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Short Reviews of Social Work Services in Scottish Local Authorities

Orkney Islands Council

Overview

Orkney Islands Council has made significant progress in recent years but it must continue to develop if it is to meet the greater demands of the future. The Council faces a continually reducing population and, at the same time, an expected increase of 20% in the older age group by 2016. Population changes, remoteness and transport costs all put resources under increasing pressure.

The Council's achievements include:

• a high rate of older people receiving home care;
• a high rate of older people receiving more than 20 hours of home care a week;
• comprehensive, co-operative measures to secure better outcomes for children and young people who are looked after; and
• successfully introducing Free Personal Care.

Orkney Islands Council needs to take urgent action to collect information regularly and monitor and improve its performance in getting reports to Children's Hearings on time.

The authority should also give priority to:

• improving respite care services;
• in partnership with the NHS, improving mental health services for children, young people and adults;
• preparing to introduce the new Mental Health Act;
• developing protocols to support families and protect children of families who misuse substances;
• renewing its efforts to recruit and keep foster carers, including moving quickly to pay them for skills; and
• improving information on the educational, employment and accommodation status of young people previously looked after.

Community Care

Services for older people

Following a large increase in the number of older people receiving a community care service in 2000-2001, the number reduced in 2001-2002. A high rate of people receive home care and the number increased in 2001-2002, with a large increase in the number receiving 20 or more hours a week from eight to 47. There was a significant increase in the number of people in special needs housing in 2001. The council has reported that inaccurate reporting of figures may account for some of the changes in the trend data for older people receiving a community care service.

Rapid Response includes social care, nursing, physiotherapy and occupational therapy services. From December 2002, it has had 36 referrals, far higher demand than in previous years. The service has saved 80 bed days, prevented16 people having to be admitted to hospital and made early discharges possible. As a result, the hospital is now reducing the number of bed in the acute wards. Rapid Response is not available on the islands but services co-operate to meet needs as far as possible.

The Council buys in a domestic and shopping service. However, shops already deliver and often put away shopping, so the Council will review the service.

Intensive Home Care is managed by a joint manager, who is also responsible for the Rapid Response and Home Support (Supporting People) Services. At the moment, 15 people are receiving 15 hours or more in personal care. There is no limit on the hours or cost of the service, with the highest at 49 hours. Many packages are longer term.

The Council has introduced Free Personal Care and made it part of the home care systems without difficulties. Demand was not as high as the Council had expected and it fell off. Free Personal Care was well publicised, with leaflets distributed, adverts placed in 'The Orcadian', seminars run by the Council for social work and health professionals, and the Community Care Forum.

Services for people with learning disabilities

The number of people receiving a service for a learning disability dropped from 52 in
2000-2001 to 39 in 2001-2002.

For people living in the community, the Council will increase short breaks and provide a more flexible service through a new, six-bedded short breaks facility attached to a day centre, using day centre staff for extra support. It is extending shared care to give short breaks in the community. It is very positive that 40% of people with learning disabilities are getting some sort of employment opportunities.

The Council is appointing a local area co-ordinator to help young people move from children's to adult services. One person with challenging behaviour is in a new unit with high staff levels. People have to go to the mainland (Aberdeen) for specialist learning disability health services. As Orkney does not have a community learning disability nursing service, all community nurses have this as part of their duties.

The Council is developing a database of people with learning disabilities.

Services for people with physical disabilities

There was a significant increase in the number of people receiving a service for a physical disability from 92 in 1999-2000 to 129 in 2001-2002.

The Council has extended a pilot project for Direct Payments - six people are now getting Direct Payments and some older people are being assessed for the scheme. The target is five people on Direct Payments by 2004. Direct Payments are being promoted through Single Shared Assessment. The Council buys in a Direct Payments support service from an Independent Living Project.

Overall, waiting times are reducing, with targets of three days for equipment to be delivered. However, at the moment the waiting time for a raised toilet seat is 16 days. Decisions can be made quickly, with occupational therapists now having responsibility for handling the funding. Monitoring is by a paper system but a joint database is being prepared. Deliveries by boat to the islands can be a problem.

People with sensory impairment

The Council provides sensory impairment services for fewer than five deaf-blind people and 42 with hearing impairment (12 of them are deaf).

Services for people with mental health difficulties

Following a massive increase in the number of people receiving a service in 2000-2001 (from 19 to 152, when people with dementia were included in the figures), the number fell back to 31 in 2001-2002.

