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Changing Lives: Report of the 21st Century Social Work Review

Published: 7 Feb 2006
ISBN:
0755948246

Report of the recommendations made by the 21st Century Social Work Review Group for the future of social services in Scotland.

100 page PDF

2.6 MB

100 page PDF

2.6 MB

Contents
Changing Lives: Report of the 21st Century Social Work Review
Chapter 6: Building the capacity of the workforce

100 page PDF

2.6 MB

Chapter 6: Building the capacity of the workforce

Introduction

We have concluded that we are not making the most effective use of social work skills. Our approach to developing personalised services revitalises and refocuses services on the core values of social work. Achieving that goal will mean making full and effective use of the whole social service workforce, building capacity, developing confidence and trust at all levels and allowing a significant shift in the balance of power and control.

For front line workers , it will mean enabling some people and their families to take far greater control over how they are supported. For those with the most complex needs and problems it will mean using and developing the therapeutic relationship as a way of helping them regain control of their lives and finding acceptable solutions to their problems.

For leaders and managers , it will mean developing trust in their staff, making sure that they are enabled and empowered to practise professional autonomy in their day to day work, within a framework that promotes personal accountability and enables safe yet creative practice.

For everyone in social work services , it will mean far greater flexibility to develop new roles, new ways of working and taking opportunities to cross structural and organisational boundaries.

Achieving this will require workers with new skills, drawing out the innovation and creativity that we have found to be often heavily constrained. New approaches to the governance of services will be needed, requiring practitioners to exercise greater professional autonomy within new accountability frameworks, able to make informed and complex decisions safely and effectively. This will mean front line teams having the proper delegation of authority and the right mix of skills to enable professional expertise to be used effectively. We will need career structures which enable highly skilled practitioners to stay at the front line of work while also expanding their expertise, providing professional leadership and educating the next generation of workers.

6. Social work services must develop a new organisational approach to managing risk, which ensures the delivery of safe, effective and innovative practice.

This requires:

  • clear accountability frameworks which make explicit the accountabilities of the social worker;
  • social workers to exercise professional autonomy within a clear framework of professional accountability;
  • a new approach to social work governance;
  • a strengthening of the governance and leadership roles of the chief social work officer;
  • structured approaches to manage untoward incidents that enable learning from mistakes;
  • a research and development strategy for social work; and
  • evidence based risk assessment and management tools.

Professional autonomy within a framework of accountability

The fine judgements and decisions that must be taken on a day to day basis, balancing risk to individuals and communities, make the role of the social worker particularly challenging. Inevitably, there have been a small number of high profile cases where individual or organisational decisions have proved disastrously wrong. More public awareness of these cases and the requirements placed on organisations to prevent them happening again have led to the social worker's role being increasingly constrained, with tighter management oversight. We have found that this strong line of management accountability has limited the scope for individual practitioners to exercise professional judgement.

Making the best use of social workers' skills, as outlined in Chapter 4, will require practitioners to be empowered and supported to take well informed decisions, using their professional judgement - to exercise professional autonomy. Of course, no professional working in the public sector can ever be regarded as fully autonomous. They must always work within the rules, regulations and priorities of their employers and practise in line with the standards and codes of practice of their regulatory bodies. Social workers must practise professional autonomy within a clear framework of accountability. This framework must emphasise the personal accountability of practitioners for their decisions, professional judgement and for any actions or omissions. It must build upon the Scottish Social Service Council's Codes of Practice for Social Service Employers and Employees and inspire trust and confidence in the people who use services, fellow professionals and the general public.

Exercising professional autonomy within a framework of accountability means that social workers must be able to explain and account for their practice, basing their decisions and planning their actions on the basis of sound assessment and robust evidence of what works. They must identify acceptable levels of risk and put in place appropriate methods of dealing with risk, using their professional judgement to balance individual rights with public safety. This new approach to practice for social workers will require:

  • social workers to develop and enhance their skills, building up their knowledge, skills and competence and recognising the limits of their competence;
  • enhanced critical decision making skills, backed up by sound evidence and best practice;
  • effective professional consultation which provides support and promotes challenge and reflective practice;
  • enabling professional leadership; and
  • new approaches to the governance of services and processes.

