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Short Reviews of Social Work Services in Scottish Local Authorities

Perth & Kinross Council

Overview

In providing a range of modern services, Perth and Kinross has to cope with a wide geographical area and a population which is partly in smaller towns but mainly scattered over communities in an extensive rural area This rural area poses obvious problems of providing services and access. The Council has recently emerged from a long period of reorganising and is now focusing on developing services by using the Care Together Partnership. It is leading a Treasury-funded project on integrated community care services.

The Council's achievements include:

• setting up the Care Together Partnership as the main way of providing community care services; and
• a marked reduction in the use of residential settings for young people who are looked after by the authority.

Perth and Kinross Council need to take urgent action to:

• collect and analyse accurate information on its performance in relation to the standards of support set for working with children's hearings;
• improve its performance to meet standard 3;
• make sure that 75% of reports are submitted on time;
• introduce further measures to improve the educational attainment of looked after children; and
• in partnership with NHS Tayside, agree and finish phase 2 of the learning disability hospital resettlement programme by 2005.

The authority should also give priority to:

• recording the number of carers' assessments offered and carried out, so that it can monitor the take-up of assessments;
• in partnership with the NHS, setting up a database of people with learning disabilities;
• setting up systems for identifying the number of people with sensory impairment and their community care needs, as a basis for developing local services;
• evaluating how it delivers equipment and adaptation services;
• being involved in the plan to introduce the recommendations of the NHS Tayside Mental Health Services Review;
• forming a project group to complete a plan to introduce the recommendations and statutory duties outlined in the new Mental Health Act;
• reviewing support which can be offered to foster carers and renewing the campaign to recruit more carers to meet local demands;
• setting up a system to provide accurate and up-to-date information on the educational, employment and accommodation status of young people receiving throughcare services;
• setting up a youth justice team and applying an assessment tool to all youth justice referrals; and
• urgently reviewing the ability of the current human resources system to produce accurate and up-to-date management information on social work staffing.

Community Care

Services for older people

The number of older people receiving a community care service increased substantially between 1999-2000 and 2001-2002, from 4,350 to 5,860. At the same time, there was a marked reduction in the number of people in sheltered housing and in those receiving an intensive homecare service of 20 hours or more a week. The number of older people receiving any home care increased slightly in 2002 after a fall in 2000-2001, as did the number supported in care homes.

The Council's home care services are relatively limited. The authority contracts with other organisations to provide 30% of the services and provides the other 70% in-house. Negotiations are being pursued with independent providers to develop external provision. The favoured recommendation of the Best Value Review is to split the roles for assessing and providing services, so that the services would be accessible by any assessor within Care Together. Within the overall home care package in 2001-2002, intensive home care packages were limited because of lack of capacity to deliver, and absence of matching health funding and resources, while the number of older people receiving 10 hours or more increased. However, at the same time, the number of older people receiving two hours and between two and four hours a week dropped.

The rapid response service, together with the early supported discharge service, has improved delayed discharge figures. As a pilot scheme, the Council has placed a home carer in the early supported discharge service.

A 'Good Neighbours' shopping scheme run by the Women's Royal Voluntary Service supported 724 people in 2002-2003. There is also a small repair scheme. A Best Value Review on home care showed the problems that needed to be addressed in shopping and domestic help.

The Council is preparing a respite care strategy and has prepared a budget. Community resources have built up as a result of fewer people in residential care and the budgets for emergency respite have been delegated to staff in localities.

Standards for measuring Care Together performance cover home care, training, a rehabilitation pilot scheme, elderly mental health and community liaison teams. This framework is to provide information for 2003-2004, with feedback from users taken from the clinical governance model. A clinical governance person is being appointed for health and social work. The Care Together Partnership is being independently evaluated from the point of view of frontline services, with a focus on outcomes.

Arrangements for Free Personal Care within care homes went smoothly, with contracts in place and payments received on time. The Council had some difficulty in keeping up with the changes on a day-to-day basis, but the new IT system for the home care service helped to make a distinction between personal care and non-personal care. Providing public information and staffing helplines is ongoing. The helpline took 1,000 calls between May and December 2002, and meetings were held with pensioner groups and with Scottish Care. The Council will make Free Personal Care part of the budget processes in the future.