Specialist health care services are limited, and meeting statutory duties is difficult at times. The new joint manager for mental health services will lead a new steering group for the Mental Health Act to produce a mental health strategy document. The problems that need to be dealt with include:

• no access to a Section 20 doctor;
• no consultant psychiatrist based in Orkney;
• no access for people over 65 to a consultant in old age psychiatry; and
• no police surgeon for forensic work.

Some joint service developments are underway. A Home Treatment programme involves phased intervention of community support services to prevent people from being admitted to hospital. Co-locating services in Stromness will be the forerunner of a Community Mental Health Team. Mentally disordered offenders would be included in joint service arrangements, as necessary.

Tackling substance misuse

Following a large increase in the reported number of people receiving a service for substance misuse problems in 2000-2001 (from three to 58, which may be attributable to incorrect classifications) the number reduced considerably to seven in 2001-2002.

There are no residential facilities in Orkney (the Council shares funding for placements on the Scottish mainland with the NHS). The Council is developing supported housing for four people. A Home Support Team provides community services for people with drug problems.

Orkney uses STRADA courses for training staff.

Criminal justice services include diversion from prosecution and a scheme that provides awareness education in drink-driving offences to avoid sentencing. In the interests of crime prevention, the Drugs, Alcohol and Smoking Action Team promotes the sharing of information and there are good links between social work and the police. Other preventative services include a SACRO programme in schools and driving awareness in schools through Community Safety.

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:

• progress the proposals outlined in their full Local Partnership Agreement;
• review specified joint governance arrangements e.g. the status, decision-making powers;
• review delegated powers, corporate and political governance of the Orkney Health and Social Work Forum;
• review specified joint governance arrangements at senior management and single management levels e.g. the decision-making powers and delegated powers of the Joint Management Team;
• review joint service and clinical governance arrangements for joint services;
• review the completeness and appropriateness of their joint human resource arrangements;
• develop further financial management arrangements (both strategic and operational) and financial protocols (both strategic and operational); and
• develop a joint protocol for Information Sharing, including requirements for consent to sharing information.

On the ground, Orkney has reorganised community care services to make it easier for them to become part of partner agencies. Some joint services are in place and others are being developed. Occupational therapists have a single manager for hospital and social work employees and a joint equipment store is well established, with increasing access across organisational boundaries. The Rapid Response Team is joint and the Community Care Team has two nurses seconded to work as care managers. In Mental Health, the joint appointment of a manager means that Orkney can go ahead with setting up a Community Mental Health Team to take forward the strategy to improve mental health services and provide support to staff, particularly to community psychiatric nurses. There is no NHS learning disability service in Orkney. Options for a joint service for people with substance misuse problems are still being looked at.

A joint Carers', Users' and Patients' Involvement Database (CUPID) supports service planning.

Working with Carers

The Council funds the Princess Royal Trust to provide a range of support services through the Orkney Carers' Centre. With Crossroads it also provides home-based short break services. Demand is high for residential short breaks, both in residential homes and independent flats, but there are not enough places. Demand from carers of people with a learning disability has risen sharply and the Council expects that demand from people with complex needs will double. There are no community short breaks for people with a learning disability.

All carers are offered an assessment as part of the Single Shared Assessment process and a database records those who take up the offer and those who turn it down. In 2001, 20 assessments were carried out and in 2002 17 were carried out, mostly by the Carers' Centre. The Council expects the offer of self-assessment to increase take-up. Carers are consulted on service developments and write the carers' chapter of the Community Care Plan. There is a separate Young Carers Strategy.

Children and Young People

Looked After Children

There was a small increase in the number of children and young people looked after in
2001-2002. No children are currently living in kinship placements.

Fostering and adoption

No children are waiting but there is a general lack of foster placements for teenagers and this limits choice. The effect of this can be significant as children may be placed some distance from home. The Council is considering developing specialist foster carers and introducing a fee structure and payment for skills. A survey of carers is being carried out as part of this process. The number of foster carers is going down and a review date of fostering has been set for November. However, this is a long-term issue for the Council to resolve.

No children are waiting for adoption. Fewer than five children have recently been freed for adoption and are in an adoptive placement. Children are normally placed for adoption outwith Orkney, and a small number of children from other areas are currently placed in Orkney.

Educational attainment

In Orkney, fewer than five 16 to 17 year olds who stopped being looked after in 2001-2002 attained Maths and English standard grade so no figures are available. Not all children and young people who are looked after have individual education plans. All looked after children have care plans which look at their individual educational needs. Teaching staff go to every review.

