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Short Reviews of Social Work Services in Scottish Local Authorities

East Lothian Council

Overview

East Lothian is transforming its services for children, building on prepared ground. They have, however, some work to do in developing further the practical links between health and community care, essential if the Joint Future Agenda and the requirements of the new Mental Health Act are to be met.

The Council's achievements include a high rate of children and young people looked after with foster carers rather than in residential care.

East Lothian Council needs to take urgent action to:

• make sure that all children and young people who are looked after have their own named social workers;
• continue improving the educational attainment of children and young people who are looked after, keeping in mind the national target; and
• collect and monitor up-to-date and accurate information on its performance in relation to producing reports to Children's Panels on time, the percentage of Children's Panel requirements which are actioned within the 15 day target and the percentage of referrals which are made within five working days of the case conference (standards 2, 3 and 15), making sure that it meets all targets.

The authority should also give priority to:

• improving the number of short breaks available for older people in residential settings and at home;
• exploring the local need for shopping and household services;
• working with authority partners in the local Sensory Impairment Group to prepare a plan to develop and put in place services to meet local needs;
• completing the review and introducing new systems to speed up assessments for equipment and adaptations;
• with NHS Lothian, completing the assessment of needs of adults with mental health problems and preparing a development plan to improve services to meet assessed needs;
• with NHS Lothian, preparing a plan to put the new Mental Health Act into practice, based on the recommendations of the Lothian-wide review;
• renewing recruitment campaigns to increase the number of foster carer to meet local needs;
• producing accurate and up-to-date information on the education, employment and accommodation for all young people who receive aftercare services;
• with partner agencies, preparing responses to the detailed recommendations of the Child Protection Review and making sure there are better links with criminal justice; and
• speeding up the pace of its joint working arrangements with health.

Community Care

Services for older people

A low rate of older people receive a community care service but numbers have been increasing since 2000 from 1,853 to 2,717. The number of people in residential care homes is reducing. The number in private nursing homes reduced in 2001 but increased in 2002.

The rapid response and intensive home care services are part of local home care services. However, the number of people receiving more than 20 hours' home care each week has shown no significant increase over the last few years. The residential short breaks provided for older people is 30% less than the Scottish average and 90% below the national average for home-based services. Home care services have been separated into a domiciliary care service to people with higher levels of need and a general housing support service which provides shopping and general household services to older people and others.

Services for people with learning disabilities

ELCAP is a major provider of services for people with learning disabilities and looks after people in supported accommodation. However, there is no provision for respite or day services as part of the Gogarburn Resettlement programme. Recently, people have moved from ELCAP registered homes to unregistered homes as part of the Social Inclusion Policy using the Supported People Funding. The Council is now paying for individual care packages, rather than buying blocks of packages from ELCAP. The Council is planning to re-organise day services, which do not have enough resources.

The Council is developing joint services and a joint database with health services. It recognises that users and carers should be involved and should agree to services sharing information about them.

Services for people with physical disabilities

More people are receiving a service for physical disability (a rise from 539 to 706).

People can pay for services through Direct Payments. The Council has prepared procedures, contracts, forms and information. The Single Shared Assessment form covers Direct Payments. The Direct Payments scheme is linked to the Independent Living Fund. The Council has employed an official to provide support for would-be users.

The turn-around for an emergency response for equipment and adaptations is usually on the same day. The Council aims to respond to any request within 72 hours, although this cannot always be achieved because of the waiting list for assessments. Delivering equipment does not appear to be a problem. The Council is proposing to review systems to improve waiting times and Single Shared Assessment will contribute to this.

People with sensory impairment

In 2001-2002, 300 people had visual impairments - 86 were under the age of 60 and 34 were partially sighted. Services for people with sensory impairment are planned through the Sensory Impairment Sub-Group which is a Lothian-wide group. The group hopes to identify needs which have not been met.

Services for people with mental health difficulties

The number of people receiving a service for mental health problems has been increasing gradually since 2000 but the rate is still low compared with other authorities.

