The Scottish Government

« Previous | Contents | Next »

Listen

CHAPTER 6 Management

This chapter looks at three areas for evaluation:

• Policy and service development, planning and performance management
• Management and support of staff
• Resources and capacity building

Policy and service development, planning and performance management

We considered that the performance of the services in this area was good - with important strengths with some areas of improvement.

The services had developed a broad range of up-to-date policies that were of good quality. They had a history of partnership working on which they had continued to build and had made significant inroads in developing integrated services. They reported on a broad range of performance information although they needed to do more to make this more accurate.

There were some areas for improvement. The pace of change in services for adults with physical disabilities was too slow and there had been delays in reviewing or implementing reviews of some aspects of the service. Home care services were not yet sufficiently personalised.

Policy review and development

The social work services had developed a comprehensive range of policies and strategies. Most of these were up-to-date and of good quality, for example the integrated children's services plan.

We found that a consistency and linkage ran through the plans across the various planning levels. Individual service specific plans - such as the homelessness, addictions and learning disability strategies - related back to the social work service plan which in turn related back to the council plan. Plans were generally SMART (specific, measurable, achievable, realistic, time-bound) containing action plans with timescales and lead responsibilities.

The services had made considerable strides forward in their planning for older people's services. They had invested heavily in homecare services, reviewed residential provision (developing a good commissioning strategy for this provision), and carried out reviews of day care services. They had set out their approach to older people's services in the joint community care plan and JPIAF submission. They now needed to take the next step and draw together all the elements of their provision for older people and outline a clearly understood and comprehensive strategy.

In recognition of the poor outcomes for young people who are accommodated the services had developed plans to reconfigure children's residential services. This included plans to recycle £10.4m pounds over four years from high-cost residential placements to increase the availability of community placements and resources. The services also planned to invest £9.1m to modernise residential care for those young people that needed to be accommodated in such care.

These plans fitted into wider proposals to improve children's services that included a focus on developing more early intervention strategies. The proposals were at a relatively early stage of development and had gone out for consultation. The aspirations of these plans are laudable and we await their implementation with interest.

We did identify some gaps in policy development. For example the services had developed a draft strategic framework for physical disability services, dated June 2004. We found little evidence that it had done much since then to develop local community based services by freeing up resources, a significant proportion of which were committed to high-cost services.

We also found delays in reviewing or implementing reviews of services such as the best value reviews of standby, leaving care services and of equipment and adaptations.

With the establishment of the five CHCPs, each area had developed locality plans setting out local priorities and associated action. The services recognised that the CHCPs had introduced their plans quickly in the first year and that they would require to develop and refine them further for future use. Responsibility for overarching strategies for care groups was to remain with the centre for the foreseeable future.

A number of the existing documents, such as the council plan and the social work service plan were due for renewal after 2007. In refreshing and updating these and future plans including CHCP development plans the services will need to give greater attention to achieving a better fit with the community plan. The five CHCPs are co-terminous with the 10 local community planning partnerships which should facilitate this.

Operational and partnership planning

The services have a significant history of partnership working. They had, with the NHS, planned and operated what were well-established partnership services for addictions and for people with a learning disability. Partly based on the experience of these two partnerships, the services and the NHSGGC established the five CHCPs in April 2006. A key objective of this was to have an approach to service delivery that was based on full partnership planning and the delivery of integrated services within local communities. A formal partnership was also now in place for homelessness and partnerships were in development for mental health and older people's services.

The approach adopted in Glasgow demonstrated a commitment to partnership working. The council and key partners had agreed a number of developments designed to further reinforce partnership working. These included:

• adjustments by the education service to its existing structure of 29 new learning communities in the city to better fit in with the five CHCPs;
• council plans to bring both the social work and education services under the leadership of one executive director;
• re-organisation of other council services in line with the CHCP structure;
• plans by the police to restructure along CHCP boundaries;
• plans in place, starting in the south west of the city, to move into neighbourhood "hubs" with partner agencies; and
• joint work with Glasgow housing association ( GHA) and other housing providers to address gaps in provision.

We also found some existing examples of effective partnership working including:

• engagement with development and regeneration services in support of the balance of care report. This had resulted in guaranteed sites in certain areas of the city where there was a need to develop the care home market; and
• partnership working with education that had led to the introduction of nurturing classes in 59 primary schools to help support vulnerable children and families.

Despite this strong overall structural and strategic framework, we found some areas where operational and partnership planning could be improved. Perhaps not surprisingly given the level of change, the links between the CHCPs, the community planning partnership and the new learning communities were not as clear as they needed to be, something acknowledged by the senior managers concerned.

Involvement of stakeholders in planning and service development

There were signs and evidence of some of the efforts the services had made to involve stakeholders. Providers' forums were in place and the services contributed funding for project managers posts for two of these - the community care and children's forums. The services also engaged with various sub-groups including the supporting people providers forum and engaged too with provider forums in learning disability, addictions and mental health.

