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Short Reviews of Social Work Services in Scottish Local Authorities

City of Edinburgh Council

Overview

As a large authority with a growing population, Edinburgh has to meet a wide range of demands on its services. Its task is affected more and more by a high rate of drug misuse compared with other authorities and the effect which this has on families and the care of children.

Edinburgh provides a rich mix of social work services but fails to fully involve its communities or work as effectively as it should, with education and social work. It could achieve much more by encouraging its staff to work with others.

The council's achievements are:

• providing good community support in the community for people with learning disabilities, with a high number of people receiving a service;
• recruiting more foster carers, an achievement which other authorities could learn from;
• improving healthcare for children and young people who are looked after by people other than their parents; and
• reducing the waiting times for equipment.

• The City of Edinburgh Council urgently needs to:

• agree a financial framework with Health to allow for community placements for people with learning disabilities (currently inappropriately placed in healthcare services, including in 'healthcare houses';
• make sure that all child protection cases are passed to the appropriate staff immediately;
• increase the educational achievement of children and young people who are looked after;
• make sure that all children and young people who are looked after are receiving full-time education; and
• improve its poor performance in relation to presenting its reports to the children's hearings on time, making sure that they meet the 75% target.

The authority should also give priority to:

• completing its planning exercise with NHS Lothian to shape the strategic development of services for older people, and in particular services based in people's homes and in the community;
• making sure that the Care Programme Approach is available on a city-wide basis for all individuals who have been needing it;
• agreeing and putting into practice a joint risk assessment and risk-management guidelines for people with mental health problems;
• creating an action plan to put into practice the new Mental Health Act (Care and Treatment) (Scotland) 2003, including the requirements for professional staff;
• continuing to develop throughcare and aftercare services; and
• renewing efforts to improve the qualifications of existing staff.

Community Care

Services for older people

Over 1,000 fewer older people received a social work service in 2001-2002 than in 1999-2000 (down from 16,296 to 14,862). This goes against the expectations of the extra funding provided under the joint future agenda to expand services based in people's homes and in the community. There have been no significant changes in the number of older people in care homes or housing for people with special needs. The number receiving care in their home since 2000 fell by 9%.

Rapid-response teams are being set up throughout Edinburgh and have a social-care worker working alongside domiciliary care teams. A community rehabilitation service is well established to provide support for people who leave hospital for up to five weeks. Similar arrangements exist for crisis care to prevent people going into hospital and to help people leave as soon as they are ready. There are plans to provide care at home for up to 600 people who would otherwise be placed in residential care.

When Free Personal Care was introduced, some providers substantially increased their fees and there were delays in providers giving residents their money back. There were many disagreements about ordinary residence. In 2003-2004, Free Personal Care will cost Edinburgh City Council 1.1 million more than they budgeted for.

The Council and NHS Lothian have agreed a joint Capacity Plan for older people's accommodation. This includes plans to buy an extra 240 care home places and an extra 600 intensive care at home packages for people with lower levels of support who would otherwise need a nursing home placement.

Services for people with learning disabilities

A high number of people receive a service for learning disabilities. The number receiving a service increased from 1,143 in 1999-2000 to 1,433 in 2001-2002.

The Council has yet to make firm plans for people in health-care houses to move into independent living, as there are problems with finding enough funds. It has set up a joint commissioning group to assess what placements need to be provided and what new services need to be commissioned. Several people have already moved on from health-care placements to independent living because of the work of this group. In the community, Edinburgh offers accommodation, support arrangements, person-centred day opportunities, college placements, supported employment and person-centred planning. There is also a supported holiday scheme, improved short-break services, direct payments and independent representation.

The Council is helping people with learning disabilities to get better access to ordinary health resources through, for example, the 'Better Health Through Better Communication' project, which provides information to people with learning disabilities and their families on health-care and health promotion. A community-based learning disability team provides these services and they also have a team that deals with people with challenging behaviour.

In 1992 the Council set up a database of people with learning disabilities which contains information about current services and what services people will need in the future.

Services for people with physical disabilities

The Council has updated procedures for direct payments for June 2003 and 270 staff have received training (which also covers the Adults with Incapacity (Scotland) Act). The Council uses a three-tier funding framework, and has identified high-dependency groups, including all adult groups and 16 to 17 year olds with disabilities.