An assessment is being made of the needs of adults with mental health difficulties for appropriate and quality services. The Council has commissioned the Scottish Development Centre for Mental Health to carry out a survey.

The Council still needs to develop a plan to introduce the requirements of the Mental Health Act. Mental health services have changed emphasis from residential to care at home and the Council has commissioned two voluntary agencies to provide these services. There is also a very high level of respite care. A joint mental health community team is being considered. The Council recognises that it needs to recruit more Mental Health Officers.

There are very few offenders who are mentally disordered. An all-Lothian Mentally Disordered Offenders Planning Group is reviewing CPA protocols and policies.

Tackling substance misuse

A major service development is underway with a new locality clinic. The Drug and Alcohol Team (DAT) has commissioned a survey which should be completed in the summer of 2003 with a view to developing voluntary services. Present services are not well integrated (for example, with Criminal Justice services).

The Council's main emphasis is to develop services in the community. Residential rehabilitation services are not always desirable and residential placements often break down.

A drug and alcohol project for children and families is made up of one senior worker and two social work care assistants. The project provides practical support for families who misuse drugs. The Council estimated that there were 87 children living with drug-using parents last year. The Child Protection Team and the DAT will develop 'Getting Our Priorities Right'.

All staff who work on drug projects in the Children and Families Section have been on relevant STRADA courses. Other staff are offered STRADA courses as appropriate.

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 5 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:

• reconsider the need for the Joint Future Executive group to continue to meet in private since this is not in line with the implementation of the "Next Steps" approach;
• clarify the high level joint operational management that is to apply to the partnership;
• clarify and reconsider areas not described as under joint operational management such as community hospitals and care home places;
• ensure the basis of delegation to the Joint Future Executive is explicit i.e. whether delegation is to officers or members etc;
• clarify and publish a scheme of delegation from the Joint Future Executive to joint teams and those services to be jointly resourced and managed but which fall outside joint teams;
• provide detail on service or clinical governance or Best Value and how in particular this will be taken forward in the joint team arrangements proposed;
• develop further financial management arrangements (both strategic and operational) and financial protocols (both strategic and operational);
• agree a statement of total service strategic financial envelope for older people's services;
• agree a statement of joint resourcing strategic financial envelope for older people's services;
• agree a statement of joint resourcing operational budget for older people's services;
• agree the process for Single Shared Assessment and implement for older people from 30 June 2003 as planned;
• deliver a joint training programme to support the implementation, for staff working with older people in the first instance; and
• 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.

On the ground, some progress has been made on developing joint services, with a new Health and Community Care Integrated Team testing information sharing using the all-Lothian protocol which is being developed. Electronic systems for sharing information are not yet in place. Paper documents are used to share information. The Council has prepared a newsletter and a training programme which includes health staff.

Working with carers

Most support services for carers is provided by Carers of East Lothian. Carers also sit on the Chief Officers' Group and are involved in deciding how to use funding for carers. East Lothian's Strategic Planning Group for Community Care Services includes carers' representatives. A record is kept of people who ask for carers' assessments and those who refuse them. Carers in East Lothian are encouraged to ask for assessments. These are recorded on an assessment form which is being developed as part of the Single Shared Assessment procedures. New funding has led to redesigning services and there are now two teams giving support and information to carers. There is also an outreach service where carers work in GPs' surgeries to make people more aware of carers' services.

Children and Young People

Looked after children

The number of children and young people who are looked after increased slightly to 163 in 2002, partly because of increased numbers of children and young people over 16 who are still looked after. The number of children in foster care increased to 92 in 2003. A number of large families with drug problems have apparently moved into the area and have contributed to the increase. Children and young people who are looked after living in kinship placements increased to seven in 2002 and the Council aims to increase this number.

Fostering and adoption

No children are waiting for a foster placement. In an emergency, it is possible to place a child with foster carers although he or she may not be able to get their placement of choice. Carers are fully occupied or looking after more children than they have been approved to take. A number of children from Edinburgh are placed in East Lothian.

