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Short Reviews of Social Work Services in Scottish Local Authorities

Midlothian Council

Overview

Midlothian is one of the smallest mainland authorities. It has to provide a range of services to a number of large towns south of Edinburgh and to a rural population, too. There are pockets of high, long-term unemployment. It is affected by new housing developments mainly for commuters to Edinburgh. As a result, its resources are limited and it depends on joint working with authorities in the wider Lothian area for specialised functions. The Council needs to speed up the development of its youth justice services if it is to meet the national standards.

The Council's achievements include:

• a high rate of older people receiving community care services;
• a high rate of people receiving community care services for learning disability; and
• introducing Free Personal Care successfully.

The Council needs to take urgent action to:

• make sure that all children and young people who are looked after (including those at home) are in full-time education, and that it regularly audits and reviews care plans, including their educational content;
• further develop its information systems so that accurate information is available on all children and young people who are looked after up to the age of 19, including their education, employment and accommodation status, and make sure that they all have written throughcare plans;
• set up a system for recording information on its performance in relation to all the time interval standards for children's hearings and to develop an action plan to improve performance in relation to standard 3 to make sure that 75% of reports are submitted on time;
• allocate all cases, including those where children are on home supervision, to an appropriate worker; and
• adopt and use an appropriate assessment tool in youth justice cases to make sure that young offenders receive the appropriate level of intervention.

The Council also needs to give priority to:

• improving its information on, and further developing services for, people with sensory impairment;
• renewing its efforts to recruit more foster carers and adopters to meet local needs,
• developing plans with housing partners to make sure young people who have been looked after have a wider range of accommodation options available to them, to prevent them having to move to Edinburgh;
• keeping up and developing initiatives to improve the educational attainment of children and young people who are looked after, including regular tracking to make sure that levels of attainment continually improve;
• further developing services for children with disabilities to reduce the numbers on the waiting list;
• developing structured programmes for young people involved in more serious or persistent offending;
• renewing and keeping up recruitment efforts to fill current vacancies, analysing the age profile of staff by sector, and carrying out 'succession planning'; and
• speed up the pace of its joint working arrangements with health.

Community Care

Services for older people

The number of older people receiving a community care service continue to grow.

• Following a reduction in the number in private nursing homes in 2001, there was an increase in 2002.
• The number of people receiving home care increased in 2001, but fell slightly in 2002.
• The rate of people receiving home care is high compared with other authorities, but a relatively low percentage receive 20 or more hours care a week.
• A low rate of people live in special needs housing and the number reduced between 2000 and 2002.

Extra community care assistants, occupational therapists and clerical support workers are supporting people at home within the Rapid Response service. A shopping and household maintenance service has been provided, part in-house and partly contracted out. 375 clients receive this as part of a generic service. The Council also provides short breaks for older people.

Joint working involves working with local organisations and also working with Lothian-wide organisations. The Council expects that fewer people will be admitted to nursing care.

The Council thinks that its allocation for Free Personal Care falls short for individual cases. The Midlothian News goes to every household and is the main information tool.

Services for people with learning disabilities

Following a massive reduction in 2001, the number of people receiving a service for learning disabilities returned to 2000 levels in 2002. The Council may submit revised 2001 figures.

The Council has a limited budget to allow people previously in long stay hospitals to change to individual tenancies. Some people chose to move to group living rather than their own flat but a few of them have since moved to their own tenancies. However, there is good progress with independent living generally - 85 people with learning disabilities now live in their own tenancies and receive transitional Housing Benefit.

Midlothian is part of a managed care network for people with learning disabilities who have forensic needs or challenging behaviour (or both). This network also extends to people with autistic spectrum disorder and provides specialist expert support to local staff. A challenging behaviour team works alongside local support staff. This team prevents people from having to be admitted to assessment treatment beds in hospital.

Midlothian is making reasonably good progress with developing a database of people with learning disabilities. Social work and education are working on a draft database, which was written by the Data Standards Project at the Scottish Executive.

Services for people with physical disabilities

The number of people with a physical disability receiving a service fell from 1,842 in 1999-2000 to 742 in 2001-2002 but is still relatively high.

Procedures, forms and processes are in place for Direct Payments. A Direct Payments development officer is being appointed. The Council provides information, advice and support, and has produced an information leaflet. To begin with, the Council targeted efforts at people with physical disability, and it expects interest from the parents of children with disabilities.

