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Short Reviews of Social Work Services in Scottish Local Authorities

North Ayrshire Council

Overview

As a medium-size authority, North Ayrshire Council has to plan and provide services over a varied part-island, part-mainland area, which is a mix of urban and rural communities. For more specialised and more expensive services, it often works with the two other Ayrshire authorities. It has high vacancy rates, which significantly affect the delivery of a range of complex services. However, it has improved the ICT support to staff and has made significant progress in some areas of children's and adults' services. It has to deal with the major challenge of a substantial increase in substance abuse.

The Council's achievements include:

• relatively high rates of older people receiving more than 20 hours home care each week;
• high rates of children and young people who are looked after living at home and living with relatives - though these have to be set against a low fostering rate and a high but decreasing rate of residential placements;
• successfully introducing Free Personal Care; and
• a substantial reduction in absence rates in childcare fieldwork services.

The Council needs to take urgent action to:

• make sure that it provides accurate and up-to-date information on the education status of children and young people looked after;
• make sure that all children and young people who are looked after have the opportunity of full-time education;
• make sure that care plans are prepared for all children and young people who are looked after and that they are regularly monitored; and
• improve its performance in relation to standard 3 of the time interval standards to make sure that 75% of reports are submitted on time.

• The authority should also give priority to:

• reviewing the conditions and support that are offered to carers;
• renewing campaigns to recruit more carers, particularly those willing to care for older children;
• setting up a system to provide information on the education, employment and accommodation status of young people who receive throughcare services;
• renewing its efforts to recruit qualified staff to children's services;
• reviewing the scope for more flexible conditions for home help staff; and
• speeding up the progress of its joint working arrangements with health.

Community Care

Services for older people

The number of older people receiving a community care service increased substantially from 2,745 in 2000 to 3,533 in 2002, but the rate is still low compared with other authorities. A high rate of people live in private nursing homes and the number increased in 2002. The number of people receiving home care reduced gradually between 2000 and 2002, and the number receiving 20 or more hours a week fell from 80 in 2000 to 62 in 2002. The Council provides residential short breaks in residential and home settings.

Rapid Response Services are an Ayrshire-wide service. They are planned to increase only slightly, and will have some way to go in providing a comprehensive service. A shopping service is offered throughout the area.

The Council introduced Free Personal Care smoothly. The process included:

• preparing private home providers through an intensive programme;
• involving a wide range of people;
• producing good publicity material; and
• completing staff training

Free Personal Care is now part of North Ayrshire's community care systems and processes. However, the Council is reviewing the charging policy because of the development of integrated health and social work services.

The Council plans to:

• convert some (about 8% to 9% of the total) of the in-house residential care home services to intermediate care;
• deliver a more responsive home care service by encouraging staff to work more flexibly;
• set up multi-disciplinary teams at locality level for assessment and care management;
• bring sheltered housing into the care system; and
• set up a Joint Implementation Team to bring about these changes and to make sure there is close working between health and social work.

Services for people with learning disabilities

A joint all-Ayrshire closure programme for long-stay hospitals has been agreed and the three Ayrshire local authorities and NHS Ayrshire and Arran have reached agreement on the recurring costs of the retraction. Plans to reorganise local community learning disability services depend on capital investment and the Council is looking to the NHS to transfer capital resources. The resettlement accommodation arrangements (small group homes and individual tenancies) still need to be settled. Most people who have been resettled so far have gone to their own or shared tenancies.

The Council is planning to carry out a strategic review of services for people with learning disabilities, which will allow it to achieve real improvements by redesigning services.

Although there are close local networks and access to psychiatric and NHS forensic services, joint community care services are seen as a major priority for improving services to people with learning disabilities in the community.

There are currently 449 people on the social work database who receive social work services, and the Council would prefer this to be a joint database.

Services for people with physical disabilities

The number of people receiving a service for physical disability more than doubled in 2001-2002 from 381 to 874 (some of the change may be due to different recording procedures).

