Accountability, A Big Word

Accountability is a very important concept in public service these days. I do not know how or why it became such an issue; what the mischief was that it was introduced to address. Nor do I know how long it has been a driver for policy. But I do know that it is one of the things which sound good, but in fact cause more problems than they solve. I am not sure that is inevitable: but in practice that is what happens. So I thought it would be interesting to explore what it means: in theory and in practice.

I am making a number of assumptions which may or may not be tenable, at the outset. This is because the term has a number of meanings. It is my view that words with multiple meanings are relatively easy to subvert: we can trade on the ambiguity, and this helps to dress up an agenda in unobjectionable terms, if that is what you want to do.

To me the proper sense of the word contains the sense of responsibility. I think that is best seen in the professions, as they were in the past. A professional was someone who had certain specific knowledge that took a long time to learn; and which was validated by a body of people who also shared that knowledge. It was accepted that outsiders could not judge the practice of the profession, because they did not have the skills and knowledge required. So even today we see that doctors who are accused of malpractice or incompetence are judged against a set of professional standards which are set by doctors: and it is doctors who judge whether those standards have been breached. This is also the case for the other professions.

From that it follows that a professional cannot be forced to do anything which breaches his or her professional ethic and/or responsibility. What that means is that there is a power base which is independent, and which serves as a counter to other forms of power and pressure. Thus there is a limit to how far "he who pays the piper" can in fact "call the tune". That rests on the "closed shop", because the cost to the individual of breaching that ethic has to outweigh any feasible reward for doing so: and it has to outweigh any threat which might force such a breach as well. That cannot be perfectly achieved (if someone is going to chop your head off if you do not poison their granny it is not likely that many will resist): but in normal circumstances the loss of the right to practice your profession is a big cost, and it is a real and enforceable sanction when a profession is properly constituted.

In those circumstances accountability is personal: one must practice within the standards set, and that is the responsibility of the professional himself. So how he practices is actually quite free and quite flexible: so long as he adheres to the fundamental standards expected and required by his peers.

In the 1960's and 1970's there was a social shift in the direction of more egalitarianism, for want of a better word. One consequence was a rejection of elitism, and that included an attack on the desirability of "professionalism", as I have just described it. That is very understandable, because there is truth in the proposition that "all professions are a conspiracy against the lay person". Good things followed: for example doctors became more open with patients, and there was a greater degree of discussion about treatment options etc. And the same process was seen in all of the professions. To me that was a good thing: but only insofar as those changes did not undermine the whole concept of a profession per se. Unfortunately that limit was not maintained, and there were many reasons for that, I think. They would form an interesting discussion in themselves, and I hope that we can touch on some of them later in this thread.

But for now I wish to look at what this has meant for the concept of accountability. As I see it, there has been a shift from the idea of accountabilty as a form of personal responsibilty. For the term can also mean "blameworthiness" and that is really quite a different thing. What seems to have happened is that we have moved from the original position of respect for the knowledge or professionals: through a stage when that was still accepted; but mitigated by the removal of some of the authoritarian elements which were not actually justified: to a point where that expertise is largely denied. And that is pretty much a disaster. As an example of that we see parents who appear to think that they know as much or more about teaching as teachers do: and so teachers have lost a great deal of status. The same is true of many other groups of workers: and the attack is currently touching even the strongest of the professions, amongst which the most obvious are doctors and lawyers. Those very strong professions have been better able to resist: partly because the process had to be quite advanced before it was wise to even try: and partly because they have a stronger understanding of the nature of the profession because it has been developed over a long time and more consciously, perhaps. But they are not immune, even so.

One consequence of that shift has been to allow the professions to be brought under the control of others to a far greater extent than was true in the past. And that is justified in the name of accountability. In many fields we see this same process. But the fact is that it is true that those outside the professions do not have the knowledge or skills to judge them. And so we get absurdity. The "regulatory bodies" make blueprints for how the job is to be done, and they do not work. They demand that the workers record all that they do, and "accountability" has come to mean proving that you followed all the steps prescribed. It does not actually matter whether the outcome is good or bad: if you have followed all the rules you are safe: and if you have not you are under threat. And all of this takes an enormous amount of time. In my own job I spend more time writing about doing my job than I do in doing it. There is a climate of fear which precludes creative risk taking: yet enormous risks are taken because the blueprints lead to that outcome.

