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CHAPTER 5 Delivery of key processes
We found that the delivery of key processes was adequate - with strengths just outweighing weaknesses.
The services had rolled out single assessment frameworks across most adult care groups and were in the process of doing so in children's services. They had begun to reduce the number of unallocated cases they had had when there were high vacancy levels and there was increasing evidence of close working arrangements with other agencies. There was evidence of partnership working with people who used services and carers.
There were a number of areas requiring improvement. Managers, staff and stakeholders all considered that risk thresholds were high but there was no clear and consistent allocation framework for non-statutory childcare work. The services' out-of-hours service was not good enough. There were no independent chairs of reviews for looked after children. The services needed to move more quickly to secure the long term future of greater numbers of children in their care.
Access to services
Information about services
The services had a wide range of leaflets available for service users, and these were consistently available in offices and places used by service users. The services no longer translated all of its leaflets into Urdu, Punjabi and Chinese, and instead publicised information that directed non-English speakers to the city translation service which aimed to give a much better service in a wider range of languages. The communication team said that this approach allowed for information to be provided on a case-by-case basis, better reflecting diversity across the city.
Good practice example
The services' communication section was involved in developing an excellent dedicated website for people with learning disabilities - www.ixseed.org.uk. This website for Glasgow's learning disability partnership offered information on entertainment and news, life and well-being, city-wide and locality services as well as discussion boards.
As a pilot initiative the city council had begun to install electronic kiosks around the city that had information about council services including social work.
Out-of-hours service
Glasgow was the host authority for the West of Scotland standby service, which provided an emergency social work service out-of-hours. Standby employees worked for Glasgow but operated across what was the former Strathclyde regional area. Inspectors heard from a number of different sources about the limited capacity of standby social work services. Many, including police colleagues, said that it could be very difficult to get through to them on the telephone and that when they did they were often disappointed at the support offered.
Standby practitioners confirmed that the service could take unacceptably long to answer the telephone and that this led to many angry callers. They said that vacancy levels meant that there were sometimes as few as two social workers on duty overnight.
Senior managers recognised that the standby service required improvement. In March 2006 the services published their best value review of the service with an associated action plan covering many of the main areas of concern. Many of the review's recommendations mirrored those contained in a 2003 review of the service. There had been little progress on addressing these recommendations. Much of the more recent improvement plan was contingent on a move of premises and the outcome of information technology improvements. One year on from the publication of this plan there remained little sign that the services and their partners in the user authorities had made any progress towards implementing it.
Recommendation 6
The services should move quicker to implement the recommendations of their best value review of standby services.
Initial contact with the services
When people made contact with social work services for the first time they normally spoke to on the phone or saw a worker who acted as a first point of assessment ('intake duty'). The CHCP areas in Glasgow operated service-specific duty systems for different service areas such as children and families, adult care, mental health, addiction and so on. There were also significant variations between CHCP areas in how they organised duty. Administration staff and some practitioners told us that service-specific intake duty could be a cumbersome approach, that they thought might be inefficient, using more resources than was necessary. We agree that these arrangements run this risk.
Senior managers told us that they were moving towards adopting corporate 'shared services' reception points using generic administrative staff to direct people to the correct service. In doing so it is important that the council recognises that people seeking social work services may have a range of serious problems that are not necessarily those that they initially describe. Any screening process carried out by reception staff must take account of this complexity as well as the need for a confidential meeting space in which to hold the initial conversation.
Day-to-day planning and resource allocation
Allocation of work
All children subject to child protection procedures, and virtually every looked after and accommodated child, had an allocated social worker. Outside these areas there were significant levels of unallocated childcare work. Managers at all levels told us that the services reviewed their unallocated work periodically. However, they were unable to tell us exactly how many unallocated cases in total there were as there was no routine reporting on these statistics.