The Council has taken steps to improve educational attainment, including:

• preparing individual education plans for children and young people who are looked after and who have complex needs;
• using core groups involving education, social work, educational psychologists and sometimes parents to make sure these plans are put into practice;
• training all residential staff in using 'Learning with Care' materials; and
• introducing individual education plans for all children and young people who are looked after by next year.

Throughcare and aftercare

Staff are working with 28 young people up to the age of 19. A database is in place to collect statistical information, which is now being put into it. Care plans for these young people are in place, although review arrangements are not consistent.

Most young people move into tenancies of their own, supported by their social worker and staff from the residential unit. Some will first have lived in the independent living flat attached to the residential unit.

Mental health

Young people who are looked after and have mental health problems are identified through the review process. There are significant difficulties accessing assessment and treatment. A psychiatrist and clinical psychologist visit Orkney every three months and tele-medicine arrangements allow access to advice and consultation with specialist services in NHS Grampian. The Council and partner agencies are working together to improve service levels. A community mental health team that will include a specialist childcare social worker is due to be up and running by March 2004.

Child protection

There is a relatively high rate of child protection referrals, children subject to a case conference, and children on the child protection register. Orkney had the second highest rate of referrals in Scotland in 2002. The high rate of referrals is not reflected in the number of case conferences or in the rate of registration. This is said to be due to increased confidence in the service and effective multi-agency working.

The Council has introduced a number of child protection initiatives, including:

• a workplan to take forward the recommendations of the Child Protection Review;
• new multi-agency protocols;
• appointing a Child Safety Co-ordinator;
• multi-agency case conferences, which are now convened by the police if a high risk offender moves into the area; and
• files on child protection and high risk offender cases, which are accessible to all relevant staff.

One ongoing difficulty is that paediatric services are limited and at the moment children who need an assessment by a paediatrician have to be flown to the mainland.

Children with disabilities

At the moment, 34 children with a disability receive a service. There has been an increase in demand for respite care services, including:

• the unit that provides residential short breaks;
• 'Share the Care' support;
• summer playschemes;
• a family focus service to support young people in their families;
• a groupwork programme to promote the social integration of young people with disabilities; and
• a Crossroads young carers' project.

The Council has had some difficulty working with NHS Orkney on services for children with profound and multiple disabilities, but has itself invested heavily in this area.

Children and family social workers go to all future needs assessments. Community care workers go to reviews up to two years before a young person moves to adult services.

Most children with special needs are identified as a result of pre-school assessment.

Working of children's hearings

No information is available in relation to Standard 2 in 2001-2002 (100% of referrals are made within five working days of a case conference). SCRA statistics suggest that performance against Standard 3 (reports to be submitted within 20 working days of the date of request) was 46%. Orkney Council said most reports are available within 25 days. The Council must make efforts to tackle these operational issues. Significant progress can be made through simple improvements in communication, and before the inspection visit, action had already been taken to set up regular meetings with the Reporter, service manager and team manager of children and families services to collect information and monitor performance with the children's panel.

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

Youth Justice

The Council has appointed a specialist youth justice worker to assess young people using the ASSET assessment tool.

The alcohol advisory service runs an education programme for young people at risk of misusing alcohol. The reporter makes referrals on a voluntary basis. Seven young people have done the programme, which is monitored from feedback to three-monthly youth crime review group meetings.

Youth mediation and reparation is run by SACRO. Last year, six young people were referred and all successfully finished the programme. Referrals are through the reporter or procurator fiscal. The progress of individuals is monitored from feedback to quarterly Youth Crime Review group meetings.

Children and Families and Criminal Justice staff carry out joint programme work with individual persistent young offenders within the children's hearing system, using material from the 'Constructs' and 'Targets for Effective Change' programmes.

Before the inspection visit, a working group was set up specifically for training on this issue, for both adult and children and family staff (to take place in November).

Criminal Justice

Structure

While Orkney is not in a formal criminal justice grouping it is committed to inter-island communication and co-ordination with Shetland and Eilean Siar. To date this has resulted in sharing of strategic plans and ideas about how to deliver services in the islands context, discussion of responses to national consultation documents, and some initial work on quality assurance issues.

Workload

Though there has been some increase in Community Service orders in the past year, levels of social enquiry reports and probation have remained stable, reflecting the static overall crime rate. The Council's ability to meet performance indicators has been at a high level over the last 4 years.