Good practice example

The services included the independent sector provider 'Carr-gom Scotland' on the management group for mental health services.

Most of the organisations we met or who responded to our stakeholder survey recognised the services' commitment to improving services and acknowledged an increase in partnership working. However, the responses were predominantly neutral when addressing the actual effectiveness of the joint planning structures. For example while the services involved the authority reporter ( SCRA) in strategic planning some locality reporters commented that they were not yet fully involved in consultations about local issues. Some voluntary organisations and other independent sector providers spoke of a desire for a more genuine partnership. In chapter 4 we noted some stakeholders' uncertainty about how the CHCP structure might affect partnership working arrangements.

In order to enhance the role of users and carers in partnership planning, the services in partnership with NHSGGC had revitalized the city-wide service user and carer group and given it responsibility for overseeing the development and implementation of user and carer involvement in the five CHCPs. The group had produced an action planning tool for the CHCPs and expected delivery on some of the action points within a year. A pre-agenda group was to set the priorities for future meetings to ensure that the agenda reflected the user and carer viewpoint. The partners had not yet determined how they would resolve the tensions that can arise in ensuring equal attention to both user and carer perspectives.

Planning and implementation groups ( PIGs) were one of the main forums for including stakeholders. We observed one PIG for learning disability services. All written information for the group was easily accessible to all. The group discussed how to involve service users in recruitment and how to widen representation to black minority ethnic groups.

Other examples include the joint mental health management team that had representation from three people who used the services. These service users had suggested amendments to a draft protocol and commented that they had received a swift and positive response to their suggestions.

Some other service users were not so positive and said that they did not feel able to participate fully. For example a number of young people and their representatives, as well as people with a hearing impairment, spoke of a lack of involvement and/or a lack of feedback to suggestions for service improvement that they had made. The services had also not made as much use as they might have of information collated by their children's rights service about issues of concern to children and young people.

The services had made efforts to involve staff in developing policy. For example, they had held workshops with staff to identify issues in children's services and potential options to address these. These had resulted in proposals that were out for consultation at the time of the inspection. Other examples include involving staff in the best value review of adoption and fostering services and working groups for the integration of occupational therapy services.

Notwithstanding these efforts many front line staff did not perceive some of these exercises as meaningful examples of staff involvement and consultation.

Our staff survey showed that less than half of the staff surveyed agreed that either their views or those of service users and carers were fully taken into account in planning services. Many front line staff that we met reinforced this view.

Developing integrated services

Consistent with the services' commitment to partnership working was their view that a key purpose of this, and a key outcome, was the development of integrated services. They had given significant attention to this and had set up CHCPs up in order to further develop integrated services.

In line with the incremental approach the services and their partners had taken, care groups were at different stages of development and transition in their journey towards integration. Some care groups, such as addictions, learning disability and homelessness were already well-established and understood on an integrated basis. Others such as mental health and children's services were at various stages of becoming more integrated. Services for older people were moving increasingly towards integration for example through the inter-relationship between Rehabilitation and Enablement Services ( RES - responsible for community social work and health provision for older people and adults) and the Rehabilitation and Assessment Directorate ( RAD - responsible for hospital services for older people and adults). A few services such as those for people with a disability still had a considerable distance to travel.

Senior managers commented that it would take the service and its partners a number of years to complete the integration agenda. The actual process of establishing the CHCPs had been very intensive and required considerable effort. In some areas, such as in occupational therapy services, this appeared to have contributed to some delay and confusion among staff around the progress of integration.

Staff were generally clear about lines of accountability within CHCPs but their understanding of integration and the contribution of CHCPs towards this varied. For example some staff said that they were still not clear on the roles and inter-relationship between RES and RAD.

Varying views amongst front line staff about integration generally reflected how far the individual service was towards becoming integrated. Staff in addictions and learning disability were positive about the integrated services in which they worked, were able to describe how service delivery had become more streamlined for service users and could see the rationale behind CHCPs. Front line staff in other services were often much less clear about this. They were of the view that local joint working arrangements with colleagues had been good anyway, and that the establishment of the CHCPs had brought no tangible benefits.

Service integration within children and families' services was less developed but the integrated children's services plan had been a significant driver. The services and their partners in NHSGGC had developed draft proposals to tackle many of the issues within existing service provision and were beginning to involve other agencies, particularly education, in taking these forward. Including children's services within the CHCPs had been a contentious step. Managers in both NHSGGC and social work had debated hard about this. They had concluded it was essential if children's services were to be improved. Some staff and managers were cautiously optimistic about improved joint working with education.