In the wider sense what this has done is centralise power. As outlined above, the original structure of professions enabled personal autonomy and supported that through an alternative power structure which served as a check on the demands of government and business. The change I am describing reflects a change in our relationship with the professions which may well have started as a move to more egalitarian individual dealings with those we rely on for their knowledge and skill. But as an unintended consequence (probably) we have taken the power of those bodies away. And we have ceded it to business and to government who are now far less constrained than they once were.

Edited by FionaK - 18/5/2011, 03:08

As I noted above, the notion of "accountabilty" has been subverted beyond recognition in many areas. I want to give an illustration of how this affects things, this from my own field of work, in the hope that this will make my argument clearer.

This particular issue relates to "Looked After Children": that is, children who are looked after by the local authority because their parents can't care for them, for whatever reason. Some of those children are placed with members of the extended family. But a great many are either in residential units or in foster care.

As you are probably aware there has been concern about these children because they do not do as well as others in health and education and, indeed most indices of the good life as that is measured. There is no doubt that is true if you compare with the general population: but that is not a fair test actually: because the vast majority of such children have not had a good start in life for various reasons. What we should be doing is comparing the outcomes with those achieved by children who have had similar problems but were not accommodated: there are a great many who stay with their families because a decision to intervene is not taken lightly at all; and because it is a judgement call coupled with legal requirements which are not themselves clear cut; and not least because the care of children by the state is enormously expensive (though woefully underfunded). Together with the research findings which point to poor outcomes these factors have meant that children are maintained with their families longer than they used to be, and so are more damaged when they finally come into care. Fact is we leave children in horrible situations for far too long. As an aside, one of the measures of "success" applied to local authority social work departments is a low number of accommodated children. That is not, as you might expect, a sophisticated measure showing that those children's needs are met through other resources: it is just a number. The local authority could do well on that particular measure if they never brought children into care at all: the check is that they would do poorly on the number of child injuries and deaths in the authority, through abuse: but it is not much of a safeguard, and the figures are seldom compared in the press. This is an example of the insidious nature of "performance indicators" as they apply to social services: what is measured is what is easy to measure, rather than what is important. And what is measured in any field becomes the job, over time. But I digress

The concern about these children has led to a number of statutory and policy decisions which purport to improve the situation. Some scandals relating to abuse of children in care were also a driver: and it is true that there was a lot of scope for that in residential units and in foster homes: as there is in family homes. Both are relatively private places and policing them is very difficult, even if you are not uncomfortable with the civil liberties implications of that. WRT families most people are deeply uncomfortable, and there has to be a trade off there. That is not a problem unique to child care, and the balance is hard to find. Where children are looked after away from home it might be thought to be easier. But again there is an uneasy tension: foster care, in particular, is at one level a substitute family: and questions of privacy are also there: though less so than in natural families.

The upshot of all this concern and proper wish to safeguard and promote child health and development led to the introduction of statutory obligations and policy changes, which aimed to address these issues. Nothing at all wrong with that. The outcome was the Looked After and Accomodated Children provisions (called the LAAC system) and it is a nationwide system: very similar provisions exist in England and Wales, so this is not unique to Scotland, though there are differences because of the interaction with the Children's Hearing system, which does not exist outside this country.

What actually happens under this system may not be clear to you. I cannot give a comprehensive account here but I will give an outline. When a child is accommodated under any of the statutory provisions which enable that to happen that child is placed either in a children's unit or in a foster home. It is a matter of policy that foster care is always better, and it is almost mandatory that that is the option for children under 12. I agree that that is best in most cases (there is whole other debate to be had about that but it is beyond the scope of this thread). So in an ideal world what we would do is plan the placement. We would match the child with a suitable carer and we would decide how long that placement was to last; what support the child needs to overcome, first, the trauma of the loss they have suffered; and then any problems which have arisen from their early experience and/or current difficulties; and what the ultimate outcome for that child is going to be: ie, return to the family after change has been made; permanent placement; or adoption etc. Those decisions would have implications for what arrangements should be made for contact with parents and siblings and other family members, and many other decisions.