The Council has employed extra staff to tackle waiting lists for equipment and adaptations. There is a seven-day target for any work that is essential for people to be able to leave hospital. A senior occupational therapist can spend up to 500 and then the decision passes to the practice team manager or community care manager. Health colleagues can access equipment directly from the joint community nursing and social care equipment store.

People with sensory impairment

In Midlothian, there are around 4,000 people with hearing impairment. The Midlothian system only identifies 'sensory needs' and there are 150 people with sensory needs receiving a service. The Council has service agreements with voluntary organisations to provide these services and the Royal National Institute for the Blind and SENSE provide training for Council staff.

Services for people with mental health difficulties

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

The Council is putting the new Mental Health Act into practice by using a local Implementation Plan. A needs assessment has shown that service priorities are a social crisis service and an advocacy group. The Council is making efforts to recruit and keep Mental Health Officers. Midlothian has a joint mental health planning group, a mental health care programme and a health care co-operative. People with mental health problems are represented on these groups. There is also a user group for people with mental health problems.

The Council is part of a Lothian mentally disordered offenders group, which plans service developments. There are no written protocols for joint assessment or management of risk.

Tackling substance misuse

The Councils aim to integrate parts of the service, including family support, a care manager and a training and development officer.

There are more people with alcohol problems than people with drug problems.

The number of episodes of residential rehabilitation in 2002-2003 was high - 22 people had 31 episodes. GPs sometimes send people to rehabilitation without referring to social work. Appointing a care manager for substance misuse should help to reduce episodes of residential rehabilitation.

For families who misuse substances, there are protocols on sharing information, and appropriate referral and response procedures are being developed. A specialist social worker works with children affected by substance misuse.

Staff and foster carers have attended STRADA training. When the Council buys in drug and alcohol services from the independent sector, clauses in service level agreements say that staff must have substance misuse training.

Joining up Community Care Services with health

Progress in improved joint working is measured through the Joint Performance Information and Assessment Framework (JPIAF), which has been agreed by SWSI, Audit Scotland and NHS Scotland. Recent evaluation of the partnership's progress in the 5 areas of joint management, joint governance, human resources, joint resourcing and single shared assessment suggest that the joint arrangements are still being progressed. The local partners were recommended to:

• further evidence and/or develop details of the Senior Management Group;
• progress the implementation of joint operational management arrangements for joint services;
• develop and document clear joint governance arrangements;
• agree and document clear statements about delegated functions and powers;
• agree service / clinical governance for joint services;
• take steps to further develop financial management arrangements to address operational arrangements, financial protocols to address operational arrangements, and an agreed statement of joint resourcing operational budget for older people's services;
• complete JPIAF proforma 5 because as it was not submitted, there was limited information on which to base evaluation of progress with implementation. The Communication and Consultation Strategy states that SSA would be in place by April 2003 but there was no evidence that this has happened;
• agree and implement an action plan to deliver training to key staff who will be assessors of older people; and
• agree and implement, as part of the process of implementation, arrangements for access to services across social work, health and housing, based on eligibility criteria and a joint protocol for access.

On the ground, care homes are being developed in localities, with staff delivering home care services from them. 800 of 1100 home care clients are 'in-house'. Advocacy and carers services are jointly commissioned. Protocols for sharing information are in place across Lothian for all client groups as part of a Joint Future Local Partnership Agreement. Training for Single Shared Assessment is being followed by training in information technology.

Working with Carers

Consultation with Carers Action Midlothian highlighted the need for more direct support to carers and more respite care. Two carers' workers are being appointed. Single Shared Assessment deals with carers and providers needing support to carry out their role. A new carers' centre is planned as part of a new community hospital development. There are now 30 respite places in day care. This will double once a new care home is up and running. Delayed discharge has meant fewer opportunities for respite and the discharge co-ordinator is looking for vacancies. Carers' assessments have been in place since 1996 and are an important part of the Single Shared Assessment. There are around 50 to 60 assessments made each year. Support offered to carers includes taking part in planning groups.

Children and Young People

Looked after children

The number of children and young people who are looked after who live in kinship placements reduced from 46 in 2001 to 29 in 2002, but the number has since risen to 34.

There is a relatively high rate of children in residential schools. The number reduced from 26 in 2001 to 17 in 2002, but has apparently reduced to 16 in 2003. The Council is trying to reduce the number of out-of-area placements - there is a new provision for eight young people in Penicuik, more young people are getting support from outreach and the Council is intervening at an earlier stage to keep young people in mainstream schools. The Greenhall Centre (the A Space) puts together packages to keep children of secondary school age out of residential care and a base for children of primary school age is about to open.

