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CHAPTER 3 Key outcomes for people who use services

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

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

The services gathered a range of performance information. This information showed that most children looked after away from home experienced stability. Their educational attainments were well above average. The educational attachment figures for children looked after at home were also better than the average. Impressive numbers of adults with learning disabilities were helped to live independently and to get employment. Hospital patients were assisted back into the community without unnecessary delays. Older people were supported at home during evenings and at weekends.

There were also areas where outcomes should improve. More care leavers needed to be helped to get jobs. Carers' needs for more time for themselves needed to be better recognised; children with disabilities needed quicker access to services. There should have been more information about outcomes for service users who have substance misuse problems.

Measuring outcomes

In common with other authorities East Lothian's social work services did not yet routinely measure outcomes for all care groups. They were collecting performance information, particularly in children's services. There was still some way to go for adult social care but senior managers were giving attention to this issue.

Recommendation 1
Children's services and adult social care should systematically measure outcomes for service users and carers.

Views of people who use services and carers

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

Overall, carers were positive about social work services, and for many questions, East Lothian's responses were at the upper end of the range achieved in the other 15 authorities inspected so far.

The majority of carers agreed that the services provided had improved the quality of life for the person they cared for. The majority also agreed they had been consulted, listened to and helped to have time for family, work and other commitments. However, a quarter did not agree that they were helped to have time for family, work and other commitments.

File reading analysis

Overall the findings of our analysis of case files were positive.

In most of those cases where there was a care plan there was evidence that the services had achieved or were in the process of achieving the objectives set out in the plan.

In most of the files there was evidence that individual had been helped to get mainstream services.

In the majority of cases there was evidence that the individual's circumstances had improved during the period under scrutiny.

Most case files provided evidence that changes in levels of dependency were in keeping with the needs of service users.

Outcome measurements

Measuring service outcomes was not yet common practice. We therefore looked for proxy measures, for example whether services met nationally identified targets and performance indicators ⁵ and any performance targets that the authority itself sets.

Looked after children

As at 31 March 2006 the proportion of looked after children (both at home and accommodated) in East Lothian was lower than the average for Scotland as a whole (9.0 per 1,000 population aged 0-18 compared to 11.6). East Lothian's figures had been below the national average for the last five years. Throughout this period, significantly more children had been looked after and accommodated than had been looked after at home, with the largest proportion of children placed in foster care. In May 2007 the figures were as follows:

• children looked after at home - 63
• children in foster care - 76
• other community placements - 28
• residential care - 21.

In East Lothian at March 2006 61% of looked after children were accommodated away from home. The Scotland average was 58% of looked after children were accommodated away from home. In East Lothian 39% of looked after children were at home.

Of the children looked after away from home on 31 March 2006, 60% had been in a placement for one year or more (compared to a national average of 74%). Twelve per cent had experienced three or more placements (compared to a national average of 29%. On 30 April 2007, only one child under the age of 12 was placed in residential care.

Fostering and adoption

The Care Commission's fostering and adoption service annual report 2006 stated that during 2006 the number of children registered for adoption/permanent care was exceptionally high (17 compared with 2 during the previous year). The report said that children's services had found homes for nearly all these children.

East Lothian's Integrated Children's Service Plan 2005-08 said that in 2005 the authority had 13 children in out-of-authority residential units compared to 10 children in its own residential units.

Educational attainment

In 2005-06, 76% of all care leavers got at least one qualification at SCQF level three or above (compared with 50% for Scotland as a whole). The figure for leavers from care at home was 67% compared with 45% nationally. For leavers from care away from home the respective figures were 79% and 57%. In the core subjects of maths and English, 33% of care at home leavers achieved qualifications compared with 28% for Scotland as a whole. For care away from home leavers, the respective figures were 64% and 41%.

There were significant improvements in performance compared with the previous year. There was a rise of 23 percentage points in the proportion of all care leavers obtaining at least one qualification at SCQF level three and a rise of 19 percentage points proportion of all care leavers achieving qualifications in maths and English.

These figures were impressive and had been achieved by effective inter-disciplinary work and training and support for named teachers.

Despite its very good educational attainment of looked after children figures the council were not satisfied with this. They had produced statistics that compared the educational attainment of looked after children with children who are not looked after. The director of education and children's services said that looked after children did not do well compared to children who were not looked after. The council were working to narrow the educational attainment gap between looked after children and children who were not looked after. We thought this was a highly commendable example of commitment to continuous improvement.

Throughcare

It is important that local authorities continue to exercise a duty of care to young people they formerly looked after.

