« Previous | Contents | Next »
Listen
CHAPTER THREE: IMPLEMENTATION ISSUES
3.1 218 was established in Glasgow as the result of an Inter-disciplinary Ministerial Group, with an expectation that the Centre would operate as a 'one-stop shop' capable of addressing multiple issues in the lives of the women referred to the service. This meant that 218 was intended to fit within the range of already established services in Glasgow while offering something unique in its own right. This chapter describes some of the basic structures set up at 218 and issues that arose in creating these.
Staff and management
3.2 Setting up the service required the establishment of networks with external agencies while also creating a unified team - made up of workers from a range of disciplines - within 218. The core staff at 218 include a service manager, responsible for the overall running of 218; 4 Team Leaders 10 (Service Co-ordinators) for the day and residential services, with one Team Leader on duty for the day services and two for the residential services, on an ongoing basis; 20 Project Workers, who conduct group work and individual counselling with the clients and liaise with external agencies with regard to clients' care plans; the Assessment Team 11, who are trained Project Workers but who assess prospective clients in the Sheriff and District Courts (custody court) and conduct assessments at 218 and, where necessary, at HMP and YOI Cornton Vale; 8.6 nursing posts directly employed by Turning Point; and 8 Support Workers, who assist Project Workers in their role accompanying clients outside 218, running activities for clients, making appointments, and acting as additional supports while Project Workers are engaged elsewhere. Members of staff at 218 also include administrative workers (4.7 posts), a chef and cleaning staff (4 full time equivalents).
3.3 One of the unique features of 218 is the presence of staff from outside agencies located in-house. These include a Health Team leader, responsible for co-ordinating health services in 218; and a number of health professionals, including additional nursing staff; a District Nurse; 2 Community Psychiatric Nurses; a psychologist; an Occupational Therapist; a Women's Health nurse; and part-time services contracted in by 218 from 3 GPs, a physiotherapist, an acupuncturist, a dietician, a dentist, and a psychiatrist. A solicitor from the Public Defence Solicitors Office ( PDSO) visited the residential unit once a week to give advice to clients who had no other representation.
Training
3.4 Most workers in the 218 project had some sort of experience in the field of addictions, counselling, and social care before coming to 218, including a number who had previously worked for Turning Point Scotland. At the outset, all staff (including those from outside agencies) had 4 weeks' residential training in counselling skills, trauma, and acupuncture, followed by 6 weeks of programme development. Ongoing training has included Solution Focused Therapy, Cardiopulmonary resuscitation ( CPR), and training on new systems of paperwork as they developed. All members of staff had been trained to give ear acupuncture (found to be effective in controlling withdrawal symptoms) and Indian Head Massage as a relaxation technique. Many were pursuing further qualifications in counselling skills. Staff were generally positive about the training they had received for their work at 218. Virtually all were keen to pursue additional training and qualifications; team leaders were supportive of additional training, but the demands of their case load made it difficult for them to find the time or cover to take advantage of this. Members of the health team in particular were frustrated with the perceived lack of opportunities for continued professional development, particularly in terms of work in addictions.
3.5 At least as important as training was an expectation of certain attitudes amongst the staff hired at 218. One member of staff described it like this:
"I think [the staff here] share a value system. We share values and share goals…Personal honesty matters, (…) consistency matters. And (…) non-judgment matters. And I think that is a rare thing to achieve in an institution … that's the indefinable 'other'-ness about the project…."
3.6 And a day programme staff member described things in the following way:
"... we were all brought on because of our attitude, because of the people we were, rather than the skills we had. Although we are all very skilled at lots of different things, there were lots of levels of ... education and experience and all that. But it was the type of people we were… feisty and having attitude and not just going with the flow. It was about fighting for stuff and fighting for clients."
3.7 This emphasis on relationships came out strongly in clients' assessments of the value of 218 as a service and is discussed more thoroughly in Chapters Five and Seven.
Management
3.8 218 is funded by the Scottish Executive Justice Department in conjunction with Glasgow City Council Social Work Department, specifically criminal justice services. Turning Point is responsible for delivering the contract to the Executive through its staff at 218. The Director and the Operations Manager of Turning Point Scotland oversee the work of the service manager at 218, who is directly responsible to the Director of Turning Point. The NHS is also present as a service provider, with its Health Team Leader and staff directly accountable to the NHS rather than to Turning Point. Both of these groups are accountable to Glasgow City Council Criminal Justice Social Work, though the Council's role is for oversight and monitoring, while Turning Point has the primary managerial responsibility.
