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Short Reviews of Social Work Services in Scottish Local Authorities

Moray Council

Overview

Moray has developed its social work services very effectively since 1997. A start has been made to move to a new stage of leadership for education and health, and to plan for the new demands of the future.

The Council's achievements include:

• developing an effective system to identify and meet the mental health needs of children and young people who are looked after;
• successfully introducing Free Personal Care;
• setting up 'For Moray's Children', to provide inter-agency management and direction across health, education and social work; and
• developing Moray Collective, to provide a planning and co-ordination framework across acute health, local health care co-operatives, mental health, learning disability, education, children and families social work, housing and community care.

• Moray Council needs to take urgent action to:

• improve the educational attainment of its looked after children;
• make sure that all children who are looked after are in full-time education, with care plans that adequately reflect their educational needs; and
• improve its performance in standard 3 of support for children's hearings and make sure that it meets the 75% target.

The authority should also give priority to:

• reviewing the planning frameworks across health, housing, education, community care and children's services, to make sure all plans are consistent and coherent;
• joint delivery and joint risk assessment in mental health and learning disability services;
• continuing to improve services for carers;
• expanding intensive support for some older people;
• improving information on young people who were looked after;
• developing fostering services to reward the skills of carers and make sure the supply of carers is kept up in the face of labour market pressures;
• improving how agencies working with families who misuse substances share information;
• evaluating programmes for young offenders;
• succession planning and attracting new recruits; and
• speeding up changes proposed for improving support for staff.

Community Care

Services for older people

Following a fall in the number of older people receiving a service in 2000-2001 (from 3,214 to 2,047), the number increased in 2001-2002 to 2,642. There was a small increase in the number of people in private nursing homes in 2002, but the rate is still relatively low. The number of people receiving 20 or more hours of home care a week reduced in 2002.

Four multi-agency locality teams provide enhanced services, as needed. Both health and Council staff can buy in services for up to two weeks at 300 a week. A pilot rapid response service was successful but not as many people as the Council hoped used it.

The Council has developed out-of-hours auxiliary nursing and home care services to respond to crises. These services are aimed at accident and emergency cases, reducing the need for people to be admitted to hospital. A delayed discharge nursing post is jointly managed and funded by the Council and NHS Grampian, and works alongside a cross-boundary liaison nurse. Together, these two posts have had a significant and positive effect on hospital discharges.

A significant percentage of 28-day discharge support relates to comprehensive shopping, household maintenance and personal care. Moray Voluntary Sector Organisation (MVSO) provides a handyman service for gardening, moving furniture, and so on, which is free to service users.

There is no limit on the cost of intensive home care packages, but it is subject to a multi-agency decision and the in-house service has difficulty in meeting the demand for such packages. The Council is developing a proposal for a 'step-down' service using sheltered housing. The effect of the November 2002 floods delayed the introduction of this service.

The Moray Council led a publicity campaign on Free Personal Care, which was supported by the Moray Carers Project. Demand was met within the extra resources.

Services for people with learning disabilities

Following a substantial increase in the number of people receiving a service for learning disability in 2000-2001 (from 86 to 210), the number fell to 175 in 2001-2002.

A speeded-up programme of closing hospitals resulted in some temporary placements. Permanent resettlement into the community is being progressed, and 28 people are now resettled, seven to individual tenancies.

The Council has had a strategic agreement with Grampian Health Board on joint commissioning of services. Services developed include:

• joint agency learning disability teams providing a single access point;
• flexible housing support;
• movement from centre-based day services to wider opportunities;
• alternatives to day care, for example, social firms with opportunities for earning an income; and
• an employment project with paid and voluntary placements.

Due to a Best Value review. the Council has restructured services to integrate staff and co-ordinate the services. The Council still needs to set up a database of people with learning disabilities, but some people have said that they do not want to be on a database.

Services for people with physical disabilities

Having already fallen substantially in 2000-2001 from 953 to 174, the number of people receiving a service for a physical disability fell still further to 26 in 2001-2002 to a very low rate.