In the real world there is a shortage of carers. So older children are very often placed in residential units by default. Younger children usually do go to foster homes so on paper that particular measure is improving most places. But foster care is foster care: the proportion of children in that kind of placement is recorded and it is used to measure performance: more kids in foster care as a percentage of all accommodated children = better performance. This masks a great many failings. For example, I have been in the situation where the only foster home available was 70 miles from the children's home. These children were under 8. So they had to cope with going to total strangers: and we compounded that by making it impossible for them to continue in the same school or to retain any of their friends. Nor could they visit family or friends as often as they should: because the round trip after school is both exhausting in itself and would mean they could not get to bed at a reasonable time.

Another problem also arises from the shortage of carers: there is no matching. I have never been offered a choice of carers: not once. But more than that: foster carers are approved to care for a specific number of children; and sometimes specified ages and genders. There are good reasons for that, which are outlined in the original assessment. When I worked in the charitable sector those approvals were rigidly adhered to: the charitable sector has that luxury. But the local authority must accommodate children who need it. And there aren't enough places. So very often even the crude matching of age and gender is breached: and the carer has more children placed than the assessment suggested would be helpful. This is getting better, I hasten to add: but it is still the case that some foster homes are really mini children's homes with a very poor staff ratio. If you think about it: a child who has been placed away from all he or she knows, and who has very often experienced abuse or neglect before they came in to care, is not a child who is likely to be easy to care for. They need more time and attention, not just because the carer does not know them: but also because most are damaged. The figures for children in care who have mental health problems are horrific; and there are very few mental health services available. But even if they do not have such problems their needs are great: think about a child in your own family facing such challenges. Do you think it would help if the foster home had another three or four children also all coping with such loss? That is what happens.

And there is a third problem: the shortage of carers means that very unsuitable people remain foster carers when good practice would suggest they should not. Quite serious issues are not properly addressed and even non serious issues would be worthy of discussion: for example I have placed children with a very experienced foster care who happened to be 68 years old. I am not saying that is wrong: but I would think hard about placing a very young child with a grandparent that age: and so it is curious that this is happening without much reflection. That is only an illustration, and not the most serious problem: but bear in mind that this system was put in place in part to deal with abuse in care: the shortage means that that issue is not addressed as robustly as it should be: and that is a serious problem.


These are just a few of the problems we face. So how does the LAAC system seek to help? Well if the placement is planned there is generally a meeting before the child moves ( not talking about the introductions to carers, which are another part of the forest). That meeting makes all the kinds of decisions I mentioned before and we fell a forest so that the paper work can be completed. There are 4 essential forms which must be completed and the level of duplication has to be seen to be believed. It takes a very long time to fill these forms out. The situation is worse in an unplanned placement, because then the social worker does not have the information required, usually. But stick with the ideal. Assume that it is reasonable to expect a social worker to spend most of a day filling in forms when they are trying to place a child with strangers and support that child in managing that change. Me, I would rather be there for the child: but I just don't have the right priorities, it seems.

After that meeting (and a children's hearing if required: yet another report) the child is placed. Now the only person who is providing any continuity is the social worker who the child may or may not know. But if the child is placed at a great distance it is really difficult to visit regularly: that is because this is not the only case you have. This child was expected to take up Y hours in the working week: that is now doubled or trebled or quadrupled if you are doing your job right. So where is that time to come from? Bah, who needs a life?

