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Short Reviews of Social Work Services in Scottish Local Authorities

Argyll & Bute Council

Overview

Argyll & Bute faces considerable challenges and seems to be battling against the odds to deliver a quality service. It has major logistical problems to overcome and, despite the significant extra investment from the Scottish Executive, particularly in community care services, limited resources seem to be a major barrier to making new developments. Moreover, the Council's services are affected by particular policies and levels of services from the health board in a way which they cannot always control.

Despite these challenges, the Council achievements include:

• a relatively high rate of people receiving more than 20 hours of home care each week;
• significant progress in resettling people with learning difficulties into the community;
• a wide range of policies to support front-line staff; and
• successful introduction of Free Personal Care.

The Council urgently needs to:

• make sure that all care plans for all looked after children contain education elements of suitable quality;
• introduce further measures to raise the educational attainment of looked after children;
• take action to ensure it has accurate information on, and improves its performance on, all three of the standards, bearing in mind the targets set.

The Council should also give priority to:

• extending the work of the rapid response teams throughout the whole area;
• improving rehabilitation services so older people can live in their own houses with help when they return from hospital;
• pursuing the joint future agenda by planning and putting into practice joint management and resourcing over a set timescale;
• providing forensic services for people with learning difficulties;
• planning future provision - direct or commissioned - for people with sensory impairment based on local needs;
• preparing a plan for putting the new Mental Health Act into practice;
• setting up a database on aids and adaptations and setting target times to meet requests for them;
• preparing a full response to the challenge of 'Getting Our Priorities Right' for people with substance misuse problems.
• gathering and monitoring accurate throughcare and aftercare information;
• analysing the age profile of social work staff as soon as is practical, introducing computerised management information and beginning forward planning for both front-line and management posts;
• completing any assessments which have not yet been dealt with for Free Personal Care; and
• speeding up the pace of its joint working arrangements with health.

The Council also needs to build on its early innovative approaches to using ICT to improve services and build a strong IT culture throughout the organisation.

Community Care

Services for older people

Fewer older people are now receiving a community care service, with the numbers falling back to nearly the 1999-2000 level (1881), from 2,507 in 2000-2001 to 1,932 in 2001-2002. The number receiving home care has increased from 39 to 45 in the last year but is still below the 62 people receiving this service in 1999-2000. As a result, overall the numbers receiving a service are at best equal to and at worst below 1999-2000 levels. However, they are moving in the right direction.

Argyll and Bute has expanded intensive home care in 2002. They do not have figures but the Council acknowledges that this approach affects the services provided to other home carers. Budgets ring-fenced for domestic care were used to extend personal care as Supporting People budgets assisted in providing some practical support in some cases. The mobile home safety project undertakes a home safety assessment for older people. This service works in conjunction with Care and Repair services.

The Council has put measures in place to speed up discharges. However, at times Community Hospital beds freed up are quickly filled by GPs who manage these resources locally. Working groups are exploring how to reduce the numbers of these beds, the release of which would help develop a community infrastructure. Outline business cases have been developed with health and community care groups for Mull/Iona, Jura, Cowal, Bute and mental health services for older people.

The rapid response service is provided by the Integrated Outreach Team in Oban and home care teams in Helensburgh and Lomond. Statistical evidence suggests that the service helps to keep people at home and speeds up access to care packages. The Council is planning to set up other teams in Cowal and Kintyre. There are, however, no resources for rehabilitation even though they are critical to 'stepping down' from the hospital into the community. The Council is setting up a new adult respite service and reducing the amount it spends on short-break respite care. This could create problems in the future but at present there is evidence that the Council is meeting the need for respite care through short breaks and the use of a purpose-built Unit for Adults.

Argyll and Bute have had some difficulty in managing the demand for Free Personal Care and still has 50 assessments to carry out because of staff pressures on Child Protection issues. Because of pressures on the budget, the Council is considering introducing a maximum rate to ensure a Best Value approach. The introduction of Free Personal Care has raised people's expectations so that more people want respite and intensive care in their own home. Free Personal Care along with other funding such as that for Supporting People and Delayed Discharge provide the opportunity to support people who have intensive physical needs. For example, the Council supports a number of major packages of care above 100,000.