Within children's services, managers received monthly reports on child protection cases, on looked after and accommodated children and on the number of Children's Hearing reports requested/ completed. They did not receive reports on other unallocated cases such as vulnerable families and children with disabilities. At our request the services supplied a list of all 'unallocated' cases. This list was not accurate, containing a number of data entry errors. We looked at a sample of these and found that some had regular social work involvement, some were closed and some were adult community care cases incorrectly entered as childcare cases. We discuss the implications of this further in chapter 6.
Given the volume of work the services have to cope with (well above the national average) it is more than likely that there will be unallocated work and a need for the services to prioritise non-statutory work. However, there was no guidance for practice team leaders (who had overall case holding responsibility) to use when making such judgements.
Within community care services we found that there were discrepancies in how CHCPs logged and dealt with cases where the service user had moved into residential care. These cases should remain the responsibility of an allocated worker, categorised under a heading 'monitor/review'. Although managers had taken steps to make sure that this happened, many cases did not yet have an allocated worker at the time of the inspection.
Senior managers and practitioners told us that the creation of CHCP areas had resulted in disaggregating existing staff to CHCP areas in a way that reflected traditional perceptions of demand and need. They said that they were undertaking a review of resource allocation citywide using more recent demographic data, and that this review would over the course of this year lead to the reconfiguration of resources amongst the CHCP areas. This process may help reduce the future level of work that is not allocated. We discuss the staffing issue more fully in chapter 6.
Staff and managers told us that childcare cases involving children with disabilities had a lower priority for allocation. This did not necessarily mean that these children were not receiving a service as many had packages of care in place. The services advised parents of these children to contact the intake system if the package needed to be changed. Carers that we met spoke of long waits for packages of care and about a lack of information about what was available. They said that the lack of contact with a case manager made them feel that they were left on their own.
In the longer term, proposals for a more joined-up approach between agencies to deliver services to children may address this issue. For the foreseeable future, however, it is likely that the services will be unable to allocate a case manager to all children with disability. In the interim they should ask carers for ideas about what more they might reasonably do to offer support.
Some staff commented that, although there was a transition protocol in place, arrangements could become problematic at the stage when a child with no allocated case manager was making the transition to adults services particularly for children with physical disabilities who were in mainstream schools.
Occupational therapy services
Occupational therapy staff and managers reported that high priority cases received a service within four to six weeks with medium priority cases dealt with within three to six months. Those assessed as a low priority could experience very long delays of two or more years. In chapter 6 we discuss delays in publishing the best value review of equipment and adaptations and of integrating this service as well as the low morale of occupational therapy staff.
Assessment and case management
Assessment
Our file reading exercise found that most files contained a written assessment though only half of service users who responded to our survey said they had seen a copy of their assessment.
Single assessment frameworks were in place with NHSGGC colleagues in the addiction, learning disability and homelessness partnerships as well as in older peoples services. The services were also in the process of rolling out a single framework for mental health.
In children's services the services were implementing an integrated assessment framework ( IAF), following a pilot of this approach in one area of the city. IAF is a framework for the multi-agency assessment of children with more complex circumstances, linking social work services with colleagues in the NHS and education service. The services had invested a good deal of time and resources in developing the framework. They had appointed a senior manager with responsibility for IAF, and it was clear that careful thought had gone into the goals and objectives of the framework and its rollout. It ought to be a useful vehicle to help agencies to work more closely together.
Some stakeholders and staff commented about the variable quality of assessments. In our file reading exercise, readers judged that six in ten of the sample were 'good' or better and four in ten were 'adequate' or poorer.
Case management
Our file reading exercise showed that the majority of care plans mostly or completely addressed the risks and needs identified in the most recent assessment, and that reviews of the plan took place at appropriate intervals in most cases.
We were nevertheless concerned to find that there were no independent chairs of reviews. Practice team leaders ( PTLs) chaired the reviews for cases held by staff in their teams. This was particularly of concern in respect of looked after (and looked after and accommodated) young people. That there should be an element of independence in this process is well established in practice elsewhere in Scotland, is favoured by the services' own children's rights officers, and is clearly set out as best practice in the Guidance to the Children (Scotland) Act 1995. 7 The services had taken the decision not to follow national guidance as they were not convinced that this approach led to better outcomes for children.
