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Short Reviews of Social Work Services in Scottish Local Authorities

Fife Council

Overview

Increased funding and expanding staff numbers and vacancies reflect the growing size and complexity of managing the delivery of social work services. Because of these factors, Fife has had to invest in new information technology and human resources systems to manage the growing 'business'. Fife has experienced a number of high-profile, difficult cases which have affected staff morale. However, it is now time to look to the future and take forward those areas like learning disabilities which have failed to develop recently.

Fife's achievements include:

• continually improving services to older people;
• recent increasing the number of intensive home care packages;
• increasing the number of people taking up Direct Payments;
• testing out projects in mental health and offending;
• successfully introducing Free Personal Care; and
• dramatically reducing offending (through the youth drugs team). Fife needs to give urgent priority to:
• monitoring and improving the educational attainment of all looked after children;
• improving performance in providing reports to children's hearings, particularly meeting the targets set;
• making sure that all care plans for children and young people who are looked after include plans for their future education and that their progress is regularly monitored; and
• agreeing with the NHS a financial framework to make sure it can meet the 2005 target for resettling people from hospital into the community.

The Council should also give priority to:

• agreeing with the NHS and other partners a plan to put the Mental Health Act into practice;
• taking forward the Joint Future agenda;
• recruiting more foster carers;
• finding ways to reduce as much as possible emergency placements of looked after children; and
• speeding up the pace of its joint working arrangements with health.

Community Care

Services for older people

Overall, more older people (15,811 compared with 14,673) received a community care service. The number of people receiving a home care service dropped from 5,486 to 4,804, but the figures are still relatively high compared with the rest of Scotland. Since 2000, the numbers receiving 20 hours or more a week of home care have increased significantly from 72 to 96. This, combined with an increase in the number of people receiving a service, reflects a continual improvement in the services offered to older people.

Three teams provide an integrated rapid response service, with all team members having access to each other's resources. The teams draw on enhanced home care provided in evenings and at weekends. The home care response team has been increased to 18 staff and works closely with community nurses out of hours to prevent hospital admissions. The shopping and household maintenance service is well developed and is used by nearly 2,000 people. Intensive home packages are now available to 67 more people, with 112 served in total. The Council is reviewing short breaks for older people.

The Council successfully introduced Free Personal Care with the support of a team which came together for this purpose. A local information campaign was set up and letters sent to every service user. Despite providing plenty of information and setting up a free contact number and website, not many more people took up home care, largely because home care charges in Fife had been kept low. However, an additional 550 people who had not previously used the service became eligible and received an assessment.

As part of the Joint Future agenda, a Single Shared Assessment has been agreed for all community care groups and its introduction will be fully completed by the end of November 2003.

Services for people with learning disabilities

It is proving difficult to agree a financial framework to complete the resettlement into the community of the patients in Lynbank by the 2005 deadline. The Council argues that there are not enough funds for the resettlement needs of the 46 remaining hospital patients who have very high care needs. The NHS is looking at developing three teams and also developing forensic inpatient beds, as part of a managed care network. The partners may need to change the favoured service structure on which the closure programme has been based so far.

Of the total number of people who have already been discharged from hospital, some have moved to care homes that provide nursing care in three eight to 10-bed units, two of them within larger homes. Housing support for another five was by services from a combined care team.

Fife has used the Change Fund to help develop a community structure involving a variety of services including short breaks, advocacy and access to leisure activities. Local area co-ordinators will be appointed across child and adult services and will include learning and other disabilities.

Services for people with physical disabilities

Overall, the number of people with a physical disability receiving a community care service has stayed roughly the same (at around 3,000) over the last two years and is still quite high.

Fife is in the forefront of delivering Direct Payments in Scotland, and they have been part of community care services in Fife since 1998. At present, there are 112 people receiving Direct Payments. A support service provides guidance and support to service users and staff, and includes a Payroll service, recruitment advice and assistance, contracts and training.

A system (to be replaced by the SWIFT electronic system by the end of 2004) is in place to monitor waiting times for assessments, but not provision or demonstration. The latter is recorded on individual case notes. There is a joint store for storing, buying, distribution and uplifting equipment but no joint resourcing of it. Decisions about stock are made in a joint forum. Both NHS occupational therapists and assistants seconded into health services and involved in supporting people leaving hospital can get access to equipment.