Social work and risk

Management of risk within social work practice is critical to safe and effective practice. We found, in many organisations, a very heavy emphasis on line management arrangements
as a means of controlling the activities of professionals in order to minimise risk. Increasing public aversion to risk and the requirements of successive major enquiries have, over time, led to ever tighter restriction on practice. Many of the people who responded to our survey spoke of working in a climate of fear, hoping that nothing would go wrong that would open them up to media vilification.

Professional autonomy and accountability for front line staff requires an organisational underpinning that enables safe and effective practice. This approach needs to:

  • support critical decision making based on sound evidence;
  • emphasise continuous improvement;
  • manage poor performance; and
  • allow the organisation and individuals to learn from both good practice and mistakes.

This should be based around a model of social work governance as opposed to management control.

Social work governance

We have defined social work governance as a framework through which social work services are accountable to the local authority and the general public for continuously improving the quality of their services, effectively managing risk and safeguarding high standards of care, through creating an environment in which excellence can flourish. A new governance framework will put in place systems which allow organisations to be assured of the quality and safety of services delivered, while freeing practitioners to practise professional autonomy. This involves changing organisational culture in a systematic and demonstrable way, moving away from a culture of blame to one of learning, so that performance improvement infuses all aspects of practice within social work services.

Social work governance in practice

An effective governance framework will need to include the following:

  • a systematic approach to identifying strengths and weaknesses in services, making sure that deficiencies are identified and improvements planned. This would need to include the views of people who use services as well as practice audit and assessment of services and teams against national and local standards;
  • a structured approach to assessing and managing risk, drawing on evidence based approaches which means that that front line practitioners can evidence and justify their decisions and organisations can take informed risks. This will allow front line practitioners to make well informed judgements;
  • regular access to consultation and support for all workers that is relevant to their level of expertise and qualification and which challenges and promotes reflection;
  • making sure that the workforce has the necessary skills to undertake their responsibilities safely and effectively and negotiating with education providers to fill gaps in knowledge and skills;
  • gathering and using good quality information about the way that services are delivered in a systematic and proactive way. The national performance improvement frameworks and the self assessment tools developed by the Social Work Inspection Agency will provide a framework for this information. However, local authorities will want to make sure that they have systems to gather and use the information needed as a by-product of delivering services;
  • making sure that all staff have access to reliable evidence to support their decision making. Work to develop national evidence based guidance will provide a basis for this. Employers will need to make sure that this is easy to access and helps inform practice;
  • a fair and effective system which identifies and tackles poor performance, rather than tolerates and manages it;
  • systems to make sure that individuals and organisations learn from experience through, for example, peer case review or systematic approaches to learning from mistakes and near misses; and
  • a system to recognise, celebrate and learn from good practice.

Some aspects of this framework will need national co-ordination and leadership. All will involve significant development at a local level. Over time, we would expect to see fewer line managers in social work, with money re-invested through professional and practice development to bolster front line services and support effective governance.

"Social workers are very important for people's lives, so their value should be recognised right across society and departments of government. 'Good news stories' should be publicised to attract people to the work and to raise morale."
Users and Carers Panel

The Chief Social Work Officer and governance

The Local Government Act 1994 (Scotland) required local authorities to appoint a chief social work officer to oversee social work services and fulfil a number of specific responsibilities. However, we found little clarity around what the oversight role meant and were concerned that some chief social work officers were being appointed at the wrong level in the organisation to exercise their responsibilities effectively. Many social workers and their managers did not know who their chief social work officer was or what they did.

The new social work governance model set out above means a stronger role for the chief social work officer. The position should be held by a single person in each local authority, who will be a responsible officer of the authority, reporting directly to the chief executive and the council for the governance of all social work services delivered or commissioned by that local authority. These weighty responsibilities are likely to be more demanding than before. Employers must make sure that the chief social work officer has the time and resources to carry out his/her governance and professional leadership responsibilities. To be effective in this new role, the chief social work officer must be a visible, credible social work professional, able to provide sound professional leadership, to access information and to challenge practice at any level and in any part of the system. He or she must demonstrate specific competencies and may require to undergo specific training to prepare for the post. The new role should be defined in guidance, setting out the rights, responsibilities, required competencies and accountabilities of the post.