Earlier we commented that the services had not done as well as they could have in permanency planning for looked after and accommodated children. For example, first line managers told us that babies could wait between 10 and 24 months to be placed with a permanent family, and that delays for older children could be even longer. Effective planning is very important for delivering good outcomes for those children and young people for whom permanency is appropriate. Managers said that delays reflected high demand and previously high staff vacancy levels. Some staff also commented that many of the services' newly recruited social workers and social care workers holding these kind of cases lacked the experience and skills to plan for permanency. We think the services should also consider whether lack of independence in the reviewing process had played a part in the drift in planning in some of these cases.
Recommendation 7
The services should reconsider their decision not to follow national guidance and should find ways to introduce more independence in the chairing of reviews for looked after children.
Managers stated that they were now taking steps to improve long-term planning for the children they accommodated, for example by carrying out a review of all 0-4 year olds in their care, and establishing task forces in some areas. In one CHCP we visited this had resulted in significant improvements in permanency planning for infants and the task force (of a PTL and a social worker) were now moving on to focus on older children waiting for a permanency service.
Recommendation 8
The services need to move more quickly to secure the long term future of greater numbers of children in their care. They should build on the good work they have started to do in some parts of the city.
Case recording
Our file reading exercise found that most records were continuous with no significant gaps and contained the kind of information that matched the needs of the service user. This offered a more positive picture than emerged from the services' 2006 audits. For example the audit of child protection cases had found little reflection or analysis in files and gaps in information.
Relatively few files that we read contained an accessible chronology of key events, especially those files that were about adult service users. A higher number of files contained a list of key dates of social work activities (case conferences, reviews, etc.) but did not identify main events in the service user's life such as changes in parenting or household composition, death of a partner, changes of accommodation or health emergencies.
Our follow up inspection of criminal justice services ( appendix 1) found some improvements in recording since previous inspections though these were limited. Criminal justice staff acknowledged that case files did not necessarily evidence the quality of their work.
Senior managers recognised that there was room for improvement in the way that managers and practitioners recorded case notes and other data and commented that later this year they would be issuing fresh guidelines about using the electronic system. CHCP directors indicated that there were still some issues to resolve regarding the respective roles of workers and administrative staff with regard to whose responsibility it was to input data.
Risk management and accountability
Our file reading exercise showed that although the majority of relevant files had an up-to-date risk assessment three out of ten did not. Four out of ten did not have corresponding risk management plans although the services dealt with most of these cases according to written procedures.
Senior managers, practice team leaders and Children's Reporters all said that risk thresholds in children's services in Glasgow were high, simply due to the intensity and volume of the social problems encountered by the services. These are greater than those routinely encountered in other parts of the country. We found no evidence of a consistent approach to risk assessment to determine whether someone was above or below that threshold. There is therefore a danger that the positioning of those thresholds will vary by area and be inconsistent. This issue relates closely to the need for clear criteria when choosing which non-statutory work to allocate or not to allocate. There ought to be a consistent structure to shape and guide professional judgment.
In proposals the services and their NHS partners were drafting to improve children's services they recognised the need for agencies to establish 'shared screening processes and agreed criteria and thresholds for access to services'. They hoped that the introduction of IAF, underpinned by training in its use, would provide this criteria. We feel that the IAF could play a key role but that there are other steps the services could consider taking to make sure that their first line managers make reliable and defensible decisions. This includes setting out clear guidelines (drawn from IAF) that equips first line managers with a practical framework that they can use on a day-to-day basis when allocating work.
Recommendation 9
As a matter of priority the services should set out a clear framework for determining which non-statutory childcare work to allocate to ensure that there is a consistent approach across the city. They should also ensure that there are robust processes for reviewing unallocated work.
