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Chapter 4 Impact on people who use services and other stakeholders

This chapter looks at three areas for evaluation:

• impact on people who use services
• impact on staff
• impact on the community

Impact on people who use services

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

Most people using services and the majority of carers were satisfied with the services they received. Service users and carers who responded to our survey thought initial contact with social work was helpful and provided within reasonable timescales. Most service users were happy with the range of services available locally. We also met with many groups of service users and of carers and found that people in similar circumstances often had very different experiences of being informed about, and offered, social work services.

The council used surveys or questionnaires to gather the views of some service user groups on their experience of social work. There were a number of recent or planned initiatives to improve information and involvement, which could strengthen performance in this area.

Experiences of adults, carers, children, and families who use services

Finding out about services

Most service users (75%) who responded to our survey had found it easy to get information about social work. Carers were less positive. Just over half (53%) of those carers who responded to our survey agreed that information was easy to get. Almost all (95%) of people who used services and most carers thought that they got a good response when they were first in touch with social work, making these among the better responses to date.

We met with a range of people on fieldwork - service users, carers, kinship carers - who told us that during the course of their first few meetings with social work about their need for a service, some staff did not give them clear information on the choices and supports that might be available to them. Some had good levels of provision: ' The support is excellent, carried out with compassion and efficiency' while others were less positive: ' I feel there are some children who are getting a lot of support …yet there are vulnerable children with special needs who are unable to access outside activities due to lack of support.'

It was clear from discussions in these groups that carers had found out about what help was available at different stages and there was some shared sense of it being a matter of chance, influence or prior knowledge which determined what services people got. Some were just hearing about what they might benefit from or be entitled to at the group itself, from other people in similar circumstances.

We did not find any explanation of why this might have been the case apart from different practice by social work staff.

The advice and response team was the first contact for some service users and carried out the initial assessment of need. Some older people we met told us they were not clear about the reasons for another team also assessing them. Some carers told us that having to go through a second assessment for a short break for a loved one, when they thought that this hurdle had been cleared, was very distressing. Staff were also sympathetic to the effect of this duplication on service users and carers, and managers said it was included in a review of duty processes.

We discuss the process of transfers between short- and long-term teams in Chapter 5.

A comprehensive range of leaflets was available including a range of languages and formats. Some carers told us that they were provided with written information but were often too tired or upset to properly understand it. They would have liked someone from social work to talk through service options, eligibility criteria and the charging policy.

Views of people who use services and their carers

We observed practice and heard from service users that staff treated them with dignity and respect. It was evident from the files we read that workers both shared information with service users and took their views into account in any decision-making about support or services.

Eight-five per cent of people who responded to our survey and most of those we met were satisfied with the quality of the services they received. This was among the highest responses to date. Most (82%) respondents agreed that they were fully involved in deciding what help they should receive. In our focus groups there was a more mixed picture of experience regarding how satisfied people were with the time taken to put a service in place, or the availability of services, but once a service was in place people spoke warmly about how helpful staff were.

Older people were the most consistently positive of all the adult care groups. Adults with addiction problems spoke of how a sense of partnership with staff boosted their self-esteem.

However, just under half of service users who responded to our survey and even less carer respondents had seen a written assessment of their needs.

Most people who responded to our survey (84%) found the services they received to be reliable and the same number agreed that they received services at the time when they needed them. When people commented in our user and carer surveys and in meetings, home care was the service which was mentioned as being less than reliable. People did appear to make a distinction between the allowances they were prepared to make for the council home care service, because they said that carers were doing their best and did a good job when they did arrive, and private home care, which they regarded as very variable.

The majority of kinship carers told us that the council was improving the support and training that they received. This was in contrast to their initial contact with the service, which had not been helpful for most of those we spoke to. They had had different experiences of the degree of support, including financial, that they had been offered, and had not felt valued as partners in care. They welcomed the recently introduced opportunities, led by social work, to involve them in a series of three training events.

Young people we met told us about their good experience of support received. Young people and their families who had been involved with the NCH intensive service told us how this had made a real difference to communication within their family. Those who had been through ISMS⁷* were also clear that this had played an important part in preventing their behaviour and/or their problems from getting any worse.

