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Short Reviews of Social Work Services in Scottish Local Authorities

Shetland Islands Council

Overview

As a very small authority, Shetland faces major challenges in providing a modern range of services to meet local needs. Geography, a scattered population and transport problems combine to create major problems of providing quality services within available resources, although the Council has had the advantage of working closely with NHS Shetland, and it has received a stream of extra funds from the Shetland Islands Council Charitable Trust. Its existing services must be fully cost-effective so that the extra funds can be used most effectively to help meet the demands of service users.

The Council's achievements include:

• a high rate of older people receiving a home care service;
• a high rate of people receiving more than 20 hours a week home care (the number increased three-fold in 2002); and
• providing high levels of equipment and adaptations for people with physical disabilities.

The Council needs to take urgent action to:

• develop a throughcare strategy for young people who are looked after; and
• collect accurate information on performance on all the time interval standards for children's hearings and improve their performance on standard 3.

The authority should also give priority to:

• working with health partners to identify the joint services, joint management and joint resourcing that will deliver improved outcomes;
• planning for introducing the new Mental Health Act;
• further developing a database of people with learning disabilities;
• promoting carers' assessments;
• developing protocols for supporting families who misuse substances;
• improving partnership working with occupational therapy staff in Health;
• reviewing risk assessment in demonstrating equipment and adaptations;
• recruiting and keeping foster carers;
• completing the review of child and adolescent mental health services;
• making sure social work and education services work together effectively on the 'New Bruce Initiative'; and
• speeding up its joint working arrangements with health.

Community Care

Services for older people

The number of older people receiving a home care service fell in 2001-2002. In 2000-2001, there was a large reduction in the number receiving 20 or more hours a week, but the number increased slightly in 2001-2002 and is still high compared with other authorities. The number of people in special needs housing increased substantially in 2001, but reduced in 2002.

A Rapid Response service is available, which has responsibility for increasing care hours for a period of 72 hours before review. The home care service provides both domestic and personal care (550 people currently receive home care and 230 of these receive personal care). The Women's Royal Voluntary Service offers a shopping service, with support for people to shop themselves, but this has had mixed success.

55 people are receiving intensive care packages to prevent them having to be admitted to care homes. The Council buys the packages from Shetland Welfare Trust, an independent sector, not-for-profit organisation. The care provided depends on people's needs and the support they get from their families. There is no limit on costs for people to stay at home. However, there is a waiting list of 20 to 30 people for residential care, as Shetland homes offer a very high standard of facilities and care. The admission rate is relatively high, but a range of alternatives is being developed, including under-used sheltered housing and more rehabilitation in different settings. The Housing Service is a main partner in considering creative solutions. NHS Shetland is reducing long-stay hospital facilities and making better use of active rehabilitation and support. The very high costs of providing intensive care at home and the exceptionally high standards of residential care are heavily subsidised by the Shetland Islands Council Charitable Trust. However, the effect of major losses on the stock market will require the Council to re-assess its spending in an attempt to protect investments for the longer term. The Council may need to consider targeting services and charging.

A comprehensive range of short breaks is available for all user groups. Rural care centres have been a success, providing care in local communities. Crossroads provide 30 to 35 home-based packages, which include respite care and short breaks. Day care and lunch clubs are also provided. Demand is greatest from older people and there are pressures in meeting this demand (for example, in Lerwick there is a year-long waiting list for day care).

The Council introduced Free Personal Care without difficulty. Very few people were being charged for care at home and the Council has had enough funding. No-one in residential care has taken up free personal care, as Shetland Islands Council Charitable Trust (SICCT) subsidise residents' care. With its grants, few people ever have to sell their home to pay for residential care. However, the financial constraints that face both the Council and its Charitable Trust will mean reconsidering their priorities for resources in the future, including whether the subsidy of care home 'accommodation' costs and free domestic care at home is best value.

Services for people with learning disabilities

NHS Grampian expects to deliver their resettlement programme, which has included Shetland people, by the 2005 deadline. A small number of people with learning disabilities were resettled in Shetland. They moved into hostel-type accommodation at first, but now most are living in their own tenancies.

People with learning disabilities have access to some specialist resources and also use mainstream resources like leisure facilities. The Council arranges access to supported employment and local voluntary organisations COPE and Moving On provide support employment opportunities in a range of industries. A learning disability nurse deals with health needs, and acts as a link with other health care professionals. NHS Grampian is contracted to provide specialist support. The learning disability nurse helps to co-ordinate services for people with challenging behaviour and provides support to staff. Staff have been given training (CALM) on physically restraining children with learning disabilities and further training is planned for adult services. No-one has needed forensic services, which would be provided on the mainland. Shetland is updating its existing database of people with learning disabilities. The Council is appointing a local area co-ordinator for people with learning disabilities and their families - this is good progress.

