Poor working conditions = unsafe practice

When I was a student social worker in the 1970s I undertook one of my practice placements - in what was then called ‘social services’ - in a large building in the centre of a large town not too far from London. I may have only been a student social worker, but, like every other social worker that worked there, I had my own office. To be sure it was not a large office and it was nothing fancy, but it was private and quiet and clean.

It seems things have changed .... for the worse.

This week I read a sad report in Professional Social Work of an interesting and alarming survey concerning working conditions of social workers in Britain in 2015. It is peppered with words like ‘cramped’, ‘noisy’, ‘dark’ and ‘dirty’. Indeed more than 60% of those questioned did not think their workplace was fit for purpose.

Many of the respondents complained vociferously about shared work spaces and 'hot desking' with more than 60% not having a quiet place to make sensitive phone calls and more than 70% saying that there was no quiet place to work and concentrate.

It is shocking that in 2015 working conditions for social workers are as bad as they are. It’s not just that it is unpleasant and dispiriting to work in an unpleasant environment, it is downright dangerous.

Distraction due to background noise is an important factor in workplace error and has been recognised as something that needs to be minimised in many safety critical industries. In civil aviation the ‘sterile cockpit rule’ is a mandatory requirement for there to be no distraction on the flight deck during critical parts of the flight. 

https://en.wikipedia.org/wiki/Sterile_Cockpit_Rule 

In nursing red tabards are worn by nurses, indicating that they should not be disturbed during a drug round. These have been found to result in reduced medication errors. 

http://www.ncbi.nlm.nih.gov/pubmed/24930500 

There is simply no excuse for employers creating or tolerating conditions in which social workers are more likely to make errors. Serious attention needs to be given to how to achieve safe workplaces – albeit on limited budgets - which are quiet, comfortable and have dedicated private spaces. Failure to do so risks more than the welfare of members of the workforce – it risks the safety of children and young people.

Ofsted and the Parable of the Red Beads

The government’s proposed reforms of children’s services in England assign a pivotal role to the inspectorate Ofsted. If a local authority’s children’s services department is rated ‘inadequate’ by Ofsted, it will now be given six months to improve or risk being taken over. That’s drastic stuff, so there has never been a better time to think very hard about how valid and reliable Ofsted inspections are.

To help do just that I have developed a thought experiment which is based on the red bead game that was used by the quality guru, Dr. W. Edwards Deming, as a teaching aid in the seminars and lectures he gave across the world until his death in 1993. Dr. Deming used the game to demonstrate that even with identical methods and tools there will always be variation in results and that this variation often has nothing to do with what individuals and groups actually contribute to delivering a particular process.

My thought experiment adapts the red bead game as follows:

Imagine you have 150 pots, each one corresponding to a local authority in England. In each pot you place 5000 beads, 4000 of which are white and 1000 of which are red. The beads represent ‘cases’ or ‘service episodes’. The white beads are examples of acceptable or good practice and the red ones are examples of poor practice. So 1 in every 5 cases (20%) is substandard. [1]

Now simulate the activity of an inspector by randomly extracting from each pot 50 beads and examining what you get [2]. You will be very lucky indeed to find that each extract contains 40 white beads and 10 red ones (corresponding to the overall proportion of 20% red beads in the pot). On the contrary you are highly likely to have quite a lot of variation in the white/red proportion of each extract. In some cases the number of red beads will be well below 10, in some it may even be 0, and in some cases it will be considerably higher than 10. In a few cases there may even be more red beads in the extract than white.

Results for the first 10 pots might look like this:

Pot	No. (%) red
A	5 (10)
B	15 (30)
C	11(22)
D	19 (38)
E	2 (4)
F	17 (34)
G	8 (16)
H	23 (46)
I	5 (10)
J	18 (36)

This variation cannot be ascribed to anything that is going on inside the pots (because we know that we put in 4000 white and 1000 red beads into each one and that they have just stayed there until they were extracted). So it would be very wrong indeed to ascribe to any particular pot a description such as “too many reds” or “too much poor practice” or “inadequate”. And it would be very wrong to conclude that pots D, F, H and J should be made subject to special measures while those responsible for pots E, A and I should be lauded for their outstanding performance!

But I hear you ask, perhaps Ofsted has taken steps in the way it has designed its inspections, and the ways in which it selects its samples, to minimise the natural variation which occurs in the red bead game? Perhaps they use clever statistics to ensure that their results are valid? Well, perhaps they do but there is no evidence of it. I have scoured the Ofsted website for anything which suggests that they have thought about the red bead problem. And I have written to them and pursued them with a Freedom of Information Act request to find out if they use statistical techniques to try to ensure inspections are valid. The reply I received gives no indication that they do. [2]

But it is not really up to me to justify Ofsted’s methods. It is up to them. In 2012 Professor Dylan Wiliam, of the University of London’s Institute of Education, challenged Ofsted to evaluate the reliability of its school inspections and publish the findings, asking: “If two inspectors inspect the same school, a week apart, with no communication between them, would they come to the same ratings?” (Times Educational Supplement 03/02/12 ).

I don’t know whether Prof. Wiliam got an answer but I can’t find one that has been published. Maybe in 2016 Ofsted could answer a similar question for me. “How can Ofsted be sure that the variation between different local authorities, revealed in its inspections of children’s services in England, is due to differences in performance rather than just due to chance?”

If Ofsted cannot answer that question in a convincing way it should not be in the business of inspecting children’s social care and the government should certainly not be assigning a pivotal role to Ofsted in its so-called ‘reforms’.