We observed reviews involving young people during the fieldwork. We were concerned that it seemed common-place that people did not receive copies of reports or minutes until the meeting. This disadvantaged service users and families in being able to participate. One parent commented that this made it 'difficult to keep track of what was agreed'. It also added to a feeling of disempowerment that young people told us about. They said that the chairperson spent more time listening to the professionals around the table than them or their family.

The development of the short break facility for adults with learning disabilities at Twechar proceeded without meaningful consultation with people who use services and their carers, although managers took the view that carers had been involved in planning. People we spoke to were clear and specific in describing the allocation of short breaks prior to the opening of the new facility, and the fact that this was reduced afterwards. They said that this had not followed a reassessment of their needs. Some carers told us that they had felt there was little choice in accepting a reduced service. Service users and carers could hardly have been more positive about the 'excellent' support provided at the short break service - they simply felt that they needed more of it or like it.

We met young adults with learning disabilities who were generally positive about their opportunities. One young woman described the support she received from the local area co-ordinators to try things she wanted to do. She worked on a voluntary basis in a local shop to help her decide if she wanted to seek this kind of employment in the future. We heard from a number of these young adults about their disappointment that a regular opportunity to get together for a social activity in the evening, had been stopped by social work.

We were concerned that some other young adults did not receive support to access age appropriate services or mainstream resources. We heard from people using services that there ' is not enough things in the area for young adults to go to' and of a young adult being taken to an older people's day service as the only option available to him. He did not feel included and told us ' I can't remember what I used to do …. I have just fitted in.'

From some written evidence on user involvement events held by the local authority, and from our meetings with service users, we found that there was a consistent theme from younger people that there was not enough support for them to access education or training, or to get work. Young people leaving care and adults with community care needs also faced severe problems in obtaining local housing.

People in contact with the voluntary sector services commissioned by the council were generally positive. They described good advice and support from services like Carers Link, Caertas and the Addiction Recovery Centre.

Direct payments

Direct payments offer people choice in the help they get and service users told us that it also gave them better control of the time and type of service they received. People in receipt of direct payments were clear that managing their services had increased their independence, with one service user describing how it ' opened up my life entirely'. They found direct payment support staff to be 'absolutely fantastic' and they had a well-developed collective advocacy group.

The major problems from their perspective were that the process of applying was so slow, that the reporting requirements were onerous and disproportionate, and the decision making processes lacked transparency. Decision-making and reporting requirements were both more cumbersome than we have seen elsewhere.

We heard from social work staff that a review of direct payments was underway which would involve people already in receipt of payments. It was good that people's experience was being used to inform planned improvements.

Staff within the council and the direct payments support agency anticipated that this would speed up the process for future applicants. In reviewing the contract with direct payment recipients, social work should aim to achieve accountability while avoiding unnecessary bureaucracy.

Impact on staff

We rated performance of social work services in this area to be good, with important strengths and some areas for improvement.

Our staff survey findings and staff interviews revealed an enthusiastic and highly motivated staff group. They expressed confidence about the effectiveness of their team, and both supervision and team meetings were said to be regular and helpful. Staff appreciated the training support that was in place but expressed some concerns about how to fit this in with the demands of their day-to-day work.

Staff also said that there was room to improve opportunities for two-way communication with senior management.

Staff motivation, commitment and satisfaction

Our staff survey ⁸ showed that most respondents enjoyed their work and felt that the work of their team made a positive difference to the lives of service users and their families. Both in the survey (90%) and during our fieldwork a range of staff groups told us how responsive their team was when service users or carers were in crisis. However, only 37% of staff who responded to our survey thought that their team had sufficient capacity to do preventative work.

While many staff we spoke to recognised the efforts of senior management to improve recruitment, training and staff supervision, there was still a fairly even split in our survey results as to whether the local authority was able to recruit enough social work staff. There were higher levels of satisfaction regarding adequate training (78%) and supervision (67%).

Home care staff stood out as being positive about all aspects of their work.

Compared with the staff survey findings from other performance inspections, East Dunbartonshire's results, although satisfactory, fell at the lower end of the scale in a number of important fields. These included feeling valued by managers (51%), feeling well supported in facing personal risk (64%) and the quality of communication between staff and senior managers (32% agreed there was effective communication while 37% disagreed).

With regard to staff morale only slightly more respondents agreed (42%) than disagreed (40%) with the statement that 'staff morale had been good for the last six months'. Within this overall group, more fieldwork staff, administrative staff and day care staff disagreed than agreed. Administrative staff respondents were fairly evenly split on the statement that they 'felt valued by their managers in carrying out their day to day job'.