Each CHCP assumed a lead responsibility for particular aspects of integrated service development in children's services, for example the south west CHCP that led on early intervention and prevention.

The services faced some challenges in moving to greater integration of children's services within the resources available. For example, we found that:

• each CHCP was establishing integration development manager's posts to increase the management capacity to progress the integration agenda. However, these were temporary posts;
• the services had de-centralised some specialist services, such as many of leaving care services with a view to local teams undertaking this role on a more integrated basis. Staff and stakeholders expressed concerns that in some parts of the city staff found it difficult to give this aspect of their work enough attention and that this was beginning to affect the level of service provided to care leavers.

Range and quality of services

The services provide a large amount and a broad range of services. In their own evaluation the services stated that the development of their community care services had been influenced for some time by consideration of the balance of care with an emphasis on developing progressive community based services. They recognised that this had historically been less evident within children's services, but signalled that this had more recently become a key element of service redesign.

The findings from our surveys and from our fieldwork largely reflected this self-evaluation.

There were some examples of services that had been developed on a local basis and that were not replicated across the service. These were predominantly ex-urban aided projects and were not large in number. Rather we found that social work services had made efforts to develop their services strategically across the city with good baseline service planning information supporting this process.

Positive examples included:

• the IRIS service (interdisciplinary response and intervention service) that made a positive contribution to the discharge of older people from hospital as well as helping to prevent admission;
• well developed specialist residential care provision for older people with dementia;
• the development of a tiered service for people with mental health problems. Each CHCP would in future provide a service for those with mild/moderate mental health problems run by nurses but with links to the social workers in the community mental health teams. This was a positive initiative in mental health services. At the other end of the spectrum the partners were developing crisis teams. These three elements should provide a good service across three tiers with community mental health teams in the middle;
• good provision of mental health officers (0.15 whole time equivalent per 1000 population compared to a national figure of 0.12);
• innovative children's services including PACT and EVIP;
• the Geeza Break project based in the east end of the city. This voluntary sector project that received social work funding supported children and families and prevented children being looked after. One hundred and fifteen families received support. The project provided respite care for families, side-by-side intensive family support group, and intensive family support;
• the work carried out by the carers' centres that we have already highlighted. Last year these centres completed over 1,200 carers' support plans; and

• the joint equipment store for aids and equipment.

Good practice example

In order to streamline ordering for aids and equipment the services, in partnership with NHSGGC and East Dunbartonshire council had developed the Greater Glasgow Independent Living Service ( GGiles) system. This electronic system enabled staff to order equipment more efficiently. It worked very much like an on-line shopping system.

There were some gaps in service provision and areas that the service needed to improve. These included:

• day care services. There had been a delay in implementing the review of these services (due to adjustments in the capital programme) that had lead to significant variation in the quality of services between those that had been modernised and those which had not;

• community support teams. These teams had dealt with young people who were beginning to become involved in offending. The services had integrated the staff in these teams into practice teams with the expectation that practice teams would then deal with these issues as an integral part of their work with young people. Many staff we spoke to said that they had not been able to do so due to other work pressures. Replacement purchased intensive community support services were not yet fully in place;
• kinship care. The services had set out objectives for supporting kinship carers and had set aside additional money for this purpose. A decision on allocating funding to a kinship carer was made locally by one of the operations managers. Carers that we met were concerned that this resulted in unacceptable variations in practice across the city. The authority may need to take steps to reassure kinship carers that the process is fair and consistent.
• home care services. Annual surveys of people who used these services had shown that they were generally positive about them, though similar themes around lack of flexibility emerged each year. These reflected the feedback we received from service users, carers and a wide range of staff. All described the homecare service as being very task-driven and not sufficiently person-centred.

Recommendation 11
Social work services should review their service level agreement with DACS to ensure that homecare services are sufficiently personalised.

Quality assurance and continuous improvement

The council had a performance management framework. Within social work services we found that as well as reporting on the agreed national performance information, they had given attention to developing a range of performance measures and information and a framework for reporting these. Examples of these included:

• annual performance reporting across all the service's care sections that was outcome-focused and was linked to a "traffic lights system";
• the introduction of quarterly performance reports related to the strategic priorities identified in the budget and service plans; and
• performance measures for the framework for an integrated service for children.

Most of the performance information documents that we saw were of good quality and well-focused, although some could have been more SMART, for example by including information about both current performance and the proposed targets. Later in this chapter we also note that the value of some of the information was undermined by data entry and recording issues and recommend that managers need to act quickly to address this.

The follow-up inspection of criminal justice ( appendix 1) notes improvements to quality assurance arrangements in this part of the service. This included increasing analytical capacity and the flow of management information to and from CHCPs.

The services' commitment to performance monitoring and continuous improvement was reflected in the establishment of a post of head of performance and the establishment of a practice audit unit staffed by seconded senior practitioners. Although there had been delays in establishing the unit the services had, in the interim, carried out audits of some aspects of the service including child protection and work with looked after and accommodated children ( LAAC).