Services for people with learning disabilities

A small number of people with challenging behaviour are due to be resettled from hospital into the community by 2005, as a second phase of the resettlement programme. They are likely to go to individual tenancies with extensive care and support packages.

Phase 1 of the resettlement programme for Strathmartine Hospital was completed, with 26 people from Perth and Kinross being resettled. Of the 26, nine people went to individual tenancies, 10 people went to care homes, and seven people went to care homes that provide nursing care. Fewer people have gone to individual tenancies. People re-settled to care homes have an 'enabling service' built into their care packages, which include one-to-one staff time and support to go out into the community.

All the different professional groups that work with people with learning disabilities are located together. This provides good opportunity for joint working and sharing information. Services include:

• an employment initiative (CANABLE), that provides 18 people with work at the national minimum wage;
• an advocacy service;
• training in 'person-centred' planning (focusing on the individual); and
• support for carers.

A range of specialist health services is available, including a day hospital service for people with challenging behaviour and input from two community forensic nurses.

Services for people with physical disabilities

The Care Together Partnership now has 13 people on Direct Payments and is evaluating the scheme. It was introduced with written guidance and initial training for staff. Care Together has asked a local voluntary organisation to offer guidance and support to people who receive Direct Payments.

People with sensory impairment

No information is available on how many people locally have a hearing impairment or deaf-blindness. Tayside Association for the Deaf has a database of people with a hearing impairment. Perth and Kinross Society for the Blind keeps the local register of blind and partially-sighted people.

The Sensory Subgroup has a strategic planning role, involving the voluntary sector, service users and carers, and there are links to education and children's services. Progress In Sight is used as a reference for the developing awareness training programme.

Services for people with mental health difficulties

The number of adults with mental health problems getting home care is 30% below the Scottish average, but 318 hours of community support worker time provides home care and other support.

The Mental Health Services Review is underway, to explore new kinds of services that will help shift the balance of care from hospital to the community. A project group is being formed to develop a plan to introduce the recommendations and statutory duties outlined in the new Mental Health Act.

Community Mental Health Teams (CMHTs) are becoming established, and extra community support workers and social workers are being recruited. A Mental Health Officer (MHO) team may be set up to link with the development of CMHTs. There are problems in recruiting and keeping them, so practising MHOs receive extra payments.

The Tayside-wide Mentally Disordered Offenders Forum is concerned with developing strategies, planning, managing performance and buying in services. There is joint assessment and risk management. A new forensic social work post will develop risk assessment and improve arrangements for managing mentally disordered offenders.

Tackling substance misuse

The number of people receiving a service for drug and alcohol problems doubled in 2001-2002 from 22 to 45. Workload figures are more than this, as service users can be recorded under more than one service. The Best Value Review in 2002 showed that the service was dealing with 105 people.

There is a service manager for addiction services and a Drug and Alcohol Team. A Tayside-wide assessment tool is in use. A Substance Misuse Action Team (SMAT) has corporate responsibility for developing local services, and a local multi-agency design and development group is mapping services and identifying gaps. The Partnership is developing a 'one-stop shop' integrated service. It has bought in a counselling service for people with drug problems (12 people got this service in 2002).

There is a shortage of community detox resources, and this has increased the need for people to go to residential rehabilitation, although the numbers are small. Extra social care officers have been appointed to expand community support.

A multi-agency group that is mapping services puts 'Getting our Priorities Right' into practice. Protocols and procedures have been developed and there is also a model of risk assessment for all workers. Multi-agency training is to be provided on supporting families who misuse substances. A range of developments is funded from the Changing Children's Services Fund, including:

• Hopscotch, commissioned to support children from families who misuse substances;
• extra support for parenting activities;
• Surestart Scotland, commissioned to provide outreach support from family centres to parents with very young children;
• a rehabilitation fund to support young people; and
• a community flat to provide activities for 8 to 12 year olds affected by substance misuse.