Notes

[1] I have no evidence that 1 in 5 cases is in fact substandard, although it seems to me to be a reasonable 'guestimate', especially in view of the fact that Ofsted finds such a large number of authorities ‘inadequate’ or ‘requiring improvement’. I have tried, without success, to discover if Ofsted is able to estimate what the proportion of substandard cases is in the entire ‘population’ of the cases they have reviewed in (say) the last 10 years.

[2] Ofsted’s ‘Inspection Handbook’ speaks of ‘tracking’ no more than 30 children during an inspection and ‘auditing’ a ‘sample’ of 20 case files. I could find no detailed information in this document about how the cases are chosen. 

Outcomes of Ofsted child protection inspections

Hard on the heels of the much trumpeted, but in my view wrongheaded, government ‘reforms’ comes the latest state of play information from Ofsted.

Apparently Ofsted has informed BBC News that more than three-quarters of reports of inspections published between February 2014 and September 2015 found local authority children services in England to be in need of improvement.

19 out of 74 (just over a quarter) were judged to be ‘inadequate’ by Ofsted inspectors. 38 out of 74 (just over a half) were judged to ‘require improvement’. Only 17 out of 74 (just under a quarter) were judged to be ‘good’. None were judged to be ‘outstanding’.

http://www.bbc.co.uk/news/uk-35088879

The pie chart says it all.

With the government now prepared to give inspections such a pivotal role in determining the future of local authority children’s services, and with recent inspections seemingly revealing such a bleak picture, Ofsted should be required to provide a robust defence of the validity of its inspections. If, as I suspect, Ofsted has been getting it wrong and unnecessarily labeling some authorities ‘inadequate’, then viable organisations are now in danger of being unnecessarily dismantled and the services they provide needlessly turned over to untried newcomers.

We don’t want ‘landmark reforms’ – we want safer child protection services

Yesterday the Prime Minister outlined what is being described as a major overhaul of child protection in England. He claims that it is “a landmark reform”. There is a very thorough account of what was announced in the Yorkshire Post.

At the heart of the package of changes is the proposal that “failing” local authority children’s services will be taken over unless they rapidly recover from an Ofsted finding of ‘inadequate’. Trusts composed of other more successful local authorities and charities will step-in to run the services.

Something similar has, of course, already happened in places like Doncaster, so the idea is not entirely new, but what the Government is now proposing appears to be much more of an automatic process. If Ofsted rates an authority ‘inadequate’, and the authority does not improve within the next six months, a commissioner, who can call in outside help from other local authorities and charities, will be put in charge. It is as simple as that.

For reasons outlined below I don’t like these reforms. They seem to me to be Ofsted-driven, process focused and not based on a clear understanding of how service failures occur. In short, they are a bad idea.

Instead of setting out the argument in a separate post I am going to reproduce (with permission) an article being published by the Safer Safeguarding Group.

This is a recently formed group of professionals from a variety of fields who all want to see much clearer thinking about safety in child protection. Needless to say I am a member. If you would like to join the group or want any more information, use the ‘contact’ section of the group’s website or email: SaferSafeguarding@gmx.com

Here is the article:

 

Members of the Safer Safeguarding Group are pleased to see that the Government believes it is a priority to improve child protection services in England. However we believe that what the Prime Minister called “landmark reforms”, announced on 14^th December 2015, are unlikely to achieve the far-reaching outcomes that ministers say they desire.

At the heart of the package is a proposal that failing local authority children’s services will be taken over unless they rapidly recover from an Ofsted finding of ‘inadequate’. In the absence of marked improvement within six months, a commissioner will be appointed who can establish a trust, composed of other more successful local authorities and charities, to step-in and run the services. With one-in-four Ofsted child protection inspections resulting in a verdict of ‘inadequate’, there looks likely to be plenty of scope for commissioners stepping in and take-overs by trusts occurring. We have important reservations about any improvement process that is largely driven by the outcomes of Ofsted’s inspections which tend to concentrate on issues of process rather than the important fundamental issues of safe operation.

Nor do we believe that root and branch organisational change is a good way to develop safer services. New commissioners, trust boards and management structures may all sound like a ‘new broom’, but we believe that lasting safety advances come about through slow, incremental and continuous improvement in which front-line practitioners, in particular, are involved in understanding how service failings occur and how to prevent and mitigate them. Large-scale organisational change is highly disruptive. All too often once the dust has settled, unhelpful and unsafe working practices are found to have persisted unaddressed. Not only that but changes of this type do not come cheap. Large-scale reorganisations eat up scarce resources and seldom demonstrate value for money. We believe that scarce resources should be targeted on front-line services and on trying to understand where the weaknesses in organisational defences are to be found. Initiatives to eliminate those weaknesses and so increase safety and service quality should be the priority.

In short we believe that the Government has fallen into the trap of believing that lasting improvements can be brought about by heavy-handed top-down initiatives. In their ideal world Ofsted will point the finger and a new commissioner and a new trust will sweep in - like the proverbial cavalry - to reconfigure services. But in reality this type of approach is unrealistic. It will fail to engage those people who actually do the work, causing a more stressful working environment, and it will fail to identify the systematic and structural weaknesses that underlie poor performance and safety failings.

What is required is to create a learning culture in which the people who do the work feel free to explore how things go right and how things go wrong and to propose and research improvements; in other words, promoting a just reporting culture. In contrast blame cultures, in which bullying and threats impede thinking, are inherently unsafe because fear prevents people from challenging the hierarchy and initiating change. Only through the development of a just learning culture can an organisation achieve real progress towards making children safer.