Fewer than five children are waiting for adoption and are at different stages of the process. The legal process is becoming more difficult and there are often problems over contact. It is becoming more difficult to get adoptive families even for younger children. The Council has service level agreements with two adoption societies, and works informally with two neighbouring authorities.

Educational attainment

In East Lothian, 46% of 16 and 17 year olds who were no longer looked after had attained Maths and English standard grade in 2001-2002. This is considerably lower than the 100% target set by the Scottish Executive in 1999 and the 94% of S4 cohort in the authority attaining such grades. The Council needs to deal with this urgently.

The Council has already introduced a range of measures designed to improve the educational attainment of children and young people looked after. These include:

• an educational assessment when children come into care to see what needs to be done, what backing carers need;
• a tuition fund that workers can use to help children and young people looked after out of school - a book token scheme, money for computers;
• a review of the exclusion policy and quick response when a child or young person looked after has been excluded; and
• training for education and social work staff.

An audit of residential units found that 95% of young people were either excluded from or not going to school at the point of admission. Almost all of them have now gone back into education. The Council is now carrying out an audit of children in foster care.

Throughcare and aftercare

Practice guidelines have been drawn up for social work and housing staff and they use an action plan for service development. The Council has appointed a throughcare and aftercare officer.

Information is available on all young people who have been looked after. Contact is kept with all young people two years after they have left care. All have an allocated worker and they are working with those who still want a service. The Council does not know about young people's education and employment status. Carefirst cannot provide this information because information is held across several separate databases.

New accommodation is available - Blue Triangle, NCH, the Mill Hill resource and supported flats - but there are still problems of access and too many young people become homeless.

Mental health

Mental health problems are identified through case reviews and care planning. The residential health project for looked after and accommodated children is being extended to foster care, providing a complete health assessment for all children and young people looked after. However, there are problems in accessing child and family psychiatric services which are based in Edinburgh and which are highly selective, although an outreach service of four community psychiatric nurses has recently been set up. Child psychologists often have to be commissioned.

Child protection

The number of children on the child protection register increased from 47 in 2002 to 77 in 2003.

The links between criminal justice and child protection are limited. However, criminal justice staff were invited to, and took part in, training on the child protection guidelines.

At the time of the annual report meeting, little information was provided about putting the findings of the child protection review into practice.

Children with disabilities

There is a range of services for children with disabilities. This includes

• residential respite care for some children from Edinburgh resources;
• a small residential unit run with Aberlour that offers 24 places, with a further 10 to 20 children receiving an outreach service;
• the Share the Care service provided for 24 children;
• respite care for some families from Share the Care and the residential unit; and
• special needs playschemes for 60 children.

Community care social workers are normally present at future needs assessments. Social workers from Children and families go to assessments when they know the child and where there are childcare issues other than just disability.

Working of children's hearings

Around 90% of referrals met standard 2 in 2001-2002 (referral within five working days of the case conference).

37% of reports were sent in within 20 working days of the date of request in 2000-2001 but information is not available on performance in 2001-2002. Because of staff shortages, reports are completed if they are seen as a priority, otherwise they will go on a waiting list.

No information is available in relation to standard 15 (the local authority to give effect to supervision requirements with no condition of residence within 15 days of issue by the children's hearing).

At present, around five accommodated children and more children living at home do not have a named social worker, because of a 25% vacancy rate. Fewer than five children on the Child Protection register do not have an allocated worker.

Youth justice

The Council has a Youth Justice Strategy Group with representatives from all the main agencies. The group has agreed a broad strategy for developing youth justice services. A specialist team has been created which includes a post partly funded by criminal justice social work working with the criminal justice system. The multi-agency 'Breaking the Cycle' initiative has played a major part in developing the new strategy.

Along with Scottish Borders, the Council is piloting fast-track children's hearing and are developing a range of specific interventions for young people, identified by the Reporter as qualifying for the pilot.