In our meetings with senior and middle managers, it was clear that the importance of both receiving and making use of performance information was well understood. The position with front line managers and staff appeared more variable. For example frontline staff in CATs received monthly reports on the performance of their teams and used this to make changes to the services they delivered. This systematic approach was not yet apparent in most other parts of social work services.

The services had begun to take steps to embed a performance review culture among the wider staff group. For example, they had introduced a local management review approach that involved staff at local level taking time out to look at how well they performed in particular areas of their work. This had included local events where staff had considered their performance in respect of child protection and LAAC. These appeared good attempts at involving staff in reviewing past and current performance at local and city-wide level. Some of the action plans that emerged were not as SMART as they might have been (containing too few timescales) - an issue the services should address in order to harness the full potential of this promising approach.

The services in partnership with NHSGGC were developing a joint performance framework and had commissioned external evaluation of the impact of CHCPs on the quality of services.

The services were also in the process of attempting to align their complaints procedures with those of NHSGGC. We found limited evidence that the services used analysis of the complaints they received to contribute strategically to service review and development. As they go through the process of alignment they should consider how they might use complaints more productively.

The services had given attention to performance monitoring as part of their contract management arrangements for purchased services and had developed a range of performance information to enable them to do so.

Case monitoring

We found little evidence that managers scrutinised files to ensure that individuals were receiving the services that they should do. There was evidence in only a few files that first line managers had regularly examined files or that senior managers had periodically done so.

Management and support of staff

Performance in this area was adequate - with strengths just outweighing weaknesses.

The fieldwork review attempted to ensure experienced staff were still practising, and to some extent this had succeeded. Recruitment had improved. But there were issues to be resolved. There was lack of clarity about roles and responsibilities of social care workers and uncertainty about the balance between management and case-carrying responsibilities of PTLs. Supervision was variable and the services had still to implement personal development plans.

Recruitment and retention

The implementation in 2004 of the services review of frontline services had had a significant impact on staffing levels. In their SEQ the services reported that "from a position in November 2003 of a 17% shortfall in qualified workers (far in excess of this in certain areas), the service now operates at full establishment". The most recent Scottish Executive figures, November 2006, showed a vacancy rate of 4% against a national average of 7.5.%. The services had received a care accolade for their work on recruitment and retention.

At the time of our fieldwork most posts were filled though there remained a 20% shortfall in the children and families' PTL establishment. Senior managers stated that they did not want to take any steps that would reduce the quality of staff they recruited to these posts. They intended to address this shortfall by introducing mentoring schemes for experienced social workers to encourage them to move to these posts and by providing support for potential applicants to compile the portfolio they needed to apply.

Problems remained in residential care, and work was underway to increase residential care contracts from 30 to 37 hours per week, in the expectation that the increase in the standard contract would reduce the use of agency staff, and resolve the recruitment and retention problem.

Sickness levels in social work had remained consistent over the previous five years. These were approximately 7% among fieldwork staff, and 10% in adult residential care - around 2.5% above the council average.

Although social work services did not have a written workforce strategy they had based their approach on two linked policies - the fieldwork review and the roll-out of the personal development plans ( PDPs) across the service. The review had provided a link between continuing professional development and salary levels. Senior managers stated that the services' long term plan was to focus on the recruitment of social care workers and offer them opportunities to qualify as social workers and eventually take up PTL posts. However the recent corporate pay review had removed the link between pay progression and professional development. Senior managers stated that they were considering how they could overcome this issue.

The services had taken a very positive approach to "trainees" undertaking social work qualifying courses. Since 2004 they had had 124 "trainees" returning with social work qualifications, 42 funded through the national graduate scheme and 82 through the services' internal scheme.

The services used a range of techniques when selecting staff, involving skills assessment and interviews. For example at PTL level, the services had developed a portfolio approach to help verify experience and competence and in residential children's services used the "safer selection" toolkit.

The services operated a "flexi hours" policy of 8.00 am to 6.00 pm for backroom staff and 8.00 am to 8.00 pm for frontline staff. In our survey, the majority of staff who responded agreed that their employer offered flexible working practices which made the job easier to manage. Worklife balance applications in 2006 showed that out of 142 application the service approved 128.

The council had a clear corporate absence management policy. Many staff we met described the procedures as 'punitive' and 'threatening'. However, in relation to other council departments, social work services had had a relatively low use of disciplinary measures. The services should consider whether staff's negative perceptions have resulted from the way in which first line managers and middle managers apply the procedures. They should consider whether the training they offer these managers is as good as it might be and whether they should build in auditing measures to make sure that managers consistently apply the procedures and the principles that underpin them.

