The Connection between Organisational Structure and Successful Outcomes - Research Paper Example

 At the heart of the modernising agenda …. Is the conviction held by government that “what matters” is the quality of practice and the service outcomes, not the structures within which the service is delivered. – Horner 2006:105 How did the government’s modernising agenda come about? We need to begin with the situation before the New Labour government took power in 1997, and then look at the thinking in the new government on this issue. The government’s conviction that quality of service is what matters, rather than the structures within which it is delivered, implies that we should not adhere dogmatically to one particular way of organising the provision of social services (Barker, 1998). It is a phrase designed to justify a major re-structuring of service delivery during the past decade. In reality however, the structure and the quality of service are not independent of each other. To fully understand the connection between organisational structure and successful outcomes, it is necessary to explain the concept of efficiency, and to discuss how different organisational structures affect this. Of course, other criteria, besides economic ones, also matter, such as fairness and hardship. We also need to consider the results that have followed from the implementation of the agenda and to assess whether the policy has been successful. Social services have developed over many years. Immediately after the war, responsibility for social services was shared among health departments, children’s departments and welfare departments. These were unified as social services departments in the 1960s (Barker, 1998). The 1948 Children Act made it the duty of a local authority to take the child into care in cases of abuse or neglect. Local authorities gained powers to take preventative action only in 1963. The 1989 Children Act set out the grounds on which a care order could be made essentially as being when a child is “suffering or at risk of significant harm”, which is defined as “ill-treatment or the impairment of health or development” (Wilson, et. al, 2008). After the Maria Colwell case, in the 1970s, when there were clear failings, child care practice became more cautious and then in the 1980s there was more concern for parental rights (Huff, 1997). The 1989 Act, restricted the circumstances under which children could be taken into care, and the numbers of children who were actually taken into care fell (Wilson, et. al, 2008). In the field of community care and important step forward was supposed to come with the Griffiths Report. “When Social Services Departments were formed, the intention was to co-ordinate their activities as far as possible with health services. The Griffiths Report on Community Care, published in 1988, proposed a different kind of arrangement. Rather than depending on co-ordination and integration of services, there should be one service with clearly defined responsibility, which would commission services from others.” (An Introduction to Social Policy). Social services departments were to develop services by making contracts with external bodies who would provide services. Managers were to be responsible for establishing priorities and allocating the resources, while the practitioners would assess the individual cases. The National Health Service and Community Care Act (1990) outlined a system where services would be purchased by the local authority from private, voluntary and statutory providers (Barker, 1998). Each service user would have a Care Manager responsible for assessment, planning and monitoring his care. However, local authorities were not tightly controlled and could decide for themselves how much care to provide (Horner, 2006). More importantly it was not an absolute requirement for all care to be contracted out, but merely a statement of government preference. As a result, during the 1990s Griffiths was not fully implemented and there was often more emphasis on co-ordination than choice. The market ideology behind the reform seemed to get lost (Huff, 1997). Contracting out was typical of the approach under John Major’s Conservative government, which sought to create a sort of “internal market” by separating the part of the system which bought the services from the part of the system which provided the services (Krauth, 2001). The new government under Tony Blair was initially less keen on this sort of idea preferring instead to simply set targets for public services to meet (Wilson, et. al, 2008). By the turn of the century, however, Blair began to fret that government services were not improving fast enough and came to the conclusion that they needed to be more substantially reformed, if necessary by re-structuring them. To understand the significance of how services are structured, we must first understand economic efficiency. Economic efficiency is of two sorts (Huff, 1997). Firstly there is productive efficiency. In essence this is the idea of maximising the output of goods and services from the available resources. In the context of social work, this might mean, for example, getting the maximum number of cases dealt with by a given number of social workers. For this to happen delivery must be organised in a manner that is cost-effective. Cost cannot be ignored in the provision of government services, since minimising the cost for each bit of individual service allows us to maximise the total quantity of services provided (Wilson, et. al, 2008). The second type of efficiency is referred to by economists as allocative efficiency. This is a fancy way of saying that what is produced should