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Short Reviews of Social Work Services in Scottish Local Authorities

Highland Council

Overview

Highland has been very successful in dealing with the practical issues of developing joined-up services for children, older people, people with disabilities and others. It has done so across the biggest land area of any council in the UK - Highland is the size of Wales and has a widely scattered rural population and relatively few large communities outside Inverness. The Council also has to serve a number of island communities. One of the main features of the population is the prospect of a very large increase in the number of older people. The Council has a constant concern to control costs of services across the area while maintaining or improving quality. This concern has been increased by unexpectedly high costs associated with the introduction of Free Personal Care, and these costs are expected to grow.

The Council's achievements include:

• an improved home care service for older people, which should make the service more responsive and release resources for much-needed packages of intensive care for people who need it;
• good progress in putting the Single Shared Assessment into practice;
• meeting all Children's Panel requirements within the 15 day target; and
• good support structures for staff.

Highland Council should give urgent attention to:

• making sure that all young people are receiving full-time education; and
• improving its poor performance in submitting reports to Children's Panels on time (72% of reports are submitted late) and making sure that 75% of reports are submitted on time.

The authority should also give priority to:

• extending rapid response services to help prevent people going into hospital, as well as the current successful programme of helping them come back into the community;
• completing the resettlement of people with learning disabilities from hospital into the community, and developing a database of people with learning disabilities;
• developing with key stakeholders a strategy for sensory impairment services across the whole area;
• introducing written instructions for people using equipment and adaptations;
• with health and other partners, completing a plan for putting the Mental Health Act into practice;
• recruiting and keeping foster carers;
• continuing to develop throughcare and aftercare services; and
• continuing efforts to recruit staff to reduce the current high vacancy rates in adults' and children's services.

Community Care

Services for older people

The number of older people receiving a community care service continued to increase from 4,433 in 1999-2000 to 6,034 in 2001-2002. However, the overall rate of people receiving a service remains low compared with other authorities but is expected to increase further over the next few years as a result of increased demand from the higher than average predicted growth in the numbers of older people in Highland. The number of older people in private nursing homes increased significantly from 781 in 2001 to 1,024 in 2002, while the number receiving home care reduced gradually between 2000 and 2002. There was a significant increase in the number receiving an intensive home care service in 2001, but the overall rate remains lower than in most other authorities.

The Council has devoted resources to increasing the number of intensive care packages, often by buying services rather than due to more users. The Council developed a spreadsheet to manage the complicated parts of the packages. Further development of intensive packages is limited by the restricted funding available for home care since commitments to residential care have increased as a result of Free Personal Care. A strong local marketing campaign by private care home providers attracted increased numbers of residents. As a result, the Council had to make changes in the social work budget, reducing the funding available for other services. The Council is dealing with the problem by freeing up existing resources and using existing staff elsewhere to provide more intensive care at home. Following a review of the Meals at Home service, the Council is moving towards using frozen meals, which should increase the time home care staff have for other tasks and allow more home care staff to help develop intensive home care packages. An agreement with WRVS provides for clients to be visited and contacted, to make up for the loss of contact in the Meals at Home service. Short-break services have been restricted due to funding problems.

Apart from the issue of increased residential costs, the publicity and launch of Free Personal Care was effective. The Council introduced the processes smoothly and the system is operating well. The level of funding needed is expected to grow over time.

The rapid response service arrangements vary across Highland. In Inverness and the Moray Firth, a service has been linked to both 'step-up and step-down' for patients needing acute hospital services. So far, the rapid response service has focused on people leaving hospital, to meet discharge targets (which were only slightly missed). Preventing people having to go into hospital is being tackled in 2003. Rapid response services are being developed in Lochaber, Sutherland and Caithness.

A Handy Person Scheme, including helping with gardens and keeping smoke alarms safe, is running in most areas. The generic community care services in each locality provide a shopping service. The level of service is greater in Inverness and the Moray Firth due to the population and access to facilities. In more rural areas, the service is not so practical due to higher expenses, more travelling and fewer staff.

Services for people with learning disabilities

The number of people receiving a service for learning disabilities increased from 520 in 1999-2000 to 792 in 2001-2002.

