Performance Inspection of Social Work Services: The Highland Council May 2007

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CHAPTER 4
Impact on people who use our services

Overall performance in this area was adequate, with strengths just outweighing weaknesses.

Introduction

In this chapter we look at the impact of services on people who use them. SWIA defines impact as the direct experiences of people who use the social work service. This section of the report focuses on what service users and carers told us about the services they received and the way staff worked with them. Our sources of information include user and carer questionnaires, observed practices and meetings with individuals and groups during the fieldwork phase of the inspection.

The responses of people who used services and their carers in Highland were mixed. Not all services were available to everyone across the region and some were exclusive to a particular locality. When services were in place they were normally seen to be accessible, reliable and of good quality. Consequently they were valued by recipients, particularly users. Conversely, other service users and carers pointed to gaps in services or to services which were not fit for purpose. Often deficiencies in services related to either specialist needs or to services not having been rolled out in all areas. There was a marked contrast between the views of people who use services and the views of carers.

Finding out about services

A majority of service users responding to our survey said that they found it easy to get clear information about the range of services which might help them. We heard from groups of service users who said that social workers were forthcoming with information and maintained good communication. We also observed social services staff providing and interpreting service information for their clients. However, less than half of the carers we surveyed agreed that it was easy to get clear information about social work services. Particular difficulties in obtaining information were drawn to our attention during inspection fieldwork. With regard to direct payments for example, many carers were unclear as to their purpose and did not know about entitlement and access criteria. We were told that this lack of knowledge occasionally extended to the social work service's staff and that requests for information were not followed up.

Information about the range of services for children was available at a single point, the Children in Highland Information Point ( CHIP). Information about other specific services was often available in the form of leaflets, for instance Intermediate Care Teams for older people. However, some carers said that they were confused at times by gaps and inconsistencies in the information available.

Obtaining services

Most service users responding to our survey said that they got a good response from their initial contact with the social work service in office hours. We met some people who use services who told us that it could be difficult to get a prompt response if their allocated social worker was not available, for example off sick or on holiday. Many users also said they did not understand the criteria that led to some being allocated a social worker and others not. One mental health service user told us his circumstances had not changed and that he still needed services but had been told he no longer met access thresholds for service. It was evident that he did not understand this decision.

Less than half of the carers we surveyed agreed that they got a good initial response. Amongst groups of carers that we met there was a perception that services were available only when crises arose. Others told us of more intractable, long term difficulties related to limited resources and lack of choice. Some said that these difficulties could be exacerbated by a lack of professional knowledge of particular conditions, such as Autistic Spectrum Disorder, and could lead to tensions in their dealings with social services staff.

Obtaining services outside normal office hours

Less than half of users who responded to our survey said that they received a helpful response from the social work service outside normal office hours. The majority of carers who responded said that they received an unhelpful response. The impact of this weakness was particularly significant for some groups of users and carers. For instance some young people in receipt of through care services from Barnardo's Springboard project drew attention to the lack of services outside normal office hours and their reliance on informal contact with project workers. We make further comment on out of hours services in Chapter 6 under 'Staff deployment and teamwork'.

Using services

People who use services

The majority of people who use services who responded to our survey agreed that they had been given a clear plan to describe the services they would receive, that there was a good range of services available and that they had been able to rely on the services received. Half agreed that they had a meeting at least once a year to discuss the services they received. A majority said that they had been given choices about the type of service they received. Most agreed that the services they received were of good quality. Almost all those surveyed agreed they were treated with dignity and respect.

We observed a person who used alcohol services telling their social worker that they appreciated being sent a copy of their review paperwork as they were then able to discuss an inaccuracy and have it corrected. We spoke to older people using day services who confirmed the quality and value of the services they received. We met a group of people with learning disabilities who told us that they enjoyed the activities on offer at their resource centre, valued the social contact and had positive work experiences.

We received positive feedback from groups of people who use mental health services in both populated and more remote and rural areas. A number of people we spoke to commented on a caring and sensitive attitude from Mental Health Officers ( MHOs) during confusing and frightening episodes of mental ill health and compulsory treatment. We also heard from people about imaginative support arrangements from mental health services.

