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Short Reviews of Social Work Services in Scottish Local Authorities

Scottish Borders Council

Overview

After major financial and organisational upheaval, the Council is developing its services in a new framework, supported by a health board that has also undergone organisational changes. This should provide new opportunities for the authority, which should make the most of them.

A separate inspection of learning disability services by the Social Work Services Inspectorate is currently in progress, and these findings will be published separately. This inspection may identify issues that the Council needs to deal with that are not highlighted here.

The Council's achievements include:

• providing a high rate of community care services to people with mental health problems and physical disabilities; and
• introducing Free Personal Care relatively smoothly.

The Council urgently needs to:

• agree with NHS Borders the financial framework for developing community-based services for people with learning disabilities;
• improve the educational attainment of children and young people who are looked after;
• make sure that all children and young people who are looked after are receiving full-time education; and
• improve its poor performance in relation to the lateness of reports to Children's hearings, aiming to achieve national targets.

The Council needs to work with NHS Borders and other partners on:

• confirming gaps and shortcomings in existing mental health services and introducing changes to make sure that it identifies and meets the mental health needs of all looked after children;
• working intensively to take forward joint services, joint management of services and joint resourcing;
• introducing the new IT system that the Council is said to be depending on to improve services;
• increasing investment in advocacy services, in particular for people with mental health problems and people with learning disabilities;
• finishing the review of home-based services to deal with the problems highlighted by the 2002 annual report in relation to home care; and
• taking forward a plan for introducing the Mental Health (Care and Treatment) (Scotland) Act 2003.

The Council needs to improve the way it collects information and monitors performance in a number of areas, including:

• educational progress of all children and young people who are looked after;
• educational, employment and accommodation details of young people receiving aftercare services; and
• children's hearings.

The Council also needs to give priority to:

• planning a range of accommodation options for young people who have been looked after;
• improving the quality and quantity of support from corporate human resources towards social work; and
• in view of the current age structure of staff, recruiting younger staff to fieldwork and management posts, introducing succession planning and encouraging appropriate skills transfer.

Community Care

Services for older people

The number of people receiving a community care service is gradually increasing. The number of older people receiving 20 hours or more a week of home care has continued to increase since 2000, but the number receiving the service is still low compared with many other authorities. The number in special needs housing reduced substantially in 2001, but increased in 2002.

One of the partners' priorities is more intensive home care services. By 2002-2003, an extra 18 people were receiving more than 20 hours a week. Further increases are planned for 2003-2004. The number of people getting more than 10 hours a week has also increased significantly.

The Rapid Response Service started in 2002-2003 in two areas and, at the moment, it supports about 75 people. The Council is extending the service to all the Borders in 2003-2004, so that it will reach 650 people.

The Council has extended and expanded short-break respite care services to provide more flexible responses, particularly at home. In 2002-2003, 80 more people had a residential break, and 70 new clients got a short break at home. In 2003-2004, the Council plans to provide a further 30 residential breaks and 270 home breaks.

The current shopping and household service, which provides support to relatively few people, is being reviewed. There are plans to reach about 250 people under this initiative.

These developments help to re-balance care services for older people.

The Council introduced Free Personal Care (FPC) but this needed a lot of work. The Council's information systems were not ready for it and definitions of what should be provided were unclear. However, funding was adequate. A phone helpline, publicity campaign, leaflets and radio programmes were used to tell both providers and carers about the service. Introducing FPC led to a review of existing home-based support services. FPC is now part of the existing community care systems and processes.

Services for people with learning disabilities

Both the Council and NHS Board realise that they have to develop a range of effective community services for people with learning disabilities and the newly reorganised NHS Board has put this issue at the top of its agenda. The NHS Board provides a wide range of therapy services, such as music therapy, which Council staff may access. The Council has not yet agreed a financial framework for community-based services with health. An assessment of the health needs of individuals with learning disabilities is being made to help to develop an effective structure of community services.

A Joint Commissioning Team (JCT) for learning disabilities has been set up between the Council and the NHS to give service development a boost. Partners have agreed 10 new posts for learning disability and one for long-term support. The joint service is not yet up and running.