Highland plans to introduce a further phase of resettlement from hospital for implementation by 2005 when some people will go to individual tenancies and the others will share with no more than one other person. This is good practice (based on evidence) where the Council has learned from previous resettlement programmes. However, progress is dependent on funding being available through Supporting People.

Local services include:

• two integrated Community Learning Disability Teams;
• a supported employment strategy that has helped many people with work opportunities; and
• a 'Health and Happiness Project' for healthy life styles, with plans that focus on people's individual high support needs.

NHS Highland will provide eight assessment and treatment beds.

Services for people with physical disabilities

The number of people receiving a service for physical disabilities increased gradually between 2000 and 2002 but the rate has stayed low compared with other authorities.

Direct Payments are in operation for a number of people and will be available for children. Direct Payments Scotland is working with local carer groups to help introduce the scheme. Local information leaflets will be issued in line with national guidance.

Improvements are being made to equipment and adaptation services and the waiting list is going down, with regular monitoring. Certain equipment can be issued more quickly with occupational therapy assistants and other staff through Single Shared Assessment, and also through self-assessment. Giving occupational therapists and occupational therapy managers the job of authorising funding also helps in this.

People with sensory impairment

A planing group has been in existence since 1995, focusing on the needs of those with hearing loss. A multi-agency, multi-disciplinary working group set up in 2002 is developing a single strategy for sensory impairment and is scheduled for completion in December 2003. Services are currently by a team for blind services and the Council buys these services from the Society for the Blind and its centre in Inverness. They cover over 200 adults and a similar number of hearing impaired children.

Services for people with mental health difficulties

The number of people receiving a service for mental health problems increased gradually between 2000 and 2002.

Plans for putting the new Mental Health Act into practice are at an early stage. There have been problems with emergency responses in rural areas, although there are clinics outwith Inverness. Basing consultants within teams has been a problem due to a persistently high number of vacancies.

Tackling substance misuse

The number of known drug users is seriously under-reported. Local services for substance misuse include:

• 'dual diagnosis' workers within Community Mental Health Teams;
• a nursing service for substance misuse and a nurse specialist for under 16s;
• a needle exchange;
• a methadone programme;
• a 'consume on premises' programme (many rural chemists do not want to be involved);
• residential rehabilitation; and
• a prison addiction team.

Other services are developing, for example, links with GPs, local needle exchanges and outreach posts in Caithness and Ross-shire.

Following a study which showed that substance misuse issues affect 10% of children, the Council is devoting new resources to services for young people and children and families, involving a number of partners (for example, Highland Youth Action Service, SACRO, the Youth Offending Service), and over 40 designated workers in a variety of posts. The Youth Action Service has a joint assessment tool and YAS and the Criminal Justice Service have joint procedures. There are recording procedures for young carers where there are substance misuse issues.

108 staff have had STRADA training and the Council has commissioned STRADA to develop training specifically for Highland. Occupational standards are to be issued to make sure the right people get the right training.

There are links with Criminal Justice and 500 people have been dealt with by the arrest referral scheme.

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:

• develop further clarity around the nature of joint services at the frontline and how these services will be operated and jointly managed;
• demonstrate the joint management arrangements at all levels and how each level relates to each other. In particular what the joint management arrangements will be between the senior officer group and the proposed teams which will be led by single managers;
• review the function and level of delegation to the Joint Community Care Committee for Action as a priority;
• consider area management and how locality teams link to this and upwards in governance terms;
• develop a service/clinical governance policy to enable joint teams to operate effectively;
• take forward the action plan to further develop their joint resourcing financial framework; and
• progress plans for direct access to services, based on eligibility criteria and a joint protocol for access.

Working with Carers

The Princess Royal Trust for Carers Centre and carers' groups have developed a carer's support plan that is used for assessing carers. If the Single Shared Assessment identifies that there is a carer, they will be offered a carer's support plan, which is reviewed at set periods. The Council does not know how many assessments there are currently, but a new system will record the number of carer's support plans offered and accepted.