Managing untoward incidents

There will inevitably be untoward incidents in any service which involves working with people. In social work services this has often resulted in negative media coverage and has damaged public and worker confidence in these services. If the public image of social work is to be improved, it is vital that the response to such incidents is planned and managed proactively. Social work services have not always been good at this. Indeed we found in an analysis of major incidents in social work over the last 60 years (Galilee, 2005) that there was a remarkable consistency in the messages emerging.

As a result, we propose that organisations should have in place procedures to deal with untoward incidents including:

  • agreed procedures for alerting senior managers to a potential problem;
  • procedures to ensure the protection of people who use services who may be at risk;
  • a quick and simple process to investigate and correct the causes of problems;
  • a means of sharing any learning from incidents locally and nationally and putting in place arrangements to prevent them happening again; and
  • proactive engagement with the media from well trained professionals to present a clear and balanced view.

In addition we need to develop a group of national experts who can be called upon by the media to give an independent view.

Developing the evidence base for practice

Many pieces of commissioned work looking at effective practice have come to the conclusion that the current evidence base is weak, reflecting a lack of research in social work practice. However, even where evidence exists it is not readily available to practitioners at the front line in a way that they can use to inform their practice. If we are serious about developing social work as a profession and having practitioners able to practise safely and innovatively, then we need to both develop and use evidence to inform practice.

Because of this, there is a need for a national research and development strategy for social work services, which not only develops new evidence but presents existing evidence in a way which informs practice and develops the expertise in the workforce to use it and evaluate its impact. An immediate priority within this strategy should be the development of nationally agreed risk assessment tools that provide a sound underpinning for professional judgement.

7. Employers must make sure that social workers are enabled and supported to practise accountably and exercise their professional autonomy

This requires:

  • the reserved functions of social workers to be set out in regulations;
  • practitioners to be equipped to exercise professional autonomy and accountability;
  • the implications of personalisation to be considered and reflected in social worker education programmes;
  • new career pathways in practice and professional leadership linked to an agreed competence framework; and
  • the continued development of a national recognition and reward framework for social workers, reflecting career pathways and competence.

In Chapter 4, we set out our aspirations for the future role of the social worker, making sure that we use their distinctive knowledge and skills to best effect within the development of personalised and increasingly integrated services. Given the complexity of current and future need, we must make full and effective use of social workers' skills, enabling them to practise professional autonomy within the new frameworks of accountability arising from social work governance.

Reserved functions of the social worker

New governance frameworks must take account of the use of the title "social worker", conferred by the Regulation of Care (Scotland) Act (2001) and the roles carried out by social workers as set out in Chapter 4. In particular they must reflect those, mainly statutory, duties of care and protection which can only be carried out by a social worker. These reserved functions now need to be set out in guidance and regulations to promote individual and public protection.

Social work education

Developing the practitioners of the future won't happen overnight and will involve an active partnership between education and practice. Universities and service providers will need to work together in a planned way to meet existing gaps in skills and help people at all levels move through a transitional phase towards adopting new approaches and systems. In particular achieving professional autonomy and stronger accountability at all levels is likely to be very demanding.

Developing new roles

Developing personalised services as set out in chapter 5 may mean new roles for social workers and other social service workers. For some, this will involve stronger therapeutic skills which have been identified as of paramount importance in achieving positive outcomes. For others, it may involve supporting and advocacy roles. The implications of these changes will need to be considered, understood and reflected in initial and post registration education for social workers.

Practice based careers

While many employers have made substantial investment in developing their staff, for example through "grow your own" (social worker) schemes, career opportunities are limited, tend to be mainly at management level and are often restricted to social workers. They also vary a great deal between local authorities and across sectors, leading to movement of staff and lack of continuity for service users. Problems in the retention of skilled staff able to develop good quality relationships have been repeatedly flagged to us as a major issue for people who use services. As a result it is essential that we create new roles that allow the best practitioners to stay and progress in practice, at the same time as expanding their professional skills and combining this with professional leadership, research and/or teaching. A new career framework should provide new resources for learning and professional leadership and reward the development of new skills. This will make sure that highly specialised skills are available to individuals and families.

Kent County Council have a career structure linked to a single pay scale that rewards staff for gaining competence and gives a range of career options. It includes:

  • four administrative grades, ranging from simple administrative tasks to business management support;
  • two social work assistant grades;
  • three grades for social workers from newly qualified through to senior practitioner, based on acquisition of competence;
  • three career options at senior level (all at the same level of seniority):
  • senior practitioner - practice based
  • practice supervisor - professionally focused with no line management
  • team manager ; and
  • consultant social worker at district manager level, with a remit to provide expert practice, advice, teaching and professional leadership.