Occupational therapists funded by housing services, but recruited and managed by social work, are based in a local network to assess the needs of people with disabilities to make sure they have suitable housing. An equipment and adaptations group works under the Joint Future agenda.

People with sensory impairment

There are estimated to be 140 people in Fife who are deaf and blind, of which 60 receive a service. The number of people wanting an interpreting service is increasing fast and it is impossible to keep up with the demand (1082 assignments in 2002). A Fife Sensory Impairment Steering Group provides a forum for service providers and representatives from user groups to consult together.

A Sensory Impairment Centre provides a base for all the organisations dealing with people with sensory impairment. The centre provides an assessment and rehab service for people with a visual impairment through Fife Society for the Blind. The RNIB provides an assessment service there for people with sensory impairment and learning disability. Social Work Service has contracts with both these organisations for providing the services.

Social Work directly manages the Deaf Communications Service, which provides an interpreting service, runs groups for hard-of-hearing service users, and teaches British Sign Language to interested professionals, volunteers and hearing relatives of deaf service users. It is difficult to recruit interpreters for the service, which means that the Council cannot always meet the increasing demands being made on the service.

Healthy Living Project in Sensory Impairment aims to raise awareness of sensory impairment issues among health service staff. This is in response to recent local research which showed that many deaf service users do not seek help for health issues because of the communication issues they meet.

Services for people with mental health difficulties

The number of people receiving a service has increased gradually since 2000. Spending on mental health increased in 2001-2002 so that 22 long-term patients could leave hospital so that the Council could provide extra funding for Mental Health Officers (MHOs). At the moment, 70% of the assets in mental health locally is tied up in hospital provision.

An executive board has overall responsibility for developing the strategy to put the new Mental Health Act into practice. There is a joint commissioning agreement and MISG is now subject to joint decision-making. Local mental health teams have been established but it is a problem to base them together.

There is concern that there are not enough resources to help put the new Act into practice, both in terms of workforce needs and service availability. The Council needs to plan for meeting the new statutory demands on service provision jointly with health partners and other interested parties. Plans are said to be in hand to move this forward.

Six locality mental health teams are supporting joint working, with their boundaries largely the same as the Local Health Care Co-operative areas. The care programme approach includes mentally disordered offenders. A RAMAS assessment process is in place and has been used for offenders with mental disorder. After a multi-disciplinary, multi-agency needs assessment of services for Mentally Disordered Offenders between January 2001 and July 2002, some action has been taken to tackle identified problems. In a pilot project, an MHO has been placed within the police to offer a dedicated response to mentally disordered detainees. Fife also has a court-based MHO. The evaluation of these innovative services will be of interest to services across the country.

The CPA has been extended with extra posts and training. It is now used for people with learning disability as well as those with mental illness.

Tackling substance misuse

The number of people receiving a service for substance misuse increased significantly from 145 in 2000 to 181 in 2002.

To meet this growing demand, drug services have expanded with a new lead clinician, a new rehab service, a large increase in services to courts, and introducing DTTO and diversionary schemes. There is also a new post of social work integration manager for drugs and alcohol. There is no community substance misuse team, but a multi-disciplinary joint court team is located in criminal justice services and a youth drug team is part of children and families services.

For residential rehabilitation, a standard protocol has been introduced, and all referrals must go through the lead clinician. Community detoxification is being developed, backed by detoxification hospital beds. While a multi-disciplinary protocol is being launched for support to families who misuse substances, issues about sharing information have to be resolved, and Fife still has work to do with its partners to develop a comprehensive response for families who misuse substances.

While the substance misuse service has improved significantly, Fife is looking to develop and re-organise the service.

Joining up community care services with health

Progress in improved joint resourcing and management arrangements are outlined in the LPA for Joint Future and 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 progressing. The local partners were recommended to:

• develop more fully the service composition of LMUs and the joint management arrangements;
• develop a service/clinical governance framework to make explicit the arrangements that will apply to joint services
• develop and publish a scheme of delegation which explains how and by whom decisions will be taken, beginning with the Joint Strategy and Resources Group to LMU's and to front-line joint services.
• develop a joint OD/training plan
• agree draft financial management arrangements and protocols
• agree a statement of a total service strategic financial envelope for older people's services and 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.
• prioritise training within agreed timescales to ensure that key staff can begin implementation of SSA by target dates. We note the scale of the training programme that will be needed for such a large number of staff (based on 51% return figures).