Most of the resources for the Carers' Strategy has gone to advocacy and respite breaks. Crossroads funding has gone from 180,000 to 600,000 and eight schemes provide support to carers. 25% of the new resources has gone into children's short breaks and support for young carers. Highland is one of four pilot areas for the Joint Future for Carers initiative to help them to be involved in the planning and the delivery of services.

Children and Young People

Looked after children

Official statistics show that the number of children and young people who are looked after reduced significantly from 623 in 1999 to 391 in 2000. However, the Council believes that statistics were not accurate before 2000 and the number has not reduced. The number of children in residential accommodation increased slightly between 2000 and 2002 but the number has reduced since December 2002. Although there can be substantial variations in numbers throughout the year, official figures suggest that the number of children in residential schools increased from 27 in 2000 to 33 in 2001; this increase is probably due to a number of factors, currently being investigated by senior managers in the Council.

Fostering and adoption

At the moment, 11 children are waiting for a foster placement. They are a wide range of ages and some have been waiting a long time. Groups of brothers and sisters are particularly difficult to place. The Council has not been successful in increasing the number of foster carers because many older carers have now retired. Carers are currently being consulted on how to modernise the fostering service to meet need in Highland.

There are two fee-based schemes. Carers are paid at the rates recommended by COSLA.

No children are waiting for adoption. The Council matched eight children in 2002-2003. The average time for adoption is 15 months.

Educational attainment

In Highland, 71% of 16 to 17 year olds who stopped being looked after in 2001-2002 attained Maths and English standard grade. This is the second highest rate in Scotland but there is still room for improvement as performance still falls below the 100% target set by the Scottish Executive in 1999 and is less than the 96% for the full S4 cohort in the authority achieving these standard grades. Initiatives to improve the educational attainment of children and young people who are looked after include:

• a training programme on education for residential staff;
• the link worker working with the residential units and using tutors to support children and young people who are looked after, where necessary;
• personal education plans for all children and young people who are looked after;
• vocational training and intensive support, including work around life and social skills and emotional development;
• an improved educational environment in residential accommodation;
• use of the Successmaker programme in a number of Highland schools. In Wick High School this being run in collaboration with the Children's Unit;
• 30 pupil support bases and more than 30 children's services posts in New Community schools; and
• support for young people into further and higher education.

96% of children and young people who are looked after and accommodated are in full-time education compared with just under 90% of those looked after at home.

Throughcare and aftercare

A database of information shows that 63 young people stopped being looked after during the year to 31st March 2003. Their last placement is recorded but there is no information available on their current accommodation or employment position.

A throughcare and aftercare service "Springboard" was launched in March 2003. In partnership with Barnardo's, the team - comprising a service manager and 4 project workers - have to date responded to over 70 referrals.

The key worker system in the Careers Service gives extra help to the most vulnerable, especially those with educational difficulties.

The range of accommodation is not wide but young people stay longer in residential and foster care than in many other areas. The Council is developing accommodation through:

• the homelessness strategy which mentions care leavers as a priority group;
• a centre in Inverness for young people who are homeless;
• new accommodation for vulnerable young people (replacing Coulpark Children's Centre); and
• Supporting People projects which support new tenants in three areas.

Mental health

Initiatives to identify and meet the mental health needs of children and young people who are looked after are:

• a dedicated 'health of looked after children' (LAC) post, which is partly a nursing post;
• a network of locally based Primary Mental Health workers, supported from Department of Child and Adolescent Psychiatry;
• a consultant psychiatrist who supports the staff group;
• mental health workers in each of the local teams;
• a pilot counselling service run by primary mental health workers;
• a voluntary group for bereavement counselling; and
• Scottish Institute of Residential Child Care (SIRCC) and STRADA training for residential staff.

An NHS Highland audit of mental health (which included vulnerable children and children of primary school age who are looked after) identified high numbers with mental health problems.

Child protection

The referral rate is high and the number of referrals increased in 2002. The registration rate is also high but the number of registrations has reduced since 2000.