The Council reduced the waiting times for equipment from the joint equipment store in 2003. There are now hardly any waiting lists for small items of equipment. Staff at the store use a computer system to monitor the equipment. There is a three-day target for delivering equipment. Practice teams have a set budget and self-assessment will be introduced for smaller items of equipment such as bath aids. They have put forward proposals for a joint occupational therapy assessment team and both health and social work occupational therapists to have access to equipment from the joint equipment store.

People with sensory impairment

There are 180 deaf and blind people and people with hearing difficulties receiving a service. The Council plans services using Royal National Institute for the Blind figures as it does not have a database for planning and developing services for people with sensory impairment.

Services for people with mental health difficulties

The Council still needs to draw up a specific plan for putting the Mental Health Act into practice. Their ongoing work in relation to the Adults With Incapacity Act 2000 is seen as a platform to introduce the new Act. Its approach is to develop services to help people in the early stages of mental health crises and to prevent people using acute mental health services if it is not necessary.

The care programme approach is not consistently in use throughout the city.

There are no agreed joint guidelines for assessing and managing risk in relation to people with mental-health problems.

Tackling substance misuse

The number of adults receiving a service for drug and alcohol problems increased from 462 in 1999-2000 to 616 in 2001-2002.

Service development is focused on early intervention and harm reduction. Many services are delivered through the independent sector, particularly those providing services for young people. The Council pays for a number of beds at two rehabilitation centres and buys more residential rehabilitation services from a variety of providers when these are required.

A newly developed social work addiction resource team has prioritised working with children and families who are affected by drug and alcohol problems. An inter-agency protocol is being developed in line with 'Getting our priorities right'. Work to link systems that contain information that is relevant to children affected by drug and alcohol problems is at an early stage, but the Council is committed to making sure it takes account of the requirements of 'Getting our priorities right' when it reviews its child protection database.

Sixty staff have been on STRADA courses and other courses are being developed which are more related to practice needs - for example, women and drug abuse.

SACRO and Turning Point provide support to offenders with drug and alcohol problems.

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. Annual evaluation statements were issued by the Scottish Executive and Audit Scotland to each local partnership in June 2003 and covered progress in 5 areas: joint management, joint governance, human resources, joint resourcing and Single Shared Assessment. The joint arrangements for these 5 areas, as documented in the Local Partnership Agreement, can be summarised as being well progressed and are, overall, satisfactory. It was recommended that the local partners:

• Further develop the shape of frontline joint services and their management arrangements.
• Clarify the nature of the proposed high level joint management structure and its appropriateness to fit with the range of models available for health and social care integration under the Joint Future agenda.
• Identify more clearly the delegated authority to be given to the joint working model to be utilised to meet their aspiration of devolved responsibility for health and social care functions.
• Develop more fully the checklist of critical components for governance, which has been developed in order to fully support implementation of the joint resourcing and joint management arrangements.
• Develop financial management arrangements to address operational arrangements.
• Develop financial protocols for operational arrangements.
• Develop an agreed statement of a 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 (as planned for September 2003).

Services have been delivered by a number of agencies for some time and the community care rehabilitation service is a combined effort which has been in place for a number of years. Other joint services include crisis care, a community laundry service and rapid-response teams.

The Council has completed guidelines for sharing information with other organisations.

Working with carers

A range of services are available for carers, including dedicated housing-support services. Specifically, the Council has developed 23 new services as a result of the carers' strategy. Voluntary organisations like VOCAL (through the Princess Royal Trust for carers) and MECOP are jointly funded to provide services for carers.

The new legislation has reinforced the message to practitioners to offer carers' assessments, and this is carried out using the service-users assessment. While the Council does not know how many carers' assessments have been done, the new arrangements appear to have tackled the under-recording that there was before. The system will be put in place as part of the SSA and there will be a separate recording procedure for carers. Edinburgh has publicised carers' rights to have a separate assessment and predicts that the numbers of carers' assessments will increase. Reports from carers suggest that some carers do not want carers' assessments because they do not want to be seen as social work clients.