A management plan has been agreed to move towards these outcomes. The governance and accountability arrangements development to support joint resourcing and joint management arrangements consist of six Local Management Units, a Joint Senior Management Group and a Joint Strategy and Resources Group. This arrangement is being developed with strong representation from the voluntary sector as well as users and carers.

On the ground, the local partnership agreement focuses on older people's services. There is a joint strategy group for older people which is trying to join up planning, service development and joint governance. There are six local management units (using SSA) involving users and carers. Local staff are managed separately but work jointly. There is limited progress in setting up joint teams under a single manager. Instead, there are twin managers throughout the system, with budget holders in each area meeting to plan spending over aligned budgets. There is a formal joint commissioning of mental health services.

Progress in sharing information is hampered by partners' systems not being compatible. An SSA call centre was set up because of this problem. A senior group is devising solutions for the longer term.

Working with Carers

Under a Carers Strategy, provision is being made for more respite care for young children with complex needs, for voluntary sector groups to provide day services and for increased flexible home-based respite care. Carers' assessments have been in place since 1995, but information is not available on how many assessments are completed.

Local partners will have to do a lot of work to put the Joint Future agenda into practice, in view of the limited progress made so far.

Children and Young People

Looked after children

The number of looked after children is low, but has increased since 2000. This is due to an increase in child protection cases (particularly where there are drugs or alcohol problems). Demand for foster placements has risen (the number of children in foster placements increased from 164 in 2000 to 199 in 2002). The Council is finding it much harder to rehabilitate children who come from situations where alcohol and drugs are key factors in their admission, and they are therefore staying much longer in foster care. This is adding to the pressure on the Council's resources.

Partly because of these issues, the number of crisis admissions to placements outwith Fife has increased, including admissions to residential schools which increased from 15 in 2000 to 35 in 2002. The Council reported no further increase in this number in 2003, to date. Placements in Fife's own residential houses have remained very stable, and a further house is due to open in 2004.

Some young people excluded from residential schools ended up in emergency care, which is very expensive as well as being unsatisfactory - they also comprise many of the one third of Looked After Children who had more than 3 placements in 2002.

Fostering and adoption

Between 12 and 15 children are waiting for a foster placement, and most have been waiting under a year. The Council is recruiting more carers than it is losing each year, but it faces increased competition from private organisations and local employers. The current target is 10 extra carers; and an extra 12 are in course of approval.

About a third of carers have more children than they were approved to take. The Council has introduced a payment for skills scheme and allowances and fees have been increased significantly. Recruitment campaigns are targeting carers who can look after young people with challenging behaviour. Carers have access to all children and family training (including child protection training) and a number of carers have gained an SVQ. The Council also pays foster carers' extended families to provide respite, which means that children do not have to go to strangers.

39 children are waiting for permanent placements. Following a crisis in adoption and fostering in 2002, children are now getting permanent places more effectively and 19 children have been placed in the last 12 months. 19 children are placed with prospective adoptive parents. There are not enough adoptive parents for children with disabilities or for groups of brothers and sisters.

Educational attainment

38% of 16 and 17 year olds who had stopped being looked after had attained Maths and English standard grade in 2001-02. This is considerably lower than the 100% target set by the Scottish Executive in 1999 and the 94% attained by the full S4 cohort in the authority. However, figures on educational attainment cover only accommodated children, not those at home. The Council must take steps to monitor the educational attainment of all looked after children, not just those accommodated.

In order to improve the educational attainment of children and young people looked after, the Council is providing:

• a 'Supporter' for children and young people who are looked after in every mainstream secondary school by the end of 2003;
• the Behaviour Support service to help young people with extra social, emotional and behaviour support needs;
• lessons in music and drama; and
• a self-assessment tool (audit) for residential houses to carry out every 6 months (information is monitored against 12 performance indicators).