An arrest referral scheme is up and running. So far, 379 people have been interviewed and 35% of them have been referred to drug and alcohol agencies. The arrest referral worker has worked with childcare services and given advice and information to families. There is a two-year pilot scheme of complementary therapies. Joint work with the Substance Misuse Action Team is being carried out with offenders coming out of prison.

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:

• consider the development of a service/clinical governance policy and of a joint complaints handling policy;
• ensure that accountability for delegated functions is set out in an agreement;
• further develop their joint resourcing financial framework;
• ensure that appropriate housing staff receive training in SSA. (JPIAF 7 indicates no housing staff trained); and
• complete and submit JPIAF 5 proforma.

On the ground, so far the Care Together Partnership -takes in mainly older people's services, and will cover other care groups in the future. Joint budgets and resources have not yet been finalised for all client groups. There are some single management arrangements for teams and a range of joint services - (intensive care at home, delayed discharge response and community liaison services).

A protocol for sharing information and systems for sharing it electronically are in place. By mid 2003, 700 staff will have been trained to use the electronic system.

Working with carers

A carers' strategy is being put into practice through the Carers' Task Group of the Health and Community Care Executive Group. The task group includes representatives from NHS Tayside Advocacy Services, the Princess Royal Trust for Carers, carers and service users from all the main care groups. This group has already launched a 'hidden carers' campaign. Groups of older people are being set up in each of the localities who will be involved in planning services. Budgets will be identified for meeting carers' needs and protocols developed for including them as part of the main services in 2003-2004.

The Carers' Task Group has developed carers' assessments. A protocol for carers is to be prepared to enter into an agreement with the Care Together Partnership. Assessments may be carried out for the Council by the Princess Royal Trust, but carers' assessments will continue to be offered in the course of a comprehensive assessment and care management service.

Children and Young People

Looked after children

The number of children in foster care increased between 2000 and 2002, while the number at home reduced. The number of children in residential accommodation reduced from 30 in 2001 to 19 in 2002. In particular, the number of children in residential schools dropped from 24 to 11. Currently there are fewer than five children in residential homes and eight in residential schools. The reduction is due to a combination of things, including:

• the 'reintegration project' (which involves teachers, a social worker and an educational psychologist) tracking children and supporting them to return to the community from residential schools (four foster carers are part of the project and 18 young people are currently receiving support);
• resources and support devoted to preventing children from going to residential schools (including social workers, teachers, psychologists, NCH and learning and care co-ordinators); and
• children's hearings now accepting that some children do not need to be in residential schools - co-operation between education and social work and the availability of alternative projects have impressed hearings.

Fostering and adoption

Foster care is still the largest provider of accommodation for looked after children in the area, in line with the aim of placing children in family settings wherever possible. However, there have been cases where groups of brothers and sisters could not be accommodated and extra supports were put in place or they were placed with relatives in the short term. Some children are waiting for respite care.

Many foster carers have more children than they have been approved to take. The Council lost five carers in a period of six months. A recent recruitment and marketing campaign included advertising in the papers and on the radio. The Council pays foster carers a carers' element and a child element, which is related to the age of the child. There are three levels of payment, with most carers at level 2.

Only a few children are fostered out of the area. No children are waiting for adoption, but 17 children are waiting for permanent placements. It takes longer to find adoptive parents for groups of brothers and sisters. The Council has approved four groups as needing permanent homes and is looking for suitable families.

Educational attainment

In Perth and Kinross, 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. The Council has taken a range of measures to improve the educational attainment of children and young people who are looked after. For example:

• eight secondary schools now have integrated team meetings with social work, and each month all schools receive an updated list of children and young people who are looked after from care and review officers;
• all schools have tracking systems for all pupils, including children and young people who are looked after, and there is supportive self-evaluation of children and young people who are looked after;
• the Council provides a programme of joint training for designated teachers, social workers and foster carers;
• foster carers have received computers and software;
• some young people have been funded to do college courses; and
• social care officers have been used to support children in the classroom.