Services for people with learning disabilities

It is very encouraging that the Council has resettled 31 people from long-stay hospital and has clear plans for resettling a small number into the community. While most people leaving hospital go to individual tenancies, nine people have been moved into care homes that provide nursing care on medical advice. They have also received extra resources to help them take part in the community as independently as possible. In another very positive development, the Council has also taken eight registered care homes with 81 placements off the register. Of these 81, 65 people are moving to individual support packages.

The Council is restructuring day services to provide alternative, flexible day opportunities such as employment and further education outwith the day service centres. Four local area co-ordinators each manage a flexible budget. Lomond and Argyll Learning Disability Network (shared with West Dunbartonshire) provides nursing, speech and language therapy, dietetics, psychiatry and psychology. Training from speech and language therapists is also available to improve the skills of support workers.

A recent Scottish Health Advisory Service report identified major flaws in the structure of the health service beyond the control of the Council. There are no specialist forensic services within Argyll and Bute and there is a history of problems in accessing these in urban centres south of the Clyde. The Council is holding discussions about community-based services to meet the needs for forensic services and for people with challenging behaviour.

The Council is one of the partners in the MGF2 funded National Database Support Project.

Services for people with physical disabilities

More people with a physical disability received a service in 2001-2002 than in 1999-2000 (337 compared with 268) but the numbers are still comparatively low.

The Council is planning to appoint new Direct Payment Advisers to encourage the take up of Direct Payments, which has been low in the past. Those using Direct Payments prefer to work through third parties.

At the moment, there is no database covering aids and equipment. The Council is working with health colleagues to create a joint occupational therapy service and equipment stores and hope that these measures will make easier the setting up of the database. It is important to move this forward to monitor and improve waiting times. With no service standards in this area, all requests for equipment are prioritised using a three-tier banding. An average of 60 people are waiting for assessment in each service.

People with sensory impairment

The Council's joint planning of services with Deaf-Blind Scotland is important and two social workers support those people who are deaf or blind. In addition, a Rehabilitation Officer works with people with visual impairment. The Council has a deaf/blind register.

Services for people with mental health difficulties

Argyll and Bute is working with health colleagues to develop a plan to put the new Mental Health Act into practice, based on the level of statutory work done at the moment.

There are five community support projects, one in each of the main population centres, excluding Helensburgh, where support is commissioned from the voluntary sector. The supported employment team for people with learning disabilities is to be expanded. The Council bought people carriers as a way of helping with transport issues. It has provided funding for an effective advocacy service, Lomond and Argyll Advocacy Service, jointly with the NHS and West Dunbartonshire Council.

The 13 practising Mental Health Officers (MHOs) are not enough to cover the workload and the geographical pressures mean that they cannot always match need. The problem is made worse by the number of staff lost to higher-paying local authorities. All out of hours calls pass through the stand-by service in Glasgow. This means waiting longer to speak to a GP. The Council would like to have direct access between MHOs and GPs but this would require a separate call centre.

There are no local services for mentally disordered offenders at present, but a social worker is being recruited to the criminal justice partnership. This worker will be part of the Argyll and Clyde Community Forensic team. Specialist staff are brought in from Renfrewshire.

The Council follows the Lomond and Argyll Care Programme Approach.

Tackling substance misuse

The number of people receiving a service for substance misuse problems almost doubled between 2000-2001 and 2002, from 12 to 23. This still leaves low numbers of service users but is in line with the overall low rate of substance abuse in the authority.

Community services are mainly provided by the voluntary sector, with three community drug rehabilitation projects in Oban, Dunoon and Helensburgh. Councils on Alcohol and on Drugs run counselling services in Oban, Dunoon, Bute, Islay, mid Argyll and Kintyre for people who have problems with substance misuse. Helensburgh has a limited service from Dumbarton Council on Alcohol.