A Direct Payment scheme links to the independent living fund. It is also available to people with learning disabilities and to older people. Service users at present are choosing not to buy from the Council.

There are joint access arrangements to the Council's equipment store. Waiting times for equipment are mainly as a result of problems with the delivery arrangements. The equipment store is in temporary accommodation although a joint store in Elgin is being planned which should ease problems such as tracking and receiving items. Staff will be able to commission adaptations. Senior occupational therapists, who will be team leaders, will be responsible for the budgets. The occupational therapy (OT) service was formally aligned with the NHS OT service in 2002, and a single manager is due to be appointed soon.

People with sensory impairment

The number of people with sensory impairment receiving a service reflects the 1,000 people registered with the two specialist societies with whom the Council has service level agreements. Agencies have very little contact with each other. The Council will develop a strategic plan for people with disabilities, including sensory impairment. The Disability Forum is carrying out a survey with users in the Moray Resource Centre on using services.

Services for people with mental health difficulties

The number of people receiving a service for mental health problems increased significantly from 293 in 1999-2000 to 449 in 2001-2002, from an already high base.

The integration of the mental health services is planned, under a single manager with a devolved joint budget led by health. The Council already has a community mental health team which takes referrals from GPs. The Care Programme Approach is in place and generally used as a preventive measure. However, there is a shortage of Mental Health Officers.

Alternatives to hospital care have been developed, including:

• a joint housing-based rehabilitation service, provided through SAMH;
• day services;
• an arts and crafts project;
• a music-recording studio; and
• nurses being seconded to voluntary agencies.

Services for mentally disordered offenders are planned under a Grampian strategy. Inter-agency working is in place between Moray Council, health and police, backed by joint training. However, there are no formal agreements for the joint delivery of services for mentally disordered offenders, or protocols for joint assessment and managing risk. The mental health team offers criminal justice staff advice and help with assessing risk. Moray has no separate forensic service and patients need to travel to Aberdeen.

Tackling substance misuse

While the number of people receiving a service for drug and alcohol misuse increased from 102 to 182 between 1999-2000 and 2001-2002 the Council still has one of the lowest rates of substance misuse in Scotland. As a result, not much is happening on the support for substance misusers. However:

• there is no waiting list for services - all initial assessments are carried out within seven days;
• there are links between social work and maternity services in relation to drug use;
• adult mental health services and children's services staff take part in training (for example, STRADA courses);
• a drug and alcohol worker is attached to the youth justice team; and
• Council, health and voluntary sector services are located together.

Services are still focused on adults and there is a clear need to pay more attention to the needs of children. There has been little progress in developing protocols for sharing information on families who misuse substances.

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 meeting the JPIAF requirements and are, overall, very satisfactory. The local partners were recommended to:

• review the completeness and appropriateness of their joint governance arrangements;
• further develop financial management arrangements to address operational arrangements and financial protocols for operational arrangements;
• agree a statement of a joint resourcing operational budget for older people's services; and
• arrange for assessors to access services across social work, health and housing.

On the ground, evaluation developed so far for Single Shared Assessment (SSA) depends on feedback on paperwork rather than on service outcomes. The Council needs to settle a number of issues, including:

• defining and agreeing roles, responsibilities, protocols and sharing information; and
• involving the independent sector, housing, the acute hospital sector and professional groups.

An evaluation brief is currently being developed to identify how effective progress is on the joint future agenda, and this is expected to be finished in autumn 2003.

A Grampian-wide group deals with sharing information. Slow progress on sharing is due to the task being complicated and the need for IT to replace the paper-based system. The best progress relates to older people and learning disability services. GPs and consultants make very little use of the SSA. Council and health workers have made wide use of training, but the involvement of the independent sector is patchy.

