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CHAPTER 3 Outcomes for people who use services

We considered performance in this area to be adequate, with strengths just outweighing weaknesses.

The Social Work Inspection Agency defines outcomes as the improvements in people's lives which directly result from the social work services they receive. Generally people who used services expressed a mixed view about the services they received and outcomes achieved.

Argyll and Bute performed well against national performance targets in some areas of adult and children's services. There were a number of key targets where they were falling well below a national average but were in the process of setting targets and timescales for improvement.

We heard from criminal justice staff of delays in offenders being able to complete their orders. We also heard from the children's reporter that the number of late reports had reduced but were beginning to increase.

Conclusions in this area were based on information gathered during the inspection as well as nationally available statistics and information from the work of other regulatory bodies.

Measuring outcomes

Argyll and Bute, in common with most other local authorities did not systematically measure or record planned outcomes across care groups. Although the OLM CareFirst computer system had been in place for some years it had not been fully operational across the council area. It was acknowledged that in the main it was used for quantitative rather than qualitative data. There was no regular use of data to inform the development of practice across the social work service. Managers at all levels acknowledged this was an area requiring improvement and performance staff in conjunction with service managers were at an early stage of identifying key outcome measures. Where joint planning was being progressed joint outcome measures, in addition to the statutory indicators, had been agreed between partners in children's and adult services. It was too early to assess whether these measures provided key information on the delivery of services.

Overall there was no systematic approach to the analysis and reporting of performance.

The delayed discharge co-ordinators and resource review groups gathered considerable information on the needs of people awaiting services but we saw limited evidence of this being used to inform the future shape of provision. However we heard how outcome measures were being incorporated into the reporting requirements from services. For example the new day centre in Garelochhead was to report on prevention of admission and early supported discharge.

Chapter 6 will look in more detail at steps taken by the council to address gaps in outcome and other measures.

Recommendation 1
The social work service should continue to develop a systematic approach to recording, measuring and analysing planned outcomes for people who use social work services and reporting any findings.

As part of our inspection we use a variety of ways of gathering views on social work services. We surveyed and spoke to people who use services, carers, staff and other stakeholders. We also read case files.

Views of people who use services

The feedback from people within Argyll and Bute who used social work services and their carers was generally good. The majority of service users agreed social work assistance had helped them feel safer and lead a more independent life as part of their community. This was also reflected by the service users we met during the fieldwork.

Good practice example
We met a young man with learning disabilities where commissioned services had made a considerable difference to the quality of his life and that of his family. In the past year he had with the provision of a daily one to one programme, developed a number of skills and more importantly had been able to interact and socialise. His previous agitated and at times violent behaviour had significantly reduced. His parents stated that the quality of their son's life and their own had improved enormously.

Views of carers

The majority of carers who responded to our survey agreed that services received had resulted in an improved quality of life for the person they cared for and that social work services helped the person they care for feel safer and lead a more independent life. However, less than half of the carers who responded considered they were helped to have time for family, work and other commitments. Of those carers who were receiving social work services less than half agreed they had an assessment of their needs as a carer. The file reading backed up this view where there was a lack of evidence of carers' assessments or of carers being offered an assessment. The council was unable to tell us the number of carers assessments (including self assessments) that had been completed. We were told by staff and senior managers that the revised assessment documentation for adults would record when assessments are offered.

File reading analysis

Overall 143 files were read in Argyll and Bute. This included older people's files read outwith the inspection period, adult and children's and criminal justice files. The majority of the results quoted relate to the 113 files read within the inspection period.

Although the findings of our analysis were generally positive, the results were at the lower end of evaluations when considered against authorities inspected to date.

Several factors can influence the outcome for individuals including the effectiveness of social work services and clear planning to promote independence. The analysis of the case files read during the inspection found that there had been an improvement in individual circumstances in the majority (73%) of cases and that was mostly attributable to effective social work services. We found in most cases that the objectives set in the care plan had been or were in the process of being achieved. Although in almost a quarter of the cases read there had been an increased dependency on services.