Services for people with physical disabilities

The number of people with physical disabilities who are receiving a service has changed little in the last two years.

A Direct Payments scheme is in place for all client groups. A voluntary organisation proposed a support scheme, but this was too expensive. Some people use a solicitor to help them to manage their Direct Payments.

The Council uses manual systems to monitor waiting times for equipment and adaptations but is moving towards electronic systems. Staff prioritise assessments. They deal with simple requests and issue items quickly so there is no self-assessment. In the past, the generous provision has led to very high expectations, which increase waiting times. All the funding for equipment and adaptations comes from the Shetland Islands Council Charitable Trust. Most delays in supply occur for non-standard items. Policies are being reviewed with the Housing Service with a view to targeting equipment and adaptations towards the most vulnerable people.

Responsibility is delegated for costs up to 3000. Joint working is effective, but a joint occupational therapy service may now have great advantages. The Council and NHS Shetland are working towards introducing a Care and Repair Scheme.

People with sensory impairment

The number of service users who are hearing-impaired and deaf-blind are thought to be 'the tip of the iceberg'. The Council is developing a database as part of the Disability Strategy, and this should give more accurate information to help in planning services.

Services for people with mental health difficulties

The number of people receiving a service for mental health difficulties fell from 26 in
1999-2000 to 18 in 2001-2002, from an already low base.

A management team drawn from Health, Social Care and Housing is being put in place for a new community support service. The team is linked to a sheltered housing scheme for people with mental heath problems. Staff in the scheme do outreach work under the direction of the Community Mental Health Team. One of the main aims of this initiative is to prevent people having to go into hospital.

The Council does not have enough Mental Health Officers to meet demand, and will need to recruit and train more officers.

Tackling substance misuse

Alcohol misuse is a significant problem locally and a database of people's needs is being developed. Shetland Alcohol and Drugs Action Team (SADAT) is increasing awareness of alcohol problems and changing people's tolerant attitudes, particularly to alcohol abuse. Every year, Shetland is seeing an increase in drug misuse, particularly heroin.

The main services include a Community Drugs Team and Alcohol Resource Centre, both funded through the Shetland Islands Council Charitable Trust. The emphasis is on providing community-based services, and more people are using detox, rehabilitation and methadone-prescribing services. In 2002-2003, seven people received residential rehabilitation in non-Shetland placements, based on recommendations arising from specialist assessment. There have been delays in setting up a dual diagnosis service because of problems recruiting a psychiatrist. Criminal Justice clients have access to treatment programmes.

Agencies work to common policies approved by the Shetland Alcohol and Drugs Action Team, which has not yet drawn up a response to 'Getting Our Priorities Right'. No formal arrangements are in place for dealing with families who misuse substances. The Changing Children's Services Fund has paid for a family support worker who works with the Social Care Service's Children and Families Team. The Youth Information Centre provides young people under 16 with access to support workers and mental health services.

Joining up community care services with health

Progress in improved joint working is measured through the Joint Performance Information and Assessment Framework (JPIAF), which has been agreed by SWSI, Audit Scotland and NHS Scotland. Recent evaluation of the partnership's progress in the 5 areas of joint management, joint governance, human resources, joint resourcing and Single Shared Assessment suggest that the joint arrangements are still being progressed. The local partners were recommended to:

• include within their Local Partnership Agreement the joint management arrangements to apply for older people's services;
• determine the shape of front line services to apply under the Joint Future Agenda;
• develop a full scheme of delegation outlining the responsibilities and decision making powers of each level of the joint management structure, in particular the decisions that the JFIG can take. For example, what must be referred to parent organisations or the community planning board? What can the community planning board decide independently of the parent bodies? What is the scope of the single manager post and how does it relate to the LHCC or acute NHS services or the community mental health team manager?
• consider whether the governance working group for joint OT services will provide all of the requirements of a governance structure for the full joint working arrangement and if so, should set appropriate deadlines for outputs from this group;
• consider the development of the joint service/clinical governance policy and of how complaints about joint services or joint activities should be handled;
• allocate a budget for the joint OD/training plan;
• develop financial management arrangements (both strategic and operational);
• develop financial protocols (both strategic and operational); and
• agree and implement an information sharing protocol.