In addition, a joint social work and education service group is looking at the collection of information on looked after children in schools, and will pilot a new system in three secondary schools. A second joint group is looking at promoting inclusion for looked after children in education services in Fife and identifying areas for joint training.

A 'resource monitoring group' looks at the quality of education looked after children receive outside the authority. It has removed children from a particular school where the quality of teaching seemed to be poor.

If children and young people who are looked after have additional support needs, they have an individual education plan (IEP). Any child attending one of the education centres will have an IEP. All accommodated children have a care plan which is audited. The recent audit showed that a future education plan was missing from some care plans, and the Council will deal with this. Reviewing officers regularly review all children and young people who are looked after.

Information

The Council did not know the ethnic origin of a quarter of looked after children and young people in 2002. The 1991 census categories do not match the categories on their database.

Throughcare and aftercare

A 'throughcare team' of one team manager, four social workers and two home carers provides housing support for care leavers who have their own tenancy.

The Council is planning to introduce a throughcare information system in 2004. At present, information is collected on where children go, their accommodation, occupation, vulnerability and age. Of 13 young people who had left in the last six months 8 were unemployed, five were on college courses or still at school.

For accommodation, there are 16 supported landladies and landlords, hostel provision and supported tenancies. The Housing Services Procurement Group looks at how many tenancies are needed for vulnerable groups, and young people no longer looked after are part of their responsibility. The Council has developed an integrated housing and social work assessment process, currently under consultation.

The 'Link Up Fife' project helps to find jobs for young people leaving care, homeless young people and youth justice clients aged 16 to 21. An evaluation showed positive outcomes for half of the clients in work, training or further education.

Mental health

Mental health issues are picked up at care reviews. Children can be referred to a clinical psychologist or to the child and adolescent mental health service, but both services have a 12 to 18 month waiting list and children and young people who are looked after frequently wait a year. There are only four whole time equivalent staff in clinical psychology for the whole of Fife.

Other services include:

• consultancy from child psychiatrists in residential units but only irregularly for foster carers;
• art therapy (this is sometimes commissioned);
• a clinical psychologist, seconded to the Youth justice team;
• the Children's Support Service's work with sexually aggressive young people;
• a service developed with Penumbra for 16 to 21 year old disturbed young people in the community and 14 to 16 year olds who are accommodated; and
• a supportive crisis service funded for two years, providing drop-in services, self-help groups, groupwork, one-to-one support and awareness-raising initiatives.

Mental health services are clearly patchy. However, the Council is trying to find ways to make best use of the limited number of psychiatrists with day-to-day psychological support to young people and their carers. The Penumbra project has the potential to provide valuable support to young people with mental health problems.

Child protection

The number of children referred for child protection is close to the national average. The Council acknowledges that the registration statistics are inaccurate. There were 152 registrations in 2002.

Child protection initiatives include:

• a midwife project where new mothers who misuse drugs go into community detox programmes;
• adapting a Department of Health framework to produce a multi-agency assessment of risk and need; and
• a regular audit of child protection case files.

Children with disabilities

225 children (including brothers and sisters affected by disability) receive a service from the disability team which covers all assessments and all child care work for children with disabilities. It is involved in all future needs assessments.

150 children are receiving respite care and 56 are on the waiting list. Some have been on the list for a long time because respite care is provided according to immediate need. Some respite care is provided through home care. A private provider gives respite care to 10 children in their own home. Out-of-school and holiday care is being improved throughout Fife.

The Council works with about 100 out of 700 young carers in a Young Carers project. The young carers can choose who they want to carry out the assessment of their needs - (for example, a teacher or school nurse). The Council has produced guidelines for people working with young carers. It has funded respite holidays to give them a break.

Working of children's hearings

All referrals were made within five working days of the case conference (standard 2) in 2001-2002.

24% of reports met standard 3 (all reports submitted within 20 working days of the date of request). This low performance is due to reporters sending requests in batches, a 33% increase in the number of requests and staff shortages. Most reports are completed in 28 days but some are very late. The Council is employing extra sessional staff to help with report writing.

All supervision requirements with no condition of residence are given effect within 15 working days of issue by the children's hearing (standard 15).

Youth justice

The youth justice team is made up of social workers, social work assistants and community education. It uses the YLS/CMI assessment tool. A clinical psychologist is to be seconded to the team. All children and family workers, including the disability team, are to receive YLS training and criminal justice staff have already been trained.