Residential rehabilitation units are used, when appropriate. An evaluation has shown up shortcomings in out-of-area rehabilitation but new contract compliance officers should improve the situation.

There are joint protocols on child protection and substance misuse. Sessional workers in the main service centres provide for children and families affected by drug use. Youth support workers deal with young people at risk from substance misuse.

Staff have attended STRADA training courses.

The Council has only recently set up a 'Getting our Priorities Right' sub-group and now needs to prioritise this work.

Joining up community care services with health

Progress in improved joint working is measured through the Joint Performance Information and Assessment Framework (JPIAF), which has been agreed by SWSI, Audit Scotland and NHS Scotland. Recent evaluation of the partnership's progress in the five areas of joint management, joint governance, human resources, joint resourcing and Single Shared Assessment suggest that the joint arrangements are still being progressed. The local partners were recommended to:

• clarify powers of the Care Management Group;
• clarify nature of senior operational management post(s);
• progress the development and implementation of joint services and associated joint management arrangements, both at high and locality levels;
• agree greater clarity about and implement corporate and political governance arrangements, including delegated powers;
• develop and implement joint clinical/service governance systems for joint services;
• put in place a joint OD/training plan;
• further develop financial Management Arrangements (both Strategic and Operational) and financial Protocols (both Strategic and Operational);
• prepare a statement of an agreed joint resourcing strategic financial envelope for older people's services;
• prepare a statement of an agreed joint resourcing operational budget for older people's services;
• agree and implement arrangements for access to services across social work, health and housing, based on agreed eligibility criteria and a joint protocol for access;
• develop and implement a joint protocol for sharing information; and
• include appropriate housing staff in training for SSA.

On the ground, a number of joint posts are already set up, for example an occupational therapist post on the islands and an island manager post for Mull (others are planned for Islay and Tiree). An Integrated Outreach Team in Oban combines home care and nursing auxiliary roles, and the same service is planned for Dunoon.

Information-sharing is limited and radical change depends on developments in IT and shared accommodation. Dunoon Mental Health Multifunction Centre is examining protocols. The Oban Outreach Team shares information but keeps separate files for health and social care. Attention, so far, has mainly focused on requirements for older people. However, most social workers are generic. Consent protocols have been introduced and data protection information updated for Single Shared Assessment.

Working with carers

The Council has a separate carers' strategy developed with Carers Groups and Health. A Carers' Networking Board (CNB) with representatives from local carers' groups decides on priorities for funding carers. New services include a development officer to support the CNB and a respite facility for adults in partnership with Fyne Housing Association.

The Council has not measured any completed carer assessments, but expects them to increase. Carers' assessment is not seen as a priority for generic staff, especially if childcare priorities intervene. The Council has evaluated a CNB initiative to produce self-assessment for carers which was piloted through the Princess Royal Trust and self-assessment is now agreed and in use.

Children and Young People

Looked after children

The numbers of children and young people looked after increased from 163 in 2000 to 194 in 2002. This was most marked in the number of under 12s and was thought to be due to young people having increasingly complex needs and challenging behaviour which meant they could not be looked after in the community. Staffing difficulties have affected the ability of community support teams to operate. However, three teams are now fully staffed which is expected to affect the numbers in 2003-2004.

The number of young people in residential accommodation fell between 2000 and 2001 but increased again in 2002. The number of residential school placements increased from 18 in 2000-2001 to 27 in 2002. The Council thinks that this is due to:

• an increase of children with very complex needs who cannot be fostered;
• restrictions on a small authority (if a mainstream school placement breaks down the closest school may be very far away and a residential school may be the only alternative); and
• low tolerance levels for young people's behaviour, especially in the rural areas. Children may be removed from the community for far less disruptive behaviour than elsewhere.

The Council still has a low rate of residential accommodation compared to other authorities but it needs to make sure that the upward trend in residential use does not continue and badly affect the children involved.