The Council has introduced a Direct Payments scheme, building on an earlier scheme. It currently provides for 17 people. Ayrshire Independent Living Network, a locally based, user-led organisation, provides an extensive range of services and support (for example, payroll services, information and advice) together with training for individuals employing personal assistants and for personal assistants themselves.

There have been significant improvements in equipment and adaptation services. The equipment and adaptations service, delivered by occupational therapy staff, is now centralised under the management of a head occupational therapist, and is providing fairer services across North Ayrshire. It is not clear what effect this has had on the relationship between equipment and adaptation services and the rest of community care. A single IT system ('Care First') is now used by all social work staff, and will give better information (for example, on waiting times for allocation). Extra staff have been recruited to improve the equipment service. Systems have been simplified (for example, in the grants systems) so that waiting times are reduced.

There is a commitment to an all-Ayrshire equipment store, which is expected to continue to improve the service.

People with sensory impairment

In North Ayrshire, 163 people who are registered as blind also have a hearing impairment and 29 people who are registered as partially sighted also have a hearing impairment. 228 service users with hearing impairments used social work services last year, as well as 10 people who are deaf-blind.

Services are planned through the All-Ayrshire Joint Planning Group. A Sensory Impairment Team has been formed from two separate teams to provide better services. A review is planned of sensory impairment services, which would build on the national service standards documents.

Services for people with mental health difficulties

The number of people receiving a service for mental health problems increased substantially in 2001-2002 (again, some of the change may be due to different recording procedures).

Mental health services have attracted increased expenditure to put a joint three-year plan into practice, although the withdrawal of NHS funding has not helped. The Council is considering its current provision of services (for example, taking two accommodation schemes off the register, to improve its use of funding).

A plan is currently being developed to introduce the new Mental Health Act. A Mental Health Joint Planning and Implementation Group is producing a joint strategy. The local partners are also developing guidance ('integrated care pathway pilot') for people with mental health problems, which will include clinical standards and triggers for action by the partners.

A Forensic Forum focuses on services for mentally disordered offenders (MDO). Ayrshire is also testing routes through care services for MDOs. The forensic team is involved in the 'diversion from prosecution' scheme and has good links with the sheriff for mental health referrals.

All MDOs have access to the care programme approach (CPA). There are currently 44 people on the CPA in North Ayrshire, and four of these are MDOs.

Tackling substance misuse

There was a huge increase from 36 in 2000-2001 to 679 in 2001-2002 in the number of people receiving a service for substance misuse problems. The rate is now high compared with other authorities (again, some of the change may be due to different recording procedures).

The Council is to carry out a review to see how efficient services are for people who misuse substances. There are two specialist Council centres and a variety of voluntary organisations and self help groups (for example, Mothers Against Drugs) currently providing services.

Managers challenge social work staff to use community-based rehabilitation services such as the home detox service instead of residential rehabilitation.

STRADA training courses are provided (eight courses in 2002-2003), such as those on children and families affected by drug and alcohol misuse. The Council also uses training courses (six in 2002-2003) run by the Addiction Forum.

Offenders with drug or alcohol problems (which are assessed as not being connected to the main causes of their offending) can still gain access to appropriate treatments delivered voluntarily through services such as the SACRO transition programme. There is a new throughcare service at the local (private) prison, which is jointly funded by the prison and the Council. Staff also can refer to home detox through local GPs.

The Criminal Justice systems are co-ordinated through the Drug and Alcohol Team to make sure that offenders can benefit from a range of treatment that is not necessarily part of the main criminal justice services

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:

• Review the purpose and function of the Joint Community Care Board taking into account the Scottish Executive Circular on Joint Resourcing and Joint Management (CCD7/2001) and the Practical Advice document.
• Develop and agree the operational joint management arrangements. It is recommended the partners focus on this aspect as soon, as is possible.
• Develop the shape of joint services and joint management at the front line.
• The role of the Joint Community Care Board should be further clarified including any powers of delegation afforded to either officers/members. We recommend this should be clarified as a matter of priority.
• Agree the completion of the operational management arrangements and the shape of joint services whereupon a full scheme of delegation should be agreed and published clearly stating what can be decided by whom at each level of the joint management structure. This was recommended as a priority.
• Develop a policy for the handling of complaints on a joint basis.
• Develop a policy/statement on service/clinical governance for joint services.
• Develop a joint OD/training plan.
• Further develop financial management arrangements (both strategic and operational), financial protocols (both strategic and operational), and an agreed statement of a joint resourcing operational budget for older people's services.
• Ensure that training is available to all relevant staff, following mapping exercise.
• Agree eligibility criteria for services and publish information.