The Council is introducing Single Shared Assessment for older people and it is underway for other care groups. Relevant staff receive joint training. A Grampian-wide protocol allows everyone involved to share information securely. Moray is part of the Grampian MGF2 project to develop an electronic version of SSA. In the meantime, information can only be shared on paper. A temporary post is providing a 'hub' for electronic sharing of information across Council and NHS systems, pending the outcome of MGF2 work.

Working with carers

The budget allocation for carers' support services is ring-fenced. A high percentage of the extra funding has so far gone to supporting the structure, mainly in funding for the carers' centre and for the Moray Carers' Forum. Focus is now beginning to shift towards developing services, especially respite care services which are flexible and varied for different groups of clients.

The Council funds the Princess Royal Trust for Carers to provide information, advice, support and advocacy for carers of all groups of clients. A 'healthy living centre' project is focusing on vulnerable people and their carers and improving access to resources. The Moray Carers' Strategy has been developed jointly by the statutory services and the voluntary sector in partnership with Moray Carers' Forum.

Children and Young People

Looked after children

The total number of children looked after by the Council has fallen significantly over the last few years. This reflects the Moray Childcare Strategy aims of working with children and families on a 'no order' basis.

The number of looked after children in kinship placements increased from none in 2001 to eight in 2002. This reflects the Council's intention for kinship placement to be the starting-point for substitute care. Kinship carers receive lower allowances than other carers.

Three residential units are run on behalf of the authority by NCH, providing 12 places. Only nine places were occupied at the time of the inspection, due to staffing difficulties. This has resulted in children being placed in residential care outwith Moray, with perhaps two extra placements needed.

Fostering and adoption

No children are waiting for a foster placement and most children are in stable placements. The Council expects future shortages, with practical problems including:

• a lack of choice of placements;
• the effect on recruitment of the increase in part-time work opportunities as an alternative to fostering; and
• the attraction for carers of working for voluntary organisations.

There is an allowance scheme and an enhanced payment scheme for carers who look after children with special needs. The Council is now considering a scheme for paying all carers a fee for skills, to improve the quality of the service and because of the need to compete with other local employment opportunities.

The Council campaigns jointly with Highland Council to recruit carers, advertising in the press and on the radio.

The NCH fostering scheme ('MAPS') offers three or four places in Moray as an alternative to residential care, including secure care.

No children are waiting for adoption, but five are likely to need placement in 2004-2005. Placements tend to be out of the area. The Council has finished an audit of adoption services to make sure they comply with national standards.

Educational attainment

In Moray, 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.

Initiatives aimed at improving the attainment of children and young people who are looked after include:

• tracking the progress of children and young people who are looked after, in relation to the wider population of children;
• improving vocational subjects through access to workshops and work experience;
• funding higher education placements from 'quality of life' resources; and
• using the system where all children in Moray are tested in primary 1,3,5 and 7 and in S1 and S3.

The Council funded research on the views of 18 accommodated young people aged 12 to 18. The young people felt supported in education by teachers, social workers, residential workers and foster carers, and thought their carers had a realistic to high expectation of educational attainment. The study found that a high percentage were doing well at school, got help with homework and were encouraged to take up other interests.

Not all children and young people who are looked after are in full-time education. Some children are not in mainstream schools. Almost all young people in foster and residential care have full-time placements. The Council is carrying out an audit of education for young people on home supervision.

All accommodated children have care plans, and forms are used to set out educational needs. Currently young people who are looked after and live at home do not have care plans. The Council needs to deal with this.

Throughcare and aftercare

The throughcare and aftercare team is made up of five staff (four whole time equivalents) who work with young people from age 14. They try to keep in contact with young people until they are in their 20s. They are in the early stages of developing a tracking system and database. Last year, 23 children and young people who were looked after left care - seven were on home supervision, two were in residential accommodation and 14 were in foster placements.

There is a series of accommodation options for young people, including:

• the Aberlour Child Care Trust, which provides accommodation to vulnerable young people in a six-flat unit (this prepares young people for their own tenancies);
• NCH, which provides support for young people in their own tenancies; and
• a young person's officer in the housing team, who develops housing and social support plans for care leavers and other vulnerable young people.