A Police Juvenile Liaison Officer (JLO) manages a police warnings scheme which has shown some success in reducing referrals to the Children's Hearings. The scheme has three stages - a warning letter, a face-to-face warning at the police station with the child's parent or carer and then a referral to the children's reporter to decide if further action is needed. The new youth justice team uses the YLS/CMI tool and joint training with Borders has been provided. There are no full-scale programmes focusing on offences. Rather, the team uses a range of materials and approaches put together to meet individual needs. A restorative justice option is available for individual offenders. Previous work carried out under Breaking the Cycle has been positively evaluated and a further evaluation has been commissioned.

Criminal Justice

Structure

City of Edinburgh, East Lothian, West Lothian, Midlothian and Scottish Borders operate as a partnership for delivery of criminal justice social work services. The work of the Consortium is overseen by a Convenor's group, composed of elected members from each authority. An inter-council justice forum of service managers and planning officers has responsibility for co-ordinating strategic and service planning and reports to an Extended Joint Liaison group, consisting of Directors/Heads of Social Work. Individual service managers take responsibility for particular areas of service development.

Workload

Across the Consortium, there has been a significant increase in demand for core services over the past year, with social enquiry reports rising by 16%, probation orders by 25% and community service orders by 32%. While all constituent authorities have experienced an increase, there are variations. West Lothian has seen a 23% increase in social enquiry reports, Midlothian an increase of 64% in community service orders, and East Lothian a rise of 31% in probation orders. Performance is generally good and improved in some areas although in others less so and is a reflection of the increases in workload coupled with earlier staffing difficulties. East Lothian, for example, had particularly acute staffing problems last year but has been making considerable efforts to improve performance on the submission of SERs.

Effective practice

The Consortium assesses the risk/needs presented by offenders using LSI-R, the Scottish Executive's risk assessment framework and the Dunscore risk of custody scale. There is a general move towards integrating structured offence focused programmes, including those for young offenders, using a modular approach into probation work in the teams. Specialist programmes are in place for issues such as drugs misuse, including West Lothian's DUO programme and the Scottish Borders' Turning Point module. The Consortium plans to submit programmes such as the Scottish Borders' "Time to Change" programme for accreditation.

Future service developments include plans both to widen the range of community service placements affording direct contact with recipients and opportunities for female offenders (as well as extending availability at weekends). Increased use of community service as a high tariff disposal requires recruitment of the appropriate staff. There are also implications for delivering this service in rural areas. The value of the relationship between staff and offenders undertaking community service is recognised and pro-social modelling training has been delivered to community service staff.

Bail services are being developed across the Consortium and the Drug Treatment and Testing Order scheme has extended to Midlothian.

Public protection

The work undertaken with sex offenders by criminal justice teams is supported by the Community Intervention Service for Offenders (CISSO). The Consortium intends to identify and introduce an appropriate risk assessment tool for use with sex offenders such as TayPrep 30. A joint police protocol for working with sex offenders has recently been reviewed. Edinburgh's Resettlement team supervises a sizeable proportion of registered sex offenders and other high risk offenders seeking to resettle in Edinburgh at the end of long prison sentences. Voluntary assistance for other ex-prisoners is provided by Edinburgh, West Lothian, and Midlothian in partnership with SACRO. Some councils access Employment services through Apex for those on supervision.

Services to mentally disordered offenders are planned through the Lothian and Borders Mentally Disordered Offenders' Group, attended by all authorities. A medium secure facility has been developed in Edinburgh, with dedicated social work services on site.

Much of the supported accommodation across Lothian and Borders is located in Edinburgh and forms a resource for other authorities in the Consortium area. There have been significant developments in the provision of such accommodation, including focusing the Albrae project on high risk offenders and a planned intensive supervision service in partnership with a voluntary organisation.

Quality assurance

The authorities use a variety of methods to monitor and evaluate their work and are at different stages of carrying out Best Value reviews of their services. The councils have developed different approaches to meeting the information needs of criminal justice services.