From examining career pathways in other fields and elsewhere in the UK we propose that new roles for social service workers might include:

  • new administrative and business support roles
  • paraprofessional roles;
  • further development of practice specialists as part of a career structure;
  • practice supervisors, who have a focus on professional supervision and practice development, but who have no direct management role;
  • consultant practitioners who combine professional leadership, expert practice, teaching and research; and
  • lecturer practitioners, ensuring that social work practice is taught by credible current practitioners.

Pay and conditions

Although not part of our original remit, we were invited, part way through our work, by the National Workforce Group to consider issues of pay and conditions in social work services. We received many contributions on this issue. Most people who responded called for greater consistency in pay to tackle some of the effects of the so-called "bidding wars" which arose over the last ten years as a result of the acute shortages of social workers in some parts of the sector. This has led to notable variation in social workers' pay and reward across the 32 local authorities. Often this reflects different local circumstances, including the recruitment and retention difficulties they have experienced or, in some cases, are continuing to experience. Greater national consistency in pay and conditions would certainly benefit the sector.

"Good social workers should be allowed to stay in the field, not promoted out of it."
Users and Carers Panel

CoSLA has already started to develop an agreed national framework which provides for greater national consistency in recognition and reward and we recommend that it should enable and support the development of careers pathways for social workers. It will be important for CoSLA to include employers from the voluntary and private sector in these discussions.

8. Social work services must develop a learning culture that commits all individuals and organisations to lifelong learning and development.

This requires:

  • full implementation of the National Strategy for the Development of the Social Service Workforce in Scotland: A Plan for Action 2005-2010;
  • further investment in lifelong learning across the social service workforce;
  • social service workers to maintain a personal portfolio as an up to date record of their skills and competence;
  • social service workers to have access to regular, quality professional support, challenge and consultation;
  • newly qualified professionals to have a period of more intensive initial support; and
  • stronger links between employers and higher education institutions.

Developing the workforce

Everyone in the social service workforce must have the necessary knowledge and skills to practise effectively in a challenging and sometimes dangerous environment with some very vulnerable people. This requires a commitment to lifelong learning from both the individual and the employer. However, when we asked those taking part in a series of workshops and conferences if there was a learning culture in social work services, over two thirds said no. Many of the people we spoke to found it difficult, if not impossible, to take time away from work to learn. In addition there was little systematic attempt to match individual learning needs to organisational skills requirements. Tackling these learning issues is an immediate priority if we are to fulfil the aspirations set out in this report.

The Scottish Executive has recently published a National Strategy for the Development of the Social Service Workforce which includes a detailed action plan (Scottish Executive, 2005). Putting the strategy into practice will mean that more investment in personal development is needed across the whole social service workforce and all sectors, so that lifelong learning becomes a reality rather than just an aspiration.

"We think the most important qualities for social service workers are anti-discriminatory values, respectful attitudes and very good personal communication skills. Users and carers should be involved in training workers to make sure people understand why this is important."
Users and Carers Panel

Developing a portfolio of knowledge and skills

Early in our work we concluded that social work is underpinned by a common set of knowledge, skills and values. However, practitioners will increasingly need different combinations of specialist skills to meet the particular needs of the client groups they work with. For example working with a group of young offenders requires different specialist skills from those needed to support an older person to remain independent. Social workers, in particular, need to be able to match their skills to the needs of their current post. We propose that each social service worker develops and maintains a portfolio of competence. This would help practitioners to demonstrate their competence, for example when asked to give evidence in court, and help employers to find a worker with a specialist skill such as an occupational therapist with skills in major adaptations or a care worker skilled in working with people with dementia. The portfolio should ideally be searchable electronically and should form a basis for annual appraisal and career planning as well as a tool to match workers with individual needs.

