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CHAPTER 4 Impact on people who use services and other stakeholders
In this chapter we look at the three areas of evaluation:
- Impact on people who use services
- Impact on staff
- Impact on community.
We define impact as the direct experience of the people who use or deliver social work services or who benefit from them.
Impact on people who use services
We considered performance in this area was weak - having important weaknesses.
Most people who received services considered that they were of good quality and that staff treated them with dignity and respect. We observed many dedicated staff working hard to provide these services. We saw some imaginative services delivered in partnership between different agencies.
However, too many people had difficulties finding out about social work services and did not believe that they had had a good enough response when they first contacted social work to request a service. The response was more positive once services were in place. Many were of the view that Argyll and Bute did not offer a good range of services and there was frustration about lengthy waiting lists and lengthy waits for follow up responses. A significant number of people had not been involved in determining their care plans and too few cases contained evidence of regular reviews of care plans.
Experiences of adults, carers, children and families who use services
There was a marked difference between people's opinion of social work services once they were in place - which was generally positive and their views on finding out about services and choices available to them at the first instance where responses were more negative.
Finding out about services
Just over half of those who responded to our survey of people who used services agreed that it was easy to obtain information about the range of social work services that might help them. This was a markedly lower response than almost all the authorities we had inspected to date.
Those responding to our carers' survey and a number of other stakeholders we met or who replied to our stakeholders survey expressed concerns about the availability of information. Many of the people we met in the fieldwork phase of the inspection echoed these views. For example some parents of children with disabilities told us they had found it difficult to get information about direct payments and carers' assessments. Some independent providers expressed the view that the service was not proactive in telling people about what services they might be entitled to.
The child protection committee had been proactive in promoting public awareness of child protection. During the inspection, we saw examples of a range of child protection information on display in public places. It had hosted a series of localised training and awareness raising events for young people and community groups which were well attended and positively evaluated. The well established child protection website also provided comprehensive information promoting awareness of child protection and domestic violence. The website included a facility for members of the public to e-mail the council with concerns.
Contact with services
Seventy-five per cent of people who used services and just under half of carers were positive about the nature of the response they received when they first contacted social work services, where this was within the last two years. More than half of carers did not agree that the response had been good. A quarter of service users were of the same opinion - again a much more negative response than most other authorities we had inspected.
A similar picture emerged from our meetings with service users and carers. Many of those we met told us about long delays in responding to requests for a service. One group of parents of children affected by a disability described the experience of getting a service as 'a struggle every step of the way'. Those linked to the pilot team for children with disabilities in Helensburgh were more positive about their recent experiences. On the other hand in response to our survey a carer of an older person told us, "it was extremely difficult, frustrating and time consuming to get services set up for the person I care for in the first place".
Changing Lives17.identified among its aspirations that people who use services should find it easy to contact services, receive a prompt response and have a consistent and reliable relationship with a worker.
A small but noteworthy percentage of cases in Argyll and Bute were unallocated some awaiting assessment and others with no worker actively involved.
Management information on unallocated cases, submitted to SWIA in June 2007, revealed evidence that people had been waiting for significant periods of time - some unacceptable. For example:
- 24 adults and 9 children had been waiting more than one year for a service
- 21 adults and 17 children had been waiting between six months and one year
- 35 adults and 14 children had been waiting between three and six months.
There was a process in place for the review of people on the waiting list but this did not include analysis or formal reporting, apart from quarterly and annual reporting in relation to key performance indicators. Such reporting did not inform future service or development or scrutinise unmet need.
Staff and managers we spoke to highlighted the impact of the financial moratorium commenting that this had created additional delays in providing services. In some areas of the service such as criminal justice, they also highlighted the impact staffing vacancies were having. For example they commented that long waiting lists for those on community service orders to begin their placements meant that 'people wanting to serve their orders couldn't get on with their lives'.
Physical access
Physical access to social work buildings in Argyll and Bute varied considerably - from well adapted or purpose built facilities, through to area offices with unsatisfactory access and facilities.
Using services
Only around four in ten of respondents to our survey of people who used services agreed that there was a good range of services available to them. This finding was significantly lower than all inspections to date. The same proportion agreed that they had been given choices about the services they would receive (lower than in most other authorities inspected to date). Three in ten carers agreed that the range of services was good and nearly four in ten agreed that the person they cared for had been given choices about the type of care they receive. This low percentage mirrors the views of carers in most other authorities we had inspected.