The LAAC system then institutes a series of "reviews". These are supposed to prevent "drift" and to monitor the child's welfare within the placement. "Drift" is a real problem: no denying it. A child in a foster home can be presumed to be safe. With the best will in the world they slip down the priority list. I am not defending that: but nor can I see how it can be otherwise. There are no easy cases at all and almost every child on a case load is at risk. If they are still in the community they are at higher immediate risk than the child in care. So with inadequate time they are the ones who are prioritised. The longer term risk is there and it is important: but the way things work that is not enough to ensure proper service.

As a response to that reality the LAAC system is a chocolate teapot. After the initial placement there is a review within 6 weeks and it sets out a plan (or if the placment is unplanned it is held within 3 days: A moment's thought will show that any plan made at that stage is not likely to be a good one: so there tends to be more meetings in the first few months). Thereafter the reviews are held at 6 monthly intervals.

The nature of those reviews is wholly unclear, and that is basically for political reasons. It is a form of "drift" in itself. The paperwork required for those reviews makes it clear that the purpose is to ensure that the placement is safe and is caring for the child adequately: and that the social worker is doing their job. So the form asks about education (how will this child's educational needs be met : well he will go to school, duh) and health and hobbies and stuff. And it asks how often the social worker has visited: no mention of the value of those visits: just a number. It does not ask about his family (except to enquire how often the social worker has seen them): so it is not reasonable to suppose that this was originally envisaged as a planning meeting: how could it be if the situation in the family is not a focus of discussion?

However over time this meeting has increasingly taken upon itself a remit to make plans for the child: and to instruct the social worker to implement those plans whether or not they make sense. In theory this is a multi-disciplinary meeting and the plans are developed on the basis of the information from all sources: in practice the chair makes the decision. The chair has no other contact with the child or his family: so if you fill the lengthy form in as asked it is not good enough for the purposes of the chair: you have to either shoe horn in the relevant information to the form: or write a separate report and attach it.

The chair is called an "independent reviewing officer". But since he or she is employed by the social work department that does not fool anyone: certainly not families. There is not much independence and there is definite pressure from financial constraints: resource led plans are the norm; not needs led ones

But there is another problem: because this body does not actually have decision making power, in most cases. Few children are accommodated without also being on statutory supervision. The decisions therefore rest with the children's panel. That is a whole separate level of safeguard and oversight and it also requires meetings and reports. So now it is required that we have an extra LAAC meeting before any children's panel so that the social worker can tell the panel what the LAAC chair wants them to do: even if it is ridiculous. I love being piggy in the middle

So we have problems of lack of carers; and we have problems with paper; and with who has decision making power; and we have not even touched on residential care. Carers are asked to do very specialised work with badly damaged children and without much training or support. And (finally) I come to my point: which is this document

www.clacksweb.org.uk/council/lacbestvaluereview/

That is a report on a review of this system undertaken by one Scottish local authority. I will quote the recommendations in full


In face of all this they apparently believe that the problems will be solved if reports are submitted on time.

It is my opinion that this is an organisation that has lost sight of what it is for. The recommendations serve the needs of the department to meet performance indicators which have nothing at all to do with children, or the service to familes, or foster carers. But getting those reports in on time is now what "accountability" consists in. It is noticeable that there is no mention whatsoever of the management failures which relate to recruiting more carers: no mention of their failure to recruit sufficient social workers: nothing at all about any of the things that matter. Just paper and deadlines. Just things that are easy to measure and which can be blamed on an individual if they are not met. Just a complete denial of the concept of professionalism and accountability, in meaningful terms

A big word, with a BIG post. I am sorry Fiona, I am not taking the effort to read that much text.

Two big posts, actually

You need not read anything you don't want to read Pseudos. No need to apologise

To progress my musings on "accountability" I found this article interesting and informative: it is directly related to the OP but this time in the field of "academic freedom". Once again we see the same processes at work: the undermining of alternative power bases in society.

This author's analysis points to the move from the idea of "academic freedom" as a collective privilege; to one which sees it as an "individual right". On the surface this analysis seems at odds with the one I proposed in the OP. But taking the article as a whole she is pointing to the same processes: and the competing values of individual rights v collective ones is used to present the move as ethical. It is, in fact, the foundation of the rightist approach to the world, and it is instructive to see how the concepts get tangled so that it is difficult to lay out what is happening.

