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CHAPTER 3 Outcomes for people who use services

The services performed to a good standard in achieving positive outcomes - having important strengths with some areas for improvement.

We define outcomes as the direct benefits in people's lives from the services they receive. People who used the services were mainly positive about the differences these had made to their lives. Carers expressed more reservations.

The services gathered a range of performance information that offered an indication of the likely outcomes for people who used their services. The information showed that the services had made it possible for many more older people to remain in their own homes or return home from hospital and that they had made good progress in improving the quality of the lives of people with substance misuse problems. They were beginning to reduce the number of children in residential placements and to improve the educational attainment of looked after and accommodated children.

They needed to do better at increasing the range of opportunities for people with learning disabilities and at meeting the needs of carers. They also needed to improve performance at reducing the number of persistent young offenders and at submitting reports to the Children's Reporter on time.

Measuring outcomes

In common with most local authorities Glasgow's social work services did not yet routinely measure outcomes across all care groups. Nevertheless, they produced a reasonable amount of performance information that provided an indication of the likely outcomes for people who used their services. This performance framework included annual performance reporting across all care sections, quarterly performance reports related to strategic priorities; and the development of performance measures for the framework for an integrated service for children. Most of these reports were well-focused, although we note in chapter 6 that data entry errors undermined the accuracy of some of the information.

In chapters 5 and 6 we discuss what this outcome information tells us about how well services were working.

Views of people who use services and carers

Most service users who responded to our survey agreed that social work services helped them to feel safer and to lead a more independent life. Most also agreed that the services had helped them feel part of their community.

Carers were less positive. The majority of those who responded agreed that services had improved the quality of life of the person cared for but less than half agreed that these had helped the person to lead a more independent life. Less than half agreed that services had helped them as carers have time for family, work or other commitments.

File reading analysis

Overall, the findings of our analysis of case files were positive:

• there was evidence that the services had achieved or were in the process of achieving the objectives set out in the care plan in most files;
• in most of the files, services had helped the individual to access mainstream services;
• in the majority of cases, the individual's circumstances had generally improved in the period under scrutiny; and
• in less than half of cases individuals had become more independent and in less than half more dependant on social work services. In most cases this seemed in keeping with their needs.

Outcome measurements

Measuring outcomes is not yet common practice. National and local targets are therefore often based on proxy measures. What follows derives from nationally reported performance indicators ¹ or from the authority's own performance targets.

People who misuse substances

The incidence of both drug and alcohol misuse in Glasgow is markedly higher than the national average. The services and their partners had taken steps to deal with this by establishing joint community addictions teams across the city. These teams were working effectively against a backcloth of significant prevalence and annual increases in demand for services.

Good practice example
Community addiction teams ( CATs) - These multi-disciplinary teams were able to offer individuals and families a full range of medical, nursing and social care supports. Senior managers said that combining health and social work services had added considerable economies of scale, with 40% more service users now in contact with CATs than were previously in contact with addiction services.

During 2005/06 the teams reported an increase to 6,863 in the numbers of people receiving a methadone prescription through the services they provided. Of this total the teams were supporting 5,934 towards rehabilitation and a further 929 required support.

The teams had also set a target to increase the numbers of individuals with drug and alcohol misuse problems who accessed pre-employment training, education and employment. They had made particularly good progress in achieving this. During 2005/06 they had managed to introduce:

• 1,103 people into pre-employment/training/education,
• 228 people into formal education courses,
• 150 people into voluntary work, and
• 322 people into full or part-time employment.

Looked after children

The services looked after a significantly higher number of children than the national average (2.1% of the 0-18 population compared to a national average of 1.2%). They had aimed to reduce these numbers but experienced a 6% increase over the period 2005/06. However, most of this increase was accounted for by a rise in the percentage of children looked after at home. This was allied to a two percentage point drop in the number of children in residential placements.

The target for 2006/07 was based on stabilising the overall figure and continuing to reduce the use of residential units and schools as part of a strategy to shift the balance of children's services ( described in chapter 6). This had included achieving a further 61 foster and adoption approvals. A further 60 were in the process of assessment.

Of the children looked after away from home on 31 March 2006, 83% had been in a placement for one year or more (compared to a national average of 74%) and 35% had been in three or more placements (the national figure is 29%). In chapter 5 we look at what steps the services were beginning to take to improve their long-term planning for children in their care.

Educational Attainment

In 2005/06, 52% of care leavers looked after away from home obtained at least one qualification at SCQF level three or above (compared to a national average of 57%) This was an increase of 1% from the previous year's figures.