In 2005-06 there were 22 care leavers in East Lothian, 45% had a pathway plan and 45% a pathway co-ordinator. The Scottish figures were 52% and 60% respectively. One hundred per cent of care leavers were still in touch with the authority (better than the Scottish figure of 85%). Twenty-seven per cent of care leavers were in employment, education or and training (the Scottish figure is 37%).

Children with disabilities

We found no outcome-related performance information about children with disabilities. Thirty-seven children got a day care service in May 2007. This was a slight increase from the 2006-07 figure of 32.

Youth justice

Between 2003-04 and 2006-07 the number of young people referred to the reporter on offence grounds rose from 162 to 440 and East Lothian's percentage of the national total from 0.5% to 1.2%.

In 2006-07 the number of qualifying persistent young offenders in East Lothian was 13. The numbers for the previous three years 2003-04 to 2005-06 were 3, 8, and 5 respectively. Their persistent offender figure had risen by 10 from the 2003 baseline of three. East Lothian did not meet the national target to reduce the number of persistent offenders by 10% in 2006-07.

Staff reported a positive evaluation of a summer activities diversion programme for 8 young people. They gained increased confidence, behaved better in public and related better to each other.

Child protection

During the year 2006-07 children's services got 345 child protection referrals, which was equal to 18.6 per 1,000 population aged 0-15. The rate for Scotland was 13.0.

As of 31/03/07, East Lothian Council had 46 children on its child protection register, which was equal to 2.5 per 1,000 population aged 0-15. This was less than the Scottish figure of 2.6 per 1,000 population aged 0-15. At a point in 2002-03 there were 77 children on the child protection register. We asked the head of children's services about the significant reduction in the number of children on the register over three years. He said that they had conducted a review of the child protection service as they felt the numbers of children on the register were too high. After the review the criteria for registration was applied more consistently.

Of the 345 child protection referrrals in 2006-07, 78 proceeded to a case conference (4.2 per 1,000 population aged 0-15). This was less than the rate for Scotland as a whole, where the number subject to a case conference was 5.0 per 1,000 population aged 0-15.

There were 62 child protection registrations in 2006-07 which was equal to 3.3 per 1,000 population aged 0-15. The rate for Scotland was 3.4 per 1,000 population aged 0-15.

In 2006-07 there were 61 child protection de-registrations in East Lothian which was equal to 3.3 per 1,000 population aged 0-15. The rate for Scotland was also 3.3 per 1,000 population aged 0-15.

Children's services did child protection audits and reviews and the local authority service, together with other relevant services was inspected by HMIe in 2006. Whilst there were many positive findings, one of the observations of HMIe inspectors was that long-term planning was not sufficiently outcome focused. We found children's services had an action plan that aimed to make sure all allocated cases had a plan with clearly identified outcomes.

The Children's Services Business Plan 2006-07 identified developing an information base of child protection activity as a priority. We also learned of plans for a research evaluation of outcomes for children who were de-registered between January 2005 and May 2006.

Older people

As of March 2006 there were 657 older people resident in care homes in East Lothian, equivalent to 39.9 per 1,000 population aged 65+. This was very close to the national rate (39.8). Between March 2000 and March 2006 there was a 6.6% decrease in registered care home places for older people, while the national percentage decrease was 2.8%.

Since 2001, the number of care homes for those aged 65+ has reduced from 21 to 17. Of these, 3 were run by the local authority, 2 by voluntary sector providers and 12 by private sector providers.

In 2005-06 council was ranked first equal in Scotland on the percentage of daytime respite not in a day centre for people aged 65+.

In 2005-06 East Lothian provided 239 nights of residential respite care for older people as a rate per 1,000 people aged 65+ (Scotland average 342).

In 2005-06 the council was the second worst in Scotland on the average time taken to provide a community care service from first identification of need to first service provision - 53 days (Scotland average 20 days). Managers told us that since they introduced the contact and response service they got the 53 figure down to 37 in early 2007.

As of September 2006 East Lothian were supporting 1110 people aged 65+ in home care, equivalent to 67.4 per 1,000 population, slightly lower than the national figure of 68.2.

East Lothian was ranked 12 out of 30 local authorities on the total number of hours of home care provided per 1,000 population aged 65+. They were ranked 6 out of 30 local authorities on the percentage (88) of home care service users aged 65+ receiving home care as a proportion of the total number of service users in this category. They were ranked 14 out of 31 on the percentage (27.3) of home care service users aged 65+ receiving care in the evenings/overnight and 7 out of 31 in respect of the percentage (62.8) of home care service users aged 65+ receiving care at weekends. The aggregate number of older people who got more than 10 hours a week home care was 17.1 per 1,000 aged 65+ (Scotland average 16.8).

