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Listen
CHAPTER 4 Impact on people who use services and other stakeholders
In this chapter we look at three areas for evaluation:
- impact on people who use services
- impact on staff
- impact on community.
We define impact as the direct experience of people who use or deliver social work services or who benefit from them.
Impact on people who use services
Performance in this area was good - having important strengths with some areas for improvement.
People using services and their carers were generally positive about their experiences.
We received a lot of very positive written comments from service users and carers about services.
Experiences of adults, carers, children and families who use services
Finding out about services
East Lothian provided information about its services in a number of formats including leaflets, newsletters and the internet. The latter offered an informative directory of services, including information about eligibility criteria.
A majority of stakeholders who responded to our questionnaire said there was good quality information available about social work services.
The majority of service users and carers who responded to our survey told us that they found it easy to get clear information about the range of services. However one in four service users disagreed with this and one in three carers. One service user said, "In my opinion social services does not give out enough information on the service".
Some carers told us provision of information was inconsistent. Some of the service users that we met during the fieldwork had not found it easy to get information about services and had to rely on word of mouth.
Contact
Most service users and carers who responded to our survey agreed that they got a good response when they were first in touch with social work services. For ongoing contact, the majority of respondents agreed that they got a good response when they contacted social work services during the day. However less than half of carer respondents agreed that they got a good response out of office hours.
Most service users and the majority of carers who responded to our survey agreed that the help they got was given at a time when it was needed and most agreed that they could rely on social services. However, carers did express more reservations, particularly they had problems contacting social workers. Carers believed this was due to a shortage of social workers.
Using services
Most files that we read showed that key information had been shared with the service user or with an appropriate representative. Most service users were also invited to attend decision making meetings or reviews. In almost all files the views of individuals were taken into account at each key stage. The majority of service users who responded to our survey agreed they have been given a clear plan to describe the services they receive, although nearly one in four disagreed.
Service users and carers that we met with during observations of practice, contributed to the development and implementation of their care plans.
Quality and choice
The majority of service users and carers who responded to our questionnaire agreed that there was a good range of services available to them, however nearly one in four carers disagreed. Most service user and carer respondents agreed that those services were of a good quality, including one in five carers who strongly agreed.
Almost all carers who responded to our survey felt that the person that they cared for was treated with dignity and respect, with one in three agreeing strongly. Most of the service user respondents also felt that they had been treated in this way. Many service users were very positive about the extent of help and support they got from individual social workers and care workers. Our direct practice observations confirmed this.
Here are some quotes from service users and carers:
"I am an elderly person suffering from multiple sclerosis and because of the services provided I am able to live a full life in the community for which I am very very grateful."
"On the whole very satisfied with the quality and standard of care received."
(older person service user).
The following quote from a carer shows both a positive and negative view.
"The service we received when my husband was first disabled was excellent. We received all the help and assistance and equipment we required very quickly. It was delivered and installed by a very helpful driver/installer. Since then we have had no contact with social work nor has the electrical equipment been tested or checked. It seems like equipment was delivered and then forgotten about."
Some of the parents of children with disabilities who responded to our survey were quite negative about the services their children got:
"I haven't as yet had any help or support from social work services. Someone from social work came to a meeting and said they felt sorry for me and our situation. They said they would get back about what help was available to me. At the next meeting they didn't turn up."
"We use residential respite care. We have no choice in dates given. Reviews are rare when they should be statutory. We have no contact name within the social work department due to 'lack of resources'."
Others were more positive:
"I receive respite care for my child. The social worker was able to make an excellent match with a very kind and caring person to provide respite. This made a huge difference to all of our family and is a very valuable service."
Direct payments and service users having more control over the services they get
We found staff and service users had little knowledge about direct payments. Managers recognised that more work was needed to promote direct payments, through training of their own staff and increasing service user and carer awareness.
Adult social care acknowledged that the uptake of direct payments was relatively low. In 2006-07, 31 service users in East Lothian got direct payments. This was an increase from 28 in 2005-06 (19 in 2004-05). This was equal to 3.3 per 10,000 population which was less than the Scottish average of 4.5 clients per 10,000 population. Of the 31 clients who got direct payments, 14 were people with physical disabilities, 8 were people with learning disabilities and 2 were people with mental health problems. Seven service users were in the "other" category.
In East Lothian the total value of the direct payments in 2006 was £438,000, while the average value received was £22,800 (the Scotland average was £13,100).