In 2005/06, 40% of care leavers looked after at home obtained at least one qualification at SCQF level three or above. Although this was below the national average of 45% it represented an increase of 16 percentage points from the previous year's figure. During the same period the national percentage rose by seven percentage points. Managers had recognised that they and their partners needed to do more to improve the educational attainment of looked after and accommodated children and had put in place systems to monitor progress on this.

Good practice example

EVIP (enhanced vocational inclusion programme) was an initiative developed through a partnership between social work, education and building services and several Glasgow colleges to enable young people to gain the skills to access jobs. It was working with disadvantaged young people and had 24 full time places for looked after and accommodated children.

Of 128 vulnerable young people who benefited from the project in 2006:

• 80% achieved a vocational qualification,
• 44.5% went on to further education,
• 12% gained employment, and
• 5% secured modern apprenticeships or skill seeker posts.

Throughcare

It is important that local authorities continue to exercise a duty of care to young people they formerly looked after. The services had performed well in this regard. In 2005/06, of the 203 care leavers in Glasgow, 66% had a pathway plan and 35% had a pathway coordinator. The national figures were 52% and 60% respectively.

In 2005/06, 89% of care leavers were still in touch with social services which was more than the overall national figure of 85%. Nineteen percent of Glasgow care leavers entitled to aftercare support were in education, training or employment. The figure for Scotland was 23%.

In chapter 6 we note that many staff and managers we met considered that more recently there had been a dilution of leaving care services in some parts of the city and that this was beginning to affect the quality of services young people received.

Scottish Children's Reporters' Administration ( SCRA)

There is an expectation that services should provide SCRA with timely assessments and reports on children and young people in need or at risk to themselves or others. In 2005/06, the services submitted 34% of reports to the Children's Reporter within the target timescale. Although this was below the Scottish average of 36% it represented a significant improvement in performance from previous years. In 2003/04, the services submitted only 9% of reports and in 2004/05 12% of reports on time.

SCRA figures indicate that the services had not maintained this progress and as of December 2006 submitted 22% on time (compared to the national average of 33%). It is important that the services get to grips with this decline in performance.

The services performed better at submitting timely reports on young people referred on offence grounds. In contrast to the general trend, performance here had continued to improve. Based on monthly data the services estimated that they would manage to submit around 65% of these reports on time during 2006/07.

Recommendation 1
The services should take steps to ensure that they provide SCRA with reports within the required timescales.

Children with disabilities

The services reported that they increased the amount of daytime respite/short break provision for children with disabilities from 18,841 in 2004/05 to 71,335 hours in 2005/06. This was a very significant increase. Over the same period they also reported an increase in the amount of overnight respite from 8438 hours in 2004/05 to 8749 in 2005/06.

Youth justice

The number of children in Glasgow referred on offence grounds as a percentage of the child population was higher than the national average (4.98% in 2005/06 compared to 3.11%).

The number of qualifying persistent young offenders ² referred was 219 in 2003/04, 210 in 2004/05 and 252 in 2005/06. This represented an increase of 33 from the baseline figure of 2003/04 and meant that Glasgow did not meet the national target to reduce the number of its persistent young offenders by 10%.

The services had taken the positive step of establishing a youth justice research and development team that had responsibility for monitoring performance and evaluating youth justice services. The team gathered a number of performance indicators and was beginning to look at collecting some outcome measurements, for example YLS/ CMI³ assessments that practitioners completed at different points in their intervention with young people. There had been some problems in doing this as practitioners were not yet all consistently using the tool.

Child protection

During the year 2005/06 the services received 1,205 child protection referrals, equal to 12.3 per 1,000 population aged 0-15, compared to a national figure of 11.3. In their 2005/06 annual performance report the services noted that the year "saw a significant jump in the number of referrals and registrations accompanied by a drop in the number of de-registrations. Re-registrations also increased and by the end of the year were sitting outside our target range".

In 2006 social work services carried out an audit of child protection cases and found that it was difficult to tell from the paperwork whether there had been any progress in making these children safer. Only 40% of those cases where the services had de-registered children contained 'adequately' recorded reasons and no 'good' reasons for de-registration. Following on from the audit the services had developed an action plan to address this and other issues that had emerged.

Older people

During the five-year period from 2000 to 2005 Glasgow City decreased the number of residential places it provided or purchased for older people by 5.6% compared to a national average of 2.4%. The majority of these places (81%) were in the private or voluntary sector.