Chapter 5 of the report looks in more detail at the delivery of services.

Outcome measurement

The following analysis is derived from nationally reported performance indicators or from the council's own performance targets. National and local targets or trends referred to in this section are not wholly outcome based but are useful proxy measures as outcome measurement is not yet standard practice.

Outcomes for children and families who use services

Looked after children

Children's social work statistics for 2006 showed there were 249 looked after children supported by Argyll and Bute Council. At the time of our inspection this figure had fallen to 233. In common with the rest of Scotland, the number of young people looked after in Argyll and Bute had been rising since 2001 and the increase in the area had been greater than the Scottish average - 12.8 per thousand in Argyll and Bute compared to 11.6 in Scotland as a whole.

Looked after and accommodated children

Of the children looked after away from home (March 2006) 77% were accommodated in community settings and 23% in residential care compared with 87% and 13% respectively for Scotland. The scrutiny review highlighted a significant increase in the use of residential schools over the preceding 5 years. Figures supplied by Argyll and Bute for 2007 ³.indicated a reversal of this trend. The biggest decrease was in children with educational and behavioural difficulties. There was no increase in community placements for the same period.

Table 1: Argyll and Bute - Social Work Arrangements Review

The reported figures indicated a greater stability in placements for looked after and accommodated children with only one in ten experiencing multiple moves compared to nearer one in three (29%) for Scotland. Two out of three children were in placement for more than a year compared with a national figure that was nearer three out of four. The high percentage of children with disabilities who were looked after and accommodated may affect the figures for the authority. The total number of children with disabilities looked after in Argyll and Bute was not significantly higher than the rest of Scotland (12% in Argyll & Bute had a disability compared with 11% for Scotland). We also heard from staff and carers that transition planning was not well managed. Service managers should consider further analysis of the information recorded to ensure that effective planning was in place for all looked after children. The file reading identified gaps in permanency planning where looked after and accommodated children were not regularly visited or reviewed and planning showed considerable drift. The appointment of an independent reviewing officer had begun to address this.

Children with a disability

There has been a marked increase in the last 5 years in the number of children with a disability being admitted to specialist residential school placements.

Table 2: Argyll and Bute - Social Work Arrangements Review

Children with a disability, once placed, tend to remain there until they reach adulthood ⁴. The Scrutiny Review recommended a greater focus on the needs of children with a disability and the council had recently appointed a principal officer with specific responsibility for developing a strategy for children with a disability. The development of a pilot team for children with disabilities in Helensburgh, was viewed positively by carers. There was not a clear process for evaluating the team to help plan development across the whole of the council area. An outline strategic plan had recently been developed which did not specify future levels of service and funding. The council told us that budget provision had been made to continue funding the consolidation and development of the service.

Short breaks

Short breaks provide necessary respite and support to carers. In Argyll and Bute much of the respite care was provided through local parent-led voluntary groups supported by the council. A new respite facility for children was being developed in partnership with the voluntary sector at the time of the inspection. We were told that services were provided on an "as required" basis. In order to plan for and anticipate demand the social work service needed to maintain more comprehensive information on the provision of respite.

Foster care

The balance of care for looked after and accommodated children was weighted towards residential care due to the lack of foster care or other community placements. Argyll and Bute were falling behind most other local authorities in Scotland in respect of this. Sibling groups were on occasion split due to the lack of appropriate foster placements. It also led to children, some very young, being admitted to residential facilities where a family placement would have been more appropriate. As part of the Scrutiny Review the council undertook an analysis of its foster care service; this took account of future needs and aimed to develop the service to meet these.

The balance of care between those provided in the community and those in out of area placements is considered further in chapter 6.

Recommendation 2
The council should move quickly to implement the recommendations of the Scrutiny Review to reduce the need for children to be placed out of the authority.