Children and Young People

Looked after children

Although the number of children and young people looked after in Edinburgh has fallen slightly since 2001, the Council still had the fourth highest rate of children and young people looked after in 2002. The number of children looked after at home dropped between 2000 and 2002 as did the number in residential care between 2001 and 2002. The number living with members of their family increased substantially from 46 in 2000 115 in 2002. This reflects a deliberate policy decision to increase the number of children looked after in the family from a below-average rate in 1999.

Fostering and adoption

There is a mainstream fostering scheme and a specialised scheme for children with disabilities and children with extra care needs. At any one time there are around 40 to 50 children who have been assessed as needing a foster carer but who have not yet been placed with one. Some foster carers are caring for more children than they have been approved to but the number is reducing. The Council has appointed two new service managers to the children and families section and one has a lead role in fostering and adoption. Edinburgh set up a recruitment team in 2002 and increased payments to carers. The number of carers has increased by far more than the 13 outlined in the children's services plan. As a result, the Council has been able to make more appropriate placements. People's houses are being adapted to allow carers to care for children with disabilities. The Council is currently carrying out 32 new assessments of potential foster carers.

20 children are waiting to be adopted and 36 carers are being assessed to become permanent carers. Problems with adopting children are increasing and the age at which children can be adopted appears to be reducing.

Educational attainment

In Edinburgh, only 28% of 16 to 17 year olds who left care in 2001-2002 attained Maths and English Standard grade. This is the eighth lowest percentage in Scotland, is considerably below the 100% target set by the Scottish Executive in 1999 and falls far short of the 91% of the full S4 cohort in the authority achieving these Standard grades. The Council has tried to improve its performance by:

• monitoring S4 pupils and offering extra tutoring to pupils to help them get through Standard grades;
• working with schools and residential unit staff to find alternatives to exclusion for young people in residential units; and
• using the outreach teaching service to provide two 1.5-hour sessions a week to young people not attending school or who need extra support.

But Edinburgh needs to do more if it is to improve the educational achievement of children and young people who are looked after. It does not have accurate information on the educational position of children and young people who are looked after, but know that not all children and young people are getting full-time education. Many only go to school part-time, and a large percentage are permanently excluded. School refusal may be a significant factor. Social workers manage more of young people's education in Wellington School and Panmuir House than teachers. The outreach teaching service offers only three hours of teaching a week to children who do not receive full-time education. The Council clearly needs to strengthen partnerships between education and social work.

Throughcare and aftercare

At the moment, supporting services are being provided for 236 young people aged 16 to 18 - of whom 146 were looked after at home and 90 were in residential care. The Council does not have any information about young people's current employment or accommodation status. The multi-skilled throughcare and aftercare team includes housing workers and a health worker who continues to work with looked after children (LAC), making sure there is a seamless service with the LAC nurse.

The 20/20 project provides employment opportunities for young people who were looked after.

Mental health

A specialist mental health team of four staff supports staff in the residential units. They take on face-to-face work with children who are in residential care, but do not provide a service to children who are at home.

Health

In partnership with social work, the Royal Hospital for Sick Children is responsible for the healthcare of children who are looked after by people other than their parents and in residential care following a study of the health and health needs of children in residential care. A nurse and secretary are employed at the community child health department of the hospital. They collect background information and arrange initial health assessments (IHA). The looked-after children (LAC) nurse then visits the carer and child and issues a health record for the carer to keep. She investigates any concerns and assesses whether the IHA has been put into practice. Carers are encouraged to contact her with any concerns about children's health.

Child protection

The number of child protection referrals and registrations was only a little above the national average in 2002. However, previously unknown levels of neglect and abuse are coming to light through early involvement and it is predicted that the number of registrations will increase in the short term, particularly registrations for neglect due to drug and alcohol problems.

Responses to the problems caused by parents with drug and alcohol problems include:

• issuing of specific guidelines for agencies;
• providing training for staff in health and social work, and for some criminal justice workers;
• linking the Aberlour Outreach Service to a range of social work and health services which deals with families affected by drug misuse with children under 12;
• the Harbour Project (Family Service Units, focusing on greater Pilton and north Leith), which works with drug services, schools and social work services to improve involvement with parents with primary school-aged children; and
• developing a new team at FSU to work with drug services to meet the needs of children whose parents are receiving therapeutic care from specialist services.