On the ground, a Community Mental Health Team is now set up with a single manager and includes Health, Social Care and Housing services. Integrated services are provided to people with mental health problems in a sheltered housing scheme and in the community. Housing has mobile housing support workers who go to the person rather than the property. The resulting benefits are better use of staff time and closer working relationships between services. This is the model for supported accommodation. The Social Care Service, NHS Shetland and Shetland Welfare Trust piloted an integrated care at home service in Unst. After its evaluation, proposals are going forward to extend integrated services across Shetland.

Working with Carers

The Carers' Strategy is funding new services through the independent sector, including:

• an advocacy scheme;
• 'Moving On' supported employment opportunities;
• travel for carers to attend training on the mainland;
• carer support groups;
• increased funding to Crossroads for the absent carer scheme; and
• using money from The Same as You? change fund and the Carers' Strategy for a full time local area co-ordinator.

The Council has no record of the number of assessments offered, taken up and turned down. Carers' assessment is part of Single Shared Assessment. The Council thinks low take-up of assessments means that people do not see themselves as 'carers' and that they feel they are receiving the support they need. Attempts to identify young carers through schools have failed.

The Council involves people from all parts of Shetland in giving feedback on services and planning services. Partners have responded to requests from carers, through a joint palliative care scheme, for a Macmillan respite service, which will start this year.

Children and Young People

Looked after children

Between 2000 and 2002, there was a large reduction in the number of looked after children who were living at home between 2000 and 2002. The number of children living in kinship placements increased from none to five. Kinship carers are paid full fostering rates.

Over the past year, a small number of young people have been sent to residential school on the mainland. This is because services cannot meet the needs of these young people in Shetland. This is not an acceptable situation and the authority is dealing with this. The inter-agency 'New Bruce Initiative' is a positive development that aims to make sure more young people do not leave Shetland unnecessarily, and to bring back some of the young people who are currently in residential schools. A four-bedded facility is planned that will be integrated with an education services close support unit. It will be based at the hostel at Anderson High School. The success of this initiative will depend on improved joint working between Education and Social Work Services.

Fostering and adoption

No children are waiting for a foster placement, but a small number of children with disabilities are waiting for respite care. Children are not always given a choice of placement - some of the young people who are in the residential unit would ideally be placed in foster homes. There are no foster placements for challenging teenagers. This is a significant gap in resources and the Council needs to do more to deal with this.

Two professional carers receive a Social Work salary. The Council has revised allowances for other foster carers. It now pays the NFCA higher rate and enhancements of 25%, 50% or 100% depending on individual children's needs. The Council should consider extra fees and payment for skills to attract new recruits and improve the skills of carers.

No children are fostered outside Shetland.

No children are waiting for adoption. A very small number of young people are in the process of being adopted by their foster carers. Some children from Orkney are placed in Shetland.

Educational attainment

Fewer than five 16 to 17 year olds stopped being looked after in Shetland in 2001-2002, so no information is published on their attainment. Some initiatives have been put into place to improve educational attainment, including:

• producing a guideline for head teachers;
• introducing an information system to give feedback on attainment and exclusions;
• appointing a link teacher to support foster carers;
• making sure there is daily contact between the residential unit and schools;
• developing a joint protocol for young people who are educated away from Shetland;
• providing computers in foster homes;
• introducing a careers project for older young people; and
• working with head teachers, guidance staff and learning support staff to make them more aware of the needs of children and young people who are looked after.

All children and young people who are looked after, including those on home supervision, receive some form of full-time education. All the young people in the residential unit are in full-time education, but some may have individual timetables that may include days at college and employment placements. Exclusion rates are low.

Guidelines have been sent to schools asking them to identify a designated teacher for children and young people who are looked after, but it is not known if appointments have been made. This suggests a lack of active communication between Education and Social Work Services to make effective care planning a reality for what are very small numbers of young people.

Throughcare and aftercare

Young people have a care plan in place when they move from care, and their key workers stay involved with them. The Council has some information on the small number of young people who have moved on in the last year. A throughcare and aftercare support group meets once a week in Lerwick.

There is a range of accommodation and support services for young people. There is an independent bed-sit and a flexible accommodation area in the residential unit for young people who are moving towards independence. The Housing Service provides young people with bed-sits and some support services. The hostel in Lerwick provides temporary supported accommodation. But the arrangements are irregular and there is little evidence of a throughcare and aftercare strategy or a co-ordinated approach to support young people in housing need.

Mental health

Specialist mental health services for children and young people on the islands are limited and services are currently being reviewed. Learning support staff in schools may identify mental health problems, and mental health needs are picked up at Looked After Children reviews. Social workers can refer children and young people to a community psychiatric nurse. A child and adolescent psychiatrist visits Shetland every three months.