Fostering and adoption

No children are waiting for a foster placement, but there are not enough placements for teenagers and the Council needs more carers across the area. Carers who take children over 11 receive a bonus. A small number of children are fostered outside the area. The Council is reviewing its foster service and producing new procedures for fostering.

There is a fostering fortnight in May. The Council places articles and features in the press, sends out information with Council Tax forms and puts adverts on the plastic bags in libraries.

Five children are waiting for adoption. The Council provides placements to other authorities.

Educational attainment

Because fewer than five 16 to 17 year olds stopped being looked after in 2001-2002 statistical information on how many attained Maths and English standard grade is not available.

The Council has introduced the following initiatives to improve educational attainment and should built on them. Initiatives include:

• supplying computers and other educational materials to children's units and foster carers;
• providing access for those living at home to the community support team's computers;
• tracking educational attainment;
• setting up joint support teams in all secondary schools; and
• setting up an 'Alternatives to Exclusion' Project.

All schools do not yet have a designated teacher for looked after children and the Council needs to deal with this.

All children and young people looked after are in full-time education apart from a small number who are on Outward Bound. Some young people get home tuition through community support rather than in the usual classroom setting.

An audit of care plans revealed that there was a wide variation in the way educational needs were recorded and of the quality of care plans in general. The Council is now aiming to bring all plans up to the best levels and to develop individual education plans. This is essential if it is to improve educational attainment of looked after and accommodated children.

Throughcare and aftercare

There are no throughcare teams, but a register of children and young people who are looked after should allow the Council to track young people up to age 19. The age of young people leaving care is increasing, and many wait until they are 18 or 19 before they leave. Staff know the first accommodation and employment placements of care leavers but not beyond this unless they want to stay in contact.

The Council has some supported lodgings available, some individual tenancies and some supported tenancies but it would like to extend the range of accommodation options.

Mental health

Mental health needs are identified through care reviews and the Council has access to the Acorn Centre project at the Vale of Leven Hospital in Dumbarton. However, in general, finding enough support in such a rural area is difficult. CAMHS cannot always provide a satisfactory service and the lack of a clinical psychologist in Lochgilphead has led to limited service delivery. To its credit, the Council had tried to help the situation by paying for an independent psychologist to visit children's units and foster placements twice a year to work with individuals and provide a specific service for sexually-aggressive young people. It also provides training on mental health needs for social work, education and health staff.

Child protection

47 children were on the register at the end of March 2003. This was twice the 2002 level. Referrals have also risen. Neglect, often involving parents who misuse substances, was given as the main reason. Referrals of children from some large families have also had an effect.

The Council already had child protection standards and an active approach in this area. However, it has taken a range of initiatives following the child protection review. These include:

• updating the procedures of partner agencies;
• information leaflets for parents whose children are in the child protection system - with extra information on the web and in phone directories;
• a regular audit of local child protection standards;
• quarterly reports and quality assurance visits to clinics;
• a protocol to assess risk; and
• training in child protection for all field work staff.

Children with disabilities

There is no designated team for children with disabilities. 95 children with disabilities receive a service, including residential respite (18), shared care (24) and home-based support (30). The number of shared carers has increased a lot in 2003. The Council is considering building a new residential respite unit to offer services such as playschemes, in partnership with the voluntary sector.

There are no waiting lists for services but the Council prioritises cases where families are about to break down. It is aware of cases of unmet need.

Working of children's hearings

Staffing difficulties and increasing cases were the main cause of the Council's failure to meet the time interval standards. 93% of referrals were made within five working days of the case conference in 2001-2002 (standard 2). No return has been made on standard 3 (all reports to be submitted within 20 working days of the date of request) but SCRA indicate that 48% of reports meet the standard. 90% of supervision requirements met Standard 15 (the local authority to give effect to supervision requirements with no condition of residence to be given effect within 15 working days of issue by the children's hearings).

As a matter of priority, the Council must improve its recording on standard 2 and improve performance across all areas, but particularly in the provision of reports.