Educational attainment of looked after children

The number of children looked after who gained qualifications was improving although for those looked after at home, the figures were lower than the country as a whole:

• In 2005/06, 67% of care leavers looked after away from home obtained at least one qualification at SCQF level 3 compared to 57% in Scotland. For looked after children at home, 33% gained at least 1 qualification at SCQF level 3 or above compared with 50% for Scotland.
• Figures for qualification in maths and English for care leavers looked after away from home were 67% compared with a national figure of 34%. These figures show an increase on the previous year.
• Children in S4 and S5 in Argyll and Bute were generally performing well and gaining NQs above the national average ⁵. This had raised the question of why looked after children were doing less well than the national average. The head of education services had recently (May 2007) taken steps to gather monitoring information from individual schools on the performance of looked after and accommodated children and the authority had invested in a specialist off site educational provision for young people with high level needs ⁶. The council advised us that the educational attainment figures for 2006/ 2007 showed considerable improvement on previous years. Senior managers needed to continue to ensure this progress was continued.

Throughcare and aftercare services

National standards set out the requirement that all looked after young people should have the opportunity to have a pathway plan as they approach independence.

Of the 27 care leavers in Argyll and Bute 30% had a pathway plan and 26% a pathway coordinator. This was significantly lower than Scotland as a whole (52% and 60% respectively). This was also evident in the case file reading where pathway plans were only evident in a small number of the relevant files. We also heard from young people using services that some staff were unfamiliar with the pathway processes and staff told us that there was not easy access to training in pathway planning. A voluntary organisation provided throughcare and aftercare services as part of an integrated project that supported young people who were homeless or in a first tenancy. This was viewed positively by young people. The number of care leavers still in touch with social services was just under the Scottish average.

The number of care leavers who were known to be in employment, education or training was 60%, significantly higher than the Scottish average of 37% ⁷. The social work service needed to build on this positive result by improving the earlier processes for young people.

Good practice example
Help Ltd's employment project worked with service users to organise young people's job fairs and had developed strong links with a range of local employers who were encouraged to consider young people, who had been looked after, for vacancies. They offered on-going advice and assistance to both the employer and the young person.

Child protection

The recent HMIe⁸ report found services in Argyll and Bute to be "focused on developing high quality responses for children that kept them safe from risk and harm", although it identified the need to "ensure that the long term needs were met". This observation was also borne out by our case file reading where we found some slippage in reviewing of cases. Children in Argyll and Bute were more likely to be subject of a case conference and placed on the child protection register than the national average and the Scrutiny Review showed these figures continuing to increase.

A significant proportion of the new registrations were children of parents who misused substances. In response to this, the child protection committee implemented a programme of multi-disciplinary training and introduced new protocols and procedures. The council advised us that the figures for 2006/07 had fallen below the national average. Their reported number of children on the child protection register was 2.2 per 1,000 of the population compared with 2.8 for Scotland. A drop from 3.5 per 1,000 in the previous year.

Youth justice

The number of children referred to the children's hearing system on offence grounds was only 2.9% of the population as compared to 3.1% for Scotland as a whole.

The most recent published ⁹.figures showed that in the council area there had been a significant reduction in the number of children and young people identified as persistent young offenders in 2006/07. Trends in previous years had shown these figures to be increasing. The council had implemented a series of local initiatives to address offending behaviour including case progression meetings. The most recent reported results showed a reduction of 27% between 2003/04 and 2006/07 against an overall national increase of 19% in the same period.

Reports to Scottish Children's Reporter Administration ( SCRA) - Time intervals

The Children's Reporter ( SCRA) sets target timescales for the submission of reports and assessments on children in need or at risk to themselves or others.

In the last few years there had been a slight improvement in reports being submitted within the required 20 days. Although by the end of 2006/07, Argyll and Bute at 23% were still well below the national average of 33% and considerably below the national target of 75%. The service should ensure that steps taken to meet the targets set out in their action plan to address poor performance in this area and move more quickly to develop a local strategy in partnership with key agencies to reduce the overall time taken to submit reports.