The authority has a holistic approach to mental health services. Young people have access to drop-in 'positive mental health' sessions. A health promotion worker works with young people and staff to deal with the problem of self-harm.

Child protection

The number of children referred for child protection more than doubled in 2002, and Shetland now has the highest rate of referrals in Scotland. This is said to be due to all services being much more aware of child protection issues, as a result of a multi-agency induction training programme. The high rate of referral is not matched by equivalent increases in case conferences or the number of children on the Child Protection Register.

Shetland has introduced a number of child protection initiatives, including:

• carrying out a comprehensive local audit and introducing a 53-point action plan combining recommendations from the local audit and the national Child Protection Review;
• introducing training courses four or five times a year for childminders, youth workers , befrienders and other staff and volunteers who have direct contact with young people;
• introducing the Child Safe Project, which identifies safe practices in the voluntary and sports sector;
• holding a train-the-trainers day;
• revising the membership of the Child Protection Committee; and
• making sure all staff working with children have the opportunity to go to the three-day multi-agency child protection course run by the Child Protection Committee.

Children with disabilities

Services for children with disabilities and their families are at a high level. There are 37 allocated cases of children with disabilities and two or three cases where a child is affected by the disability of an adult. The wide range of services includes:

• an award-winning five-bedded unit providing a respite care service to 22 children;
• a respite fostering service;
• a subsidised childminding scheme;
• joint packages of support through Crossroads for children with complex needs;
• summer playschemes;
• out-of-school leisure activities for five to 19 year olds with a record of need; and
• the pre-school home visiting service, which works with 28 families (for example, with hearing impairment, visual impairment, learning disabilities or premature babies).

Working of children's hearings

All referrals from case conferences were made within five working days in 2001-2002 (standard 2).

No information is available from the Council on standard 3, but figures from the Scottish Children's Reporter's Administration (SCRA) suggest that only 29% of reports were submitted within 20 working days of the date of request. This is a poor performance and must be dealt with urgently. The Council says that low performance is due to staff shortages and the fact that report requests from the Reporter tend to arrive in batches. Much of the difficulty could be easily resolved by faster communication between the offices of the Reporter and Social Work.

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

Youth Justice

The scale and extent of youth justice work in Shetland is limited. For example, at the moment there are no young offenders who meet the Scottish Executive's definition of 'persistent offender' (five or more offences within a period of six months). Shetland has therefore appointed one part-time specialist worker, who works alongside colleagues in Children and Families and Criminal Justice Services. This member of staff carries out all youth justice assessments, using the YLS/CMI assessment tool. If Children and Families know the case, they may keep it there. Or the youth justice worker may take the case on, working out individual plans and interventions based on the LSI-R assessment and, where appropriate, consulting with Criminal Justice Service colleagues. Where necessary, the Drugs and Alcohol Service can get involved in the plan. No full programmes are delivered, although some structured work may be done. The young person fills in an evaluation and feedback form when the supervision has ended, and the LSI-R is applied again.

As a preventive measure, the youth justice worker also receives police reports in cases which are not taken any further. The worker carries out an assessment and, following consultation with the reporter, may offer the offender a voluntary service to help with any problems related to their offending.

There are no specific programmes for young offenders. The youth justice worker works out individual programmes for young people based on information from the YLS assessment. The young person fills in an evaluation and feedback sheet. YLS is applied again at the end of a programme.

The Council does its own restorative justice work. Recent training in restorative justice approaches has taken place and the Council plans to put these into practice.

Criminal Justice

Structure

While Shetland is not in a formal criminal justice grouping with any other authority it is committed to inter-island communication and co-ordination with Orkney and Eilean Siar. To date this has resulted in sharing of strategic plans, discussion of responses to national consultation documents, inter-island quality assurance and sharing of materials.

Workload

The service has experienced a small increase in orders over the past year, but given the low numbers it is not realistic to compare annual statistics in percentage terms. The service is well funded and fully staffed with a good mix of skills. Performance on key indicators is high.

Effective practice

The authority uses the assessment tool LSI-R to assess the needs and risk of re-offending presented by offenders and determine the level and content of supervision. Those at highest risk of re-offending can be offered an intensive probation programme, though only one offender met the criteria last year. Additional structured work is offered to those on standard probation who require more than minimal standards of supervision.

For those with substance misuse problems, a drug awareness programme has been developed which will be co-run with Shetland Community Drug team. This will complement the alcohol awareness programme co-run with the Alcohol Advice Centre.