In that context that article is clearer in describing the process than the op is: I talked of individual responsibillity within the context of an alternative power base and set of value which could directly resist attempts to control and manipulate the profession. I do not think I emphasised the importance of the collective enough and so this article advances that understanding.

It is a peculiar delusion that an individual can stand up effectively against an organised group. This is seen most clearly, to me, in labour laws in certain american states. Apparently there are states where there are no employment rights at all. The idea is that the worker is absolutely "free" to take a job and to walk off it: no notice or reason required. And the employer is absolutely free to hire and fire at will: no notice or reason required. That idea has to be founded on the deeply laughable notion that the two have equal power.

If academic freedom is converted to a matter of individual rights the same considerations apply: because big corporations are not individuals and they do not face the academic on equal terms. He who pays the piper...and all that. This is the reason we need unions: and professional bodies with union values. And that is why the corporations and their political supporters are steadily centralising the power by undermining those alternative bodies

It is difficult to see far through a brick wall and academics are no better than plumbers in this respect. The water we swim in is full of big words like freedom: but freedom means different things and the freedom to starve if you do not do what you are told at all times is not a sense I find helpful, on the whole.

In the cases cited in the article there are again the questions: accountable for what, and to whom?

www.aaup.org/AAUP/pubsres/academe/2011/JF/Feat/wash.htm

www.bbc.co.uk/news/uk-politics-14302891

Today a committee of MP's finds itself suprised that Probation Officers spend 75% of their time on paprwork. They think this is not a good idea and the Ken Clarke, the minister in charge of the probation service, concurs. He pledges to change this. Well Hurrah!! Better late then never. The committee talk of a "bean counting culture" which prevents people from doing a good job: they are precisely right

It is a wee bit unfortunate that on the same day, in another part of the forest, the regulatory body proposes to increase the inspections of children and families' social workers, extending inspections to two weeks and making them unannounced. That is in line with recommendations from a report from Professor Eileen Munro, whose interim report also noted that

The problem is exactly the same: but in this report we have tinkering: whereas, with the probation service, it seems that the failure of the whole "micromanagement in the name of accountability" has finally been recognised to be actively detrimental to doing the job at all.

It is a mystery to me why the bean counters were allowed to interfere with things which they know nothing about in so many fields: but if it is recognised how bad their effect is on one part of the services it surely follows the same considerations should be applied to the others: because the "solutions" imposed were the same; the outcomes are the same; and changes required are also the same

David Cameron is on a roll. First he "ordered" integration of health and social care, and now he has decided that he can manage the day to day work of nurses. The issue is recent reports that some patients are getting a very poor standard of care in our hospitals. That is a scandal and it needs to be changed. Nobody can disagree with that. But once again the sheer naivete (or disingenuousness) of the right wing mindset as informed by stupid economic or management theories is evident.

This government is making cuts to the NHS and it is affecting the numbers of staff, despite assurances it will not.

http://www.guardian.co.uk/society/2011/oct...tients-revealed

The reduction includes loss of nursing jobs. Like most jobs which provide a direct service to the public nursing is not amenable to "percentage" reductions, entirely. If you have a hospital ward of, say, 4 beds you need a certain number of nurses. Let us say you just need one to look after those patients. But you need them 24 hours a day, so you need 3 if each does an 8 hour shift. If you reduce bed occupancy so the ward is now caring for only 1 patient, you still need 3 nurses. I am leaving out the question of whether community care is better for patients, in theory or in practice: the point is that if you move away from hospital care one consequence is a fall in "productivity" as measured by the bean counters. A dedicated nurse with less to do is very likely to lead to better quality of care and increased "patient satisfaction" (which, you will recall, was the measure used when justifying the privatisation of Hinchingbroke): but that doesn't count. It is a curious feature of applying inappropriate simplistic measures to things like this that a better service translates to poor "productivity" and is used to justify charges of inefficiency in public service. But I digress.