All children and young people who are looked after are receiving a full-time curriculum but are not necessarily in schools full-time. At the moment, 12 children have a flexible educational support curriculum.

All children and young people who are looked after have care plans, but an audit found that the quality was varied. There are links between the care plan and Individual Education Plans for children with special needs. Schools are moving towards every child having a personal learning plan.

Throughcare and aftercare

The Council has expanded the throughcare service to include social care officers from a range of backgrounds. The service can be accessed 24 hours a day, seven days a week, and the Wellbank and the Go projects go out to any area. The Independent Living Service (ILS) also provides a service in rural areas. Cases are transferred to the Wellbank team when young people are 16 or 17. The team goes to reviews when young people are 15-and-a-half.

An information system is not yet in place and there is no proper tracking information. The throughcare team is working with 120 young people at the moment. There are normally 30 to 45 new cases a year.

Accommodation initiatives include:

• the Homeless Person's Review Group, chaired by housing and involving social work and health;
• Wellbank providing 10 accommodation places with 24-hour support - there are also four supported accommodation placements, a range of supported flats and two dedicated carers who link into throughcare and aftercare; and
• seven young people who were in foster placements have been able to stay in them as the carers have moved to being supported landladies, so providing continuity of care and support.

Mental health

Medical officers go to all reviews on accommodated children and access psychological support. There is only one psychologist in the area. Occasionally, the Council employs a psychologist. Positive developments in mental health include:

• as part of the local Child and Adolescent Mental Health Service (CAMHS) review, officers reviewed the mental health of every looked after and accommodated child;
• three extra mental health workers have been appointed;
• two mental health community workers identify children at 'tier 1' level and identify children who need to be fast-tracked into tier 2 or 3; (they hold a small caseload monitored through the local CAMHS implementation group and provide training and awareness raising to foster carers and residential workers); and
• the Bridge project is designed for sexually aggressive young people.

Child protection

Following increases in 2000-2001, the number of referrals, the number of children subject to a case conference and the number of registrations reduced in 2001-2002. The number of child protection cases involving substance misuse is said to have risen by 25%. Some recent child protection initiatives are aimed at the issue of substance misuse. For example:

• an inter-agency training strategy includes basic awareness-raising, specific topics and conferences (all levels of staff can attend training);
• integrating social work and education child protection policies and procedures;
• protocols for referring unborn babies in high-risk families and newborn babies born to parents who misuse drugs;
• links with the drug and alcohol team;
• social care officers to support parenting (for example, where the child is not going to school or nursery);
• a Barnardo's Hopscotch project to work with children and their carers if the family misuse alcohol; and
• a yearly audit of child protection cases.

Children with disabilities

The Council uses a grid designed locally to identify levels of need. Currently, 91 children are referred and 85 are getting respite care services. The number of children receiving a service has increased.

Local services include:

• respite with family carers for a small number of children;
• the Princess Royal Trust providing a young carers' service to 45 to 50 children;
• a playscheme service provided by Open Minds for three to four weeks in the holidays;
• the Splash summer playscheme;
• residential respite provided by Capability Scotland; and
• a 'take a break' scheme run by Barnardo's.

Working of children's hearings

Information is not collated on how many referrals are made within five working days of the case conference (standard 2).

Information is not provided on performance to standard 3, but SCRA's statistics suggest only 17% of reports met the target. Low performance is said to be due to staffing problems and an increase in referrals from the reporter. Particular problems arise in rural areas where there are many referrals.

In the absence of information on standard 15, it was claimed that all supervision requirements with no condition of residence were given effect within 15 working days of the date of issue by the children's hearing.

Youth Justice

The Council still needs to set up a specialised youth justice team. Community learning and field workers, and sometimes the police, run the youth justice programmes. The Council has not yet started to use assessment tools. Quality indicators are being tested across the service and the Asset assessment tool will be included.