Recommendation 3
The social work service should take steps to ensure that they provide SCRA with reports within the required timescale.

Outcomes for adults who use services

Outcomes for older people came under close scrutiny in Argyll and Bute over the past year. Concern had been raised in Parliament about the waiting time for the delivery of services to older people including free personal care. Part of the inspection process was brought forward and a sample of older peoples files was read towards the end of 2006. At that time the social work service budget was overspent and a range of measures had been introduced to increase scrutiny of care packages and control spend. The impact of these measures is discussed later in the report. At the time of the inspection, the council was awaiting the outcome of a judicial review on the Ombudsman's ¹⁰.decision in relation to the operation of waiting lists.

Older people

Home care is an important service in supporting people to remain at home. Increasing the flexibility of services is a key policy objective for both central and local government.

In 2006 there were significantly fewer people per 1,000 population aged 65 years and over in Argyll and Bute receiving a home care service than in Scotland as a whole. This was reflected in both the number of people in receipt of home care, which saw a decrease of 13.1% between 2005 and 2006 compared to the national average of a 0.6% decrease. There was a decrease of 9.3% in the number of hours available between 2005 and 2006 (compared to an overall increase of 3.4% nationally). The service was ranked 22nd out of 30 local authorities ¹¹.on the total number of hours of home care they provided per 1,000 of the population age 65 and over.

In seeking to address the balance of care and provide more targeted support in the community, the social work service implemented the recommendation of the Scrutiny Review and reduced the number of home care packages which provided domestic only help.

Figures reported to the council's executive in June 2007 showed a reduction in the number of people waiting for free personal care at home by the beginning of the 2007/08 financial year. Senior managers reported that this reduction was reflected in an increase in the number of people receiving intensive support. It was too early to evaluate if the changes to the service had resulted in the reported improved targeting of services or if the trend would be sustained. Nevertheless, it was of great concern that the total volume of home care hours provided had reduced in 2005/06. The reported increase in service was against a backdrop of only 52% of those receiving home care, receiving free personal care services at home. This was considerably lower than the national figure of 71%.

In contrast, people in receipt of free personal care received on average more hours than the national average. A recent published report ¹².also highlighted that in 2003/04 Argyll and Bute Council was spending the highest per capita on free personal care. More recent figures produced by the council showed considerable improvement in this regard. However, the council needed to examine further the effects of levels of spend on individual care packages on equitable delivery and targeting of services.

We noted that there had been more recent attempts to relate the level of care to the level of need.

Recommendation 4
The social work service should consider benchmarking with comparative authorities and interrogate the information further to ensure that their targeting of services is the best way of meeting needs.

The number of registered care home places for older people in Argyll and Bute reduced from 748 in 2000 to 734 in 2006. This represented a reduction of 1.9% compared with an average national decrease of 2.8% with much of the reduction happening between March 2004 and March 2005. The reduction in places occurred across the sector although many were in the independent sector and at a time when the cost of council provision was considerably higher than the commissioned rates.

Performance on delayed discharge had improved. The social work service reported to the council executive a reduction of 79% in the total number of people delayed in hospital between July 2006 and May 2007 from 61 to 5. They reported that waiting times for free personal care reduced considerably and at June 2007 nobody was waiting more than 3 months and the majority waiting less than a month.

The council and NHS Highland had made additional resources available to fund services in order to achieve improved performance. Chapter 6 looks further at resource implications. Vacancies created by delays in making placements may have contributed to the council's ability to move quickly in placing people. The social work service should continue to monitor and report on performance.

Both the Scrutiny Review and the older people's services plan recommended that a tendering exercise was undertaken for care home services, and at the time of the inspection, market testing in the independent sector was underway. Providers were asked to consider a range of provision options including a flexible service which offered both care home and home care services.