When people received a service they were markedly more positive about its quality. Eighty per cent of people who used services and 53% of carers agreed that these were of good quality. Level of disagreement was highest among carers of children with special needs. Most people who used services and carers who responded to the surveys also agreed that staff treated them (or the person they cared for) with respect. Comments from surveys and from those we met included: 'I've always found my experiences with the social work department very helpful and have been treated as a person not a number'; and 'My worker goes out of her way for me - she's helped me to get my self-esteem back'.
Our observations of practice and case file analysis support these perspectives. In the majority of case files read we found that the views of individuals had been taken into account and in the majority of cases there had been an improvement in the individual's circumstances. We saw many examples of hard-working and committed staff providing good services for people.
Direct payments
Direct payments and the independent living fund enable people to personally manage elements of their services. Argyll and Bute performed well and had made incremental increases in the number of people receiving such funding. A greater number of people per ten thousand (8.7) of the population were in receipt of direct payments than the national average of 3.6 per ten thousand (although we found different practices across the localities). For example during the fieldwork we spoke with one group of parents of children with disabilities who told us that they had never heard of the direct payment scheme while in another group in another part of the authority, several parents were in receipt of direct payments. We also spoke with a group of adults with disabilities who told us that they were unaware of the independent living fund. The council should consider how information and support to access direct payments and other funding options is shared more consistently with carers and service users.
Keeping people who use services and their carers involved
Most case files we read contained an assessment of the needs of the person using the service. Around five in ten respondents to our service user survey agreed they had seen their written assessments. Similarly, around five in ten carers agreed they had seen the assessment of the person they cared for. The majority of carers (67%) nevertheless agreed that they had been fully involved in deciding what help or services the person they cared for should receive.
The majority of people who used services (66%) also agreed that they had been fully involved. However, a third disagreed. This level of disagreement was higher than that recorded in all other inspections to date. This response may be linked to our finding that a third of cases contained no evidence of regular reviews of the care plan and in some files we saw instances where carers were managing deteriorating situations without additional support being made available.
We heard from both service users and carers of slow responses to telephone calls and our survey found that the service was among the poorest in terms of responding to the needs of people who use services.
Carers
Carers' assessments look at the level of support required by a carer to continue in their caring role. The assessment should also identify any help that would maintain their own health, and balance caring with other aspects of life such as work and family commitments. Funding of carers' services was devolved to the Carers' Network to set priorities for support to both adult and young carers in each locality. For example we heard of one project in Helensburgh that was proactive in supporting carers positively manage their health and support needs. Partners had been slow in disseminating this to good practice across the whole of the council area.
Good practice example
In Helensburgh we visited a Carers' Health Drop-In Service which had been developed in partnership between the local Carers' Centre, District Nurses and Social Work. The drop-in facility offered carers the opportunity to have a health check and to talk to a social worker about their own needs. On occasions this had enabled the early identification of difficulties and had increased support provided to carers and avoid a crisis.
The Carers' Centre is just one initiative funded through the carers' respite funding provided by the council to the Carers' Networking Board to facilitate direct access to support services.
Thirty-seven per cent of all carers who responded to our survey agreed they had an assessment of their needs. During the fieldwork we met with a number of carers of both children and adults, some were not aware that they could have a carer's assessment undertaken.
Recommendation 5
The social work service should increase the number of carers' assessments they offer. They should monitor performance in relation to the number of carers' assessments they do.
Impact on staff
On balance, Argyll and Bute performed to an adequate standard on this measure with strengths just outweighing weaknesses.
We found that social work services staff enjoyed their work, and were committed to delivering good services that made a difference to individuals and families.
There had been a succession of significant changes in social work with the service about to be restructured for the third time in 10 years. Although staff were generally positive about the planned changes to structure we found that management of these changes in community care had adversely impacted on staff morale. Staff from other parts of the social work service were generally positive about planned changes to structure and services.
Most staff felt that the director and elected members could have done more to demonstrate that they value staff.
Motivation and satisfaction
In our staff survey, we found high levels of motivation and job satisfaction, with 92% agreeing that they enjoyed their job. The same percentage felt that their team helped people to lead independent lives and that their team did everything possible to keep people safe.
During fieldwork staff echoed the view that their work was both enjoyable and valuable. There were contrasting perspectives between staff from different parts of social work services. Many staff we met also raised a number of de-motivating factors in relation the organisation and management of their service. We found that the following features made a difference to how positive staff were feeling:
- an inclusive approach to the management of change
- clear communication from senior management
- confidence in the ability of senior management to effect improvements for staff and for services
- being valued by management and by elected members.