There is a three-tier system of levels of intervention and assessment. SACRO provides the personal change project for young people who have five offences against them and this is the main service to young offenders. The range of projects at level 2 is made up of:

• the Alyth Youth partnership, which runs preventative schemes aimed at reducing anti-social behaviour;
• the Scottish Centres Project, which is for those who are disaffected at school;
• the YMCA project, which works with young people who find it difficult to integrate in school (with DJ workshops and football groups); and
• the Thrillseekers Project in Blairgowrie, which draws in young people on Friday evenings at a time of high crime rate in the area.

At level 1, there are karting and Futsal projects, which include drugs education.

Criminal Justice

Structure

Angus, Perth and Kinross and Dundee operate as a partnership for delivery of criminal justice services. Management direction for the partnership is provided by a team of senior officers from the three authorities, answerable to a steering group which includes an elected member and a chief officer from each council. A partnership development manager has been appointed to co-ordinate and oversee service development.

Workload

There has been a small increase (3%) in demand for core services across the partnership as a whole though there are variations between the constituent authorities. Both Angus and Perth and Kinross have experienced an 8% rise in probation orders and the latter has seen community service figures rise by 13%. The grouping advises us that they are experiencing some pressures as these increases in workload coincide with a period when recruitment and retention of staff is especially problematic.

Effective practice

The partnership uses a structured assessment to assess the risk/needs presented by offenders and determine level of intervention. The risk assessment tools that are in use are similar across the grouping, but are not identical. However, all members of the grouping indicate that they intend to adopt a nationally agreed framework for risk assessment when this becomes available. Structured offence focused group work is available across the partnership and to all residents of East Port House. Programmes which deal with substance users and those which deal with young people's offending behaviour are also available in each of the authorities. The partnership has successfully submitted a joint bid with Northern Partnership to the Scottish Executive for funding to develop a women's programme for accreditation. There is a commitment to undertake a best value review of programme provision and to use this as the basis for future developments.

Services to women offenders are also being developed through identification of more Community Service work placements which meet their needs. There are presently women-only Community Service squads in Dundee and light duties resources available in Perth. In Angus, women subject to community service are offered individual placements, with mixed gender teams operating only following requests from women offenders to be placed in such teams. Discussion is under way to provide a core training programme to Community Service staff, including offence / harm risk assessment. The core training programme for CS staff will involve training in pro-social modelling skills.

Other developments include extension of the Drug Treatment and Testing Order (D.T.T.O) scheme to Tayside Courts and establishment of an arrest referral scheme across the partnership. While the D.T.T.O scheme clearly has healthy levels of uptake and confidence from sentencers, compared to other schemes there was a very high proportion of two and three year Orders. While each case must turn on its merits and will depend on the individual sentencing decision made in Court, the grouping should continue to liaise effectively with the judiciary to manage the scheme in terms of ensuring sufficient ongoing treatment capacity.

To promote the social inclusion of offenders, the partnership has also contracted an Employability scheme from Apex. In addition, the partnership is developing its service to the prisons in its area, including undertaking risk assessments on all prisoners in the Open Estate and on those approaching release on licence or order from HMP Perth. For next year, the partnership aims to introduce a new prison throughcare service.

Public protection

Services to sex offenders across the partnership continue to be provided by the Tay Project. The Project now offers an additional programme for those sex offenders in denial of their offending. It has also extended the range of training it offers, including training earlier this year for Police across Scotland on its risk assessment tool, TAYPREP 30. The partnership aims both to seek validation for this tool and accreditation for its Induction programme for sex offenders.

Quality assurance

The partnership has embarked on a review of its data systems to ensure that information on needs, processes and outcomes is available on a regular basis. The partnership aims to establish an integrated approach to assessment of quality and to monitoring and evaluation.

Human resource

Structure of the workforce

Although the figures reflect the changes in classifying any workers with children and young people to education, the Council says that the number of staff providing social services to children has risen from 158 in 2001 to 194 in 2003. Over the same period, the number of staff in the Care Together Partnership (which covers all other elements of social services) has risen from 570 whole time equivalent in 2002 to 590 whole time equivalent in 2003. No updated vacancy figures were available from the authority in June 2003.