Professional consultation

A great strength of social work has traditionally been using professional supervision to challenge practice and discuss complex problems and their solution. We were therefore concerned by evidence which suggested that supervision was, in effect, often being used as a means for the manager to take accountability for the social worker's actions rather than promoting and enabling personal professional accountability. Many social workers reported that supervision had become little more than workload management, others that it was used as a means to have their manager make decisions for them, or to tell their manager about decisions they had taken so they can pass on responsibility for them. Our approach to developing professional autonomy within a framework of accountability will require a revitalised approach to professional supervision. Supervision is, therefore, no longer the right terminology for a process which supports and challenges rather than supervises professionals. The new term "consultation" should include three core elements - performance management, staff development and staff support. It should aim to enable practitioners to deliver high standards of practice and improved outcomes for service users. Consultation will not always be provided by a line manager, as working environments become increasingly multi-disciplinary. As a result, we propose that new standards for professional consultation be developed as a key part of our approach to social work governance.

Consultation which provides development, support and, when necessary, challenge is equally essential for all social service workers, many of whom may be the only person in regular contact with vulnerable people and their families. This would need to be a qualitatively different approach from that applied to professionals, recognising differing accountabilities and limited autonomy to act. This should also be considered in developing governance standards.

Newly qualified workers

Making the transition from student to practitioner and having to make complex and challenging decisions on your own, is never easy. Employers have a vital role in helping people to make that transition. The workforce development strategy addresses the vital role of induction in smoothing that transition. The Scottish Social Service Council Codes of Practice and requirements for Post Registration Training and Learning for social workers emphasise the need for continuing learning throughout their professional career. This must be enhanced by more intensive support and consultation during the first year in practice, helping professionals move towards professional autonomy. A similar approach needs to be taken with other social service workers, recognising that they often work alone and ensuring that they develop safe practice.

Linking learning and practice

Developing a learning culture will mean all organisations have to bridge the boundaries between learning and practice. Approaches such as rotation, secondments, shadowing, involvement in international programmes and exchanges between voluntary and statutory sectors provide a way of sharing learning and expertise as do new approaches to e-learning, for example the Leading to Deliver programme which combined face to face learning with access to additional support materials and online discussion via Robert Gordon University's virtual campus or the new Learning Exchange established by the Scottish Institute for Excellence in Social Work Education.

These new approaches to learning mean organisations which employ staff must behave and think differently. They also challenge some of the traditional boundaries between the higher education and college sector and practice, requiring greater openness and a better understanding of one another's needs. Developments such as the Scottish Practice Learning Project and Learning Networks will start to address this gap, but there is much more that employers and universities could do, for example by creating joint posts such as lecturer/practitioner.

9. Social work services should be delivered by effective teams designed to incorporate the appropriate mix of skills and expertise and operating with delegated authority and responsibilities.

This requires:

  • employers to invest in building and sustaining effective teamwork;
  • a team based approach to performance improvement;
  • budgetary and decision making authority to be delegated as near to the front line as possible;
  • the development of a new para professional role;
  • teams to have the right mix of skills to operate efficiently and effectively;
  • social service workers to be treated as a mobile workforce
  • investment in increasing the capacity of teams to respond to growing need; and.
  • an integrated approach to workforce planning and development.

Building effective teams

Most social workers and other social service staff work in teams, both in a single service and, increasingly, in integrated settings, sometimes across organisational boundaries. Whether they are working in a dedicated social work team or in an integrated team, team members must have a good knowledge and understanding of the team's objective and how they and their colleagues can contribute to this. High performing teams are inter-dependent. They have common goals, shared values, shared knowledge about the needs of clients and the opportunity to share expertise, and learn together. They celebrate success and are rewarded for achievement. They are adaptable and provide continuity in information, planning and decision making.

We have found good and bad experiences of teamwork. Some of the most effective appeared to be specialist teams which bring together people from a range of disciplines for a common purpose such as rapid response to hospital discharge. As integrated working becomes the norm, we need to build upon their success. Effective teamwork does not happen by accident or by simply putting people together and leaving them to get on with the job. It requires dedicated time and effort to be invested in creating, coaching and developing teams over the long term. This will then reduce the disruptive effects of staff turnover. Effective teams need to have team based planning, evaluation and regularly reported outcomes. To help teams become more effective our performance improvement sub group have adapted the school based "How Good is our Team?" self assessment tool for social work services. This simple set of measures will give teams a way of assessing their performance and provide a focus for identifying improvements.