Youth justice projects include:

• early intervention and restorative youth justice work through SACRO's mediation and reparation project;
• a reporter diversion programme (this has proved successful - after tracking young people for three to four years, 69% of them have not been referred back to the reporter on offending grounds);
• SACRO's personal change programme for persistent offending;
• Youth 1st Bridging the Gap group work programmes (early intervention programmes for first or very early offenders);
• the Equip groupwork programme and 'Offending is Not the Only Choice' individual programme; and
• anger management for young people whose offences are solely related to anger control.

The youth drugs team, made up of police, social workers and community education staff, deliver group and individual support programmes to 14 to 16 year olds. Most referrals are from schools.

Criminal Justice

Structure

Fife is not in a criminal justice grouping with any other authority. Whilst this has provided considerable stability for service development there have been a number of staff changes recently, particularly at management level, which has caused disruption and the aim is now to work to maintain the current position. Because the service is Fife wide they will deploy staff across the authority to meet service needs.

Workload

Demand for core services has increased, with social enquiry reports rising by 19%, probation orders by 15%, and community service orders by 16%. This has placed pressures on staff with a corresponding decrease in attainment of some areas of performance during the past year. The authority intends to take action in the coming year to improve this.

Effective practice

The authority uses the Scottish Executive's risk assessment framework to assess the risk and needs presented by offenders. The risk of re-offending assessment tool - LSI-R - is used for young offenders and alternative to custody programmes are delivered for 16-20 year olds as a condition of probation. The authority does not currently offer structured groupwork or 1-1 programmes for other adult offenders apart from a well established sex offenders programme. However, there are some developments taking place with plans for a probation induction group and consideration of delivering the Constructs programme. They also deliver a short programme aimed at road traffic offenders, in partnership with other services such as Police. There is acknowledgement that the focus has been on developing specialist projects at the expense of routine service provision and the intention is to refocus on core elements of service delivery.

There has been significant development in relation to drug misusing offenders through the piloting of a drug court in Fife. In the first 6 months 66 orders were issued. The evaluation of the first 6 months will be published shortly. Future developments include establishment of a dedicated throughcare team and a review of community service orders is under way.

Public protection

Sex offenders are assessed using the specialist Matrix 2000 and Tayprep 30 tools. Assessments are conducted jointly with Fife constabulary and a case conference held on a monthly basis to agree risk gradings and management plans. Existing protocols and practice in relation to other high risk offenders will be reviewed at the end of 2003. The authority's Community Protection team delivers groupwork programmes to sex offenders, including a group to those with learning difficulties. The authority has lead role in piloting the Community Sex Offender Groupwork Programme, developed and accredited in England and Wales, across a number of authorities in preparation for accreditation. The service also aims to deliver a programme to perpetrators of domestic violence in the next year.

A multi-agency protocol has been developed in relation to services for mentally disordered offenders and mental health officers have been appointed to court services and an out of hours service within Fife constabulary. For homeless high risk offenders who require accommodation that balances supervision, support and monitoring, SACRO, Housing and criminal justice services have developed a supported tenancy service.

Quality assurance

The service is working towards having detailed service manuals for each element of service delivery. Fife Council has adopted EFQM as the model for assessing services against best organisational practice. Criminal justice services will undergo a full assessment in 2004.

Human Resource

Structure of the workforce

Between 2000 and 2002, there was a large increase in the number of whole time equivalent staff and in vacancies across all social work services.

The latest figures provided by the Council but not yet confirmed suggest that, at the end of June 2003, the social worker establishment (whole time equivalent including vacancies) was 277 compared with 267 in October 2002 and the number of social work vacancies was 34 compared with 48 in October 2002.

Staff numbers have risen significantly between 2001 and 2002. New funding has helped the Council to recruit extra staff, including assistant social workers, but vacancy rates have also increased significantly.

Pressures are being felt in:

• recruiting staff for children's services and community care staff for West Fife;
• recruiting home care staff in face of competition with other employers; and
• areas such as community care where experienced staff have been seconded out to new initiatives.