Under the Joint Future Agenda (JFA) partners will deal with joint operational management arrangements and joint resourcing, which will now be taken forward very positively, because of the strong commitment by councillors and senior managers.

On the ground, the main focus has been on older people's services and putting in place processes such as Single Shared Assessment (SSA). Examples of joint working for older people include:

• a respite flat and crisis intervention facility
• joint care plans kept by the users themselves;
• an integrated care project to prevent inappropriate hospital admission; and
• a care project with East Ayrshire Council and NHS Ayrshire and Arran to prevent delayed discharges.

Progress has also been made in other areas, for example:

• a joint community nursing and social care equipment store;
• joint work with the Council's housing service on accommodation for people with head injuries and learning disabilities;
• the community mental health team; and
• joint work on substance misuse.

An all-Ayrshire protocol for sharing information has helped joint working, as have the personal records of care (held by individuals in their own homes) and the joint training of staff. North Ayrshire is a member of the Care First Consortium and is also linked into the Ayrshire Modernising Government bid. At present, paper systems are being used.

Working with carers

North Ayrshire and the NHS Board invest heavily in supporting carers, for example, in the carers' centre in Irvine which has outreach services to Arran. It is intended to develop further a service for young carers (there is already a young carers' service in Irvine). Voluntary organisations such as Alzheimer Scotland also provide day care and support to carers.

Carers are offered assessments under the Single Shared Assessment process but so far only a few have asked for them. Staff tend to promote them where if there may be a conflict of interests between the carer and the service user. When the IT system is in place, it will provide , extra encouragement, because staff will have to confirm that they have offered the carer an assessment.

Children and Young People

Looked after children

Statistics show that the number of children and young people who are looked after reduced from 479 in 2000 to 376 in 2001, but the Council thinks that this is an overestimate. Figures supplied by the Council but not yet confirmed suggest that the number of looked after children in residential accommodation has gone down from 57 in 2002 to 44 in 2003.

A high rate of children live in kinship placements. The number increased from 56 in 2001 to 84 in 2002, partly due to increasing numbers of parents who misuse drugs.

In its statistical returns to the Scottish Executive for 2001-2002, the Council could not identify how many looked after children and young people had three or more placements. Information gathered for 2002-2003 indicates that 10% of them had three or more placements.

Fostering and adoption

Fewer than five children are waiting for short-term placements and a small number are waiting for long-term placements. There are no short-term carers to take older children and there are difficulties placing groups of brothers and sisters. The Council is developing an enhanced scheme for challenging older young people. It is planning a fee-based scheme. Nine carers were recruited in the past year but some carers have been removed from the list so overall numbers have not increased. The Council recruits through the radio, local papers, posters and leaflets, and it focuses on carers who will take older children.

There are Barnardo's placements, CAPS placements and adoption placements out of the area.

Fewer than five children are waiting for adoption. The Council is able to place children under the age of two, and older children go to the West of Scotland Consortium.

Educational attainment

In North Ayrshire, 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. The Council has followed a number of initiatives to improve educational attainment, including:

• providing computers and software in residential units;
• giving carers IT equipment; and
• using measures of quality and developing joint training with education services.

The attainment figures apply only to accommodated children and the Council does not know whether or not young people who live at home are in full-time education. A system is being developed to track those at home. Five out of 32 accommodated children and young people are getting a part-time education programme. Some young women have stayed on to 6th year and two or three are likely to go on to university.

Not all young people who live at home have care plans, but this will be looked at through the development of an integrated care assessment. Those who are looked after away from home have a care plan and an education plan.