be what gives the consumers of the products the greatest satisfaction. In other words it is no good having a highly productive organisation that churns out huge quantities of goods or services in a very cost effective way, if what is being produced is not actually what the consumers’ want (Krauth, 2001). In the context of social services, productive and allocative efficiency require that the system should deliver services to as many people as is physically possible within the available resources, and that the services should be tailored to suit the needs and preferences of the people receiving them (Huff, 1997). What then is the connection between the structure of the organisation of social services and the likely success in achieving economic efficiency? Most economists believe that for the production of most goods and services, the best way to achieve both productive and allocative efficiency is to leave it to the free market (Barker, 1998). Competition between commercial providers tends to lead to them tailoring their product to suit consumers in the hope of capturing market share. Another feature of this competition is the need to keep prices down, which in turn requires costs to be minimised (Huff, 1997). This tends to move us towards the desired efficient outcome, effectively promoting both a high quantity and a high quality of supply. Of course we cannot leave the provision of social services to the market. Most of us would not consider it fair if people in need of social care only had access to it if they happened to be rich enough to buy it in the market place. The people who need personal social services are almost always going to be unable to afford to buy them commercially (Wilson, et. al, 2008). The argument for government provision is extremely powerful. The trouble is that simple direct central provision involves no competition between providers. This means that the quantity and quality of care may not be maximised. So there seems to be a dilemma between efficiency on the one hand and social justice on the other. But is there no way of having the best of both worlds? Government attempts to modernise the provision of social services are an attempt to do precisely this. They have most commonly involved giving the money to an agency or even to the individual who needs the services, and then allowing the purchaser to choose between a range of providers, including voluntary and private sector providers (Huff, 1997). This effectively introduces the benefits of competition by the back door, so to speak, with all the theoretical benefits discussed above. Naturally, the New Labour government did not talk much about economic efficiency, but instead used phrases such as “value for money” and “the choice agenda” to reflect this thinking (Huff, 1997). Nevertheless, value for money is just code for productive efficiency and the choice agenda is another name for allocative efficiency. Introducing competition by the back door is a major concession to market forces, and not very different from the Major government’s “internal market” policies (Krauth, 2001). The government was particularly concerned that traditional delivery methods favoured the interests of “producers” (i.e. the staff) rather than “consumers”. The Modernising Agenda for social services involved four key principles. These were: performance management, devolution of management, flexible employment structures, expanding choice and diversity. The government also stressed the need for innovation, diversity and partnerships. Local authorities were to become strategic planners, but not necessarily providers of services (Wilson, et. al, 2008). Local authorities were to purchase care services from a variety of suppliers, state, private and voluntary. Individuals receiving care services would even be allowed to manage their own personal care budgets. Critics claimed that this was a thinly veiled cost-cutting exercise and also that it amounted to privatisation by the back door (Wilson, et. al, 2008). This line of criticism is questionable. It implies that cost-cutting is a bad thing, when it might not be. The government and local authorities have a responsibility to the taxpayer who is funding the services, as well as the needy people who are receiving them. Cost cutting can come from improved efficiency, and if the efficiency gains are big enough, it is theoretically possible to spend less money and at the same time deliver a better outcome (Barker, 1998). For example, if I had bought a new 32 inch TV in 2004, it might have cost £1,000. Since then, improvements in efficiency and competition have brought down costs, so that today, I could buy a 40 inch TV and only pay £800. As for privatisation, if competition is injected into the system, this could improve the quality of delivery as organisations seek to attract business by offering to provide a better service and/or it could reduce costs to the taxpayer as organisations seek to attract business by offering a lower cost service (Wilson, et. al, 2008). This can been seen as part of the general trend in business towards “outsourcing”. There are however, other criticisms that are more effective. In order to bid for contracts to offer services at a lower price, it is likely that commercial organisations will seek to cut corners in delivery (Huff, 1997). Otherwise, lower prices would mean a lower profit margin. The quality of delivery might easily fall. Alternatively, they might seek to keep costs down by simply paying their staff less than was previously being paid to carers employed directly by local authorities. The fragmentation of the system that follows the outsourcing of care to a range of different