Following the recommendations of the Child Protection Review, the Council has taken action to:

• audit 75 cases following a high number of referrals for emotional abuse;
• review social work and other agencies' guidance;
• review two cases by the Child Protection Committee;
• set up a working group on public information (a website is being developed and leaflets on case conferences have been produced);
• provide information to school staff and develop procedures for the voluntary sector; and
• provide all social workers with multi-agency training.

Highland have created 5 senior practitioner posts and a specific policy officer for Child Protection.

Children with disabilities

At the moment, 300 children with disability receive a service. Local young carers' projects support between 70 and 80 young people. Family support workers in the youth action team support young people whose parents misuse alcohol and drugs.

Increasing the amount of respite care is a local target. The number of children receiving respite care has gone up but the amount of respite care has gone down. Despite the introduction of a fee-based respite scheme, it has been difficult to recruit carers and increase access to respite. The Carers scheme is currently being reviewed to see how recruitment can be increased.

• 124 children receive residential respite;
• 136 receive other respite; and
• 21 children are receiving respite care at home.

The amount of respite at home is increasing but the amount of residential respite has reduced. There are no longer any children in hospital - residential units now cover this need. The number of children receiving other respite (overnight family-based care) has gone down because of a shortage of carers. A number of children are waiting for family-based respite.

A residential respite unit on Skye is currently being considered.

Working of children's hearings

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

Only 28% of reports met standard 3 in 2001-2002 (all reports to be submitted within 20 working days of the date of request). The figure is now 29%. Differences in performance between offices are due to flows of reports coming in and to staff vacancies in the Children and Families teams.

All supervision requirements met standard 15 (the local authority to give effect to supervision requirements with no condition of residence within 15 working days of date of issue by the children's hearing).

Youth Justice

Highland is tackling youth crime by creating a multi-agency youth action service. The service is led by social work and involves other local government services as, well as the prison service and a range of voluntary agencies including NCH, SACRO, Barnardos and Apex. A formal partnership was launched earlier in the year.

There are four youth action teams based in the main areas of population. Each team has a co-ordinator and dedicated worker for youth crime and substance misuse. The approach adopted aims to provide preventive services for people on the brink of crime and also more intensive services for those who become more criminally involved. Local partner agencies act as 'satellites', supporting the teams. Each area has a youth offender forum, on which all the main agencies with an interest are represented. One task of the forum is to identify young persistent offenders and to put together supervision and support packages before a children's hearing takes place, with the aim of preventing a residential placement wherever possible. Examples of the type of service available include:

• one-to-one mentoring by NCH staff for young people aged 12 to 17 who have developed (or are at risk of developing) a substance misuse problem;
• a reparation and mediation service for nine to 17 year olds provided by SACRO; and
• intensive supervision and support provided by NCH.

The main programme for young offenders is based on the 'Time to Grow' materials. As well as doing this programme, high-risk offenders also do the NCH intensive supervision scheme. Asset scores decide whether a young person goes to youth action or to youth action and NCH. Barnardo's Highland Link Project provides a service to young people whose behaviour is sexually aggressive.

The Council has carried out some audit work and more is planned. The type of service is well thought through but it is complicated. It is at an early stage of development and the Council will need to look at strict monitoring and evaluation if it is to work as it should.

Criminal Justice

Structure

Aberdeen, Aberdeenshire, Moray and Highland operate as a partnership for delivery of criminal justice social work services. Management of services across the grouping is overseen by a Joint Committee, supported by a Joint Officer's group. Operational managers, who meet regularly, have responsibility for all aspects of service delivery and individual lead role responsibility for developing particular aspects of policy and practice. The grouping also operates within the wider umbrella of community planning which includes representation from Police, Procurators Fiscal, Sheriffs, NHS as well as the island authorities.

The partnership has benefited from funding as one of the Scottish Executive's "Pathfinder Initiative" areas. This aided authorities to merge as a partnership, delivered high quality training, and contributed towards a learning culture among staff.

Workload

Over the past year, there has been a small increase (4%) in demand for core services across the partnership as a whole, though some constituent authorities have experienced significant rises. Aberdeen has seen an 18% increase in social enquiry reports and a 21% rise in probation orders, while Highland's probation orders have grown by 43% and community service orders by 17%. Despite workload increases, performance has generally remained high although there are evidently areas of pressure. Moray has seen an improvement to 100% of SERs submitted on time during 2003 (data as yet unpublished). However, reduction in staff in some areas coupled with increase both in volume and complexity of the workload has had an impact.