Vulnerable adults
We found inconsistencies in respect of vulnerable adults procedures. Although the services had a written policy in place and had trained some staff many other key staff had not yet received this training including staff in day care services for adults with learning disabilities, staff working in the homeless community care team, standby staff and staff in the addictions team. The services had asked two CHCP heads of community care to take forward the rollout of vulnerable adults training to all relevant staff and the services should ensure that this process takes place as quickly as possible.
The services also invoked vulnerable adults procedures in cases involving adults subject to Adult with Incapacity legislation and accorded these vulnerable adults status on the IT system. Many of these were older people in residential care. This meant that it was not possible to differentiate from the services' statistical reports between these people and those vulnerable adults who still needed active steps to protect them.
Children at risk
Glasgow has approximately 22% of all Scotland's problematic drug users. Staff and managers highlighted the strong link between the extent of this problem and the high levels of childcare cases they dealt with. We would therefore have expected to see evidence that the city's integrated community addiction teams were working jointly with a significant number of childcare cases. We have highlighted the successes these teams have had in helping people with addiction problems find their way into employment or training and in chapter 6 we comment on how positively social work staff and other stakeholders view the services they provide.
The services carried out a review of the interface between children and families and addictions services in 2004 that set down a framework and standards for joint working. Managers stated that they were confident that these arrangements were working well. However, they had no performance information that would support this view. A recent audit had indicated that only around 10% of children and family cases were also active cases of the addictions team. Managers were of the view that this reflected a gap in the way that staff recorded their activities on the IT system rather than an absence of joint working.
Recommendation 10
The services need to be certain that staff working with children of substance misusing parents are making best use of the services' addiction services. They should make sure that they robust performance information to evidence this.
Criminal justice
The follow-up inspection of criminal justice services ( appendix 1) found that staff were still not routinely screening for risk of harm and that procedures for dealing with high risk offenders were not sufficiently well established.
Other services for adults
The services reported that they had implemented the recommendations of the Mental Welfare Commission in relation to two recent 'deficiency in care' enquiries.
The services had a risk assessment tool for all people who use mental health services completed by consultants though staff reported that it was sometimes difficult to get them to do this. Managers reported that they had also trained or were in the process of training practice team leaders on the use of risk assessment tools for adults with learning disabilities.
Partnership with people who use services and their carers
Evidence of partnership working with users and carers was encouraging. Of those users responding to our survey most agreed that they had been fully involved in deciding what help they should receive and the majority agreed that there was a meeting once a year to discuss the services they received. Of carers surveyed the majority of respondents agreed that they had been fully involved in deciding what help was required for the person they cared for and reported that they felt consulted and listened to.
Our observations and the findings of our file reading exercise reinforced this picture. For example we met a vulnerable adult with a learning disability during fieldwork who had taken part in selecting her care workers. In most cases we sampled there was evidence that the service took account of the views of users and their carers at each key stage. In the main they did so through formal meetings and reviews or through users' and carers' groups in some of the residential and day units. Some areas of the service had begun to explore different and systematic and consistent means of doing so. For example the services had piloted the software package 'Viewpoint' to obtain the views of 150 young people in foster care.
Some service users and staff injected a note of caution. They pointed to those people who used services who were in residential care or receiving a specialist service (such as from youth justice services) who received little or no contact with case managers and for whom partnership planning was less meaningful. For instance, some accommodated young people commented that their social workers did not 'pay attention to what we need'.
The services received on average 300 complaints a year only a few of which progressed as far as the review complaints committee.
Inclusion, equality and fairness in service delivery
The council had in place up-to-date equalities action plans in respect of disabilities, race equality and gender.
Almost all files we sampled involving a service user from an ethnic minority or with a disability contained evidence that the service had taken into account potential barriers arising from the disability or from differences in language, culture or beliefs. Almost all service users who responded to our survey agreed with these findings.