Staff deployment and teamwork

The services had issued staff with role profiles resulting from the pay and benefits review. Despite this many operations managers, PTLs and social care workers remained uncertain and confused about roles and responsibilities.

Senior managers told us that as they viewed many social care workers effectively as 'trainees' who would eventually undertake a social work qualification. They considered it important that these workers carried increasingly complex cases to provide them with relevant experience. Although this seems a common sense approach if properly managed many staff told us that lines of responsibility had become blurred. Outside of child protection work there was often little distinction to be made between the role of social care workers and that of fully qualified social workers. Staff also commented that relatively straightforward cases could become more complex over time but they were not clear about the point at which responsibility should transfer to a qualified worker.

The 'Changing Lives' report of the 21st Century review sets out what is distinctive about the role of qualified social workers.

"Social workers are skilled navigators and co-ordinators of services across these boundaries. They are used to taking a whole system approach on behalf of people who use services, taking decisions in complex cases and collaborating with others in joint work around the needs of an individual or family." ¹²

The practice team model requires PTLs to 'allocate cases according to the skills and experience within their team'. It is important that the services equip them sufficiently to exercise that responsibility consistently and fairly.

Recommendation 12
The services should make sure that practice team leaders are clear about what work requires the professional skills of a qualified social worker and that which social care workers can appropriately carry out. This should include ensuring that they have adequate training on the criteria that they should follow and establishing auditing processes to make sure that they apply these criteria consistently.

Social care workers are key components of the practice team model. The introduction of the model resolved the services' immediate problem of a shortage of qualified social workers. It is not possible at this stage to evaluate whether the model offers an appropriate solution in the longer term. Managers and staff alike acknowledged that there were still issues to be resolved.

The services had held an event for PTLs in October 2006 to review the model and identify areas for improvement. At the event PTLs identified strengths in the new model, such as better recruitment and retention and clearer career paths. They also identified weaknesses including problems in properly balancing caseload/management responsibilities and appropriate use of social care workers. The event had led to an action plan that a group of PTLs under the leadership of a senior manager had responsibility for taking forward.

There were no agreed workload management guidelines in place, and PTLs were expected to use professional judgement in allocating work and monitoring staff caseloads. The services were aware that there were imbalances in workloads between the CHCPs and planned to reallocate staff according to recent demographic information. They had no plans to address other imbalances in workloads. Staff reported that there were wide variations in sizes of caseloads between workers and between teams. It would seem opportune to include attention to this issue in the work of the PTL action group.

We found that levels of staff supervision varied across the service. Although the majority of staff who responded to our survey agreed that they received an adequate level of supervision to undertake their roles some staff we met described it as "erratic" and "inconsistent". Staff in the standby service had had no access to supervision. The services included modules on delivering supervision within the two-day course offered to newly appointed first line managers but no further follow-up to this course.

Administrative staff reported that they felt particularly under-valued. This situation had endured for some time. The staff action plan (2005/07) noted that "admin. staff as a group feel under-valued and aggrieved that the admin. review had not been concluded nor had proposals to deliver continuing professional development ( CPD) for administrative staff on the promised timescale". Other staff confirmed that the services had yet to quantify what the administrative needs of the new CHCPs were and to begin to meet these.

The services were behind in implementing personal development plans ( PDP) because they had had to delay this to fit in with a new corporate PDP system. Managers said they would be launching this in a phased manner starting with administrative staff and that each employee would have a PDP by the end of 2007.

Development of staff

The comprehensive Learning and Development Plan 2005/07 set out the key challenges and requirements to support the development of the workforce. In our survey, the majority of respondents agreed that they had received adequate training to fulfil the responsibilities of their job. A notable exception was criminal justice staff and managers who highlighted a need to improve the quality of training available to them.

The services told us that they were on target for achieving registration requirements for most staff, with targets more or less achieved in children and family and adult services and they were now focusing on older people's services.

Management training was in high demand throughout the services, and the response to this demand was through the Scottish Executive "Leading to Deliver" programme, the corporate course in local authority management, the Certificate in Social Work Management course, and the internal two day management for PTLs. A focus group of operational managers commented that it would also be helpful if they could receive training in managing integrated services, specifically in managing staff from other disciplines. The services had carried out two pilots for managing joint arrangements.

There was to be a lead social worker in each CHCP with responsibility for learning and development. During the fieldwork review the services had carried out an audit of all fieldwork staff. Before embarking on a further reallocation of staff it will be important that they update this.

The services had developed outlining routes through continuing professional development for social care workers from entry to qualification as a social worker, outlining entry qualifications, timeframes, competencies, and practice requirements. They had placed 117 social care workers on the HNC/ SVQ programme and all social care workers who wished to complete the SVQ3 had been accepted for a place though there were lengthy delays.