Good practice example
We visited a group for men with mental health problems in Ullapool. Each of the men who attended the group lived a considerable distance from each other and from Ullapool where the group met. They were also socially isolated. A social worker and two support workers collected the men individually and brought them to the resource. During each journey the workers were able to discuss more personal issues with the men, check out their mental wellbeing and prepare them for the group. It was obvious that the participants had formed strong bonds with each other and that the group provided a rare opportunity for social interaction. The workers were also able to support the men to go shopping, visit the GP and sort out benefits issues, while they were in town. We were impressed by this service and felt that the arrangements made a virtue of geographical distance and transport limitations. It was evident that the men derived real benefit from attending.

However, there were degrees of disagreement on access and quality between different groups of service users. A majority of users with physical disabilities who responded to our survey disagreed that there was an annual meeting to review the services received. Less than half the service users with a learning disability agreed that that they were given a choice about the type of service received. In focus groups people who use services also told us on more than one occasion that their difficulties were made worse when telephone calls were not returned, and letters and e-mails not answered.

Carers

We did meet carers who were satisfied with the services the person they cared for received. We met the mother of a young man with learning disabilities who was very happy with standard of care on offer and with the future planning and review process. We also met the mother of a boy with Autistic Spectrum Disorder who had successfully applied for direct payments and who had engaged support staff and developed a package of care that enabled her to return to work and to find time for her other children. We were also aware that carers of people with learning disabilities affected by the joint re-provisioning process at New Craigs Hospital were generally satisfied with the level of engagement and with the services they received. However, in relation to both our survey results and our experiences of meeting numerous groups and individual carers during the fieldwork phase, positive views such as these were an exception.

Levels of disagreement about the services received were generally higher amongst carers who responded to our survey. The majority of carers said that they had not received a written assessment of need for the person they cared for. Less than half agreed that there had been a clear plan that described the services that the person cared for would receive. The majority did not agree that there was a good range of services available. Less than half agreed that there was an annual review of services received and that services were of good quality.

We met with groups of carers across Highland including carers of children, young people and adults with learning disabilities, physical disabilities, mental health problems and Autistic Spectrum Disorder. We also met with carers of older people with dementia. Consistently, we heard strong views about poor performance by the social work service in relation to a range of issues.

Levels of dissatisfaction were particularly high in relation to transitions for young people with disabilities. Carers were highly critical of lack of information, resources and choice. They criticised a lack of engagement by the social work service in relation to forward planning of transitions from school to further education, training and employment. Older parent carers were also concerned about a lack of planning towards more independent living. Many carers asserted that they felt pressured into giving up work and had no time for other family members and little social life. We met some carers whose relationships with the social work service had deteriorated to the extent that they had almost no expectations in relation to receiving help and support. We note that many groups and individuals we met had no knowledge of the social work service's complaints procedure.

Like all local authorities, the Highland Council has to manage unmet need within in a financial framework and competing demands. The demand created by people's understandable optimal expectations in terms of the costs of packages of care can be difficult to meet in that financial context. Nonetheless, it is evident that relationships with carers across Highland are particularly poor and that there is substantial room for improvement in the quality of communication between the social work service, at all levels, and individual carers and representative groups. We note that there was no carer's strategy in place during the period of our inspection and that an outline strategy had very recently been drafted. We have commented further on this issue in Chapter 6.

Relationships with social work staff

The generally positive response to our survey contrasted with some findings from our fieldwork. Most service users who responded to our survey said that their social worker or care manager responded quickly to any change in their situation. The majority of carers who responded to our survey also said that the person they cared for was treated with dignity and respect.

We met groups of carers and some service users who were not happy about interactions they had experienced with individual social workers. They were concerned about issues of staff's knowledge, competence and, on occasion, attitudes. We have considered this further, in this chapter, under 'Staff ownership of vision, policy and strategy'.