Over this period the services had continued to increase the level of home care they provided. The service from the provider DACS (direct and care services) offered an extremely high volume of homecare, including intensive homecare. The homecare service had played a very important role in the action taken by the services to shift the balance of care to develop community based services across the care group. During 2004/05 they ranked third nationally on the total hours of home care provided as a rate per 1000 population 65 and over.

Of those receiving home care, 77% received free personal care services at home. This was higher than the national figure of 68%. The services reported that they had no waiting list for funding for free personal care and that it was immediately available for people whether they were in the community or in care homes.

Joint performance information and assessment framework

The Scottish Executive requires reports from local authorities and the NHS about how effectively they are working in partnership to deliver aspects of community care. In response to the partners' 2005/06 'Joint performance information and assessment framework ( JPIAF)' the Executive assessed their overall performance as 'improvement required'. In respect of some indicators (10 and 11) the evaluation focused solely on services for older people. The evaluation concluded that the partners were:

• "Above average" on the comparative model
• Showing "good progress" on understanding the holistic approach and its application
• "Falling well short" of its local improvement targets for 2005/06
• Setting "insufficient" local improvement targets for 2006/07

Along with other councils Glasgow had expressed concerns to the Scottish Executive about some of the JPIAF outcome measurements. In their response to the evaluation the services and their partners had highlighted the progress they considered they had made in other care groups and their development of a joint performance management framework across health and social work. They reported that they were unable to reflect national targets for completing single shared assessments or for reducing emergency admissions as their systems were not configured in a way that allowed them to do so. They stated that their joint information group would be considering how to address this issue.

Delayed discharge

There is an expectation that local authorities and their NHS partners will aim to ensure that older people do not remain in hospital longer than is necessary. Glasgow and its partners had successfully dealt with the high volume that they faced and more than met their 2005/06 target in this respect.

The same as you?

Glasgow had a marginally higher than average proportion of adults with learning disabilities known to social work services - 5.6 per 1,000 adult population as against a national average of 5.5. The services had managed to allocate most of these people a care manager and we saw evidence of good outcomes for some of these people.

Good practice example

One joint learning disability team was supporting a young woman with very challenging behaviour to remain with her family. A team of day centre staff provided the support coached by the clinical psychologist who was part of the team. The young woman's mother spoke very highly of the service she and her daughter received from social work and commented that there been a great improvement in the quality of adult learning disability services.

The services had successfully resettled large numbers of people with learning disabilities from hospital back into the community and were continuing to support them. They had made very good progress overall in enabling a higher than average number of adults with learning disabilities to live in their own tenancies. In 2006, they enabled 32% to do so (the national average was 28%).

However, performance in addressing other recommendations that emerged from 'The same as you?' national review of learning disability services was more variable.

Only 1% of adults with learning disabilities had community short breaks in 2005 (the Scottish average was 11%). There were no figures supplied for 2006. A number of people made use of the services' traditional building-based respite.

In 2006, 18% of adults with learning disabilities had a personal life plan (29% for Scotland) which was a decrease of four percentage points from 2004.

In the same period, only 6% of the adults with learning disabilities known to social work services had employment opportunities. The national figure was 16%. The services funded employability projects across the city. These projects did not seem to us to have sufficiently high aspirations about the number of adults with learning disabilities they could help to get jobs. This was particularly disappointing given the buoyant state of the Glasgow economy.

Recommendation 2
Social work services should work with a range of partners to increase the number of people with learning disabilities who are in work. The priority should be helping people to get open employment. ⁴

There were only two local area coordinators in Glasgow, one working with adults and one with young people with learning disabilities. This was a pilot initiative. We were impressed with the work they were doing to socially include people with learning disabilities by finding ways to meet their needs that did not involve statutory services. The services were not sure whether the pilot would continue and if local area coordination would be rolled out across Glasgow. We think it should be.

Adults with physical disabilities

In 2005, Glasgow had 0.6 people with physical disabilities per thousand attending day centres. This was slightly above the Scottish figure of 0.5 per thousand.

Social work services had set high targets for delivering occupational therapy equipment on time and in 2005/06 managed to exceed these targets:

• they delivered 85.2% of equipment on time (the target was 85%)
• they delivered 87.3% of equipment in four-hour emergencies on time (the target was 84%)

Gaps in outcome information

There were some gaps in information, for example on outcomes for people who used criminal justice social work or mental health services.

The follow-up criminal justice inspection ( appendix 1) found that practitioners were not yet consistently using the LSI-R tool ⁵ which could be used to evaluate change over time.

The new mental health partnership had plans to develop a framework of indicators based on discussions with the Mental Welfare Commission and the Scottish Executive.

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