Fostering and adoption

Fewer than five children waiting for a foster placement are proving difficult to place. There are also 14 young people on referral for weekend respite and 11 are waiting for long-term placements. Some children wait up to nine months for a permanent placement. Most of those waiting are between 10 and 12, and occasionally they are younger.

Carers receive payment levels related to the age of the children they care for. The supply of carers falls short of needs. There is an ongoing recruitment programme, but only two new carers were selected from the last preparation group. Recruitment is through word of mouth, radio adverts and leaflets. Carers often have more children than they were approved to take.

A small number of children are placed in neighbouring authorities out of a total of 69 placements.

Nine children are on referral for adoption and 12 children are in the process of adoption. It is hard to get adopters for boys over seven and for groups of brothers and sisters. Most children are placed outside of Midlothian.

Educational attainment

In Midlothian, fewer than five 16 to 17 year olds who stopped being looked after in 2001-2002 attained Standard Grade English and Maths so no figures are available. A number of initiatives have been put in place to improve educational attainment, including:

• new guidelines issued to schools;
• a process developed in schools to track young people on a regular basis;
• training for foster carers on education and homework;
• a supply of computers into foster homes;
• technology introduced into residential units; and
• residential managers trained on educational issues.

Around 90% of children and young people who are looked after are in full-time education. The figure varies from day to day. Children are picked up quickly when they have been excluded, but if they are looked after at home this may take longer. Some young people have gone into higher education.

The Looked After Children (LAC) review system makes sure that educational needs are picked up. Care plans are audited but not in a structured way. Young people who live at home have care plans but they are less developed.

Throughcare and aftercare

The Council is appointing a throughcare manager to lead the service. Staff work with 24 young people aged up to 19 and another 19 who are aged over 19. They are in contact with young people up to the age of 25. All young people have a throughcare plan but not all plans will be on paper.

A homelessness team officer and a mental health officer help in throughcare work. There are very few accommodation options for young people who were looked after. Most go to Edinburgh and are supported by housing associations there. It has proved impossible to recruit supported landladies. As a result, 10 young people aged over 16 are still in foster care and three are still in residential units.

The Council has organised access to employment training for vulnerable young people, including those who are looked after through a one door approach.

Mental health

Medical assessments of children and young people who are looked after pick up any mental health problems. A Looked After Children (LAC) nurse links up with residential units and foster carers. Mental health services are limited. Young people often have to be placed out of the authority. Edinburgh services are used for sexually aggressive young people. Lack of specialist care resulted in two young people inappropriately ending up in secure accommodation.

Child protection

The number of referrals, the number of children subject to a case conference and the number on the register all increased in 2002.

An all-Lothian working group is assessing the recommendations of the Child Protection Review. The initiatives taken are:

• a child protection co-ordinator and assistant co-ordinator appointed for Lothian;
• inter-agency training on child protection guidelines;
• preparing leaflets for the public; and
• joint working between criminal justice and children staff when a sex offender is released.

Children with disabilities

The number of children with disabilities who receive a service has risen to 100. Overnight respite services have not increased but day services have been extended to more children and for more hours. A range of services are available, including:

• children with a disability and children who are affected by disability go to the Hawthorn children's centre;
• nine children with a disability are in full time foster care;
• 12 children receive share the care and others are getting respite foster care;
• five children receive residential respite in Midlothian and one in Edinburgh;
• fewer than five children go to the Blind School;
• individual packages for families (ELCAP and Lothian vouchers);
• there are play schemes and financial support to access mainstream after-school clubs and other services; and
• six young people get a befriending service, and Sports Link makes sport user-friendly.

Although the range of services has extended, 55 children are on the waiting list at the moment (half for a Section 23 assessment) and some children wait 18 months to two years for a service.

Community care deals with most future needs assessments. Occupational therapists are involved in future needs assessments.

Working of children's hearings

The number of referrals made within five working days of the case conference was not recorded in 2001-2002.

37% of reports were submitted within 20 working days of the date of request (Standard 3). Performance has been affected by problems recruiting staff and locums have been used.

There is no recorded information on 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). Cases are allocated across the teams, and it is known that not all cases meet the target. It is estimated that there are about 12 unallocated cases, some of which have been waiting three to four months.

Youth Justice

Criminal justice and children and families teams together work on youth justice. They do not use an assessment tool at the moment, although training for staff in using the tool ASSET has been arranged.