Supporting People funding was used to help 70 people live in individual tenancies in 2002. At the moment, there are only three people still in long stay hospitals whose accommodation and care package have been jointly identified by health and social work. Their accommodation is in the form of secure tenancies in the private sector. An independent study is being made of the accommodation element in all care packages.

It is planned to appoint a single manager, an additional team manager and two social work posts for a joint service by early 2004. A new service is due for 2005, to support people with challenging behaviour or forensic needs.

The local partners are planning a joint database, which will become part of the new Scottish Borders Council information system.

People with physical disabilities

The existing scheme for Direct Payments has been well used (including a high percentage of older people). Training for staff has been extended and now includes health staff, carers and service users. People will be able to buy services from the Council. Borders Voluntary Care Forum is providing support for service users, and the Council is also using 'circles of support' to help people.

Recently, the profile of equipment and adaptation services has been raised significantly. Systems have been formalised and responsibilities made clear to deal with shortcomings. Extra funding is being provided because of this improvement. Training is being provided to give more staff groups access across health and social care. Staff and members of the public have access to an innovative web-based information system, developed with funding from the Modernising Government Fund.

People with sensory impairment

There is no formal process for collecting information on people with hearing impairments. However, there is a register for people who are blind or partially sighted. At the moment, 33 people identify themselves as deaf (people who use sign language), 680 as partially sighted and 120 as blind. Services for people with sensory impairment are planned with the help of user groups which feed into the consultation and planning process, such as the Physical Disabilities Working Group, part of the Community Care planning process.

There is one visual impairment development officer, one social worker for people who are deaf or hard of hearing, and one visual impairment rehabilitation officer.

Services for people with mental health difficulties

A high rate of people receive a service for mental health problems, and the number increased from 288 in 2000 to 481 in 2002.

Local services for people with mental health needs includes outreach or dementia work with people in their own homes, and the Council believes this is not properly reflected in the service figures. Some people with complex needs are supported in their own homes. However, the health and social work managers are planning to redesign the services, to provide more integrated mental health services.

As part of the its Business Planning process, the Council is developing a plan to introduce the new Mental Health Act. The Council understands the need for more advocacy and tribunal work and an action plan should be ready by October 2003.

It has been agreed that more joint services should be developed and provided through a range of joint health and social work structures. More joint outreach and dementia services will be promoted.

Mentally disordered offenders are included in mental health services whenever appropriate. Mental health services have now become a priority for both health and social work, following the Mental Health and Well Being Support Group Report. The Council hopes that this will encourage the NHS to develop local forensic services, currently provided by Edinburgh.

The partners are jointly developing a protocol and procedures for assessing risk, and a multi-agency risk panel, with police representation, has been set up to co-ordinate multi-agency care planning, joint working and reviews. There is also a system to divert offenders from prosecution. The Borders care programme approach (CPA) arrangements include everyone who needs these arrangements. There are currently 45 people on the CPA.

Tackling substance misuse

Recent reviews show a high level of hidden need in relation to substance misuse. The Council has increased services for drug users, although the number of them receiving a community care service has not changed much. The Council intends to concentrate on making it easier for people to get treatment, and providing more support for people living in the community, to reduce the need for residential rehabilitation and to reduce possibility of relapses.

Around 80% of referrals to residential rehabilitation are for people with alcohol problems. The Council is developing more home detoxification and services to prevent relapse for people with alcohol abuse problems, through a joint statutory and voluntary organisation bid.

Scottish Borders is developing local joint policies and procedures, for example, a shared assessment tool, building on good practice in Aberdeen. Adult Addiction Services now see the issue of families who misuse substances as part of their role. Information on the number of children affected and their needs comes from a wide range of local records, for example, the Child Protection Register and from referrals to addiction services.

Half of Scottish Borders' community care staff have trained with STRADA.

The Council buys in services for offenders with problems of substance misuse from independent providers. The Council has also asked the Big River Project to deliver an intensive programme for drug-related offenders. The programme involves a variety of methods, and offenders must attend every day.

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 well progressed and overall, satisfactory. The local partners were recommended to:

• put in place joint locality management arrangements, operational and locality joint governance and accountability arrangements and service and clinical governance arrangements.
• further develop financial management arrangements (both strategic and operational) and financial protocols (both strategic and operational)
• agree a statement of a joint resourcing strategic financial envelope for older people's services
• agree a statement of a joint resourcing operational budget for older people's services
• include housing services in all aspects of the implementation of single shared assessment.
• provide joint training to all appropriate staff in social work, housing, and health.
• arrange for assessors to access services across social work, health and housing.