Resources and capacity planning

Performance overall in this area was good - having important strengths with some areas for improvement.

Financial planning and monitoring was based on sound practice which the services had carried forward into the development of the five CHCPs. More than half of the entire social work services budget was aligned within CHCP budgets from 1 April 2006. The services had agreed the main financial management arrangements for CHCP funding with NHSGGC. Although the management information system was well-established, there were issues around accessibility, inconsistent use of information to enable monitoring and evaluation and deficiencies in the recording of unallocated cases. The services had made good progress in commissioning arrangements with all sectors but a considerable number of providers did not have signed contracts in place despite the existence of a comprehensive monitoring process.

The services needed to move more quickly to put an asset management plan in place.

Financial management

Financial Plans

In recent years, the social work services budget was set at a level that was, on average, well above the grant aided expenditure ( GAE) level. Outturns were close to budgets over the same period with the exception of 2005/06, when the direct cost of social work services was £26m in excess of budget. This was due to exceptional items. Excluding these the 2005/06 departmental outturn would have been close to budget (£0.78m underspend). Exceptional items included equal pay costs of almost £24m and unbudgeted severance payments following the services' closure of a residential school.

Budgeted spend on children's services during the three years to 2006/07 averaged 29% of the SWS budget, compared to the Scottish average of 23%. Despite this higher than average allocation, the children and families budget was under pressure in 2006/07. The percentage budgeted spend on elderly services was lower than the Scottish average over the same period, 41% against the national figure of 48%. ¹³

In general, we found that there were clear links between the operational service plans and the financial plans. The service plans contained appropriate finance and other resources information to support the aims and objectives of the service. The services had produced high level financial plans for the two years beyond 2006/07.

CHCP budgets were aligned rather than pooled. CHCP directors managed £151m of the total gross SWS budget of £560m. In addition, each CHCP participated in managing certain service budgets by target setting per CHCP, but with the overall budget retained at the centre. This accounted for a further £201m and covered the consumed budget, for example purchased/commissioned services and children's residential care.

An integrated steering group, chaired jointly by the head of finance (social work services) and NHSGGC director of finance, had issued interim guidance to the CHCPs and was to review this at the end of the financial year. Three finance managers responsible for the 5 CHCP areas held regular monitoring meetings with a team of management accountants from NHSGGC. The services' chief accountant was the main point of contact and link for all CHCP finance managers.

The services' budget and service plan for 2007/08 contained a total efficiency savings target of £13.1m of which £11.5m related to CHCPs. Heads of service and CHCP directors met to agree how they would achieve target savings. The services' central finance section monitored progress against target savings on a quarterly basis and reported on the achievement of the savings.

Budgetary Control

Overall, the services managed budgetary control well and had adequate financial skills.

The services performed budget monitoring on a monthly basis and submitted reports, excluding year-end forecasts, to the CHCP committee for information only (at least every 2 months), PDS committee (six weekly) and the corporate management team (four weekly).

Finance officers provided budget monitoring reports to budget holders every four weeks, issued in the week following the period end. Budget holders commented that there could be delays in the processing of central recharges and accruals which could potentially result in misinterpretation of their budgetary position at any particular time. The services should consider how they might streamline processes.

The senior management team and the finance managers received more detailed versions of the above reports by division of service on a subjective analysis with an overview of the budget pressures and an action plan setting out the action the service was taking to address the cost pressures.

Budget holders were properly consulted and supported by central finance staff during the budget setting stage. There was a robust service planning process that allowed budget holders to develop growth proposals and to bid for enhancements. Likewise, when endeavouring to identify savings, the budget holders could apply their local knowledge to facilitate this.

There was good, comprehensive budgetary control guidance that the services required all budget holders to sign as evidence of their awareness of their role and responsibilities over their budget. Not all budget holders had seen or signed this procedural guidance.

Training was mandatory for all budget holders and the services provided new employees who were budget holders with an induction pack that included an element of financial training/guidance. The services and their partners were at the point of rolling out joint training on financial management to all budget holders.

Although current budget pressures indicated a potential overspend in 2006/07, the services were confident that they would achieve a breakeven position by the year-end. There were significant overspends within the children and families budget that the services aimed to address through shifting the balance of care. This will be a long term process and is unlikely to be cost-neutral. Managers said that that the 2007/08 budget and service plan would identify cost pressures associated with these changes.

Supporting people funding was due to increase by over £5m in 2007/08 to a total of £78.9m. It was a condition of the grant that all services should be subject to review by 31 March 2007. The review had not progressed as quickly as originally envisaged although the services had taken steps to speed this up, including revising staffing structures.

Capital Expenditure/Planning

Control over capital expenditure was good and reports to management and to members were generally clear and comprehensive, although expressed at a high level of information.