Human Resource

Structure of the workforce

Between 2000 and 2002, there was an increase in the number of whole time equivalent fieldwork staff working with all client groups except offenders, with the number of staff increasing by 59 to 146. There were also smaller increases in the number of social worker posts (main grade and first line managers) from 52 to 65. In the same period, staff vacancies increased for adults and children to 14 whole time equivalent.

Latest figures provided by the Council and as yet unconfirmed suggest that, between October 2002 and the end of June 2003, vacancy levels have increased from four to seven whole time equivalent.

In spite of this increase in the number of social worker posts, the Council felt that there were still pressure points in the system. These mainly centred on different working practices due to initiatives such as New Community Schools, Mental Health Officer work, and work on the Joint Future Agenda. The Council was working towards a clearer understanding of which grade of staff could be used in these different circumstances.

There was a 13% staff turnover in some parts of the authority and the Council felt that it had difficulties in attracting staff, particularly in rural areas, because of added travel costs. East Lothian are dealing with this by introducing a more formal structure for career progression.

At the time of the visit, there was no information available about the age of social work staff.

Support for staff

East Lothian has a Total Employee Health and Wellbeing Project which includes:

• how to manage stress;
• back care; and
• a 'fit for life/fit for work' project.

The Council gathers figures on absences regularly. It was unclear if the Council had identified any particular groups of staff or areas where absence rates were higher.

Working towards a more highly qualified workforce

An Employee Development and Review scheme is in place, which includes a pilot on Personal Development Planning. This will give information on present and future training requirements. Courses promoted at the moment are the registered managers award, DipSW and SVQ 4. Courses for occupational therapists and continuing professional development (CPD) are provided at Queen Margaret's College.

Staff in Children and Families have access to advice from a training consultant whose specific role is to promote staff development. Staff development is also promoted by the senior practitioners.

The Council recently ran a campaign to promote practice teaching and managed to take on seven student placements this year. They are considering, but have not yet introduced, a financial package to encourage practice teachers to take on placements.

Preparing for registration

East Lothian have made few preparations for registration because of other pressures, although they have had meetings with union officials where concerns were raised about the payment of registration costs. At present, they thought they would be 10 short of their target figure, but were confident that this could be tackled successfully in time.

Race Equality

0.7% of the local population are from a minority ethnic group compared with 2% for Scotland as a whole.

Under its Race Equality Scheme, a framework action plan outlines what the Council will do to develop Race Equality measures across its services. The Council has produced leaflets to tell employees about Race Equality and explain the importance of Race Equality and Equal Opportunities.

The Council takes part in an East Lothian Ethnic Minority Forum.

Use of Information Communications Technology (ICT)

Social Services Department

All social workers have personal computers (PCs) with access to the Intranet, e-mail and restricted access to the Internet. The Council is also providing residential units and day centres with PCs. Social work does not have a separate ICT strategy but follows the Council's strategy. The Council has set up a group to use ICT to reduce unnecessary paperwork involved in social work. The Council is not involved in e-care developments.

Partnerships

A protocol for sharing information applies to the three Lothian authorities and Edinburgh and Lothian NHS and covers adult services. The protocol is going to be extended to children and families.

Background Profile

The drug misuse rate is below average (1.6% of 15 to 54 year olds) (2001).

East Lothian contains a mix of urban and rural communities, and deprived and well-off communities. There are some areas of social and economic disadvantage, particularly in the west.

The economy of East Lothian has changed significantly over the last 10 years. The area's economy was previously based on farming, fishing, coal mining and general manufacturing. Agriculture remains important, but fishing is now only a small-scale industry. Tourism and recreation are becoming more important in the coastal towns. The area has a large commuter population that travels to Edinburgh, and this group is mainly catered for in substantial new housing developments.

Spend for every person on social work in 2001-2002 was 246, whereas for Scotland it was 267.

Expected population change

Community Care

In the period 1999-2002 expenditure on community care services rose steadily.

Children and Young People

Expenditure on children's services increased significantly in the period 1999-2002.

Criminal Justice

Human Resources

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