The absence rate in social service is 5.2% (8.4% including long-term absences). The absence rate tends to be higher within residential and day care. A new absence management approach focuses on giving managers practical guidance for managers. This approach should show an improvement in a year's time. Improved technology will also allow better recording of absences.

Support for staff

Following an assessment that showed the need for better staff feedback, the Council is working on initiatives which include:

• a staff survey;
• a pilot occupational health service;
• more staff involvement in developing policy; and
• a new supervision policy.

These are very positive moves, but it is too early to assess their effect. High profile investigations have caused considerable stress and problems with staff morale, particularly in community care.

Violence and aggression from clients, particularly people affected by drug abuse, is a growing problem and the Council is providing extra training in this area and developing a new support service for lone staff. It is also considering ways to improve its family-friendly policies.

Working towards a more highly qualified workforce

The Council's only formal human resources development plan, 'People Making a Difference', was produced in 1998. While strategy groups are currently developing training plans, copies are not yet available.

At the moment, the priority is to get staff through SVQs, and over 200 staff are currently involved. Also, 190 staff have done level 3 of 'Promoting independence' and over 100 people working in home care have gained the professional certificate.

For post-qualification (PQ) training, there is no formal commitment to the number of days training for staff, but the Council must provide PQ1 training within one year, including payment of registration fees.

Fife is also introducing a trainee scheme through the Open University. With 52 practice teachers, it is not difficult to provide enough placements. The Council is also working on a one-stop shop on the Intranet for opportunities for training and resources for social work staff. The system, named ELSIE, is a new resource for social work professionals.

A leadership development programme is targeted at first, second and third tier managers. A Fife-wide 'leading and learning' programme accredited by St Andrew's University provides joint training. Staff mentor partners from other organisations, leading to improved understanding of partners' planning processes and procedures.

Preparing for registration

Fife is aware it needs to increase its workplace assessment to increase the numbers achieving SVQs and is appointing a registration service manager to ensure they meet registration demand. Ensuring they retain qualified staff is also critical to this process.

Race Equality

1.3% of the local population are from a minority ethnic group compared with 2% for Scotland as a whole.

A Race Equality Action Plan was prepared by the department for 2002-2003. There is a joint strategy group with health, joint awareness training with staff, and the Council is making links with local representative groups.

The Council is giving key staff a practical 'tool kit', which includes:

• information around responsibilities
• a form for monitoring racial incidents;
• a Race Equality Action Plan; and
• information on the minority ethnic groups in Fife.

The Council has provided training for some staff.

Overall, the Council has taken a more pro-active approach to this area than most councils. It now needs to make sure it monitors the effect of its work.

Use of Information Communications Technology (ICT)

Social Services Department

At present, the department's system is not serving adequately the Council's business information needs. However, a new system should be fully operational in 2-3 years. A new IT post within the department, held by a social worker, seems to have given new momentum to IT development. The new Anite system should provide a comprehensive management information system and on-line recording. To achieve this staff are being trained to encourage them to use IT rather than paper-based systems.

A number of imaginative projects use IT to support staff and users and are at various stages of planning. The occupational therapy service is piloting a palmtop system which allows users to see information about equipment and adaptations which can be ordered immediately. An occupational therapist is then automatically told once the item is in stock and can arrange a meeting with the user. The Council is also introducing a support service for lone workers involving mobile phones and a central call centre which will take action if the worker does not report in at the agreed time.

Partnerships

The Single Shared Assessment is based at present on a paper-based exchange of information, based on a protocol between social work and health. The development of the new system will open up opportunities for fuller exchange of information with partner agencies. Information sharing is being developed through community planning.

Background Profile

Fife's economy has changed from being based on mining and heavy engineering to a modern economy with a mix of traditional industries, electronics and precision engineering, and a large service sector. The south and west are dominated by large, urban areas and have a mainly industrial economy. Areas in the north and east are mainly agricultural, with tourism being important in the economy in and around the coastal towns and villages.

Fife contains a mix of communities in towns and the countryside, and both poor and wealthy areas.

Spend for every person on social work in 2001-2002 was 235, below the Scottish average of 267.

Expected population change

Community Care

Expenditure on community care dipped between 1999 and 2001 and then increased very significantly in 2001-2002.

Children and Young People

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

Criminal Justice

Human Resources

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