Unfortunately we did not find this to be consistent for all service areas.
This was reflected in our staff survey where only 34% of staff who responded to our survey agreed that morale in their team had been good for the previous six months. The level of disagreement was among the highest to date, with fieldworkers recording the highest level of disagreement. Around a third of staff agreed that they expect their working conditions to improve in the next twelve months. During fieldwork, it was evident that staff from children and families services had a more positive outlook on most of these questions than their colleagues in adult care services. The factors detailed above featured to a significant degree in the contrasting perceptions. A key factor was how staff viewed the communication of change. For example how staff were told about the funding moratorium. We comment on how well different managers had addressed these factors in chapter 7.
Only 30% of respondents in our staff survey agreed that social work was highly valued by elected members and a similar percentage (31%) agreed that there was effective leadership of change in social work. These findings are consistent with the results of a staff attitude survey conducted by the council, for the first time, last year. While staff agreed that their work was interesting and they were provided with good access to development opportunities, nearly half felt that the council did not keep them well informed about changes which affected their job or service. A number of additional factors affected staff morale. Some staff were aggrieved about matters relating to terms and conditions and we were told by staff and managers that there were high levels of appeals from staff following the pay and grading review 18. Some administrative staff were also concerned about the possible consequences of the on-going review of administrative support services.
The chief social work officer had begun a series of visits to service centres in 2006. These had been extended to include heads of service in order to help managers understand and respond to the concerns of staff, and offer staff the opportunity for dialogue and recognition. The Director of Community Services had a wide remit embracing education, social work, community regeneration and planning and performance and had not been involved in these meetings.
Staff in adult services were generally more negative about links with senior managers. We consider that the director and elected members should investigate the differences across staff groups in greater depth and use the more positive experience of children and families staff to inform their strategy to address the low morale of many of their staff. They also needed to address the view expressed by the majority of staff that they do not appear to value the work and the commitment of staff.
Home care staff, some community service staff and some support workers were employed on zero hours contracts, despite the fact that we heard from staff that many of them had been working a regular pattern of hours for a number of years. This policy exposed employees to a number of disadvantages and staff were disappointed that their lengthy service had not resulted in job security and positive recognition from senior managers.
We were also concerned about arrangements for home care cover at weekends. We were told by staff that there were two 'grades' of home care staff and those paid at the higher rate could undertake duties that lower paid workers could not. Some staff told us that these distinctions did not apply at weekends, however, when lower paid carers had to undertake the full range of tasks to cover for those staff who were not on duty. Managers may wish to review and clarify practice with staff. A review of home care employment conditions and duties had taken place over a period exceeding two years and reported at the end of 2006. A key proposal to introduce minimum hours core contracts was superseded by single status bargaining and home care staff told us of their frustration at these delays. The council should move quickly to put in place the review recommendations in relation to staff contracts. We make a recommendation in relation to this later in the report.
Staff ownership of vision, policy and strategy
Less than half of staff in our survey agreed that there was a clear vision for social work in Argyll and Bute and indeed we found that an overarching plan for social work services within the council had only recently been produced. Thirty-six per cent of staff agreed that senior management communicate well with staff, while 41% disagreed that this was the case.
We spoke to frontline staff from children and families services, including family support and youth justice, during field work. They were aware of the central principles of the integrated child care services strategy and were enthusiastic in their support of these plans. Other staff were of the view that not all of the current plans and developments supported improvement.
Staff we met in the social work service were generally optimistic about the planned management structure having a positive impact on service direction.
Changing Lives19.identifies a number of key challenges for social work including "the decision making ability and professional autonomy of social work professionals being constrained by line management arrangements that require escalation of decision making up a chain of command in order to manage budgets or risks".
A key difference between children and families staff and their colleagues in adult care, was their experience of the moratorium on spending, imposed in 2006. Staff in child care did not feel that the measures had resulted in many changed consequences for them accessing services for the children and families they worked with. The senior manager in children and families was also credited with ensuring that staff at all levels were informed about the changes in policy and procedures.
Staff in adult care were markedly more negative about their experience of the moratorium and service reviews, and on-going planning processes. A number of factors had clearly contributed to this more pessimistic view, including:
- the on-going review in home care, care homes, learning disability services
- the level of engagement with staff during the reviews and post review period
- the lengthy processes and lack of clear timescales for decision-making
- the intervention by some elected members which cut across the processes in place
- the communication and management of change in relation to the scrutiny and other service reviews.