We observed examples of initiatives designed to meet the particular needs of marginalised groups. The work of the homelessness partnership 8 provided a good example. The partnership had established a number of multi-agency teams, including the homeless assessment and resettlement team that had a remit to re-settle single men who had been living in the council's large scale hostels that were incrementally closing. As a result of the work of this and of the services other homelessness teams 9 the partnership had achieved a reduction both in the number of homelessness applications and in the level of repeat homelessness.
Other initiatives - on a much smaller scale - included the Roshni women's group of Asian women who used drama and arts to deal with issues that affected them, and the Central Mosque day centre for older adults in the Muslim community which had a bi-lingual staff group.
Good practice example
We visited a support group for asylum seekers and refugees that social work services ran in conjunction with the Scottish Refugee Council. Social work services provided translators for this group. Participants were very positive about their experiences of attending the group and unanimously appreciated the support it had provided to their families in settling into a new country, sometimes under difficult circumstances.
The service also supported a number of advocacy projects that could represent the views of vulnerable service users although some, including those with mental health issues or with learning disabilities, had greater access to these services than others. The services had not properly established advocacy for children. The services purchased a service from the national provider 'Who Cares?' and had its own in-house children's rights service (consisting of two staff with a third due to join the team). With this limited capacity the team had focused on children and young people accommodated in residential units and had not been able to look at the need among those in foster care, those looked after at home and children with disabilities.
The services had taken some steps to identify the extent of unmet need for example by carrying out a recent audit that identified a low take-up of services from black and minority ethnic ( BME) communities and by compiling demographic profiles of each CHCP area. The 2001 Census recorded the city's BME population at 5.5%, a percentage that had since grown significantly due to the large number of asylum seekers living temporarily or permanently in the city. In respect of social work services 3.5% of service users were from BME communities. The services had yet to establish a wider strategy for enabling access to its services among these groups.
Multi-disciplinary working
The services had made a significant investment in promoting multi-disciplinary working. Around three quarters of files in the file reading sample contained evidence of work alongside partner agencies. Just over three quarters of staff who responded to our survey reported a good working relationship with health services and around six in ten agreed that relationships with education services were also good.
Integrated teams provided the most obvious examples of working across agency boundaries. Examples included:
- community addiction teams;
- learning disability teams;
- community mental health teams;
- PACT (parents and children together) teams. These newly formed teams made up of social workers, health visitors, nursery nurses, family support and money advice workers, provided an intensive service for twelve weeks to mainly mothers of young children who were depressed, isolated or affected by drugs or alcohol; and
- CLASS projects. These five units staffed by education and social work staff provided an alternative to residential schooling for young people experiencing difficulties in coping with mainstream school.
Good practice example
The women's health review meeting. This multi-disciplinary group met fortnightly to discuss cases involving vulnerable women who were pregnant and might need support or intervention. The group included social workers, midwives, liaison health visitors and addiction workers. It held assessment and review meetings two months prior to birth and post birth. Group members were confident that by flagging and checking women coming through the city's six women's health clinics they were identifying those that were most vulnerable.
The move to single management of health and social work services for children's, older people's and mental health services may help agencies to continue to build on these arrangements and improve links particularly where they are weakest.
Partners stated that they were working to strengthen links with education and needed to do still more. This was evident for example in the need to improve links between the departments in relation to the education of looked after and accommodated children and in the lack of clear links between integrated support teams 10 and resource screening groups 11 (that were likely to be dealing with some of the same young people). Initiatives such as the introduction of the IAF may help improve these links.
Looking beyond these partner agencies there were examples of sound working practices with other disciplines as well as some instances where these were not operating as well as they could be.
Working arrangements with partners in the police offer one illustration. While both social work and police reported close working relationships in dealing with child protection issues and managing the risk presented by sex offenders, arrangements at the frontline to deal with young people who offended or who were at risk of offending were less co-ordinated. Good links at a strategic level did not yet extend as well as they might to the operational level. The services and police colleagues did not liaise enough with each other about high-risk young people who were offending and there was not a sufficiently joined-up approach with colleagues in community safety services (part of development and regeneration services) about young people on the fringes of offending.
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