The Scottish Borders partners have set up one joint board made up of two sub-committees, with clearly delegated powers. This is a positive and possibly very powerful way forward for promoting the Joint Future Agenda. They have also agreed to the idea of Local Care partnerships based around primary care teams, and to co-location of health and social work staff wherever possible. Joint resourcing is still being taken forward in a wide range of activities and this includes acute medicine for older people and parts of housing as part of a holistic approach.

The partners are developing joint services gradually. A rapid response service is now set up with health and social work staff. There is a joint equipment store for community nursing and social care equipment, and joint commissioning teams for services for people with physical disabilities. The partners are committed to developing a single service for adults with learning disabilities. They are considering joint mental health services, and agreed plans should be in place by early 2004, in line with Joint Future recommendations. A Joint Health and Care Partnership Board and a joint senior management group are leading these developments.

Under an agreed protocol, the partners share information mainly through Single Shared Assessments (SSA) and care management. The local NHS has three different information systems that need to be made more efficient before these can link with the local authority's IT systems. At present, SSA covers older people, people with physical disabilities and people with dementia.

Support for carers

The Council is committed to involving and supporting users and carers. Users and carers sit on the joint commissioning teams and act as advisers to the Joint Future Partnership Board. The local partners have invested significant resources to support an effective contribution from them, for example, in the planning processes.

The Council supports the Princess Royal Trust, which provides services such as those for 'hidden' carers and young carers. The Borders Voluntary Care Forum runs carers' groups and information services. 844,000 has been freed up from the community care budget to support carers. Carers are offered carers assessments as part of the SSA process. A new IT system will identify which carers' assessments have been carried out.

Children and Young People

Looked after children

The number of looked after children and young people living at home reduced from 68 in 2000 to 51 in 2002, while the number in foster placements increased from 70 to 84 and the number in kinship placements increased from 2 to 12. These shifts are said to be due to:

• greater investment in family centres and early intervention;
• more targeted programmes, linking with health and school staff, meaning that fewer children are on home supervision; and
• increased drug use leading to more children being looked after away from home.

In 2002, one third of looked after children had had three or more placements. This is because children are sometimes placed in an emergency and then a move is planned. Most moves are said to be planned, with few emergency disruptions.

Fostering and adoption

Under five young people are waiting for a foster placement. The families are getting outreach support.

Despite a succesful carers' recruitment campaign in 2002, there remains a shortage of carers including emergency carers. The Council is currently assessing five carers and has approved six. The supply of carers is likely to improve in 2004. The Council has reviewed levels of pay for foster carers. It pays COSLA rates and also makes enhanced payments. There are contract carers for young people who are especially challenging.

The Council has 12 to 14 young people placed outside the authority, compared with 28 in 1996. 12 children have been approved for long term fostering and adoption. Complications are often created by delays in the legal process, particularly due to contact, and children have to wait up to two and a half years. Of the 12 children currently waiting (mostly children younger than eight), there is a number of groups of brothers and sisters. There are currently 15 children placed outside of the Borders for whom the Council is paying adoption allowances. Children from other areas are sometimes placed in the Borders.

Educational attainment

42% of 16-17 year olds who stopped being looked after in 2001-2002 had attained Maths and English standard grade. This is a little above the national average but compares poorly with the 100% target set by the Scottish Executive in 1999 and 94% of the S4 cohort attaining Maths and English. The Council has taken steps to improve educational attainment, including:

• setting a target to close the gap for the lowest-achieving 20% ( many looked after children come into this category);
• introducing written statements of educational improvement;
• identifying low achievers and one-to-one teaching support; and
• using the SWELL group (social work and education lifelong learning), which focuses on learning with care and take referrals of any children to the group.

96% of accommodated children are in full-time education. Fewer than five children have some package of education in place. There are no figures to show how many children on home supervision have full-time education, because of a focus on accommodated children.

All looked after and accommodated children have care plans which look at their educational needs. However, the Council does not monitor the plans. Care plans are being introduced for looked after children living at home.