3.9 The multiple service providers and holistic nature of the service beyond a purely criminal justice role created difficulties from the outset in terms of how the Centre would be managed and monitored. The Service Level Agreement for the Centre was deliberately kept flexible to allow the service to develop as its purpose became more defined with experience. This, however, combined with the delay in establishment of a Monitoring or Advisory Group to follow on from the Commissioning Group, resulted in confusion and uncertainty in the overall management and oversight of the Centre, with no clearly defined outputs and outcomes.
3.10 Within 218, the management team is known as the Direction and Focus Team ( DAFT). It is made up of the Service Manager, 2 part-time team leaders, 3 full-time team leaders, administration team leader (Turning Point Scotland) and the Health Team leader ( NHS Trust). The team meets weekly and has a standing sub-group known as the rota workshop that also meets weekly. The team directs and manages the workload of all staff operating within the building either directly through line management responsibility or indirectly through shared work goals and agreements.
Staff structure and support
3.11 Almost all members of staff interviewed spoke positively about the support from managers and colleagues at 218 in theory. In practice, the biggest frustration for staff was that the timetables and caseload for all staff and managers meant time for staff supervisions tended to be overlooked or to take lower priority (an issue also highlighted and subsequently addressed in Turning Point's own internal review; see 7.55 below). 12 They believed managers were well-meaning, but they also said they had to chase them up to have the supervision sessions they needed, and delayed or missed supervision sessions seemed commonplace at all levels.
3.12 Particular concern was expressed by and for staff who worked in the residential unit, where they faced staff shortages due to sickness or unfilled vacancies, a particularly demanding client group, and 12-hour shifts. This had led some staff to feel tired and over-worked; however they did indicate that team leaders had noticed this and attempted to respond, and this problem appeared to be easing as the research progressed. The 12-hour shifts in particular were under review at the time of this research.
3.13 The increased case load in the day services (see below) meant that staff there too tended to feel overstretched. Project workers, for example, technically worked a 39-hour week. Within this, however, they were supposed to fit at least 3 one-hour individual counselling sessions with each client in their case load as well as attend court, case reviews, and children's hearing sessions, run group sessions, and take part in any additional training. With case loads running at about 10 clients each on the day programme, staff required, in the words of one project worker, a constant ability to "juggle" the demands on their time.
Resources
3.14 As a long-awaited and hoped for aid in addressing the complex needs of female offenders, 218 received significant funding from the outset. Staff and managers at 218 were aware of the impact this has had on their service:
"I know there has been a lot of money thrown at it …. I mean it is nice…everything is nice and new and shiny. I think that makes a difference, I think it maybe makes a difference for staff as well, everyone just feels quite good. Everything is the way it should be, but I know now, the second year, that money is…well it's drying up…the budgets are slightly less than they were in the first year so… [we have to] pull things in a wee bit". (Member of day programme staff)
3.15 Physical conditions can reflect the value a service places on its clients, intentionally or otherwise (Wood, 2005), and the new service at 218 excelled in this. Equally, staff recognised that a good service could not depend on funding for its effectiveness:
"Because on a pragmatic level, I feel like on a one-to-one, woman-by-woman level, I could have had every single resource that you could wish for and still be unsuccessful." (Member of 218 management team)
3.16 Concerns about resources related less to budgets and more to the day-to-day operation of the service. Pressures on staff, particularly in the residential unit, meant staff turnover there could be relatively high, occasionally leaving staffing levels under complement. Some 'rationalisation' of staff in the health team was also put forward as an issue in need of attention. Further, planning for the services estimated a case load of 35 clients on the day service at any one time. In practice this had increased to 60 women, with no corresponding increase in numbers of Project Workers. 13
3.17 The physical structure of the building had some drawbacks. The residential unit was on the top 2 floors of the building, while day services were delivered on the ground floor and basement, with one floor for administrative work and staff offices sandwiched between the 2 services. In practice, this meant there was little integration between staff in the day and residential services. This resulted in some distinctions between the different sections of 218 (one respondent referred to the different work cultures between residential and community staff as being like a "sort of upstairs/downstairs". During the evaluation, office space in the unit for residential staff was almost non-existent, consisting of a small single room with 3 chairs and only enough desk space for 2 people at a time. Larger rooms for staff in the building to meet jointly did not exist, even for team meetings. The number of services on offer and number of clients who attended on a daily basis also meant that rooms to conduct 'one-to-ones' 14, interviews, or other consultations tended to be in short supply.