Throughcare and aftercare

A record is kept of all the young people the throughcare team are involved with, and a system is being developed so that the team can accurately and methodically record and report information on young people. Throughcare staff are linked to residential units and schools. There is a drop-in service. Young people at home are not routinely assigned a throughcare worker but they may get support from housing services. All accommodated young people have a throughcare plan, which the throughcare team reviews every six months.

25 supported accommodation places offer 24-hour support to young people. First Care Network provides mentors for young people and nine sessional staff support more than 30 young people to keep up their tenancies. The number of supported carers has been increased.

Mental health

Mental health problems are picked up at reviews of children and young people who are looked after. The Child and Adolescent Mental Health Service covers all three Ayrshire authorities but is based in North Ayrshire. It is being redesigned. An Ayrshire-wide group looks at mental health issues that affect different agencies, and these will be part of the Ayrshire and Arran Child Health Strategy. Local developments are progressing through the North Ayrshire Children's Services Plan and the Social Services Service Plan (in which the development of mental health services is a key priority). Residential staff and foster carers are trained together on issues such as self-harm and drug and alcohol misuse.

Child protection

Rates of registration are low and the number of children on the register halved in 2001-2002. Half the children on the register in 2001-2002 had been on it before, but the percentage reduced to 20% in 2002-2003 and 77% of young people had been on the register less than six months compared with 22% in 2001-2002.

A number of child protection initiatives have been put into practice, some of them following the recommendations of the Child Protection review, including:

• studying how referrals are counted;
• appointing a child protection co-ordinator;
• reviewing the structure and status of the Child Protection Committee;
• setting up a working group to take forward the recommendations of 'Getting our priorities right' and developing a maternity services strategy;
• providing joint training for criminal justice and children and families workers; and
• setting up the Ayrshire-wide 'Change Project', which deals with the effects of sexual abuse on the abuser and the young person.

Children with disabilities

At the moment, 166 children up to the age of 18 receive overnight or residential respite care, a befriending service or home care in the family home. Services have increased, but 11 children are waiting for a service. The range of services available includes:

• the Muirfield More outreach project, which supports children to be included in mainstream recreational activities;
• Shared Care Plus, which is for children with profound disabilities; and
• a summer playscheme and a playscheme for children under five, which is partly funded by the health improvement fund (72 children receive one-day respite care over the holidays, and those with profound needs get two to three days).

There are fewer than five children with disabilities in residential school and seven children are getting respite care - there is joint planning and funding for these children. Also, 11 children receive a home care service.

A member of staff attends future needs assessments. A transition development worker has been appointed to develop individual planning for young people moving into adult services and to collect information on the probable future needs of young people.

Working of children's hearings

Information is not available on the Council's performance in relation to standard 2 (the number of referrals made within five working days of the case conference) in 2001-2002, but all referrals have met the target in 2002-2003. Around 95% of fast-track hearings reports are being returned within the 20 days.

17% of reports were submitted within 20 working days in 2001-2002 (standard 3). The figure is said to be 39% in 2002-2003. Low performance is said to be due to 50% understaffing. Outstanding reports are being given back to area teams who are being given overtime to complete them.

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

Youth Justice

North Ayrshire is a pilot area for fast-track hearings for persistent offenders.

Staff assess every young person referred to the Children's Hearing on offence grounds, using the assessment tool YLS/CMI. All childcare and criminal justice staff have been trained in using YLS/CMI.

The Council provides an intensive, supervised, structured support service for young people who have been discharged from secure accommodation. A close support unit has been opened. A mentoring scheme is part of the intensive support package, and the Council employs mentors on a sessional basis. The Rosemount Project works with young people who are about to be admitted to residential care and who are coming out of residential care.

The NCH Crossover project is for serious and persistent offenders aged 14 to 18 who are at risk of custodial sentences or secure or residential placements. Some young people on bail conditions have attended. Young people are reviewed at six months and after one and two years. Some young people are hard to track. For those who were tracked, there was a 50% to100% reduction in offending behaviour. Tracking is through self-referrals and the hearings. The police will not take part due to data protection issues. Evaluation looks at school attendance, links to employment, leisure time, and so on, as well as re-offending.

