Compliance and Risk Management: Embracing Change in a Modernising Welfare Service

Compliance and risk-management in social services is not a tick-box procedure however, it is the bottom line in service users care. The social service staff has as much responsibility as the organisation to maintain standards within budgets.

It is been well noted that social services is facing unprecedented change, focusing on four structures which are: planned; unplanned; safeguarding and procurements. This is certainly the case with the “Birmingham County Council” (May 2011) who was summon to the Court to determine the eligibility criteria matrix (DH 2002) for care needs assessment (within critical level of needs) and it lost the case on technicalities. The decision of the court was that Birmingham County Council did not consult its intentions widely to all the stakeholders.

The Court’s decision has halted drastic changes that most social services would have wished to pursue in recent times. However, the intended changes may have resulted in many challenges but, also opportunities for efficiency. One critical task is to standardise compliance to governance and risk-management requirements across the new structures and streamline the organisation’s activities. In health and social care, compliance is not just a process of ticking the right boxes and this is the difference between services to people who can make contibutions towards their well being and tragedy. Care giving has to be tailored to individual needs irrespective where the service is delivered (in the primary or secondary sector) while compliance is imperative.

Monitoring services has taken on even greater resonance with the “Care Quality Commission's” new authority to sanction and even close down services if concerns of significant risk to service users are identified. The Commission can and does turn up unannounced at any service within an NHS trust or a care home and question staff, patients and service users about key areas within the standards of quality and safety, as set out by the legislation (DH 2000, 2005). The task of ensuring our enlarged workforce and all the services provided within the NHS and social service organisations should complie with the standards. In the present time, the standards are further complicated by the reorganisations and restructuring around the departments while bridging operational and culture differences between services.

Nonetheless, developments in technology has enhanced as well as embedded a sophisticated but easy-to-use real-time quality monitoring tools; from allocation of cases, to self-assessments, inputting relevant activities in the system, and ensuring correct processes. Through the dashboard technology, managers have instant access to up-to-date information or are able to extract information and give advice to all concerned at any giving time about what assurance is available to them, gaps in services or budget constraints that exist, and what is being done about issues in question.

This level of visibility is an absolute prerequisite to running health and social care at this point of demographic change and budgetary control. Yet, it is not uncommon to work in an organisation such as social services that still relies on multiple spreadsheets with outdated information and a poor grasp of what their problem areas are. Not only are these organisations ill-equipped to cope with the changing demography, policies, budgets as well as staffing issues, transformation and redesigning of the systems, they are also impeded by an intellectual deficit to embrace business culture within the organisations. In reality, the health care and social care sectors should welcome the extra stringency being exercised by the “Care Quality Commission”. It is now empowered to help drive quality performance and safeguarding of service users care, a goal we should all strive to achieve. Equally, as long as good governance is implicit in everything we do, we need not fear its new powers.

For a long time, the NHS and social service organisations have exhausted their resources and attention by seeking to back up everything they do with documentary evidence of good practise rather than focusing on practicing budgetary management on a day-to-day basis, in the field, where it matters. To date only a few management teams have placed adequate emphasis on taking a bottom-up approach to service developments and delivery. Time has come to shift the emphasis from creating paper trails and searching for proof of protocol, to each member of staff taking personal responsibility for their actions. This approach requires a level of education for all front line staff, which will involve keeping standards in the front of their minds in everything they do.

Compliance in budgetary rules, quality assessment and care as well as risk management is paramount for the NHS and social care to survive in the current macro and micro financial challenges and increasing demand for care. Front line staff needs to be reminded that compliance is not about form filling or chasing evidence for abstract standards, it is in fact about practicing the basic standards of care every day.

New Face of Home Care: The Telecare Systems

Successful home care and assisted living for older people is depended upon on a holistic assessment framework carried out by assessors who are able to identify risks and draw up strategic risk management plans to overcome the risks within the environment. The Social Work Task Force Board identified among other things: the need for more emphasis on risk assessment frameworks; risk analysis and joint working with other professionals such as the occupational therapists. On refection, Telecare systems are changing the face of home care for older people within the wider welfare services. Telecare by definition is electronic tools (sensor mat, medication alert system, task alert reminder) designed and capable to assisted living in the community. These devices are now helping many older people to achieve their aspirations to be cared for in their own home. Most local authorities prefer to maintain, as many older people as possible in the community rather than in residential care, settings and telecare have been instrumental to achieve this policy framework. Telecare also provide assurance to some family members that their older relatives are safe in their own home and potential risks are reduced. Thus, to greater extent, telecare has enhanced home life environment, older people are no longer compelled to move into residential setting because of risks within their environment.

Institutional care is an environment where, despite good intentions, there is a great imbalance of power between the residents and those providing care or support them. This power imbalance can also arise when older people receive a lot of support at home. From practice based observation, the author argued that low self-esteem amongst older people living in different kinds of supported accommodation (residential care home' sheltered accommodation) is a huge and multifaceted issue. Low expectations of a fulfilling life are issues of concern and as a result older people prefer to remain and receive care in their own home for as long as possible.

According to Raynes et al (2001, 2005), older people rejected institutional care in favour of home care because there is a clear lack of strong and unifying vision of good life for older people with high support needs. Increasing choice for older people and their carers/families has been one of the cornerstones of government policy, both Conservative and New Labour. The NHS and Community Care Act (DoH 1990), and more recently the Royal Commission on Long-Term Care for Older People (1999), aimed to ensure that older people have increased opportunities to stay at home rather than enter residential care. Jospeh Rowntree (2009) noted that this was the choice of older people and their carers/families, and that more resources should be put into enabling them to satisfy that choice.

The author emphasise the need for telecare systems to form a significant part of home care package for older people.Telecare is a wake up call for social workers to advocate for their clients psychosocial wellbeing and their safe environment. For detail reading, refer to "http://www.articlesbase.com/authors/dr-felix-ugwumadu/550700