organisations makes it difficult for local authorities to monitor outcomes (Barker, 1998). The likely result is a variable quality of delivery in practice, with some recipients receiving good care and other poor care. We know for certain that there has been a crisis of recruitment and retention in the adult care service. The lower wages associated with commercial service providers have made it more difficult to staff the services. The majority of adult care givers are now migrants, who are more willing to accept the lower wages and long hours being asked for by private companies (Huff, 1997). Social workers who have not left the profession feel dissatisfied with the new system. “Professional ethics are jeopardised every single day because the proper resources don’t exist or you have to wait months, even years” (Nunn, 2004). It is, however, sometimes difficult to disentangle gripes by professionals whose role has been changed in ways that they dislike, from genuine problems with the system. The quote here adopts the familiar approach of assuming that cost should not be a significant factor. Health and Social services staff sometimes seem to think that money should be available on tap to provide whatever they feel might be beneficial to the people they are trying to help, regardless of the cost (Wilson, et. al, 2008). There may also be practical difficulties in making the competition designed into the new system a reality. In practice it might be difficult for a local authority to quickly get rid of a poor service provider or take work away from them, depending on the contractual details and the availability of alternatives. In reality few individuals have taken up the option of managing their own personal care budgets (Krauth, 2001). In cases where they want to do this it is often because they have established a good rapport with particular care-givers. But it is unlikely that one individual would generate enough work to employ a care-giver full time. Many disabled people require two visits per day to get them up and put them to bed (Barker, 1998). To employ somebody, an individual would usually have to co-ordinate with other individuals in a similar situation. Otherwise, it would just be a case of the individual hiring in the services of a commercial company in exactly the same way as the local authority. For many adults in need of care, the last thing they would want is the additional burden of worrying about the budget for their care (Wilson, et. al, 2008). In children’s services, unlike the NHS and adult care, provision was not “outsourced” to any great degree (Carvel, 2008). The major concern in this area was the question of whether the various agencies dealing with children, such as social workers, schools and doctors, were communicating properly with each other (Carvel, 2008). This issue came to a head following the murder of Victoria Climbie in 2000 and new policies were put in place. These involved the integration of children's services, bringing the different professionals involved under the umbrella of local children's trusts, as recommended by Lord Laming in 2003. However, there were concerns about this approach. “It was decided that the trusts should not have any statutory authority and would not own assets, employ staff or have legal accountability for spending public money. The commission said the trusts were unsure of their role and relationships with other organisations” (Carvel, 2008). Recent events in Haringey and Birmingham have called into question the effectiveness of the new approach, and highlighted the pressures that care workers are under, particularly in certain inner city areas (Wilson, et. al, 2008). If the government wants to be judged according to the principle that “what matters is what works” then there has to be a question mark over the success of its modernising agenda (Wilson, et. al, 2008). In the context of adult care services, provision has become fragmented and variable. It is, however, likely to be more cost effective than was previously the case. The quality of children’s services is now a major concern, and has risen towards the top of the political agenda (Krauth, 2001). The problem of low morale which the government’s reforms have undoubtedly contributed to cannot be ignored. In social services, the morale of the staff makes a very big difference to the quality of the service being delivered. A further difficulty is that any further changes will create at least some extra burdens, since changes to working practices always do, and this could make morale even worse. References Barker, Robert L. (1998). Milestones in the Development of Social Work and Social Welfare. Washington, DC: NASW Press. Nunn, Alex. (2004). Modernising Social Services. Retrieved on 23rd January 2009 from http://www.european-services-strategy.org.uk/publications/cps-reports-and-books/modsocialservices Carvel, John. (2008). Child services reforms after Climbié death are hampering efforts, says watchdog. The Guardian. Retrieved on 23rd January 2009 from http://www.guardian.co.uk/society/2008/oct/29/victoria-climbie-children-services-reform Horner, N. (2006). What is Social Work? Context and Perspectives. Second Ed. Exeter: Learning Matters. Huff, Dan. (1997). The Social Work History Station. Boise: Boise State University. Krauth, Brian. (2001). Social Interactions, Thresholds, and Unemployment in Neighborhoods. Mimeo: San Francisco University. Wilson, K, Ruch, G, Lymbery, M and Cooper, A. (2008). Social Work: An Introduction to Contemporary Practice. Harlow: Longman. An Introduction to Social Policy. Retrieved on 23rd January 2009 from http://www2.rgu.ac.uk/publicpolicy/introduction/pss.htm Read More