Youth Justice

Because it is mainly a generic service, the Council does not have a youth justice team. All relevant fieldwork staff are trained in using the YLS/CMI assessment tool.

SACRO provide a restorative justice service, which takes the form of a diversion programme for first referrals. The community support teams provide improved supervision programmes for young people in trouble, using 'Targets for Effective Change' and 'Constructs' and relying on individual programmes rather than groupwork. YLS is used to assess who needs what. The Council has a purchase agreement with 'Includem' to provide intensive services to young people at risk of residential placement.

Criminal Justice

Structure

Argyll and Bute, West Dunbartonshire and East Dunbartonshire operate as a partnership for delivery of criminal justice services. Management direction for the partnership is provided by a partnership manager accountable to the heads of service for the three authorities. They in turn are responsible to their respective directors who are accountable to a joint committee with fully delegated powers from each of the three authorities. The three Heads of Operation from each authority meet with the partnership manager on a quarterly basis. A strategic group meets monthly and a management group comprising the senior criminal justice staff across the partnership meets bi-monthly. A systems officer has been appointed, responsible for updating the partnership plan on a regular basis and highlighting progress.

Workload

There has been a significant increase in demand for core service across the partnership, with social enquiry reports increasing by 34%, probation orders by 31%, and community service orders by 40%. There are variations across the constituent authorities with Argyll and East Dunbartonshire experiencing the highest percentage increases particularly in SERs. Staff have been re-deployed across the grouping to support areas of pressure. Despite pressures, performance has remained at a very high level.

Effective practice

The partnership uses the risk assessment tools, LSI-R, and the Scottish Executive's risk guidance framework to determine the risk/needs of the offender and appropriate levels of intervention. Those on probation or licence are then matched to a package of modules from the partnership's structured offence-focused programme, Constructs, which was recently submitted for accreditation. Initial evaluation carried out by the Social Work Research Centre at Stirling University suggests some encouraging outcome data in that offenders in the control group who received prison sentences were 25% more likely that those who had completed their probation order to have been reconvicted within 12 months. The programme contains specific modules for women offenders and those who misuse substances. A youth version is available for persistent young offenders. A 1-1 pack is being developed to reflect the differing service needs in Argyll and Bute.

A bail information service has been available since May 2002 to Dumbarton Sheriff Court, which covers the jurisdiction of over 50% of the partnership population. Four bail supervision orders have been made. A review of all court services throughout the partnership is to be completed by March 2005.

Recent developments in the partnership include an employment strategy which incorporates a detailed employment assessment and production of an individual action plan. The partnership has also appointed an employment officer who helps offenders access training and employment. In addition, a skills accreditation scheme has been established involving assessment of painting and decorating work carried out by those on community service to count towards a basic SVQ qualification.

Public protection

Services to sex offenders within the partnership are overseen by a high risk offenders' senior who reviews and approves all case management plans. The partnership is adopting Tayprep 30 to assess the risk presented by sex offenders and adoption of a sex offender practice pack is under review. The committed protection protocol is being reviewed in consultation with the two Police Divisions and other departments of the three councils. It has also been approved by the Joint Committee. Protocols for working with mentally disordered offenders will be established once the Forensic Teams are operational.

Quality assurance

A partnership wide Best Value review was completed in 2002-2003. It noted that measures of quality in terms of positive outcomes as opposed to inputs and outputs were not systematically available or applied. This is a major focus of the work of the management group. A review of monitoring and evaluation systems has been completed and a standardised format is in place supported by the Carejust database. A Single Integrated Information system has been implemented.

Human Resource

Structure of the workforce

Between 2000 and 2002, the numbers of whole time equivalent fieldwork staff increased a great deal in services for children and generic workers but otherwise stayed the same. Vacancies rose significantly in services for children and generic workers but otherwise also stayed the same.

In the same period, numbers of whole time equivalent social work staff increased greatly in services for children but otherwise stayed the same as did the numbers of vacancies. However, there were no figures for services for adults.