A SACRO restorative justice service started in November 2000. There is a police warnings system in operation, where:

• for a first offence a warning letter goes to parents;
• for a second offence there is a face-to-face warning; and
• for a third offence a charging report is sent to the reporter's office and they decide whether the case is suitable to be referred to SACRO.

There are three programmes - five or 10-hour behaviour offending programmes or a 30-hour personal change programme.

There is no structured programme for anyone placed on supervision due to an offence, but the Rural and Urban Training Scheme is used.

Criminal Justice

Structure

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

Workload

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

Effective practice

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

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

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

Public protection

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

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

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

Quality assurance

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

Human Resource

Structure of the workforce

Between 2000 and 2002, the number of whole time equivalent generic fieldwork staff increased from 12 to 39, mostly due a change in the way staff are classified. However, vacancies stayed fairly constant at around 10 whole time equivalent staff.

The increase in the number of social worker posts was slight, with vacancies falling from nine to four over the same period.

The latest figures provided by the Council and not yet confirmed suggest that, between October 2002 and the end of June 2003, vacancy levels have increased significantly, rising from just under 7% to just over 27% of the social work posts - a total of 15 vacancies.

The area under most pressure is care at home, where social services has to compete for staff with supermarkets and shops. It is also difficult to recruit Mental Health Officers.

The age profile of staff shows an ageing workforce, with nearly half of the staff over 50.

Support for staff

The range of courses to support frontline staff includes:

• personal safety courses for reception staff;
• managing aggression; and
• managing change.

Also, an SVQ assessor for care at home is looking at the qualification structure for home care staff.

In 2002-2003, 6551 days were lost due to sickness absence, representing 7.75% of the total available days. Most significant problems were in home care (stress, limb injuries and terminal illness), sheltered housing, residential units (stress) and service support at headquarters (back problems).

Working towards a more highly qualified workforce

Midlothian has a training and development strategy in place. Courses taken include the registered managers' award, an HNC in social care, DipSW, K100 (the Open University course), SVQs 2 and 3, Mental Health Officer and a certificate in child protection. The Council now offers most staff post qualifying (PQ1) training after two years' employment.

Preparing for registration

The Council's training and development strategy concentrates on qualifications for registration purposes.

It has targeted those groups who will need qualifications for registration purposes, mainly through SVQs, and has encouraged managers to do the registered managers' award. Occupational therapist staff must register with the Allied Healthcare Profession.

A corporate project is reviewing Council policies and procedures in light of the codes.

Race Equality

In Midlothian, 0.9% of the local population is from a minority ethnic group, compared with 2% for Scotland as a whole.

The Race Equality Scheme includes a corporate action plan and timetable of assessments. Divisional action plans are developed in line with the assessment timetable.

The Council's Race Equality Forum monitors how the arrangements are put into practice to meet general and specific duties.

Use of Information Communications Technology (ICT)

Social Services Department

Most social work staff have access to computers and to the Internet. At the moment, care at home staff do not have access, but they will when the Council's re-grading is finished.

There is no formal ICT strategy for social work services. Also, there is no formal e-learning strategy in place and the Council still has to deal with staff training needs for new technology.

Midlothian inherited the existing information system and it is not adequate. It is being reviewed in preparation for substantial change. There is a Council-wide website and an acknowledged need to update this. A group has been set up to remodel the social work content of the website and bring it up to date.

All departments are involved in a 21st century working group, which has a small project developing a call centre specifically targeted at social work. However, some groups of staff do not yet fully realise what new technology has to offer.

Partnerships

A protocol has been developed for sharing information for Single Shared Assessment, which can be used by all care groups. It links social work, health, education and other Council services. The Council is part of a Lothian project to develop Single Shared Assessment based on computer technology.

There has been little development of smart technologies other than the community alarm scheme. The Council is currently considering the core technologies and finance that might be needed to develop 200 smart houses based on the West Lothian model.

Background Profile

Midlothian is the second smallest mainland authority based on the size of its population. It is an ex-mining area made up of a number of small towns and a rural area. It is increasingly an area where people live and travel to work in Edinburgh. As a result, it is the focus for major new housing developments.

Poverty indicators are low. Average earnings were 7% lower than those for Scotland as a whole.

Spend for every person on social work in 2001-2002 was 266, very close to the Scottish average of 267.

Expected population change

Community Care

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

Children and Young People

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

Criminal Justice

Human Resources

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