3.18 On the other hand, the building itself was in excellent decorative order, and its location in Glasgow city centre was ideal. Clients spoke very favourably about the physical conditions in the residential unit: each had her own room with an electronic pass, en suite facilities, television, kettle, and microwave. Shared facilities for laundry and ironing were also available in the unit, as was a large dining area with additional tea and coffee facilities. The upper level of the unit also had a small common room with a television; the room was often used for group work. The only complaints from residents were the lack of an outdoor area for them to use, as the residential unit tended to feel "claustrophobic" for them after a while, and the change in rules for smoking that allowed them only to smoke in their rooms, with the result that women spent more time alone in their rooms rather than mixing with others in the common areas.
Developing the service
3.19 Six months had been allocated to develop the service and to ensure resources were in place before it opened. This in itself was a point of criticism, with senior members of staff at 218 noting that a much longer period of development and preparation was needed. The lack of an operational statistical database to record information about the clients and details of their progress from the outset was one casualty of the relatively short period for development and implementation. More thorough marketing of the services at 218 should also have been possible with a lengthier planning period; instead key agencies were not always aware of 218 and the services it offered (see below).
3.20 Once operational, the service developed by a process of trial and error, where things were tried and tested on an ongoing basis, and services developed accordingly. The groupwork programmes were a prime example of this, and by the end of the research period, staff were still in the process of finding the right type of support packages to deliver at 218. Some were particularly keen that validated, measurable programmes designed for women be used wherever possible - with the obvious problem that few such programmes exist. 15
3.21 Another example of changes in service design was the shift from an approach where women stayed at 218 as long as they felt they needed support to a time-limited period of residence. This followed from the realisation that initial practice had the drawback of creating a dependency on the service, of possibly making women 'stagnate' in their progress, and of creating a backlog of clients so that spaces were not readily available to new clients. In practice this meant that the service moved from one in which women could stay 'on programme' for months at a time to one that was more specific, giving clients a deadline to work towards and a gap between programmes to 'practise' what they had learned.
3.22 The uniqueness and complexity of the service made it difficult to set specific goals or outcomes at the beginning, and there was a view among the staff team that this specificity could be self-defeating. Instead, it was seen as important to try a method and then to adjust and alter it along the way as needed. It had taken some time to develop the service but this was seen as necessary to "get the basics right first". This meant that the service had developed pragmatically, and change was ongoing. While this was generally viewed as beneficial, there was an acknowledgement that it could be more inclusive. For example, a shift to more structured programmes was seen as an important development, but it impacted on the access that some staff had to the women:
"They have quite a strict sort of timetable programme and it's trying to slot in what you have to do and the kind of time slots when they're available and when mealtimes are and sort of trying to initiate that." (Member of health team)
3.23 The functions of 218 were viewed as crucial by 218 staff and workers in external agencies. 218 was viewed as providing 'holistic' care, something that was seen as important for women who needed different levels of help at different stages in the recovery process. 218 could offer women support with the development of their self-esteem and self-confidence - something which traditional agencies, particularly criminal justice services, were not considered to do particularly effectively.
Working with other agencies
3.24 218 was very proactive from the beginning of the service in establishing an identity and publicising the service to other agencies. However, this was a slow process, and awareness of 218 was piecemeal in developing, particularly through the criminal justice system (also noted in earlier research by Brown et al, 2004). This impacted on the levels of referrals made (see Chapter Four) and use of the service by other agencies. Additionally, until other agencies were familiar with 218, there were difficulties in sharing and accessing information on individual women. This was a particular issue for the health team as, on occasions, other health services were reluctant to forward information such as case notes as they did not fully comprehend the primary care set-up within 218. 16
Joint Working
3.25 One of the significant attributes of 218 is the importance of providing a service able to deal with all the issues a woman may face, in one place. This meant that workers from a range of disciplines were located together and required to work together as a team while retaining their own identity and working to the ethos of their own professional background. Co-existence between agencies does not always go smoothly. Some members of health staff had experienced confusion regarding their role and where they fitted into the management and service structure. By the end of this evaluation, the issue had yet to be resolved.
3.26 The confusion in role was also reflected in practices of line-management with workers in some cases being required to supervise others from the same professional background but employed by a different contractor and who were subsequently working to different policies and procedures. Other difficulties included policies on the disposal of client records, which varied between NHS and non- NHS staff in term of the length of time records were retained.