Being involved, in and consulted about, services and service planning

Most service users who responded to our survey said that they had been fully involved in deciding what personal help and services they should receive. We met groups of service users who agreed they were consulted and involved, particularly people using mental health services and some users of services for people with learning disabilities. However, other groups told us that they were not fully involved in planning the services they received, or that choice was limited.

The majority of carers who responded to our survey said that they had been fully involved in deciding what help and services the person they cared for should receive. We have already alluded to the negative feedback we received from individual carers and representative groups during the fieldwork phase. This feedback is supported by responses we received in our questionnaires. In both the questionnaires for staff and for partners and stakeholders less than half of those who responded agreed that the experience of carers was fully taken into account in planning services. There is room for improvement in involving carers in the planning of services for the people they care for. We comment further on the issue of carer involvement in Chapter 6.

Impact on staff

We rated performance in this area as adequate with strengths just outweighing weaknesses.

We found that staff generally were well motivated and satisfied with their jobs and felt supported by their line managers and team colleagues. However, fewer staff regarded communication with senior managers positively or had confidence in their leadership. Staff morale was affected by a number of factors including concerns about leadership, pay and conditions, recruitment and retention, shortages of resources, limited service capacity and uncertainty about the implications of the restructuring of Council services.

Motivation and satisfaction

Our staff survey showed that most staff enjoyed their jobs and the majority felt valued by their managers. Most felt that their team was successful in helping people to lead independent and less isolated lives and the majority agreed their team was successful in helping people to develop their skills and abilities to the full. Almost all staff felt that their team did everything possible to keep people safe and most felt that their team worked well with other agencies in protecting children and vulnerable adults. However, less than half of staff surveyed felt that the quality of service offered by their team had improved in the last year.

These survey results were reflected in our experience during inspection fieldwork where we spoke to a range of staff who were motivated and committed to the people who used their services. It was evident that the process of restructuring the social work service had created some uncertainty for staff and this was reflected in concerns about job security and the continued availability of resources.

The majority of staff felt that they were adequately trained to fulfil their responsibilities, that their workload was manageable and that they received an adequate level of supervision. Staff in focus groups spoke positively about the Highland Council investing in people already living in the area, encouraging unqualified staff to train as social workers through the 'grow your own' initiatives. Staff also acknowledged positive working relationships with colleagues in education and housing, and with partners in the NHS.

Staff were more critical in relation to strategic leadership. Less than half agreed that social work was highly valued by elected members and that senior managers communicated well with staff. Less than half agreed that there was effective leadership of change in the social work service.

Staff ownership of vision, policy and strategy

While staff were confident about their immediate responsibilities and those of their teams they were less clear regarding the Council-wide direction of travel. We recognised that the restructuring had created uncertainty and that information about the proposed new structure was only just reaching frontline managers and staff at the time of our inspection. Some staff welcomed the proposed delegation of budgets and decision making from the centre towards the three new operational areas, feeling this would give them more of a stake in departmental and corporate objectives. Others felt unable to pre-judge as information about the new arrangements was limited in relation to proposals for new structures for front line staff and their managers.

There was a degree of variance between how children's services staff felt about working for the social work service in comparison to community care staff. Generally children's services staff spoke more positively about the development of their services and their contribution to the process. Community care staff were less likely to agree that services were developing well or that they were consulted on strategic decisions. Both groups generally spoke positively about working with partners and with other social work services. Some residential staff were apprehensive about the implications of the care home re-provisioning proposals.

This was reflected in the responses of staff in our survey, where only half agreed that the Highland Council had a clear set of local social work priorities and less than half agreed that there is a clear vision for social work. Less than half agreed that the experiences of people who use services and carers were fully taken into account in planning services.

There was a high level of awareness amongst staff of the standards that their team was expected to adhere to. In our survey almost all staff agreed they were aware of the standards their team was expected to follow, and that they were aware of their responsibilities set out in the Scottish Social Service Council's ( SSSC) Code of Practice. A majority of staff agreed that the Council fulfils its concomitant responsibilities to them as employers.