Mr Cameron has decided that the way to deal with poor care is not to ensure adequate staffing: and not to ensure that senior front line staff have the power and resource to deal with any failings. Instead, and in line with his narrow focus on "accountablity", he has made two concrete proposals.

http://www.guardian.co.uk/society/2012/jan...meron-hospitals

The first is hourly ward rounds by nurses. Now I am not suggesting that increased patient contact (or "nursing", as we call it) is not a good idea. But once again we see micromanagement by outsiders with no knowledge of the service: and it has this consequence: it will have to be recorded. Yet Mr Cameron wants nurses to "focus on patients, not paperwork" and this is what we always hear. In my own work I have seen this time and again and it is a complaint from other public servants of my acquaintance from teachers to tax inspectors: you spend more time writing about doing your job than doing it. I have no doubt that hourly ward rounds will generate paperwork because without that how will the managers and politicians ( who spend very little time on the ward) know it being done? It is yet another insult in the form of simplistic prescriptions generated by ignorance and ideology. Mr Cameron says he will get rid of other "bureaucracy" to enable this to happen: I have heard this before. A document called "Social work in the 21st century" recognises the importance of client contact and pledges to reduce paperwork to allow that to happen: the major policy driver in social services for children is another document called "GIRFEC" and it is a paper generator. They are entirely at odds with each other and guess which one takes priority?

The linked article shows that Mr Cameron recognises that paper is getting in the way and he says it will be reduced: if it is then there is no need for him to micromanage nurses because they know what is needed: the fact it is not being supplied is not because they are callous nor yet stupid. The origin of the problem is this obsession with bean counting, and he even acknowledges that: but he does not follow the logic through. As I said, mere insult.

The other proposal he makes is for patients and relatives to undertake regular inspections. That is also familiar. "Empowering customers" is the idea: and it has its merits, no doubt. But the fact remains that "customers" are not equal in their knowledge base, and so in many fields "empowering" them only leads to problems for staff. That is not a problem if the limits of expertise are known and acknowledged. But the thrust of the attack on public service includes and element of "customer is always right": that might work in retail: it does not work in education or health care or many other fields: this is because they are different from businesses which are primarily concerned with medium sized dry goods.

It is quite interesting to see the examples which are given. One that is mentioned is food. In the local hospital where my mum lives, food used to be prepared in the hospital kitchens. That is "inefficient" apparently: so now it is not prepared on site. That was in part due to the fact that the hospital was built through the PFI scheme: it replaced the old hospital and it is smaller: an adequate on site kitchen was one of the frills cut to keep costs down. Catering has been contracted out to a private company which, astonishingly, is in England. The contract was awarded for 20 years: go figure.

When my mum was in that hospital the food provided was inedible: special diets ordered by the consultant looking after her just did not appear: staff who were serving it out knew it was inedible: a complaint was made using the much vaunted "complaints procedure" and what that produced was a visit to my mum by a manager. That manager arrived at lunch time but refused to actually taste the food offered: instead she said there was nothing wrong with it:and that was that. That experience was not unique: it is replicated by many of my mum's friends who have had hospital stays. Ultimately it became the focus of a campaign by the local paper and that produced cosmetic responses only.

http://www.eastkilbridenews.co.uk/lanarksh...68653-29207174/

As that article notes: the nurses know the problem: they cannot do anything about it. As the article also notes: the "management information" shows that the food is rated satisfactory by 90% of patients. That is a lie and I suspect what it really means is that 10% of patients actually complain. Well that is worth precisely nothing. People who are ill are dependent and anxious: they are very loathe to complain, in truth. But what is certainly true is that patients don't eat it: visitors bring food rather than flowers and grapes. Shame for those who dont have regular visitors, really. How are nurses to blame for this mess? Cameron hasn't a clue: or he does but, as usual, prefers to target staff than the economic nonsense generated by poltiicians wedded to business practice as the answer to all problems

http://www.guardian.co.uk/commentisfree/20...urses-time-care

Comment from a nurse.