SACRO is involved in restorative justice and restorative conferencing. Referrals are from the reporter or the procurator fiscal. Young people are tracked for two years, through self-referral and the reporter.

The Council is buying a service from Children 1st to work with children aged seven to 12 who have conduct disorders.

Criminal Justice

Structure

North, South and East Ayrshire operate as a partnership for delivery of criminal justice social work services. Strategic direction for the partnership is provided by a partnership management group, comprising elected members from each authority, Directors/Chief social work officers and criminal justice managers.

Workload

Demand for core services has risen in 2002-2003 with a 7% increase in social enquiry reports, a 22% increase in probation orders, and a 14% increase in Community Service Orders. There are variations between constituent authorities with East Ayrshire experiencing a 13% rise in social enquiry reports, South Ayrshire a 69% rise in community service orders and North Ayrshire a 30% increase in probation orders. Whilst the overall trend is upward, particularly in probation, there has been some fluctuation in the demand for services over the past four years with some significant dips. Managers report staff to be working under considerable pressure to meet current demands, a situation not helped by some long term sickness and staff vacancies. This has, in particular, led to the "stacking" of community service orders in North Ayrshire Council, with delayed starts, and to an acknowledgement that other national standards are not always being met. The three authorities have performed well in relation to prompt submission of social enquiry reports.

Effective practice

The partnership uses the tool LSI-R to assess risk of re-offending and criminogenic need. The YLS/CMI version is used for 16-18 year olds. Other risk assessment tools used include the Scottish Executive risk assessment framework, the 'Change' domestic violence assessment, the Dunscore risk of custody scale, and TayPrep 30 and Matrix 2000 for sex offenders.

The partnership recently reviewed aspects of its core services. Probation is well targeted though there are inconsistencies in service provision and in the way orders are enforced and performance monitored. Similar inconsistencies were uncovered in respect of Supervised Attendance Orders. The review recommends a 'pan Ayrshire' approach to the development of core services. In addition, a review of Court services addresses the current anomaly of two local authorities providing a service at one sheriff court. A review of Community Service is not yet complete.

There are a number of new initiatives. Already up and running are an intensive probation project for young offenders and an Ayrshire wide bail service. An Ayrshire wide Drug Treatment and Testing Order scheme will be introduced later in the year. Criminal Justice and Children and Family teams are co-operating in developing youth justice services, including implementing the Fast Track Children's hearing pilot project and introducing the Intensive Probation Project for young offenders. The 'Change' domestic violence programme is scheduled to commence early next year within South Ayrshire Council with a view to subsequent roll out across the partnership. A post has been funded to help create a pathway for a joint health/social work forensic team. The Progress 2 Work service (for those with drug problems) is now in place across Ayrshire, complementing the existing employment initiative commissioned from Apex.

All these initiatives show that the partnership is putting significant effort into service development. The evidence suggests, however, that that there is still some way to go in developing both a consistent and comprehensive set of services across the partnership and a consistent approach to monitoring standards and effectiveness. There have been some difficulties with staff sickness and recruitment but it is concerning that there have been delays in allocating offenders to community service and problems in meeting other national standards.

Public protection

The partnership is developing a service for sex offenders. The so-called Ayrshire 'Change' initiative (not to be confused with the domestic violence initiative) has commissioned a State Hospital psychologist to develop a 2-1 programme for use with sex offenders. The programme is intended to meet the particular needs of staff working with sex offenders in rural areas and the plan is to submit it for accreditation during 2004.

Quality assurance

Some work has begun across the partnership in developing systems to evaluate outcomes. The introduction of practitioner-based management information systems will assist in this.

Human Resource

Structure of the workforce

Between 2000 and 2002, there was an overall increase of 24 in the number of whole time equivalent fieldwork staff. This overall figure hides a drop in establishment in 2001 for adult services due to restructuring that year, and a drop in the number of staff classed as generic (the change was mainly due to re-classifying posts). There was also a slight increase in the overall number of social worker posts, with a substantial increase of nine in the number of those working with children. Vacancies for fieldwork staff have risen to 25. Social work vacancies have also risen to eight.

