the policies and systems in your organisation are benefiting the people you work with, or whether they need to be reviewed. And as you gain more experience and are able to see how these polices are influenced by social policy and legislation, you will be in a position to contribute to reviews of these in a meaningful way so that they are fit for purpose.
TASK 2
What policies and systems frame the work in the service where you are on placement? Talk to your supervisor, the staff team and the people who use the service about how they experience these policies.
- Do they know these policies and systems exist?
- Do they know where they came from?
- Do they think they work?
- What would they change about them?
Tips for Practice Educators
As discussed, students need time and support to understand the role of policies and systems in your service in action, not just as a concept.
Beginning of placement: discuss with the student the relevant policies and systems that they need to know about, and when and how these are intended to support their work. Show the student where the service policies are located and give them time to review them, setting aside time in the first few weeks of placement so that they can ask you questions about them.
Middle of placement: this is the time for the student to take an active role in critically understanding the policies and systems that frame the work, and the ethos that informs them, and how people who use the service experience them.
References
Blakemore, K. and Warwick-Booth, L. (2013) Social Policy: An Introduction. UK: McGraw-Hill Education.
Boyd, A., Addicott, R., Robertson, R., Ross, S. and Walshe, K. (2017) ‘Are inspectors’ assessments reliable? Ratings of NHS acute hospital trust services in England’, Journal of Health Services Research and Policy 22(1): 28-36.
Brechin, A., Brown, H. and Eby, M.A. (eds) (2000) Critical Practice in Health and Social Care. Maidenhead: Open University Press.
Child Care Act (1991). Dublin: Stationery Office. Available at <http://www.irishstatutebook.ie/eli/1991/ act/17/enacted/en/html>.
Connolly, D. (2019) ‘How Do Social Care Managers in Disability Services Experience Regulation and Inspection?’ Master’s dissertation, TU Dublin. Available at <<https://arrow.tudublin.ie/cgi/ viewcontent.cgi?article=1105&context=aaschssldis>.
DCEDIY (Department of Children, Equality, Disability, Integration and Youth) (2021) Mother and Baby Homes Commission of Investigation Final Report. Available at <https://assets.gov.ie/118565/107bab7e- 45aa-4124-95fd-1460893dbb43.pdf>.
DCYA (Department of Children and Youth Affairs) (2017) Children First National Guidance for the Protection and Welfare of Children. Dublin: DCYA. Available at <https://www.tusla.ie/uploads/content/ Children_First_National_Guidance_2017.pdf>.
DoH (Department of Health) (2020) COVID-19 Nursing Homes Expert Panel: Final Report. Dublin: DoH. Available at <https://www.gov.ie/en/publication/3af5a-covid-19-nursing-homes-expert-panel-final- report>.
Featherstone, B., White, S. and Wastell, D. (2012) ‘Ireland’s opportunity to learn from England’s difficulties? Auditing uncertainty in child protection, Irish Journal of Applied Social Studies 12(1): 49-62.
Health Act 2007. Dublin: Stationery Office. Available at <http://www.irishstatutebook.ie/eli/2007/act/23/ enacted/en/html> [accessed 10 May 2021].
HSE (Health Service Executive) (2006) Leas Cross Review. Dublin HSE. Available at <http://hdl.handle.net/10147/44494>.
HIQA (Health Information and Quality Authority) (2012) Guidance on Information Governance for Health and Social Care Services in Ireland. Dublin: HIQA.
HIQA and MHC (Mental Health Commission) (2019) National Standards for Adult Safeguarding. Dublin: HIQA.
Jones, C., and Smey Carston, C. (2016) ‘Lessons from abroad: Rebalancing accountability and pedagogy in the Irish social care sector through the use of effective leadership’, Administration 64(2): 61-83.
Koornneef, E. (2010) ‘Measuring the Effects of Regulation on the Quality of Health Services: Developing a Conceptual Framework for Evaluation’. ECPR Third Biennial Conference, Regulation in the Age of Crisis. Dublin: UCD.
Linehan, C., O’Doherty, S., Tatlow-Golden, M., Craig, S., Kerr, M., Lynch, C., McConkey, R. and Staines, A. (2014) Mapping the National Disability Policy Landscape. Dublin: School of Social Work and Social Policy, Trinity College Dublin.
Martin, S., Downe, J., Grace, C. and Nutley, S. (2010) ‘Validity, utilization and evidence-based policy: The development and impact of performance improvement regimes in local public services’, Evaluation 16(1): 31-42.
OECD (Organisation for Economic Co-operation and Development) (2000) Reducing the Risk of Policy Failure: Challenges for Regulatory Compliance. Available at <https://www.oecd.org/gov/regulatory- policy/46466287.pdf
Raftery, M. and O’Sullivan, E. (1999) Suffer the Little Children: The Inside Story of Ireland’s Industrial Schools. Dublin: New Island Books.
Smithson, R., Richardson, E., Roberts, J., Walshe, K., Wenzel, L., Robertson, R., Boyd, A., Allen, T., and Proudlove, N. (2018) Impact of the Care Quality Commission on provider performance: Room for improvement? London: The King’s Fund.
Spicker, P. (2014) Social Policy: Theory and Practice. Bristol: Policy Press.