Our interviews with staff fleshed out some of these issues. Some staff said senior managers had not handled the single status negotiations well enough. Community care staff said their workloads were not manageable within a 35-hour week. Administrative staff felt they were often the last to know about important changes that were going to affect them.

On the positive side, almost all staff thought that their team was effective in assisting service users to enjoy a better quality of life and achieve greater independence. Staff were very positive about relationships within their teams and across teams in different parts of the service.

Between 2004 and 2007 East Dunbartonshire had undertaken some quite detailed staff surveys. The findings of these had prompted a range of initiatives including more flexible working, the introduction of an induction programme and other training opportunities, and greater staff involvement in planning. Separately, staff in both child care and community care attended an annual 2-day residential event where senior managers talked with them about current concerns and their agenda for the future. Child care also held a 'How Good is Our Team?' event in 2007. Child care staff were very positive about these opportunities for collective stock-taking, planning and dialogue with senior management.

Child care had a more developed approach to planning and managing the learning from these events than community care. Nevertheless, and although community care staff expressed some scepticism about positive follow-up action by managers, the service as a whole was making good efforts to foster staff inclusion in forward planning.

Staff perceptions about career and professional development

The advance information, the survey findings and discussions with staff all showed that career and professional development were very much part of East Dunbartonshire's change agenda. A new staff appraisal system, with a direct link to workforce planning and continuous professional development, was in the process of being rolled out. The corporate human resources service had been expanded with posts focused on strengthening staff development. In part this was to support staff who might otherwise have been disadvantaged following the single status agreement. Social work had invested heavily in a wide range of related training opportunities for staff.

Thirty-four per cent of respondents to the staff survey agreed that the annual staff appraisal system helped them to do their job. Home care and management respondents were the two most positive groups whilst the opinions of fieldworkers and administrative staff were more negative. The explanation for this latter finding may lie in the fact that the new appraisal system had yet to reach all staff.

Staff told us that East Dunbartonshire were good employers and that they had ready access to training to improve their current competencies and enhance their career prospects. Managers had provided good support to staff to qualify to register with the SSSC. Steady progress was also being made in registering staff working in residential children's services, where there had been a very low up-take and completion of training. The most recent figures showed that 86.4% of these staff had either completed or were undertaking SVQs.

Seventy-eight per cent of staff who responded to our survey agreed that they had received adequate training to fulfil the responsibilities of their job, including 21% who strongly agreed. Criminal justice staff were positive about the training opportunities available to them. They said that the induction was valuable in that it covered the whole of social work and not just criminal justice. They appreciated the advantages of specialist training through the criminal justice partnership, and the encouragement to participate in joint training events concerning child protection and parental substance misuse.

Whilst staff appreciated the opportunities for continuous professional development the issue for most of them was finding time to participate. Staff talked about the short notice for some courses, courses arranged too close together, and a failure to understand that 'something had to give' when so much training was on offer. It was not uncommon for courses to be cancelled because staff said they could not take more time away from their work.

Staff perceptions about working with other services and agencies

Our staff survey findings show that respondents agreed that they had good working relationships with a range of other services/agencies including education, housing and health. They also agreed that they worked well with colleagues in other sections of their own service. The level of agreement was particularly high in respect of working with other services to protect children at risk or affected by parental substance misuse, and also between criminal justice and addictions.

During our fieldwork we found evidence of positive working relationships between criminal justice social workers and the police in the management of high-risk offenders, and between child care and education services in respect of a wide range of work with children and families. Criminal justice services staff had established clear links with colleagues in child protection services and their involvement in joint training provided a good foundation for collaborative working. Home carers said that health teams had helped them to develop their skills to 're-enable' service users to maximise their independence. Addiction service colleagues had also offered ongoing assistance to home carers in responding to the service needs of older people with substance misuse problems.

Staff ownership of vision, policy and strategy

Eighty-seven per cent of survey respondents agreed they were aware of the standards that their team was expected to follow, including 25% who strongly agreed. A similarly high percentage also agreed they were aware of their responsibilities as set out in the code of practice for social service workers. These results suggested a high degree of confidence on the part of social work staff that they knew what they should be doing and how they should be doing it.