It was noteworthy that the perceived style or handling of the briefing arrangements by some senior managers had left many community care staff feeling disenfranchised and disaffected, rather than understanding and owning a strategy for their services. This was against a climate where outcomes in areas such as delayed discharge were improving and better engagement by staff could have been anticipated.
Particular examples included the following:
- home care staff said that they heard about possible plans for contracting out their service at a meeting for members of the public
- learning disability staff said that they had read in a report that contracting out of their services was being actively considered. They commented that their worries were exacerbated by the time lag in being officially advised that this was the case
- many staff expressed concern about lack of information following recent service provider changes which left them unable to advise or reassure service users about future arrangements for their care
- when the moratorium was introduced staff were sent letters from senior management which stated that they would be subject to disciplinary action if they did not comply with the new procedures.
In short, community care staff, perhaps due to the higher volume of cases, felt that they were on the receiving end of information that should have been more timely, more comprehensive and which failed to engage them or anticipate and address their concerns.
Impact on the community
Performance in this area was adequate, with strengths just outweighing weaknesses.
There were a number of locality planning groups in place to enable the service and its partners to respond to local need. These had played a part in the development of a variety of services. Voluntary groups were also a feature of life in Argyll and Bute and the service provided support to some of these. A recent HMIe report had commended the inclusion of voluntary and community groups in child protection training. Stakeholders described good working relationships with social work staff on the ground.
However, stakeholders including partner agencies, service users and voluntary groups considered that there were too many variations in practice across the authority. They were also critical of strategic relationships.
There was not enough evidence that the service based its locality planning on an analysis of current and future need within communities. The service needed to do more to publicise some of the good work that it did. More elected members needed to support the work of social services.
Community perception, understanding and involvement
The service had taken steps to respond to local need through a range of local planning groups. For children's services the local ' FUSIONS' 20.planning groups held funding through integrated community schools and changing children's services budgets that they could use where needed. However the service's operational plans did not identify key targets and timescales for services delivered through FUSIONS leading to possible imbalance of services across localities. For adult services there were local joint future planning groups, community care forums and carers' groups. Funding for carers' services had been devolved to the local carers' networks to set priorities.
In such a large geographic authority it was important that agencies have processes in place that allow them to meet local need. However we were not convinced that there were sufficiently robust systems in place to allow the partner organisations to identify the level of need within each locality or to give them an overview of how they might respond to need across the authority. The service had undertaken work to project need for older people's services. An annual profile of young people who offended helped them target youth justice resources appropriately. Similar exercises for other service user groups were at the stage of agreeing the methodology for data collection and analysis.
Without comprehensive demographic profiles and a clear outline of current and projected need (carried out jointly by key partner agencies) there was a risk that services would not direct resources to the communities that needed them most or there would be unacceptable imbalances in provision. We found that there were clear variations of services across the authority which were neither measured or monitored. Services were piloted but there was not a clear strategy to assess and roll out if a service proved to be beneficial. For example the rapid response service in Oban was developed from resource release and positively viewed by all stakeholders but implementation across all of Argyll and Bute was slow. Some staff and service users that we met felt strongly that there were inequalities of provision. For example those from one community said that it was 'the end of the earth in terms of resources'. Nearly 40% of staff who responded to our questionnaire were of the view that there was not a fair geographic coverage of services within the authority.
Recommendation 6
In order to inform strategic planning the social work service should move more quickly to ensure that it has a clear profile of the community it serves and of current and potential future need of all service user groups.
The service had made efforts to involve the community in planning for some of its services. For example, alongside partner agencies it had consulted with island communities, in Bute, Jura and Mull to identify sites for progressive care units and to help shape the service these units offered. This had enabled amendments to the design of the planned unit in Mull. Other examples included the involvement of people with learning disabilities in gathering feedback about learning disability services, and consultation exercises about the Ardlui centre and the youth justice annual report. We heard from community groups that senior managers responded to requests to explain actions in social work, for example, the head of service met with a community care forum to inform them of the reasons behind delays in funding free personal care.
Some stakeholders were critical that consultation was not as routine or as robust as it could be. For example, members of one locality community care forum commented that they did not feel that they were meaningfully involved in planning or consultation. Some service users that we met shared this view and commented that there were no service user forums that would allow them, as a matter of course, to play a greater part in designing and developing services. Around four in ten of staff who responded to our survey were of the view that the service did not take the experience of carers into account when planning services.