The authority has increased the number of individual placements with voluntary organisations for those on Community Service, offering a greater range for those who are assessed as vulnerable. A more intensive Community Service induction programme is also now in place.

Public Protection

The risk posed by sex offenders is assessed by use of the tool TayPrep 30 that the council is piloting in conjunction with Northern Constabulary. Offenders are now jointly assessed by the two agencies, and an inter-agency high-risk offender protocol is in place. There are also procedures for inter-departmental working with the Child Protection team. The criminal justice team works closely with other local authority services to address accommodation needs and wider social inclusion issues.

Quality assurance

The service is developing a system of client feedback to assist in evaluating the impact of the service. It is hoped that progress demonstrated can be consolidated over the next period.

Human Resource

Structure of the workforce

The latest figures provided by the Council but not yet confirmed suggest that, between October 2002 and the end of June 2003, vacancy levels for social work staff fell from eight whole time equivalent to one (a return to the low vacancy rates enjoyed up until 2001, in spite of an overall increase in the establishment of three whole time equivalents).

The Social Care Service runs on the basis of teams with specific functions. However, all staff have some responsibilities, for example, taking part in the out-of-hours and day duty rotas. The Council has introduced senior social worker posts.

The Council has no difficulty in recruiting trainee social workers, but does have problems finding qualified staff. However, apart from in the Children and Families Team, there are no vacancies among fieldwork staff.

Detailed information on the age profile of the workforce is not available.

Support for staff

Procedures to support staff include:

• training in handling conflict and aggression and in understanding mental health issues;
• a supervision policy;
• staff development days to allow staff to comment on policies and to give other feedback; and
• access to a welfare officer.

In 2002, the department lost 8586 working days as a result of sickness absences. Absence rates were highest in community care fieldwork, particularly among residential staff. Staff working with looked after children and young people and older people in residential homes were also affected. The Council monitors reasons for absence and these are usually problems with the muscles or bones, or are stress-related.

Working towards a more highly qualified workforce

Under a joint training strategy with Health, new developments include:

• preparing for the registered managers' award;
• making sure that child care staff get the qualifications they need to register;
• staff development plans; and
• incentive schemes for staff getting Mental Health Officer or practice teacher status.

The Council currently has three staff who are trained Mental Health Officers and three practice teachers. Five members of staff hold the child protection certificate.

Preparing for registration

The service faces a number of real issues in preparing for registration. Many childcare staff in particular may find it difficult to achieve appropriate SVQs as the few who have already tried have reported difficulties. The registered managers' award, which the local SVQ Partnership are introducing in 2003, may bring problems by increasing pressures on residential staff teams.

A longer-term challenge is how to deal with staff who may have a number of part-time jobs, making it more difficult for them to study.

Race Equality

In Shetland, 1.1% of the local population are from a minority ethnic group, compared with 2% for Scotland as a whole.

Under the Race Equality Scheme, the Council is preparing a corporate action plan, based on the results of analysing the effects of current services. It will meet the general and specific duties of the Race Relations (Amendment) Act.

Use of Information Communications Technology (ICT)

Social Services Department

There is a corporate strategy for ICT which Social Care follows. All Social Care staff have access to computers and now all community nurses also have access to them. In the meantime, information has been shared manually.

Partnerships

Although procedures are in place, the Council has not yet completed a protocol for sharing information. At the individual level, joint procedures have been in place for assessment and sharing information for some time. People with higher levels of need keep their care files at home and all staff involved in their care have access to these. Electronic sharing will be possible with the new SWIFT system which is being introduced as part of the ICT Strategy. Appropriate staff in the Council, Health Service and Shetland Welfare Trust will have direct access to it. The system will be set up first for home care, then children and families, and for other community care services in 2004.

Background Profile

The second smallest local authority in Scotland in terms of population, Shetland is an island community made up of one main island and over 100 smaller ones. It has a lengthy coastline and, apart from two main centres, its population is scattered throughout small communities. Since the 1980s, it has benefited substantially from oil revenues and oil-related employment, though these have both reduced recently.

Farming and fishing are long-established industries. The number of jobs fell by 9% between 1995 and 2001, with most of these job losses in the service sector. The drug misuse rate is low, but it is still three times higher than the rate for Orkney.

Spending for every person on social work in 2001-2002 was 437, far in excess of the figure of 267 for Scotland as whole.

Expected population change

Community Care

Expenditure on community care increased in 2000-2001 but fell in 2001-2002.

Children and Young People

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

Criminal Justice

Human Resources

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