Recording

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Purpose of recording

  • To provide information to deliver highest standard of services
  • To meet statutory requirements
  • To meet agency requirements

More specifically recording should satisfy the following requirements:

  • Enable staff to assess intervention, plan, monitor and evaluate work with service users
  • Provide continuity of service when workers change
  • Communicate information to other staff and agencies where appropriate
  • Enable managers to monitor the work of staff and give appropriate advice, support and direction
  • Provide a means of accountability to whoever is entitled to it, so that actions and decisions that have taken can be understood and justified
  • Meet specific legislative requirements (reference: Mental Health Act 1983, Children Act 1989, NHS and Community Care Act 1990, Data Protection Act 1998, Human Rights Act 1998)
  • Provide information that may be needed as evidence in court proceedings, judicial reviews, internal and external enquiries, complains investigations
  • Provide a means of financial control
  • Enable information and data to be collected as a basis for evaluating service delivery, managing resources and future planning
  • Provide information to clients if they wish to have access to their records

Key Principles

  • Records should be clear and accurate
  • Records must differentiate between opinion, judgements and hypothesis
  • Actions and decisions must be recorded
  • Information clear and accessible
  • Sharing information with others appropriately

Department Of Health, Working Together to Safeguard Children (1998)

 

As a social care worker, you must be accountable for the quality of your work and take responsibility for maintaining and improving your knowledge and skills…this includes maintaining clear and accurate records as required by procedures established for your work

General Social Care Council Codes of Practice for social care workers and employers

 

Recording is an important part of a council’s duty of care. To record the person’s circumstances and personal details accurately is a fundamental part of respect. Administratively it helps continuity and should prevent people having to give personal details about themselves more than once. Accurate recording allows the worker to spot a pattern of experience, of particular importance to safeguarding children and vulnerable people. But all too often recording is seen as an extra or a chore…. ..Working together with users and carers to gather, record and share information is a valuable part of the care management process…. Good recording can also assist communication, whilst taking into account the person’s language knowledge and skills. Performance monitoring shows that there are problems with access to suitable translated material and translators, which need to be addressed.”
Extract from the 10th Annual Report of the Chief Inspector of Social Services 2000/2001

“If the goals of a user-focused service are to be achieved then steps must be taken to make all relevant information about the needs, services and expected outcomes for an individual accessible in electronic form. The generally recognised way to achieve this will be through the development of a comprehensive electronic social care record… The assessment and care planning processes depend on the gathering and recording of information - information about the service users and their needs, about the options for meeting those needs and about the providers of relevant services. Managers need information to plan the services they are going to deliver, to make sure the appropriate resources are available and to monitor delivery of those services.

DoH, Information for Social Care, 2002

 

Key messages

  • Case recording is part of the service provided to children and families
  • All social services staff working with children should be clear about the principles and purposes of case recording
  • Children and families should be encouraged to contribute to and see their records
  • Written records should be written in a manner that conveys respect, irrespective of the background or culture of the individual
  • Social services departments should have management arrangements in place to support good recording practice.

Social Services Inspectorate, Recording with Care, DoH, (1999)

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