Joint performance information and assessment framework ( JPIAF)

Local authorities and NHS boards are required to report annually to the Scottish Government on the effectiveness of their partnership working. A new performance framework will be introduced during 2007 and the partners were aiming to build these performance measures into future working arrangements.

The Argyll and Bute submission for 2006/07 had only recently been put forward and the Partnership had not received its evaluation. In 2005/06 the overall performance showed "steady progress". However they were found to be falling well short of their local improvement targets and the submission for 2006/07 showed that their own targets had not been met for intensive home care and rapid response services.

People with learning disabilities

Overall Argyll and Bute were performing well in relation to The same as you?¹³.indicators for people with a learning disability. Service users and carers were particularly positive about the input from local area co-ordinators and day service staff in supporting the personal planning processes. We heard that a number of learning disability cases were unallocated and these staff filled some of the gaps to support delivery of services. The number of adults with a learning disability known to social work services was less than the national average.

• In 2006, 44% of adults with learning disabilities were using the services of a local area coordinator ( LAC) - significantly higher than the national average of 10%. People who use services, carers and independent providers we met spoke highly of the role the LAC in making a positive contribution;
• 61% of adults with learning disabilities had a personal life plan - significantly higher than the national average of 29%;
• People with a learning disability in Argyll and Bute also had a greater opportunity of employment (27%) than the national average (16%), with a significantly higher number (13%) in training opportunities compared to the national average (8%);
• Adults with a learning disability had a greater chance of obtaining their own tenancy, with 51% living in their own home compared to 28% in Scotland as a whole;
• 33% of adults with learning disabilities were accessing community short breaks compared to 10% nationally.

On a less positive note the number who had an independent advocate was less than half the national average and for some service users this meant that their views were not heard in important decisions about their lives - for example changes of service provider as part of the recommissioning of services. This is considered further in chapter 5.

At the time of the inspection a proposal for the integration of learning disability services and management structures across the council and NHS was to be considered by the Joint Strategic Partnership Group. ¹⁴.

Criminal justice social work services

The criminal justice partnership had taken some encouraging steps to evaluate the impact of its services. This included reporting on the reconviction rates of those given a community disposal between 1999 and 2003 and considering these alongside similar figures for those sentenced to custodial sentences during this period. Figures for six months following sentence and for one, two, three and four years thereafter indicated that the reconviction rates for the partnership were favourable when compared with the national average. The partnership intended to continue this process and to provide an annual report on reconviction rates to the joint committee.

The partnership also collated and reported on feedback from people who used its services and from staff about the differences the service had made to people's lives. The report for the period 2004/05 showed that 70% of those on probation or licence considered that the service had addressed the problems they wanted help with well or very well. Ninety per cent considered they were now unlikely to re-offend. Fifty-five per cent of this total were of the view that this was a direct result of social work supervision.

Reports did not differentiate between the performance of the partnership's constituent authorities.

Gaps in information

Substance misuse services

The Scrutiny Review highlighted the lack of focus and dedicated resources to this area of service. This was echoed in the experience of the inspection team as there was little evidence of specific substance misuse services being available across services. With over 50% of parents with children on the child protection register misusing substances, the council had developed a protocol and assessment tool in response to Getting Our Priorities Right¹⁵.

At the time of the inspection there was a proposal for the integration of substance misuse services. The management structure was to be considered by the Joint Strategic Partnership Group. ¹⁶.As an initial step the council was seeking to appoint specialist social workers in each area, with one of the four social workers in post.

Mental health service

The partnership was at an early stage of developing its joint strategies for mental health and substance misuse. It was anticipated by service managers that joint performance measures would flow from these.

We were however made aware by staff, and the Mental Welfare Commission of key deficits in the availability of Mental Health Officers ( MHOs), and crisis provision leaving some adults inappropriately detained. There was also a need to develop performance in relation to a recovery based approach.

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