Elected Members Role

Elected members are the ultimate decision makers within the Council. Reports on which they base their decisions should therefore be clear, complete and unambiguous.

We were generally satisfied with the quality and frequency of finance-related reports to members. Although the information provided was at a high level and was succinct, the content of reports was sufficient for members to adequately interrogate the data and ask informed questions. Nevertheless, formally reported explanations of variances were very concise and the services did not report the projected outturn.

Income

In April 2006, the council reviewed and made amendments to the charging policy for non-residential services that took into consideration COSLA guidance to councils on charging policies for social care.

The council charged for all services for which it could reasonably levy a charge (with the exception of day care services). The services' income maximisation team carried out financial assessments and benefit health checks prior to levying any charges and had generated an additional £4m of income.

The services notified providers to apply standard charges to service users from point of admission until they received contract letters stating the exact contribution the service user needed to make. Providers we spoke to were unhappy with the quality of financial assessments and delays in the services completing these. They pointed out that this affected not only providers but service users who could build up debts for contribution to care costs. Through their liaison arrangements with providers the services should try to resolve these concerns.

The services' approach was not to make a provision for repayment of any amounts charged for food preparation. This stance was based on the services' view that the current legislation was open to debate and inconsistent with Scottish Executive guidance. The services only made a charge when a client could prepare his/her own food but chose not to do so.

Resource management

Asset Management Plan ( AMP)

The services had an asset register and a three year asset management strategy that, when fully implemented, should improve decision-making on asset maintenance and use. However, the implementation of this strategy had slipped due to a focus on the ICT property management joint venture and the disposal of surplus property initiative.

It is difficult to be clear about the capital needs and optimum utilisation of the assets of the service without an AMP that facilitates the production of a capital plan and that is linked to the services' priorities and objectives. The services therefore need to move more quickly to develop their plan.

A review of the CHCP property portfolio commenced during 2006. This involved the examination of land and property assets with the ultimate aim of developing a property strategy to maintain the estate at an acceptable standard and identify opportunities for adaptation and rationalisation. The estates appraisal covered both social work services and NHSGGC operational properties. Managers expected this to be completed by the middle of 2007.

Risk Management

During 2005/06, the council appointed a risk manager who had the responsibility for further developing the council's risk management strategy as well as assisting the council and departments in its implementation. Risk registers had been created at departmental and corporate levels, and the audit and ethics committee had taken presentations from all service departments on how departments applied the principles of the policy in practice.

The focal point for promoting risk management was the operational risk management forum that was designed to raise the awareness of managers and staff of their responsibilities for risk management in carrying out their duties. The social work services register specified risks, accorded a score for impact and probability of occurrence, defined control actions, and assigned an "owner" for the day to day management of each risk. Managers recognised they needed to do further work to disseminate the content of the risk register to frontline staff.

The register, dated July 2006, acknowledged the risk that CHCP implementation might prove ineffective and result in a failure to deliver statutory duties or to protect vulnerable adults. Senior managers recognised the need to update this and develop a joint register with NHSGGC that was more specific.

Health and Safety

The health and safety function of the council was responsible for the operation of the health and safety management system that included relevant policies and procedures and a monitoring process to ensure risks were assessed and managed accordingly. There was a health and safety policy and manual containing formal procedures and standards.

An audit process monitored the effectiveness of health and safety arrangements, supported by accident investigations and reports that identified areas for improvement action.

Notwithstanding these arrangements there was little sense of a health and safety culture at fieldwork level. Staff had access only to a limited number of mobile phones and it had been some time since the services had issued personal panic alarms. Staff we spoke to were not clear about the services' lone working procedures. We found that staff were often working in premises that were in very poor condition.

Management of information systems

The services' information system 'Carefirst' had been in place for some years. The system had the potential to provide a comprehensive range of management information. Earlier we described how the services used this for reporting performance to senior managers and elected members and commented on how the accuracy of this information was undermined by data errors. At its most basic the services were unable to accurately quantify how many allocated and unallocated cases they had.

The services were establishing an audit team consisting of experienced social work staff, supported by research staff to review the quality of recording and identify key information required to monitor and plan services.

A joint information group was overseeing the development of an information strategy for CHCPs. This was largely a management group that would benefit from involving key frontline staff to help identify core requirements in shared information.

Practice teams had access to computers and e-mail although for many electronic communication was restricted to council internal staff and to agencies with secure systems. Some staff said that this could create difficulties. Work was underway to include NHSGGC staff in CHCPs in the global address list to improve communication.

The services had established key linkages with other systems including education and homelessness housing services. Communication with other partners, in particular with colleagues in DACS, could be improved. Staff could access home care tracking managed by DACS to monitor care plans but seemed unaware of changes until there was a crisis. The services may need to develop an alert system for changes to care plans linked to event recording. Frontline social work staff also complained that it took an inordinate length of time to input care planning and financial information in order to initiate a home care package.