Pressure points are:

• home carers, who are on renewable temporary contracts - this causes practical problems in certain geographical areas;
• the Children's services fieldwork team, which has 3.5 vacancies out of 11 staff; and
• over 100 children's services staff being aged between 40 and 60 - within the Care Together Partnership, 31% of staff are over 50, and within home care in particular over 50% of staff are over 50.

Support for staff

The Council has made a number of changes, including:

• introducing a manager's guide about flexible working, which goes further than national guidelines;
• extending arrangements for staff on maternity leave so they go further than national requirements;
• introducing home working (after a six-month pilot scheme), but this is more suited to staff working in the centre;
• regularly carrying out a stress audit, involving five working groups across adult services;
• upgrading the IT system used by home carers; and
• providing management of physical intervention so that every team and establishment has at least one trained member of staff.

The Council still needs to prepare staff for managing clients' violence and aggression and for dealing with persistent and abusive people who make complaints.

Between April 2001 and March 2002, the absence rate was very high at 9.6% and was due to stress-related illness, particularly with home care staff and residential staff. A counselling service is available.

Working towards a more highly qualified workforce

The Council employs a wide range of qualified and unqualified staff in social work services. Within adult services, there are 50 staff with social work qualifications and 146 with Vocational Qualifications (VQs). There are nine staff with a nursing qualification and eight qualified occupational therapists. Within children's services, there are 91 staff with qualifications. The Council is actively encouraging its staff to undertake post-qualifying awards, particularly the Certificate of Child Protection, the Practice Teaching Award and Mental Health Officer Training. The Council also has 89 staff taking VQs and is planning to fund six existing staff to take the DipSW. The Council expects that staff within adult care who need to achieve the Registered Managers Award will do so by 2005.

Children's services and the Care Together Partnership for adult services have separate training strategies. Where there are common issues such as VQs and continuing professional development (CPD), then the services work together. The Council operates a system of employee development and review, which allows staff to review their development needs.

Education and Children's Services have introduced a new policy on training and CPD for social work services staff, as part of their preparations for the regulation and registration of the workforce.

Preparing for registration

The Council has taken a number of steps to prepare its staff for registration with the Scottish Social Services Council in December 2004 and to make sure they comply with the Codes of Practice for Employers. This has included training workshops for staff and giving the codes to all staff. The Council has amended staff contracts. It has developed a policy for CPD for staff in children's services (initially covering qualified social work staff) and will amend it to cover staff in adult services.

Race Equality

In Perth and Kinross, 1% of the local population is from a minority ethnic group, compared with 2% for Scotland as a whole.

The Council's Race Equality Scheme dates from November 2002.

Education and children's services use an evaluation framework for schools. It is designed to help schools evaluate their current position in promoting Race Equality and help them identify areas for improvement.

The Care Together Partnership is preparing an action plan which integrates social work and health elements for the Race Equality Scheme.

Other action includes:

• amending complaints forms;
• issuing shorter service plans in appropriate community languages for consultation purposes;
• giving translation and interpretation guidance to staff; and
• consulting on a form designed to monitor the ethnic origin of service users.

Use of Information Communications Technology (ICT)

Social Services Department

Social workers have access to personal computers (PCs) and to the Intranet and Internet. The Council is providing PCs to residential and day care units. There is a strategy for ICT development in social work. A new system is being rolled out for using the Single Shared Assessment electronically. Development projects are under way as part of the MGF2 scheme for care planning, client records, delayed discharges and learning difficulties.

Partnerships

A protocol for sharing information and systems for sharing it electronically are in place. 700 staff have been trained to use the electronic system.

Background Profile

Perth and Kinross covers a large rural area, and around 70% of the population live in rural communities. There are large populations in Perth and the south, where there have been extensive new housing developments.

Poverty indicators are low, but poverty and disadvantage do exist and tend to be concentrated in the north. Average earnings were 13% lower than those for Scotland as a whole.

Spending for every person on social work in 2001-2002 was 236, whereas for Scotland it was 267.

Expected population change

Community Care

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

Children and Young People

Expenditure on children's services rose steadily in the period 1999-2002.

Criminal Justice

Human Resources

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