Delegated authority

Delegating authority and decision making to frontline teams is a crucial part of the new approach to governance. It supports practitioners to exercise professional autonomy within a clear accountability framework. It should also free workers from the bureaucratic and time consuming procedures that have developed around decision making. In a commissioned study McLean (2005) concluded, following consultation with stakeholders, that there were few objections in principle and many examples of good practice on delegation, but none were universally applied. Learning from existing good practice, a tool kit on delegation of authority should be developed to support systematic delegation of authority to the front line.

Changing the mix of skills within teams

Our evidence shows that we are not making best use of social workers' skills and expertise. We have found social workers filing, ordering taxis and filling in forms or carrying out simple case work which does not need their skills. Putting in place the right mix of staff with the right mix of skills in any team will mean redesigning the service and roles, based on a sound analysis of need. This will need to be supported by flatter management structures, integration of business support into teams and developing leadership skills among front line staff. A typical team might then involve a combination of professionally qualified workers, leading and being accountable for the work of the team,
para-professionals, support workers and administrative and business support workers. Each team would be different, bringing together the distinctive mix of skills and expertise required to meet the needs of the client group or community served.

Stirling, Clackmannanshire and Falkirk councils have created the role of community care worker, which can be filled by people with a professional qualification in either social work, occupational therapy or nursing. The professions are equally regarded, with a common grade for posts, aiding retention as well as providing a complementary mix of skills in teams and enriching each professional's knowledge base.

Developing a new paraprofessional role

We need to develop a new role, that of a para-professional worker in social work services, skilled to a nationally recognised and accredited level and able to work across and between different services. Paraprofessionals would be skilled to directly manage cases, under the supervision of a professional as well as contributing to more complex work alongside professionals. While many paraprofessionals would work initially with social workers, they would increasingly work with other professions across service boundaries, so for example, a paraprofessional may work with a child in school and with his family in the community, enabling more effective support. This new role would also create new career pathways within social work and other professions.

Glasgow City Council's approach to addressing a high vacancy level in social worker posts was ambitious and radical. A new model of service delivery was developed along with investment in training and continuous professional development, a review of salaries and creation of new opportunities. This resulted in a dramatic reduction in both qualified social work vacancies and the creation of para-professional social care workers.

A mobile workforce

Most social work needs to take place where people are. To be effective, workers need to be supported to work away from the office, sometimes working from clients' homes, their own home or a variety of local public sector facilities, saving on travel time to and from a fixed base. New technologies now make this much more possible. Employers should exploit this opportunity, recognising that social services workers are a mobile workforce and using mobile information and communications technology to make them more effective and ensure their safety.

Increasing the capacity of the workforce

Recent initiatives have been successful in recruiting more social workers into the workforce. Although it is difficult to say precisely what need there might be in society in the future, we are not convinced that there is a need for more social workers in the short term. However, we cannot estimate the potential impact of forthcoming policy and we urge the Scottish Executive to consider the resource implications of changes in policy, as, in the past, such changes have placed unpredicted and unsustainable pressures on social work services.

We have designed our recommendations to retain professionals in the workforce and to make sure that we use their expertise effectively, giving them challenging and rewarding roles. If we are to make sure that practitioners have the space to build therapeutic relationships with their clients and create a system that can focus on earlier interventions and preventive work, then we will need more people working in social work services. We have concluded that significant investment is needed on an ongoing basis to increase the capacity of the supporting workforce, using changes in skill mix to create the time and space to make best use of social workers' skills.

Integrated workforce planning

There has been important progress in workforce planning through the workforce intelligence workstream of the National Workforce Group. However, the data used to inform workforce planning is mixed. While there is a well evidenced understanding of the local authority workforce, there are some significant gaps, most notably around occupational therapists and other professional groups. Information on the private and voluntary sector workforce remains under developed. Given that those sectors account for around a half of the workforce, it is essential that this issue is addressed in order to allow for more accurate workforce planning. Faced with a changing skill mix and a shift towards greater integration, more sophisticated workforce intelligence and planning will be needed if we are to have the right staff with the right skills in the right place to meet current and future service needs. Increasingly, that planning will need to take place across agency boundaries on a user group basis.

"The workforce should reflect the diversity of the population. Social workers should come from all sections of the community, e.g. the deaf community and minority ethnic communities, etc. Recruitment must not exclude people with life skills - qualifications are not enough. Social work services should take a strategic view of recruitment and retention and seek to overcome variations in pay and conditions."
Users and Carers Panel