Effective practice

The Scottish Executive risk assessment framework is in use across the partnership. Other available risk assessment tools have been reviewed and the partnership is keen to see agreement to a national approach to this. Further initiatives include involvement in the development of the structured offence-focused programme, Constructs, for the accreditation panel. Aberdeen has also updated its pack for use in work with substance misusers and this will be introduced across the partnership. In addition, the partnership has successfully submitted a bid in partnership with Tayside for funding to develop to accreditation standard a programme for women offenders. In support of these developments, training in case management and cognitive behavioural interventions has been delivered to social workers.

Reflecting the particular needs of female offenders, the partnership has also developed individually tailored packages for those subject to Community service or supervised attendance orders. Pro-social modelling training has been delivered to Community Service staff across the partnership.

Services to young offenders have been developed individually in each council area reflecting the Joint Committee's emphasis on the need for inter-agency working and cross cutting council services. In Aberdeenshire, young offenders, women offenders and those with mental health problems will be targeted as part of a social inclusion pilot.

The Drug Treatment and Testing order scheme has just completed its first operational year and is now well established. Although there has been a substantial uptake, numbers appear to have reached a plateau and this may reflect recent staff vacancies.

Work in respect of domestic abuse has been funded by two authorities with the intention of this being rolled out across the partnerships.

Public protection

Services to sex offenders are provided through the partnership's joint sex offender project. The Scottish Executive's risk assessment framework is now used across the council areas and, in addition, project staff and those at the social work unit at Peterhead have undergone training with Northern and Grampian Police respectively in use of the tool Tayprep 30. A bid has been submitted to the Executive, in collaboration with Tayside and Dumfries & Galloway, to have the Joint Sex Offender Project programme prepared for accreditation.

Quality assurance

Development of monitoring and evaluation measures continues. The partnership reviewed the suitability of the quality assurance system as part of the Pathfinder initiative and submitted subsequent findings to the Scottish Executive. The partnership has continued the development of quality assurance systems e.g. SERs through the work of a Pathfinder Practice Development Group.

Human Resource

Structure of the workforce

Between 2000 and 2002, the number of whole time equivalent fieldwork staff rose substantially across services for adults, children and offenders but fell for generic workers (because of restructuring into more specialist services). The number of vacancies for whole time equivalent fieldwork staff also rose substantially across services for adults, children and offenders but fell for generic workers.

In the same period, the number of whole time equivalent social workers rose substantially in services for adults and children but remained the same in services for offenders and reduced substantially in generic services. The number of vacancies for whole time equivalent social workers also rose substantially in services for adults and children but remained the same in services for offenders and reduced substantially in generic services.

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 160.3 compared with 125 in October 2002 and that the number of social work vacancies was 40.5 compared with 36 in October 2003.

Information provided during the annual review visit suggested that the census for 2000 (which showed a reduction in frontline staff) was not a helpful comparison because of changes in categories and classifications. Instead, the Council said that:

• the total number of whole time equivalent staff in 2001 was 1,432 and 1,548 in 2002 (an 8% increase);
• the largest increases have been in day care and care services at home; and
• the most significant increase was within Strategic and Central Services (a 31% increase) due to the restructuring of the Directorate for Social Work Services.

The Council confirmed that most of the vacancies for qualified social work were in children and families services (21 in 2002) and that some area teams were particularly badly affected. The Inverness, Culloden and Alness teams, for example, had a 50% vacancy rate in the previous year and special measures were put in place to support staff. In other parts of the authority, rural and seasonal working led to difficulties in recruiting, particularly to home care and occupational therapy.

The Council has taken some positive steps to tackle this. These include:

• guaranteed hours, mileage rates and other incentives, as well as improved training opportunities to staff;
• recruitment initiatives, for example, attending career fairs and employing an advertising agency to recruit for vacancies in children's services; and
• making sure that the induction programme for new staff encourages a feeling of belonging to Highland Council.