3.27 Such issues appear destined to arise in the course of inter-agency work (Eley et al, 2002; Malloch et al, 2003; Popham et al, 2005) and are a recurrent feature of work between different professions. As one respondent commented: " interagency work can often appear to be co-located rather than integrated" ( member of Routes Out SIP). It seemed however that the historical development of 218 had contributed to the separate identities that appeared to exist to some extent between workers from different backgrounds. Staff appointed by Turning Point were in place from the outset and were joined much later (in January 2004) by staff employed by the National Health Service ( NHS):
"I mean it was obviously part of the initial planning, but NHS being the NHS it didn't plan ahead as quickly as Turning Point did, so all your (Turning Point) staff are in post, the project opens unofficially in December so therefore all the staff were around, they were all setting it up, they were all building furniture and working together and getting to know each other..." (Member of health team).
3.28 As well as different experiences of involvement in the development of 218, different working practices and expectations had caused some tensions between different workers. Issues raised in interviews included uncertainties about line management; different policies and procedures utilised by different professionals; blurred boundaries in relation to roles and responsibilities (particularly regarding addiction work); and lack of clarity about decision-making processes. This was perhaps a particular problem for team nurse project workers: their role was increasingly focused on nursing and dispensing, yet they were employed by 218 rather than by the NHS, and lines of responsibility were not always seen to be clear by those involved.
3.29 Some NHS staff in 218 appeared to feel isolated in their tasks and had started to develop their own recording and auditing practices. The issue of recording has subsequently been identified as an area for improvement in the 218 action plan (Turning Point, 2005:2) in terms of monitoring and evaluation 17. In some cases, certain individuals required to be supervised outwith 218 due to their professional status and the fact that they were the only one with a specific remit within 218. Additionally some workers (employed by the NHS) were expected to supervise other workers who were not employed by this body: "Sometimes it's kind of hard to supervise someone who is not in your service…" (Health team member).
3.30 A number of NHS workers described the difficulties they experienced in "finding their feet" and identifying how they were expected to fit into the working environment of 218: "I'm still struggling to clearly define it (role), and I don't think it's even possible" (Health team member).
3.31 Posts in the health team appeared to be filled by a number of extremely qualified and enthusiastic people who then had to slot into a particular niche within the service in order to fit in with those around them. A number of individuals felt they had not been able to develop their role in a way that fulfilled their potential or enabled them to use their experience and develop more skills. This frustration was felt particularly in relation to addiction work and illustrated some confusion about the roles and responsibilities of team members.
3.32 It was acknowledged that communication was crucial in the development of joint work and continuation of effective working: "it's how you provide holistic care in that setting, you have to have excellent communication with each other to make sure that we're all doing our bit" (member of health team). However, given the size and complexity of the organisation of 218, communication was problematic:
"I think communication is probably the biggest issue at 218, that's my feeling about it, because there are a lot of different types of people involved and you've got drug workers, maybe social work background, you've got nursing staff, you've got doctors, you've got psychiatrists, you've got CPNs, so that there is a lot of people. I don't think it's perfect yet but I think it's getting better." (Member of health team)
3.33 This is not an experience unique to 218 and appears to be encountered whenever diverse professional teams are established . Even with somewhat disparate approaches on occasion, all the staff interviewed believed people in 218 worked towards a common purpose, and almost all believed they managed to do this as a team. Overall, there did appear to be a strong commitment, particularly at an individual level, to work together and to provide the best service possible for women using the centre.
Summary
3.34 218 is viewed as a distinctive service which provides 'holistic' care for women involved with the criminal justice system. This has required the co-operation of staff from different agencies and with distinctive professional backgrounds. Joint working had led to some difficulties during the implementation of the service in terms of management responsibilities and the role of individual workers. These tensions are invariably a feature of inter-agency working and have been reflected in the operation of diverse professional teams elsewhere. Initial tensions were evident however, relating to the management and monitoring of the Centre. Delays in the establishment of a Monitoring/Advisory Group exacerbated this, and the absence of such a group appeared to limit a more structured oversight of the Centre. Despite initial difficulties with communication between different agencies, inter-agency working was viewed positively by respondents from 218 and other agencies, and workers expressed a clear commitment to delivering a unique and effective service
3.35 Initial funding has been significant compared to that for other criminal justice services of this size and available resources were viewed positively. Nevertheless, the increasing number of women accessing the day programme has impacted on staff workloads and working shifts were under review. Despite minor problems regarding the availability of communal space for staff and the lay-out of the building itself, the resources available have been appropriate. Programme development has been pragmatic and informed by knowledge gained in the process of service-delivery. The six month development period was considered helpful; however a longer planning period may have increased the profile of 218 before the service opened, hence limiting delays in referrals from appropriate agencies.
« Previous | Contents | Next »