As of September 2006 of the 1,110 people aged 65+ got home care, 889 got free personal care at home. This was 80% which was higher than the Scottish average of 71%.

Joint performance information and assessment framework ( JPIAF)

The Scottish Government gets returns from local authorities and the NHS about how effectively they work in partnership to deliver aspects of community care. The system for this is called the joint performance information and assessment framework ( JPIAF). In 2005/06 the then Scottish Executive assessed the overall performance of the East Lothian Council, NHS Lothian partnership as average. In respect of some indicators (10 and 11) the evaluation focused solely on services for older people. The evaluation concluded that the partners were:

• average on the comparative model
• showing 'good progress' on understanding the holistic approach and its application
• falling well short of its local improvement targets for 2005-06
• setting 'sufficient' new targets for 2006-07.

This was a 'significantly improved performance' on 2004-05. Along with other councils, East Lothian had expressed concern to the then Scottish Executive about the value of some of the JPIAF outcome measures. East Lothian was developing a performance framework capable of alignment with the new national outcomes framework and the new national targets that will emerge from this.

Delayed discharge

In March 2006 East Lothian had a total of nine delayed discharges, two of which were for more than six weeks. This was an improvement on the (low) 2005 figures. The council and its partners exceeded the Lothian delayed discharge targets and had met the national targets for the last three years. This was achieved through:

• the work of the discharge response team
• the introduction of the occupational therapy simple assessment service and the introduction of community care brokers ⁶ to set up care packages.

Adults with learning disabilities - The same as you?

East Lothian had a lower than average proportion of adults with learning disabilities known to social work services - 4.6 per 1,000 adult population compared with 5.5 for Scotland as a whole.

There were some very good outcomes for this group of service users. For example in 2006:

• 50% were living in their own tenancies (Scotland 28%)
• 47% had employment opportunities (Scotland 16%)
• 21% ⁷ attended a day centre five days a week (Scotland 26%)
• 47% of known adults with learning disabilities got alternative day opportunities ⁸ (Scotland 27%)

Performance was much in line with the national figures on access to an independent advocacy service (13%) and community short breaks (12%). However, other comparisons were a little below the Scottish average. 24% had a personal life plan (Scotland 29%); 11% were in further education (Scotland 18%).

Adults with physical disabilities

In 2006 there were 25 people with physical disabilities attending day care services in East Lothian. This was equal to 0.4 per 1,000 population aged 16-64, slightly lower than the Scottish figure (0.5).

In 2004-05 11.7 people aged 18-64 (per 1,000 population) with physical disabilities got a community care service (Scotland average 16.1).

Early in 2007 there was an initiative to reduce the number of people who were waiting for an occupational therapy service. Many of them would have been adults with physical disabilities. The waiting list was reduced from 300 to zero. It was disappointing that by October 2007 the waiting list was again over 300 (see table below).

Adults with mental health problems

The number of people with mental health problems admitted to hospital dropped from 235 to 181 between 2005-06 and 2006-07. This had been achieved by increasing the availability of home support services.

In 2004-05 in East Lothian 1.5 people aged 18-64 with mental health problems/dementia got a community care service per 1,000 population (Scotland average 5.2 per 1,000).

East Lothian's self evaluation questionnaire said that Crossroads Care provided 800 days of respite for 31 adults between April 2006 and March 2007. Many of the adults who got this service were people with dementia.

People who misuse substances

In 2004-2005 in East Lothian 0.1 people aged 18-64 (per 1,000 population) with drug/alcohol abuse problems received a community care service (Scotland average 4.8).

Sensory impairment

We found no information about outcomes for people who have sensory impairment.

Care Commission reports

The Care Commission told us about its 2005-06 to 2006-07 inspections of East Lothian Council run services. The Care Commission took no statutory enforcement actions against East Lothian Council for the years 2005-06 and 2006-07.

A Care Commission officer attended two of our inspection activities as part of its inspection of East Lothian Council's adoption and fostering services. The Care Commission's reports were published in November 2007. ⁹ The Care Commission found the adoption service was robust. The fostering services had some deficits. The Care Commission's recommendations and requirement deal with these deficits.

Gaps in outcome information

East Lothian was working to reduce gaps in outcome information by:

• inviting adult service users to evaluate the benefit of the service to them by themselves developing performance indicators
• revising the adult social care performance framework to reflect national and local outcome measures
• training assessment and care management staff to use a person-centred care model and to commission care for outcomes
• developing a joint outcome performance framework to drive forward joint plans to be delivered locally from April 2008
• appointing a consumer involvement officer.

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