Support for staff

The Council carries out a regular survey on staff views of the Council as an employer and uses the findings to shape initiatives for supporting staff. They have put in place:

• team development days for new managers;
• family-friendly policies;
• a regular newsletter; and
• a lone-working policy and 'buddy' system.

Further plans still being developed include mentoring and a health and safety strategy.

A corporate absence management policy has been in place for some years. Managers receive regular absence reports (broken down by service area) and local targets are set. Staff can also access counselling and occupational health services.

Working towards a more highly qualified workforce

A training strategy is in place. A personal development plan (PDP) picks up on individual training needs and helps the service plan for the future. Social work staff will begin to get PDPs during 2003. By summer 2004, there should be a local action plan and all social work staff should have a PDP. The links between PDPs and service plans could be stronger. Regular meetings are held between the training section and local area managers.

Nearly a third (429) of the social services workforce is qualified. Fieldwork staff are most likely to have qualifications, some more than one. The Council piloted a trainee scheme which offered eight places in its first year leading to the DipSW, and it is hoping to continue with this. The Council is also looking at ways of providing support to the existing staff who are funding their own professional training (around seven or eight each year).

The Council offers a practitioner trainer scheme, a management development programme, and an SVQ programme, and encourages staff to progress up to SVQ4 or 5. In terms of continuing professional development, the Council supports Mental Health Officer (MHO) training, practice teaching and recognition and response courses leading to the child protection certificate.

The practitioner trainer scheme is a new scheme led by the training team. This team developed a 'training for trainers' course for staff who go on to deliver training locally - for example, communication skills for home care staff. Managers of practitioner trainers have agreed to release the trainers for a set number of hours each year. This has been running for around one year and could be extended to cover a number of core skills.

In terms of post-qualifying (PQ) training:

• there are 50 qualified Mental Health Officers (MHOs), three more already in training, and six about to start;
• 34 staff have the practice teacher award - 26 are active practice teachers, another eight are on the programme, and three-quarters are about to start;
• 10 staff have the PQ1 award and another seven are in training; and
• five staff hold the full PQ award and one member of staff has the advanced award.

Preparing for registration

The Council is making staff aware of Codes for Employers through a series of meetings.

Staff are aware of the Scottish Social Services Council criteria for registration and targets are being set to make sure the conditions are met. The Council is in partnership with Forfar College to offer staff HNC and SVQ3.

Race Equality

In Highland, 0.8% of the local population are from a minority ethnic group compared with 2% for Scotland as a whole (2001).

Under the Council's Equality Scheme, priorities include:

• making sure that policies and service delivery take account of the needs of minority ethnic communities and that everyone has equal opportunity to access services and employment within the Council;
• making sure that Council staff and members are aware of their responsibility to promote Race Equality and end discrimination; and
• creating a realistic and achievable action plan which will deliver improvements to members of Highland communities, and against which the Council can measure and review progress.

Each year, the Council's Resources Committee will receive reports on progress against the plan.

The Council has run a number of race awareness sessions for its staff and regularly distributes information on Race Equality.

Use of Information Communications Technology (ICT)

Social Services Department

ICT services are provided by Fujitsu. All staff with access to a computer also have access to the Internet. There is a corporate strategy for ICT, of which social work is part. The Council has a corporate and social work strategy to replace its information management system.

Partnerships

Protocols are at present in place with health for all care groups except child care. They are paper-based and support the development of Single Shared Assessment, but they will be brought into the wider 'Discovery' development.

Background Profile

Unique in many ways after many years of depopulation and decline, Highland occupies one-third of the landmass of Scotland. While the main population centres are found around Inverness and Easter Ross, there are distinct and significant communities scattered over many parts of the authority. The economy is largely taken up with agriculture, fishing, distilling and associated industries. Average earnings are 4% lower than those for Scotland as a whole.

Spending for every person on social work in 2001-2002 was 256, a little below the figure of 267 for Scotland.

Expected population change

Community Care

Expenditure on community care has risen progressively in the period 1999-2002.

Children and Young People

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

Criminal Justice

Human Resources

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