We also heard from people who use services, their carers and independent advocacy providers that, on occasion, the performance of some staff did not meet these standards.

Although our survey indicated that almost all people who used services agreed they were treated with dignity and respect, we were told that there had been issues about the knowledge, competence and attitudes of a small number of staff regarding explaining and assessing in relation to thresholds for access to certain services. A number of service users and carers told us about negative and upsetting experiences. We received this feedback from a number of sources in a variety of service settings and locations.

We heard this particularly in relation to how some staff managed the process of assessing against the 'Fair Access for All' criteria, and also regarding requests for information and guidance on how to apply for direct payments and for carers' assessments. In these instances performance would seem to have fallen below the standard expected. We question the degree to which certain staff have taken ownership of service policies and also how well first line and senior managers have prepared them, particularly in representing policy to potential users of services and their carers.

Recommendation 2
Social work staff throughout the service should ensure that they fully understand, and can professionally and accurately represent, relevant service policies to people who use services and their carers, and should be supported by their managers to do so.

Impact on the community

Overall performance in this area was good, having important strengths with some areas for improvement.

Introduction

In this section we look at the impact of services on the communities they serve. This section focuses on community perception, understanding and involvement; the impact on other stakeholders; and community capacity. The main sources of information include the partners and stakeholders survey, inspection fieldwork and the self-evaluation questionnaire completed by the social work service. Partners and stakeholders include other statutory agencies such as the NHS and the police, as well as voluntary, independent and private organisations providing social care and other services.

We found that promotional work by the social work service had raised awareness and understanding of some key services; some stakeholders had been appropriately involved in service planning; good use had been made of volunteers in some areas of activity. However, if Council strategies for integration, building capacity and sustainability in isolated communities are to be achieved these examples of good practice need to be generalised.

Community perception, understanding and involvement

As the region's largest employer, with operational management currently devolved to 8 areas and many local services and facilities, there should be strong identification between The Highland Council and local communities. However, some key elected members told us that the public generally were not well informed about Council business until they became directly affected. Consequently appropriate priority was given to raising public awareness and understanding of policies and services through publications, such as 'For Highland's Children 2', and presentations at area committees. There was evidence that these initiatives had been successful in raising awareness and understanding in some groups of service users and providers, for instance early years providers.

Understanding and involvement were also promoted by support for liaison arrangements, for instance local implementation groups for mental health and learning disability services. Such arrangements had been of considerable assistance in re-settling people with learning disabilities from New Craigs hospital to community provision in Inverness.

Impact on other stakeholders

Our survey of stakeholders elicited a relatively high response rate. The majority of respondents said that they were clear about service plans and strategies and that these were based on analysis of both need and demand. They were also positive about access to and the effectiveness of partnership arrangements, particularly in contributing to service improvements. However, they also pointed out that a lot of priority need went unmet, for example in relation to services for people with Autistic Spectrum Disorder.

Some individual partners and stakeholders were very positive about the relationships they had established with the social work service, for example, Highland Children's Forum acknowledged that they had been enabled by the Council in meeting their objectives for greater involvement of children in planning and development. However, we met with other groups of representatives who felt that they had little involvement in planning and service development.

Community capacity

We found good examples of volunteering and the use of volunteers, for instance in supporting day care activities for older people at Poolewe. Such activities, particularly in isolated communities, were often only viable because of community transport which also made good use of volunteers. In addition generation of community capacity was a spin-off from other activities, for instance the involvement of parents in early years provision. Providers described a cycle in which some parents started as users of early years services, became volunteers, trained and became early years workers.

However, there were significant exceptions, notably the failure of the Highland Council to offer any employment opportunities to people with learning disabilities in some remote areas. Consequently, at this stage, the Council's strategy of building capacity and sustainability in isolated communities remained aspirational for some groups.

Recommendation 3
Highland Council should continue to prioritise the provision of paid employment opportunities for people with disabilities. In particular, the Council should review its provision of employment opportunities for people with disabilities in remote and rural locations, including people with learning disabilities and those with mental health problems.