Other child-protection schemes include:

• reviewing and revising the membership of the child protection committee;
• appointing an assistant child protection co-ordinator;
• review local agency practice and the performance of the child protection system;
• draw up general standards for child protection;
• put in place an inspection and enforcement system; and
• develop a training strategy for all agencies.

The Council is greatly concerned with the fact that around 10% of children on the register do not have their own worker. This is unacceptable and the Council must put this right immediately.

Children with disabilities

Children with disabilities receive a range of services:

• 20 children are placed in out-of-authority schools throughout the UK (some funded jointly by education and social work, and eight funded by education).
• 74 children receive residential respite care paid for by private and voluntary organisation, and 75 receive care in the Council's own unit.
• 240 children receive respite care in their own homes or as part of community-based activity - 220 from private and voluntary organisations and 20 from the Council's (Family Focus) service.
• 86 children receive a service from the Council's Share the Care befriending service.
• Some children receive a service from the Council's domiciliary-care section.

The number of children and young people receiving a service has increased substantially. However, the Council cannot meet the full demand. 24 children are on a waiting list for new packages of care or an increase to their current package, and in house services all have waiting lists. 110 children are waiting for the Share the Care befriending service and nine children are waiting for a place with specialist carers. Together with the voluntary sector, Edinburgh is appointing a respite co-ordinator to develop more flexible packages of care.

The Council carried out 103 assessments of future need in 2001. Children's and families' social workers are present at these assessments when they know the young people involved. A protocol has been developed with community care colleagues to deal with the issues of moving from child to adult services.

Working of children's hearings

50% of referrals met standard 2 in 2001-2002 (referral within 5 working days of case referral).

34% of reports met standard 3 (all reports submitted within 20 working days of the date of request). Levels vary across the City. A dedicated reporter for youth justice is being appointed with youth crime funding to co-ordinate referrals around persistent young offenders and to standardise the practice of referrals to the Reporter on offence grounds.

Electronic systems do not show how many supervision requirements with no condition of residence are given effect within 15 working days of issue by the children's hearings (standard 15). The Council estimated that 95% of supervision requirements met the target in 2001-2002. In March 2002, 9.5% of home supervision requirements were not allocated.

Youth justice

There are a good range of projects with the voluntary sector for dealing with youth crime including:

• the Children's Hearings Interface Project (CHIP) delivered by NCH, for young people aged between 15 34 and 18 to reduce the likelihood of them committing crimes;
• the City Youth Café;
• the RUTS project targeting young offenders to give them other interests, with an emphasis on those at risk of getting involved in car crime;
• the Council's Junction Project for persistent young offenders which includes a programme for girls who offend and targets young people aged between eight and 15 34 ;
• a project run by SACRO which offers early treatment and restorative justice; (this service is available to serious and persistent offenders, and there is an option for family group discussions); and
• an intensive service provided by Lighthouse for 8 to 18 year olds who are involved in serious or persistent sexually aggressive or offending behaviour.

The Council monitors all youth justice services and has completed an independent assessment in July 2003.

An interesting new development is the appointment of a youth justice Children's Reporter in Edinburgh.

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 that delivered by Scottish Borders Council and the 'Time to Change' programme delivered by Edinburgh 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 2001, there was a slight decrease in the number of full-time equivalent fieldwork staff for adults and offenders, and an increase in number of full-time equivalent fieldwork staff for children.

The Council's latest unconfirmed figures suggest that, at the end of June 2003, there were 533 social workers (full-time equivalent including vacancies) compared with 487 in October 2002. The number of social work vacancies was 34.5, compared with 30 in October 2003.

Information given at the time of the visit for the annual review suggested that changes to the figures were affected by including Blindcraft staffing figures and transferring staff to the Scottish Commission for the Regulation of Care. Between 2000 and 2002, the number of social workers stayed the same and the number of vacancies increased slightly across all user groups.