At the moment, throughcare and aftercare services are not wholly connected, perhaps due to the range of initiatives and agencies involved. The overall structure could be better developed through more effective partnerships between social work, housing, education and careers services. This is being tackled through a multi-agency group set up following the 'Throughcare and Aftercare of Looked after Children in Scotland' report.

Mental health

The service for identifying and meeting the mental health needs of children and young people is based in the Rowan Centre, where a multi-disciplinary mental health team serves children and teenagers aged 0 to 16, sometimes 18 and their families and carers. Referrals come from GPs, school doctors and paediatricians, and colleagues working in the adult mental health services. There is co-operation between social work, education and the children's hearing system. Demand for services is high and there is a five-month waiting list for routine referrals.

To support these services, the Consultation Advice Liaison in Moray (CALM) service has recently been set up. Run by a multi-disciplinary mental health team, the service supports all those working with children and young people by providing consultation, advice and training about mental health concerns. This provides a quick route to advice and can help to identify problems as early as possible and fast-track services for young people who are most at risk. In the face of significant pressures, this new initiative could provide creative solutions. The partner agencies should give priority to evaluating the effect of CALM.

Child protection

The number of referrals fell in 2001-2002 but the number of children subject to a case conference and the number on the register increased.

The Council is drafting its response to the recommendations of the Child Protection Review with the help of an inter-agency child protection forum. Local initiatives include:

• an increase in early intervention resources;
• the introduction of family support workers;
• links with maternity services in relation to drug misuse; and
• training for education staff.

The Council sees a need to develop better quality assurance systems. For example, it is considering using peer reviews to improve case recording. More progress needs to be made to improve how information is shared with education staff and drug and alcohol services.

Children with disabilities

There has been an increase in demand for services and an increasing need to prioritise resources. 143 children received either residential or at home respite care during the year, but a number of families who need respite care are not receiving a service at the moment.

More than 100 young people receive a groupwork service. The Moray Options Scheme has expanded and provides groupwork programmes, supporting young people into leisure activities. There are two whole time equivalent dedicated staff to work with children with disabilities.

A range of in-house services is supported by services provided by Crossroads, Aberlour and the Moray Carers Project, including:

• home carers and family support workers who provide respite care at home;
• a Care at Hand scheme for primary children;
• a play scheme for children aged six and under who do not go to primary school;
• Crossroads workers who go with children to traditional group activities, such as Brownies; and
• residential activity holiday breaks, provided through the Carers Project.

Moray Inter-agency Developmental Assessment and Support (MIDAS) provides an interagency framework assess pre-school children with developmental delay disorder or complex disabilities. It provides a co-ordinated support plan for children and their families. The service provides for children with the most complex needs, reducing the need for them to travel to Aberdeen for assessments.

A focus for future development is to improve the process of moving into adult services.

Working of children's hearings

All referrals from a case conference are made within five working days (standard 2).

Only 56% of reports are submitted within 20 working days of the date of request (standard 3): Failure to achieve the target of 75% is put down to staffing difficulties.

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

Overall, Moray is providing a good level of service to families in the Children's Hearing system, but managers could do more to effectively tackle delays in reporting.

Youth Justice

There is a well-defined multi-agency approach to dealing with youth crime that was developed following consultation and reference to relevant research. The approach clearly identifies the range of services needed to supervise and support persistent young offenders in the community and help them live within the law. Representatives of those agencies responsible for these services form part of a local service planning group.

An audit of local offending patterns found that in 2001-2002, 43 young offenders met the national definition of 'persistent' (five or more offences over a six-month period). A target has been set to reduce this figure by 10%.

A team of three full-time staff has been set up to respond to young offenders in crisis. The longer-term service involves putting together a package of supervision and support detailing what will be done, when and who by. Staff from the voluntary sector (NCH, Children First, Aberlour), the police, housing, child and family psychiatry and Careers Scotland have all done a four-day training programme in working with young offenders (an introduction to the 'Time to Grow'). The ASSET assessment tool is being introduced for all front line staff. This is being combined with the development of a database to follow progress, including information about re-offending from the police.