Effective practice

The Council uses the Scottish Executive risk assessment framework to assess the risk and needs presented by offenders and determine the level and content of supervision. The Council uses a range of available materials to deliver structured offence-focused work. A programme for the perpetrators of domestic violence was recently launched and early indicators are that it is working well. The "Care and Respect" programme for drink drivers commissioned from SACRO as part of a deferred sentence is well used. SACRO continue to operate a 4 bed residential unit for offenders. This provides a bail bed facility and takes offenders with accommodation and support needs. Its occupancy level is of some concern, running at between 50 and 60%. SACRO has recently been commissioned to run a Young Offenders' Mediation and Reparation project.

The Council has plans to develop its community service scheme to incorporate a greater training/skills component and is considering the possibility of the CS supervisor gaining a qualification as an SVQ assessor. The Council is investigating the possibility of establishing a befriending service for low risk offenders.

Public Protection

The Council has experienced challenges in providing specialist intervention for the low numbers of those convicted of sex offences. It has arranged with the Northern Partnership that its sex offender programme can be used, either under the advice and guidance of the specialist team, or by arranging for offenders to attend sessions in Aberdeen or Inverness.

Quality assurance

Evaluation has improved over the last year with client feedback now built into 3 monthly reviews. The criminal justice section is to be included in a rolling programme of policy reviews under the Dept. of Community Social Services quality assurance system.

Human Resource

Structure of the workforce

There are currently no vacancies. Social services are in functional teams, with a generic out-of-hours service. Major pressures are seen not on the current workforce but in planning for an increased level of service in the future.

Support for staff

The Council has introduced:

• regular frontline staff meetings with senior managers;
• a supervision policy and standards, together with staff review and development procedures;
• mobile phone access for everyone who needs it;
• training in dealing with violence or aggression;
• a staff newsletter; and
• access to an occupational counsellor.

A corporate absence management policy allows managers to monitor attendance and organise any necessary actions before problems become too severe. Absence levels are the highest among staff in residential units for older people.

Working towards a more highly qualified workforce

The Council has a training strategy that includes succession planning. Currently, all fieldwork social workers are qualified, but Orkney also ran an advertisement campaign highlighting training possibilities. Fifty people responded to the local advertising campaign, and currently six staff are supported on degree or DipSW training - five are fully-funded (including one fast-track), and one is self-funding. The service has five practice teachers (reduced to four since the inspection visit), with an extra two taking the Practice Teacher Award, and four Mental Health Officers.

Preparing for registration

The service has invested a lot of money (relative to the size of workforce) in training to make sure staff are prepared for registration with the Scottish Social Services Council. There is a training and development manager, and two peripatetic workplace assessors aiming for 30 awards (SVQ 2 or 3) each year. Current estimates are that reaching SVQ 2 would take nine months to a year and SVQ 3 in 12 to 15 months, although some staff had finished SVQ 2 in around five months. The Council expects problems in acquiring the correct qualification levels for staff in residential settings for adults, but work is underway.

The service is working in partnership with Orkney College to deliver the combined award for children's services staff and for adult services supervisors.

Race Equality

In Orkney, 0.5% of the local population are from a minority ethnic group, compared with 2% for Scotland as a whole.

The Council has completed a corporate Race Equality Scheme.

An agreement is in place with the police to access interpretation and translation services when needed.

Use of Information Communication Technology (ICT)

Social Services Department

There is a corporate strategy on ICT (which covers social work) with a special interest in developing a 'one-stop-shop' computer link with the islands. All staff, except for home care staff, have access to personal computers, and mobile technology would be invaluable for staff working in more remote areas. Records held by clients are well established for health and social care information.

Partnerships

Orkney is preparing a protocol for sharing information between social work, housing and health. Currently, information on clients and patients is shared on paper systems and this is used for Single Shared Assessment. This will be replaced soon by a joint system to send secure e-mail by fibre optic cable. An MGF-funded project for an integrated electronic system should be up and running next year for community care and children's services. Orkney is one of five areas for putting the Resource Use Measure into practice and it is already providing information that is being used for joint planning.

Background Profile

Lying off the north coast of Scotland, Orkney is made up of a number of islands, the largest being Mainland, which is connected to four others by the Churchill Barriers. The inner and outer isles have sea or air transport links. The local economy depends mainly on tourism, agriculture, fishing and their associated industries.

Between 1995 and 2001, jobs in the manufacturing industry reduced by around 29%. These have been partly offset by an increase in the services sector.

Spending for every person on social work in 2001-2002 was 407, whereas for Scotland it was 267.

Expected population change

Community Care

Expenditure on community Care has increased slightly over the period 1999-2002.

Children and Young People

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

Criminal Justice

Human Resources

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