• The main pressure points are the vacancies for qualified social workers within the teams for children and families, and domiciliary care staff and assistant unit managers in young people's centres.
• Over 50% of staff are over 45, and at senior management level nearly 55% of staff are over 50.

Support for staff

Initiatives based on the main themes identified within the Supporting Frontline Staff resource pack include:

• on managing stress in the workplace - improved supervision arrangements, a new performance review scheme, leave for family care and procedures to allow staff to challenge bad practice;
• on violence and the threat of violence at work - health and safety guidelines for managing and controlling the risk of violence at work, and introducing an incident report form which is monitored by a health and safety advisor;
• absences - a policy on managing absences and procedures to put it into practice; and
• helping staff manage change - more effective communication with staff, including drawing up co-ordinated team plans and publishing newsletters every month.

Absence figures are high but decreasing slightly. 68 staff are on long-term sick leave, but the reasons were not made available to the Inspectorate at the visit.

Working towards a more highly qualified workforce

The overall picture is that the Council has lost qualified staff and had to replace them with unqualified staff. If this pattern continues, the Council will find it difficult to meet targets on the number of qualified staff. Measures to encourage staff to achieve higher qualifications include:

• introducing a new supervision and appraisal system;
• offering a Return 2 Learn programme;
• using GSVQ to prepare for HNC/SVQ3 qualifications;
• setting up recruitment and development centres;
• providing information on DipSW and HNC courses, and preparing staff who want to study them; and
• offering time-limited work-management schemes to give staff experience of working in management posts.

For staff who are already qualified, programmes include the practice teaching award, Mental Health Officer accreditation and child protection courses.

The Council has also set up 2.5 practice units for students, including the developing unit in Saughton prison.

Preparing for registration

The qualifications strategy already takes account of SSSC requirements. The Council is investigating a piece of software that will provide more accurate predictions on turnover, recruitment and costs.

It also has approval for the Registered Manager Award and are currently seeking approval for SVQ 4 in care.

Occupational therapists have their own CPD programme, and their budget is monitored by the employee development department.

Race Equality

4.1% of the local population are from an minority ethnic group, more than twice the national rate of 2%.

The Council has held briefing sessions for all managers on the Race Relations (Amendment) Act.

As a first step to identifying gaps in the services available to people from minority ethnic groups, Edinburgh is focusing on improving the way they record their clients' ethnic group. The Council was unable to identify the ethnic origin of 75% of the children and young people who were looked after in 2002. It has reviewed its information systems to find out how efficient the departmental information systems are at recording young people's ethnic origin. This revealed gaps in the current recording system which it will tackle:

• giving all staff instructions to make sure they understand the importance of recording ethnic origin;
• carrying out assessments every three months to work out the changes in the rate of completion for each team and unit; and
• recruiting a Data Quality Manager to improve data recording, including information on ethnic origin.

Using Information Communications Technology (ICT)

Social Services Department

At the moment there is no central client index in use and childcare and community care services have limited access to ICT. These problems, should be overcome when the Council buys an ICT system for the entire social work department. The Council jointly delivers information services in Edinburgh with BT Syntegra, and developments in ICT are jointly managed by the partners. This relationship represents best value for the Council and has become more efficient as a result of the private contractor learning more about social work systems and organisational processes.

Funds will be made available in 2003-2004 to replace social work information systems with modern systems that:

• support information sharing with health, housing, education, and are in line with ISCJIS;
• use the corporate database of property addresses; and
• support their customer relations solutions (call centres, one-stop shops, and on-line access).

Partnerships

The Council has agreed guidelines for sharing information at senior levels for all care groups. They are currently developing a system to use Single Shared Assessments.

Background Profile

Edinburgh is a city of contrasts. It has enjoyed fairly strong economic growth and is a thriving centre of commercial activity with areas of considerable wealth and prosperity. But there are also areas that experience high levels of deprivation and over 15,000 children live in families who depend on Income Support. The rate of reported crime is fairly high, as is the number of people who have drug problems.

In 2001-2002 the Council spent 294 on social work for each person in Edinburgh, more than the Scottish average of 267.

Expected population change

Community Care

Spending on community care has increased significantly in the period 1999-2002.

Children and Young People

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

Criminal Justice

Human Resources

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