Latest figures provided by the Council but not yet confirmed suggest that, at the end of June 2003, there were 50 social workers (whole time equivalent including vacancies) compared with 56 in October 2002 and that the number of social work vacancies was 24 as compared with five in October 2003.

Staff vacancies have led to a system where the Council prioritises workload within community care and children's services, in which, for example, Section 22 work is given lower priority than assessment or management. There are also signs of problems in meeting requirements for registering residential care establishments.

The Council is currently considering ways to attract and keep staff. These include paying for qualifications, a move to more specialist team structure and promoting the quality of life to be enjoyed in Argyll and Bute. Financial restrictions are affecting the move to specialist structures.

The Council currently relies on human resources information which clearly does not fit its needs, although it plans to develop computerised information. In absence management, 6.3% of working days were lost in 2002. There were more absences in staff providing a frontline service, though few staff were absent because of stress-related illnesses.

Support for staff

The Council has taken on board many of the 'Supporting Front-line Staff' recommendations. For example, it has introduced:

• training on managing absence;
• training on managing stress;
• a range of family-friendly policies;
• training on managing supervision;
• risk assessment;
• SHAW - the social work department is working towards Bronze award;
• an occupational health scheme; and
• an in-house counsellor, though staff may also use Glasgow's counselling service.

Working towards a more highly qualified workforce

The Council has a training plan, although this operates more at an activity level rather than as a strategic document. The Council emphasises the importance of 'growing its own' future staff, for example it supports staff through distance-learning courses for Higher National Certificates at Clydebank College. A number of staff are undertaking DipSW training and PQ courses. The latter seems to depend on individual request rather than a planned process. The Council supports staff through Scottish Vocational Qualifications and hope to set up a recognised assessment centre.

Preparing for registration

The Council admits that getting its staff to the required qualification level for registration will be a challenge. Overall there seemed to be little awareness and preparation for the demands of registration although the Council was aware they needed to do more to let staff know about registration and to increase its ability to assess them for SVQs.

Race Equality

Under the Council's Race Equality Scheme, there are action plans for each service describing how it should meet its duties. Progress against action plans is monitored as part of the Council's standard service planning process.

Race Equality training for staff is built into the Council's equal opportunity training programme. Guidance for staff on the use of translation services is widely available.

A Multi-Agency Racial Incident Monitoring (MARIM) Group operates in Argyll and Bute to improve support to victims of racial inequality and harassment.

Use of Information Communications Technology

Social Services Department

Despite the fact that all fieldworkers have PCs, the Council seems to give them limited encouragement to use the Internet because of limits on resources. Residential managers do not have access to the Council network, because this has not been considered a priority. As an authority, Argyll and Bute has pioneered innovative projects, for example offering video conferencing facilities to three remote islands and taking part in the Digital Communities project providing a PC and Internet access to island households. However, limits on internal resources were repeatedly said to have created barriers.

As a result, the Council seems to be missing out on the considerable opportunities which ICT provides to such a rural, dispersed authority. This may change as the department moves from the paper-based Carenap system to the computer-based Care First but cultural change will be needed to change attitudes and practice.

Partnerships

At present, information is shared with partner local councils on criminal justice and with the NHS for SSA, but not much information is shared electronically.

Background Profile

Argyll and Bute has 26 inhabited islands and 3,000 miles of coastline. The third most sparsely-populated authority in Scotland, its main centres of population are in several small widely scattered towns. Many people have moved from rural areas over many years - some islands have suffered particularly serious depopulation.

Relatively high levels of employment in rural areas mask a heavy dependence on part-time and seasonal employment. Economic activity is focused on agriculture, fishing and tourism. The crime rate is very low and the drug misuse rate is half the national average.

Spend for each person on social work in 2001-2002 was 257 compared with 267 for Scotland.

Expected population change

G15

Community Care

Expenditure on community care has increased steadily in the period 1999-2002.

Children and Young People

Expenditure on children's services has remained steady in the period 1999-2002.

Human Resources

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