Local planning groups had nevertheless played a part in developing a range of services within their communities including carers' centres, progressive care centres, community childminding, family support projects and health promotion days.
Many of the community-managed groups that we met were developed by the group members to fill a perceived gap in services rather than as part of an overall strategy. Although social work services had an active role in some of these groups and the services that they initiated they acknowledged that the wider public might not be aware of this role. There was little evidence overall that the service had done as much as it might to publicise some of the good work that it did or could do or the services it supported. Many service users, carers, stakeholders and staff that we met or who responded to our survey commented that social work services were not well enough publicised and that it was difficult for the community to know what services were available.
The community's elected members should have a key role in promoting the social work services for which they are responsible. The evidence would indicate that not enough of them did so. Members that we met (the leader of the council and the spokesperson for social services) were clear that they had a responsibility to 'improve the quality of life for the most vulnerable in their community'. Staff and managers and people who used services described the steps some elected members had taken that demonstrated their investment in social work services, for example, their support for performances at the resource centre in Oban and involvement with the Cowal Community Care Forum. However staff and managers described many others as having little or no interest in these services unless they had a complaint to make. Stakeholders who responded to our survey echoed this view. Only two of these respondents agreed that elected members engaged with the work of social work services. This view was echoed by a key stakeholder who commented that "social work does not appear to be considered as a priority for the council with the exception of child protection and some pockets of joint working on the ground".
Impact on other stakeholders
Just under half the twenty stakeholders who responded to our survey agreed that social work in Argyll and Bute provided a good range of services and that these were responsive to individual needs. The same proportion agreed that the services provided good outcomes. Around a quarter were of the view that the range and quality had improved over the past two years while a similar number disagreed with this view.
Many stakeholders who responded or that we met over the course of the inspection commented that the quality of practice varied across the authority and that it was largely dependent on the quality of individual members of staff. Comments included: 'things feel piecemeal'; 'there are many hardworking individuals and pockets of good practice'; 'there appears an inflexible and inadequate approach to delivery of some services in remote and island communities'; 'this organisation receives a very good service from the senior social workers and social workers'.
Stakeholders expressed mixed views about how well social work services communicated with and worked alongside them. Less than half of those who responded to our survey agreed that there were effective planning structures in place and that there were effective arrangements to ensure consideration of potential partnerships with others either in the statutory or independent sector. A number of stakeholders described good working relationships at an operational level.
Good practice example
Local area co-ordinators had established PACT (people and communities together) groups in some areas. These groups brought together people with learning disabilities using services and support providers. People who used services said that the groups gave them a chance to meet friends and to arrange activities in their local communities.
Several stakeholders commented about lack of consultation during the services' scrutiny and other reviews ( discussed in chapter 6) and lack of information following conclusion. Comments included, 'service reviews do not involve staff from partner agencies and structural change is agreed within the authority'; 'it's hard to keep track of who is in what post and what responsibilities they had'; and 'I need to know soon who I have to link with'. We discuss partnership arrangements in later chapters.
Community capacity
Volunteering played a significant role in local communities in Argyll and Bute. A recent HMIe inspection of the council's community learning and development services for instance, noted that in Cowal alone there existed around 80 community groups and organisations. A number of these projects throughout the authority received financial and other support from community regeneration services (services that sat alongside social work within the directorate of community services) and others received support directly from social work services. Examples included support to parent-led groups offering a service to children affected by disability and to carers' projects. Some community projects had evolved through the support of social work staff, for example, the Woodland Garden project in Cowal and the ASET employment service in Lochgilphead that promoted employment opportunities for adults with learning disabilities. The service also funded provision such as a befrienders scheme, an advocacy service and 'Homestart', that used local volunteers to assist families living in their communities.
These were commendable initiatives. Nevertheless, concerns remained about the nature of the working relationship between voluntary providers and social work services. Social work services were complemented by a range of community based services developed in localities, some with little input from social work services. The service should consider if it was doing enough. For example the fresh approach to recruiting more foster carers and kinship carers, highlighted in the scrutiny review, might now result in more looked after and accommodated children remaining within their own communities.
The council could do more to
- capitalise on the culture of community involvement in its communities
- reassure organisations that their work was valued
- involve them in shaping future service provision
- ensure services developed by community groups fit the overarching priorities of the service.
Chapter 6 looks further at partnership planning.
Recommendation 7
The social work service should work with community groups to target resources to meet priorities identified in the community plan and social work services plan.
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