The latest figures provided by the Council but not yet confirmed suggest that, between October 2002 and the end of June 2003, vacancy levels for social work posts have almost doubled, rising from eight to 15.5 whole time equivalent, representing nearly 23% of their establishment.

The Council identified areas where it was under pressure, including:

• Mental Health Officers are difficult to recruit;
• home care staff are currently contracted to do a fixed 20 hours a week (the Council is reviewing this as part of a wider strategic review of services to older people); and
• the ageing workforce, with half of the home care staff aged over 50 (across all client groups, there are 44 staff aged over 61 and a further 80 aged between 54 and 60).

The Council has tried to deal with the shortage of qualified social workers by introducing a case management system, strengthening its supervision policy and bringing in extra support staff where possible. An attempt to recruit from overseas has not been successful.

Support for staff

The Council introduced procedures in line with the recommendations of 'Supporting Frontline Staff'. These included:

• adopting a corporate policy to manage stress;
• adopting a corporate procedure on violence and aggression towards staff, together with a harassment and bullying policy;
• investing considerably in ICT, with almost every member of staff having their own personal computer (the Council offers training routinely and personal coaching is also available); and
• holding regular meetings with staff unions and management to agree how to introduce any necessary changes in the best way.

The Council has made considerable progress in reducing the number of days lost through sickness absence (20,000 days in 2001-2002, and 17,000 in 2002-2003). This is said to be due to improved reporting of absences leading to quicker intervention when absence rates reach a certain level. An absence procedure document has been produced, which is now used across the Council.

Absence rates in childcare services, traditionally amongst the highest, have fallen from 9.8% in the first three months of 2002 to 5.3% in the same period a year later.

Working towards a more highly qualified workforce

The Council now uses Personal Development Reviews widely. The Council also:

• supports staff to do Masters courses, MHO training, practice teaching and the certificate in child protection;
• pays staff who are practice teachers (750 for every placement);
• supports staff through the DipSW course; and
• concentrates on keeping staff by offering all the benefits of a good employer.

Preparing for registration

The Council has taken a number of steps to prepare its staff for registration with the Scottish Social Services Council (SSSC) and to make sure that it complies with the Codes of Conduct for Employers. All staff are made aware of the conditions for SSSC registration and have received a copy of the codes. The council has also started to map out its needs in terms of registration, and has identified training needs to meet the registration deadline.

Race Equality

In North Ayrshire, 0.7% of the local population are from a minority ethnic group, compared with 2% for Scotland as a whole.

The Race Equality Scheme sets out the Council's functions, which have been identified as relevant to the new duty, and describes the arrangements being made to comply with the general and specific duties set out in the Act.

The Council has been a member of the West of Scotland Race Equality Local Authorities Forum for many years. An Ayrshire MARIM steering group is in place. This is supported by a local North Ayrshire MARIM group, which was set up in November 2001.

Use of Information Communications Technology (ICT)

Social Services Department

The Council has provided many more personal computers for staff and all social workers now have them. They will also be provided to residential and day care units. Internet access has to be approved by principal officers. The department has no ICT strategy of its own but is part of the Council's corporate strategy. It is part of the consortium that is developing the Care First information system, which already includes performance and planning functions.

Partnerships

Protocols are in place between social work and health for sharing information on older people. These will be applied to sharing information electronically as the new information system is introduced.

Background Profile

North Ayrshire Council covers around 340 square miles, including a coastal area, an inland area, and the islands of Arran and the Cumbraes. Most of the towns and most of the population are at or near the coast.

The social and economic situation is varied. The island of Arran and the northern coastal area are relatively advantaged, while almost all of the other urban and rural areas are significantly disadvantaged. The north coast is relatively well off, but there are areas of deprivation elsewhere.

Spending for every person on social work in 2001-2002 was 250, 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 rose in 2000-2001, and fell back a little in 2001-2002.

Criminal Justice

Human Resources

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