Staff said they wanted to increase the number of people who had self-directed care packages. The In Control model aims to change the organisation of social care and support so that people get more control over their support and their lives. East Lothian and Midlothian councils were working together on a self directed care project. Two staff from the Thistle Foundation had been employed to work on this. We thought it was good that this issue was being progressed.
Carers
Adult social care had increased the number of separate carer's assessments done by 900%. The figures were as follows:
- 10 carer's assessments completed in 2004-05
- 38 carer's assessments completed in 2005-06
- 278 carer's assessments completed in 2006-07.
We think this was excellent progress. The self evaluation questionnaire said that the increase in carers assessments had led to an increase in the provision of respite for carers. Our file reading showed that, where there was a carer, one in four carers had an up to date assessment of their needs. Most carers who responded to our survey agreed that they had been fully involved in deciding what help or services the person they cared for received.
Impact on staff
Overall, performance in this area was good - important strengths with some areas for improvement.
We found that staff motivation was generally high in children's services and adult social care. Children's services staff generally welcomed the fact that children's services and education were joined in one department.
Motivation and satisfaction
In an independent survey of staff (June 2007), commissioned by the council across the social work services, 89% of staff agreed they found their job satisfying. Our survey found that levels of staff motivation were generally high, with 86% of respondents saying that they enjoyed their job. We got some very positive comments from staff about education and children's services joined in one department. They praised service managers and team leaders for their efforts to improve the quality of the work. We confirmed this during the fieldwork. One fieldworker said, "Overall, I think East Lothian Council is an excellent employer. Senior managers are always accessible to staff; they listen and offer guidance and support. The team culture is hard-working, supportive and positive". Another fieldworker said, "I believe that East Lothian Council is one of the better authorities to work for. We have a good reputation for being able to recruit and retain staff which I believe is due to a strong and supportive management team".
Half of the staff respondents to our survey agreed staff morale in their team had been good for at least 6 months, while 33% disagreed. Managers and home care staff were most positive with agreement levels of 72% (of 36 respondents) and 62% (of 21 respondents) respectively. Several staff groups were negative; administrative staff (19% agreed, 71% disagree, out of 31 respondents), residential staff (28% agree, 50% disagree, out of 18 respondents).
Eighty-three per cent of staff respondents agreed they were aware of the standards that their team was expected to follow, while 9% disagreed. Residential care workers were most positive (95% agreed out of 19 respondents), and managers, day care workers and "others" also all had over 90% agreement. Least positive were fieldworkers (68% agreed, 15% disagreed out of 53 respondents).
Fifty-eight per cent of staff respondents agreed that their employer offered flexible working practices which made their job easier to manage, while 15% disagreed. The responses from different staff groups were quite different. Managers, fieldworkers and administrative staff were all much more positive (with agreement levels of 70% or more) than residential care, day care and home care workers (with agreement levels of 36% or less). East Lothian's result was comparable with other inspected authorities, but at the lower end of the scale.
We held a focus group with the local authority mental health team. Most team members said that they enjoyed their work and felt that they were strong as a team. Staff gave similar views in other focus groups.
When we met with practitioners in adult services they told us that they were well managed by their team leaders and were able to raise issues with them.
Children's services held annual team development days. The purpose of these events was to team build, promote good practice and support staff through change.
Adult social care had a programme of team away days. The national development team ran multi-agency training about practice.
However, some staff said that morale had been adversely affected by a combination of factors, including:
- single status proposals (which relate to pay and grading)
- often having to deal with crises which they saw as related to the need for more resources
- senior managers in community services were seen as remote from front line staff.
Our survey also found that 35% of staff respondents felt valued by elected members.
Our survey showed that there was a particular issue with the morale of administrative staff. One said, "The overall low morale within the admin team is probably worse than any other team". Another said, "I feel we currently function in a permanent state of crisis management. Without more funding or resources, this situation will not change and will continue to lower staff morale".
Most staff who responded to our survey agreed that they were effective in helping service users to:
- lead more independent and less isolated lives
- live in the community.
Almost all staff respondents agreed that their team did everything possible to keep people safe.
The results from our staff survey showed that 59% of staff who responded agreed that their workloads were manageable within normal working hours. Managers who responded to our survey were particularly negative about the manageability of workloads.