Throughcare and aftercare

A throughcare and aftercare team become involved with young people before their 16th birthday through the review process. It carries out a detailed initial assessment plan. A transfer implementation group is assessing education, employment and other support for 2004.

The Council's database includes information on care leavers, but it does not cover education, employment or accommodation. A significant number of young people over the age of16 stay in placements until they are 19 or 20.

Developments in throughcare and aftercare services include:

• accommodation for young people leaving care provided by the voluntary organisation, Penumbra;
• two supported lodgings;
• a social worker is part of the 'In Touch' employability project and the Careers service provides 'Include'; and
• the Who Cares? organisation has been asked to carry out interviews with young people as they leave care, and to follow them up six months later.

Child protection

The number of children referred for child protection reduced between 1999-2000 and 2001-2002, while the number of children subject to a case conference and the number on the child protection register doubled in 2001-2002. Almost a fifth of children who were taken off the register in 2002 had been on it for more than two years. Just 2% of children were taken off the register in less than six months. Although the Council tries to remove children from the register after six months where possible, this is difficult because of the large increase in the number of children whose parents misuse drugs and badly lack parenting skills.

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

• a child protection unit where staff are all located together;
• a public awareness campaign;
• the Big River Project run by Turning Point Scotland linking to family support services;
• reviewing the membership of the Child Protection Committee;
• reviewing child protection cases every three months;
• a protocol for managing Schedule 1 offenders which involves a joined-up assessment of risk and automatically sharing information with the child protection unit and with adult criminal justice services; and
• a joint scrutiny panel monitoring where sex offenders are living and where they move to (the panel focuses on child protection so children are not at risk, but it also leads to offenders being included more in local communities since they get access to appropriate housing).

Children with disabilities

The centralised multi-disciplinary team that deals with children with disabilities knows of 231 children affected by disability. There are 138 active cases where children are receiving services. Health knows of 700 to 800 children with disabilities and Education knows of 400 to 500 children with disabilities.

The Council has provided a relatively low level of respite care, and disability services all have waiting lists. However, the Council has made progress on redesigning services to meet people's needs. Aberlour provides 52 residential respite places which are jointly funded, and the Council is developing a residential respite unit to replace the Aberlour service. When the Council consulted families, they said that they did not necessarily want respite care, but did want day care and after-school care, and Aberlour now provides weekend care, holiday care and after-school care. Services are being redesigned around individuals. Home care, childminding and outreach are provided in people's houses, and Health have provided nurses in people's homes to prevent children having to go into hospital.

Social workers from Children and families attend future needs panels.

Working of children's hearings

The Council did not provide a return in relation to standard 2 of the time intervals standards (referrals will be made within five working days of the case conference) in 2001-2002, as they said their database could not provide the information. The Council believed that they were not far short of the target.

40% of reports were submitted within 20 working days of the date of request (standard 3). The Council said that most reports only miss the target by a day or two. Some months, the figure is up to 65%, but in others it is as low as 30%. Cases are prioritised.

The Council said that all supervision requirements are given effect within 15 working days (standard 15), but they do not have a system to prove this. The worker who goes to the hearing carries the work forward.

Youth Justice

Scottish Borders are partners with East Lothian in a pilot scheme for fast-track hearings. The Youth Justice Team has been strengthened to take part in the pilot. A health officer will be appointed to the team. A juvenile liaison officer supports the police part of the pilot. The pilot is being independently evaluated and monitored.

The Youth Justice Team use the assessment tool YLS/CMI. Management and assessment of risk in social work has been adapted to assess risk of harm in young people. There is self-monitoring every three months and action plans are altered accordingly.

All staff in the Youth Justice team are trained to deliver 'Offending is Not the Only Choice'. It will only be offered to those referred to fast track. It is a groupwork programme, but the Youth Justice Team also work with individuals.

Two youth justice social workers deliver the Offence Resolution Programme. This is a diversionary and early intervention service which aims to reduce re-offending by young people aged 11 and a half to 16 (or 18 if still on a Supervision requirement), who have committed up to three offences or episodes of offending. Referral is through the children's Reporter. The programme is firmly based in the principles of restorative justice, and restorative conferencing is being piloted. The re-offending rate of young people who stay within the hearings system has been tracked and the project has brought about a significant reduction in re-offending rates - 84% had not re-offended within 12 months of completing the programme.