Funds have recently been made available to set up restorative conferencing and to employ a drug and alcohol worker. Grampian Police are introducing a restorative cautioning scheme.

Overall, Moray has put together a comprehensive youth justice strategy which draws in a wide range of agencies and services. The services include evaluation (with feedback and comment from offenders, victims and staff). The Council is also arranging for external evaluation. It is important that this is followed through and the findings used to review and further develop the strategy.

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 2 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

There was an increase of 53 in the number of fieldwork posts between 2000 and 2002, 40 being in adult services and 10 in children's services. From having no vacancies in 2000, the total rose to six. The pattern is the same for social work posts, with vacancies increasing to four.

Latest figures provided by the Council but not yet confirmed indicate that, between October 2002 and the end of June 2003, vacancies rose from 11.5 to 22.

Support for staff

The Council has a very stable workforce with a low turnover. Significant features are that:

• the Council has increased the number of posts substantially over the last year, especially in community care (the greatest difficulty is to fill qualified posts, especially in Children and Families and Criminal Justice);
• there are senior practitioner posts in all service areas; and
• each home care team now has a team leader, which gives the Council's experienced staff a route to progress their careers.

The main area of concern is in home support where around 20% of the workforce is over 50, and in senior management where all staff are over 50.

Given the low staff turnover overall, Moray has not had to adopt new human resources policies, and support measures have been limited to:

• introducing senior practitioner posts in all teams to encourage keeping and developing staff;
• more access for staff to mobile phones and tightened office security;
• an induction pack for new staff;
• a move towards a more systematic use of ERDP (Employee Review and Development Programme;
• an occupational health and therapy service; and
• a co-ordinated social care recruitment campaign, run jointly with JobcentrePlus.

Staff turnover is relatively high in home care (around 20%). The Council is reorganising the service and looking at a clear career progression for staff in the sector.

Figures provided by Audit Scotland suggest the Council has the lowest absence figures in Scotland.

Working towards a more highly qualified workforce

The department has a training team that includes six staff. A strategic training plan is due to be finished by June 2003.

The Council can fund up to 50% of the cost of training that is not job-related, and it has set up devolved training budgets for childcare.

The Council does not pay individual social workers who supervise students - the funds go to teams involved in practice learning.

Preparing for registration

The fairly informal training system works reasonably well in a small authority. No evidence was available on current levels of qualifications and what plans are in place to meet the qualification targets for the Scottish Social Services Council by 2005.

Race Equality

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

A corporate Race Equality Scheme is in place.

Moray's community safety group looks at ways to promote race equality across the service. It has introduced a racial incident monitoring form, and monitors and deals with any incidents arising from this.

There is a designated travelling families' site in Moray. There are existing links to both social work and education, and the Council is planning some investment in on-site childcare facilities.

Black and minority ethnic service users are able to get involved in planning for services through the Council's approach to community planning.

Use of Information Communication Technology (ICT)

Social Services Department

An early OLM system is in operation, but take-up is low and case notes are still held in manual form. No formal strategy is in place for IT in social work. Social work is included in the corporate strategy under which a new CRM system, currently being tested in Forres, is to extended to other areas by 2005. The corporate strategy is based around the Council's MGF2 Easy Access programme, with social work and housing being lead services.

Partnerships

Inter-agency protocols are in place for sharing information to develop the Single Shared Assessment, but they are focused on older people and adults with learning difficulties. They will be applied to other care groups at a later stage.

Background Profile

Poverty indicators for Moray are low. Drug and alcohol problems have increased in recent years, but the drug misuse rate is still one of the lowest on the mainland.

Spending for every person on social work in 2001-2002 was 239, compared with 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 has risen very gradually in the period 1999-2002.

Criminal Justice

Human Resources

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