Staff ownership of vision, policy and strategy
The majority of staff who responded to our survey agreed there was a clear vision for social work in the council. This contrasted with our findings that there was no clear vision for social work in the council (see chapter 7). Staff views about the future of social work services in East Lothian were mixed. Most staff who responded agreed that the service they provided could be improved. Our staff survey found that only 35% of staff who responded thought that their working conditions would improve in the next 12 months. Sixty-four per cent of staff respondents felt that their team would provide a better service over the next 12 months.
The council's 2007 staff survey and consequent action plans showed that staff were concerned about the level of consultation and communication from management. Less than half reported that they were encouraged to think of ways to improve services. In the group strategic plans for children's services (2007-08) and for community support (2006-07) there was a checklist for managers to confirm they had consulted staff.
Senior managers in community services should improve communication and consultation with staff. Senior managers in community services should try to improve their level of visibility to staff.
Impact on the community
We consider performance in this area was good - with important strengths with some areas for improvement.
We found a clear commitment to working collaboratively with stakeholders in the planning of services. A range of approaches had been used to make sure services were responsive to the needs of specific communities in East Lothian.
We found children's services performed very well in recruiting, retaining and supporting foster carers. So much so that they could offer foster placements to a neighbouring council.
There needed to be a strategic vision for social work about how to develop the capacity of the community to support people who use social work services.
Community perception, understanding and involvement
We read a number of documents that set out the range of ways the council planned to engage with the local community. The East Lothian Community Plan 2007 - 2016 mentioned "involved communities" and creating localised structures. The recently published document Our Contract with the People said the council would start a discussion about devolving local decisions to local people in order to "empower our communities to make informed decisions". We met a number of councillors from the new administration. We found they were very committed involving local communities and to working alongside local communities.
East Lothian Council was developing a community engagement strategy. The council should have had this strategy in place sooner. The council was committed to linking planning processes with the community engagement strategy. We were impressed that the council were trying to engage with a wider group of older people and not just existing service users and their carers.
There were a range of specific initiatives aimed at identifying the needs of different communities. There had been some research into the needs of black and minority ethnic carers, gypsy travellers and homeless families There was also work to find out about the needs of the increasing number of residents from the new accession countries to the European Union.
A range of information was available to the public about services in East Lothian, for example, Ageing Well in East Lothian and the mental health directory. The council had also used the local community planning forums to circulate information. The council's newsletter Aiming High was used to share performance information with the general public.
Senior housing managers told us about a very positive approach to anti-social behaviour. There was an anti-social behaviour co-ordinator with a small team that included a housing officer, a police liaison officer and a statistician. We learned about successful initiatives in Prestonpans and Dunbar. The council, and its partners had worked with the local communities to deal with a range of the communities' anti-social behaviour concerns. Adult social care and children's services were represented on the overarching co-ordinating group. Children's services was represented on the anti-social behaviour monitoring group. This group screened all referrals. There was only one anti-social behaviour order in place in East Lothian.
Impact on other stakeholders
We found stakeholders were involved in a wide range of strategic and planning activity across the services. We got information about a conference Partners in Planning held in 2006 that was about future developments in joint planning. This reflected a clear commitment to partnership working with a wide range of stakeholders, including service users and carers. The community care chief officers group included representatives from East Lothian community care forum and voluntary sector groups.
Stakeholders who responded to our questionnaire praised the council's commitment to involve them in strategic planning. We got some very positive comments from stakeholders including:
" The department is very approachable and easy to work with. They are also very supportive with any difficulties we are experiencing with any of our service users."
Community capacity
There were a range of opportunities for volunteering in the council. Some of these gave opportunities to service users such as people with learning disabilities and young people who were accommodated. The council acknowledged in the self-evaluation questionnaire there was no corporate approach to volunteering in East Lothian.
Home start ran a befriending service for vulnerable families with children under school age. Thirty volunteers supported 35 families.
The councils three older people's residential care homes were involved with their local community. The homes were supported by local businesses; the support included providing cars to take residents to appointments.
Recruitment campaign had successfully maintained the number of foster carers. An advertising campaign in 2006-07 had led to an increase in the number of enquiries. The council had a surplus of foster parents. East Lothian was supplying some of its foster parents to the City of Edinburgh Council. This was evidence that children's services had developed a lot of community capacity to foster children.
The welfare rights team gave advice to 1,552 people in 2006-07. This resulted in a total benefit gain of £1.36m. The Royal National Institute for the Blind income maximisation officer helped 12 people to get a total £31,824 extra benefit.
Children's services worked with the kinship networks of families. Family group conferencing was well used into practice. This made sure the child's wider community was involved in their care and support.
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