Data collection from external providers was at an early stage as part of the contract monitoring processes.

Recommendation 13
The services should take steps to improve the use of their management information system. They should establish why there are so many data errors that undermine their ability to monitor and plan services and should make sure that auditing arrangements can quickly identify such errors. They should ensure that staff understand the importance of management information.

Partnership arrangements

CHCPs were the pivotal structures for partnership delivery of social work and health services across Glasgow as well a platform for integrating children's services. Some governance issues in relation to these partnerships remained to be resolved. CHCPs are health bodies in statutory terms and their committees operate as sub-committees of the NHSGGC and have no direct line of accountability to the council. Accountability therefore remained respectively with the council and NHS board. Under the arrangements that existed CHCP directors linked via the director of social work to the policy development and scrutiny committee.

It was not clear how proposed changes to the council's management structure - in particular the appointment of an executive director for social work and education services - would impact on the continued development of the CHCPs.

Many we spoke to were also uncertain about the future of existing partnerships (such as those in addiction and learning disability services) following the establishment of the CHCPs. These partnerships had held key responsibility for joint planning and commissioning of services. Some providers were no longer clear who they would link with.

Good practice example

In learning disability services providers spoke of an enabling partnership that recognised the potential for providers to reinvest any savings they had made back into delivering additional services.

Providers spoke of good arrangements with the services to streamline monitoring arrangements between the services' and Care Commission requirements. The service had developed a memorandum of understanding with the Care Commission about information-sharing.

Many providers identified the development of the community care forum as a key arena where they could identify areas of practice that needed to be addressed and were confident that the services responded to any concerns they raised. Consultation and communication with private providers was not so clearly developed.

Commissioning arrangements

Social work services had developed a comprehensive written policy on contracting and commissioning of services and were in the process of rolling out an updated version of this. It clearly linked planning and development of services with key frontline staff who had a role in evaluating the quality of contracted services delivered to service users.

It was too early to say how this would impact on commissioning strategies for the care teams. The framework showed a good beginning in addressing the commissioning of services and in ensuring that key personnel were involved in commissioning decisions. We were impressed that the implementation was supported by a training programme delivered to key staff who were involved in managing and supporting the framework. There was good progress on the development of the infrastructure to support commissioning strategies across care teams.

Strategies were better developed in some areas than in others, most notably in those where partnerships were in existence. Other examples include the older peoples' residential strategy that not only showed the volume but also reported back on deficits and reset targets. However much commissioning strategy was more an indication of the direction of travel rather than a specific statement of the volume and type of service required. Information on commissioning of services was contained in a range of documents rather than within a strategic plan for the service.

Commissioning strategies were less developed in some services for example children's services. Managers said that tendering for specific areas of service would follow from the reconfiguration of services that included specific tendering initiatives.

The services had no plans to develop an overarching commissioning strategy. They intended to appoint a member of staff to lead on the development of commissioning plans to ensure a consistent approach across the care groups.

Senior managers stated that responsibility for commissioning was likely to remain with strategic care teams at the centre for the next three years to ensure development of a consistent approach across the city. CHCPs were represented at the overarching commissioning, contracts and contracting management group.

The services had met their deadline for reviewing both purchased and social work supporting people services.

Recommendation 14
The services should consolidate the work they have started and develop comprehensive commissioning strategies for each care group.

Contract Framework

Contracts with service providers were underpinned by quality standards that the service set out and regularly reviewed. These clearly specified the services to be provided, including providers' obligations in relation to care planning and review, quality assurance, racial equality, health and safety, risk assessment, complaints handling and reporting. However we found that a considerable number of providers did not have signed contracts in place despite this comprehensive monitoring process. The appointment of two solicitors with a role in developing social care contracts was a positive step. The services were also in the process of developing model contracts.

The services gathered a considerable amount of information from providers for example on numbers of placements, staffing levels, and absences and were beginning to draw conclusions from this information. Managers said that they shared issues emerging from this information with providers at liaison meetings but many providers that we met did not agree. The services should explore why there is this difference of opinion.

There were regular quarterly reviews of the quality of services provided under contract. This review process included collecting information from service users and communicating with social work staff to ensure there was good service quality and that any concerns were acted upon. The services were developing a timetable for contract reviews. Some providers were positive that the processes helped them re-evaluate information that they gathered to self-assess services.

Not all commissioning strategies that we saw included (where we would have expected them to do so) supporting people services in the range of services they commissioned or would seek to commission. However, care teams were involved in reviews of supporting people services, and would be reporting on the outcome of these to inform future commissioning strategies.

The contract management framework was still at the first stage of baseline monitoring but had the potential to provide clear analysis of the care market in Glasgow.

« Previous | Contents | Next »