Criminal Justice

Structure

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

Workload

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

Effective practice

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

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

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

Public protection

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

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

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

Quality assurance

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

Human Resource

Structure of the workforce

Latest figures provided by the Council but not yet confirmed suggest that, between October 2002 and the end of June 2003, vacancy levels fell from 12 to nine whole time equivalent.

The main pressures are:

• a shortage of diploma-qualified social workers, particularly in the core teams;
• difficulties in recruiting managers of residential units within community care; and
• difficulties in filling home care posts.

The Council has worked in partnership with the local college to set up paid placements to let people on social care courses work part-time in the Council's home care service.

Another positive move was the fall in turnover, with most staff moving inside the Council.

A recent staff survey showed that 50% of social workers are over 50, compared with 48% of staff in home care.

Support for staff

Action has been taken to put the recommendations of 'Supporting Frontline Staff' into practice, including:

• introducing absence management monitoring (initially done manually);
• linking a supervision policy to the personal development scheme;
• introducing a pilot lone worker scheme, carried out jointly with criminal justice;
• regularly reviewing local offices to check that they are safe working environments;
• providing CALM training for staff in children's services and intervention training for staff working with people with disabilities;
• launching a health improvement initiative for staff, promoted by the joint health employment team; and
• drawing up bullying, harassment and stress management policies.

Working towards a more highly qualified workforce

The Council offers the following courses:

• for home carers, a progression award (SVQ level 2.5), for residential unit care assistants SVQ 2 and for social care workers SVQ level 3 (staff can then move to a managerial post and registered manager's award and SVQ level 4);
• programmes on leadership development, which are delivered by the University of Stirling; and
• CIPFA courses of training in project management.

The Council has invested heavily in its own assessors and aims for staff to reach SVQ level 2 in nine months and SVQ level 4 in 18 months. The Council also runs a diploma in management care standards and is an accredited assessment centre.

Preparing for registration

The Council has its work on improving its human resources information well in hand, through the planned introduction of its SDMS system.

The main weakness in getting staff qualified is in career opportunities in the workplace, with long-established managers reducing the career options for those below them.

A 'Return to Learn' course is planned to run in autumn with the Council's health partners.

There have been two awareness-raising workshops for staff (around 50 people came to these).

The Council has run the diploma in management care standards (VQ qualification). It has linked this to the registered manager award and is recognised as an assessment centre. There are four managers doing the registered manager award. Out of 23 unit managers, 19 are recorded as holding a qualification (four were not recorded). Out of 13 assistant unit managers, 10 hold a qualification.

Race Equality

In Scottish Borders, 0.6% of the local population are from a minority ethnic group, compared with 2% for Scotland as a whole.

The Race Equality Scheme includes a three-year framework action plan, which was developed closely with local police. An equal opportunities group is responsible for the scheme and reports regularly to senior management on progress.

The Council has collected information on minority ethnic groups within the area. However, it will need to do a more comprehensive audit to get full information at a local level of black and minority ethnic service users.

Use of Information Communications Technology

Social Services Department

Most social workers have access to personal computers and to the Intranet and the Internet. The Council itself does not have a strategy to modernise the ICT system. There is no formal strategy for developing ICT for Social Work, but the department is introducing a new client-based information system (Framework).

Partnerships

There are already protocols for exchanging information with the NHS. There will be an opportunity to extend these to Education.

Background Profile

The Council area is geographically large, mostly rural, with a dispersed settlement pattern and no dominant urban area. There are several towns with a population of more than 1,500. Over a third of the area's population live outwith these towns in smaller villages and rural settlements.

Compared to Scotland as a whole, there is a higher percentage of jobs in agriculture, forestry and fishing and in manufacturing, and a lower percentage in the service industries. Average earnings are some 19% lower than the national average. The crime rate is low and the area has one of the lowest rates of drug misuse.

Spend per head on Social Work in 2001-2002 was 247, whereas for Scotland it was 267.

Expected population change

Community Care

Expenditure on Community Care rose steadily in the period 1999-2002.

Children and Young People

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

Criminal Justice

Human Resources

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