However, when staff were asked if there was a clear vision for social work in East Dunbartonshire, and about their actual performance against local service standards, there was a sharp drop in the levels of agreement. Quite a high percentage of respondents (42%) neither agreed nor disagreed that there was a vision for social work, compared to 44% who agreed. Fifty-two per cent of staff agreed that their team performed well against local service standards, which was low compared to other inspection results.

The advance information pointed to a number of initiatives to raise staff awareness. These included:

• staff surveys to determine the extent of staff understanding of the corporate and service change agenda
• seminars focusing on particular aspects of policy and strategy, for example 'the changing lives agenda', child and adult protection and substance misuse
• a 'refreshed' vision, values and aims statement sent out in late 2007 by the head of social work
• the regular posting of key policies and procedures on East Dunbartonshire's corporate intranet (the HUB).

Nevertheless, the survey results outlined above suggest that staff were not entirely confident about what the authority expected of them, and management should engage with staff to address these gaps.

During the fieldwork we found a number of examples of staff implementing forward-looking approaches to service planning and delivery. Home care staff were working flexibly with service users to help them regain their self-reliance; the learning disability services co-ordinators had a strong commitment to helping service users to 'personalise' their services; the direct payments officer was taking an inclusive approach to increasing up-take; the child protection co-ordinator had introduced and was continuing to develop quality assurance processes and procedures.

Impact on the community

We considered performance in this area to be good, having important strengths and some areas for improvement

The local authority showed recognition of the mix of communities within its boundaries and promoted their involvement through a number of forums and citizen panels. Social work services had also taken steps to develop services that took these into account and we saw some good examples of community engagement in the development of plans and of services.

We found a strong commitment to supporting the voluntary sector from both social work staff and elected members.

Some voluntary sector agencies complained that social workers did not take the time to find out what their service offered, resulting in inappropriate referrals or people not being directed to their service who might benefit from it.

Community perception, understanding and involvement

The involvement and engagement of local communities as well as people who use services and their carers in the planning and delivery of services should influence the range of services in an area.

East Dunbartonshire covers a mix of urban and rural communities several of which had no historic or natural link. Indeed the transport infrastructure did not support easy passage between some of its communities. It is to the credit of the local authority that they have endeavoured to create a sense of shared involvement across the area.

A series of three detailed mapping exercises of communities in the area was produced for the Children and Young People's themed partnership in 2007. These highlighted areas of deprivation, levels of actual and projected use of services, and how these impacted on planning service developments.

East Dunbartonshire had well-developed community planning processes for informing and involving the public about council services and plans. We heard of a number of community consultations in relation to the development of services covering both specific developments and planning for services, including widespread consultation on the community care plan. We saw examples of corporate consultations that were sensitive to the specific needs of the different communities, including minority ethnic groups and people with dementia.

The seniors forum told us they had been consulted on the development of some older peoples services as well as the community care plans. The black and minority ethnic forum was consulted and could identify their influence in the shape of some council wide services. They expressed disappointment that support from the council to the forum seemed to them to have diminished in the months since a local authority liaison worker left and their liaison role was not re-assigned.

The youth forum had been set up to ensure consideration of the views of young people on subjects that affected them. Topics raised by the forum included employment and housing options. The council supported young people to attend and to raise issues on local and national forums. Plans were also underway to involve young people in the future development of the child protection website.

However, they did not ask for views from all service user groups. Or in some instances extensive consultation had not resulted in change. For example in learning disability day services the views of people using services, carers and staff had all been gathered but the outcome of these had not been developed into clear plans for the future of the service. An event for people affected by physical disability or sensory impairment was held in early 2007 which highlighted their frustration with the lack of local services, and of support to enable them to overcome barriers to employment. There had been no tangible progress in the year between then and the inspection.

The social work service had a contract with the local Council of Voluntary Service ( CVS) to support the involvement of service users and communities in the planning and development of services. This was still at an early stage. Consultation sensitive to the needs of different ethnic groups in East Dunbartonshire had been commissioned and good efforts - not always fruitful - had been made to reach across ethnic communities.

Home carers had been provided with a handbook about delivering culturally sensitive services but could give no examples of actually delivering such services when we met them. Older people attending the Anand Bhavan day service welcomed the opportunity to meet friends. Those attending were almost exclusively from the Indian community. The social work service should consider further how to reach and involve other ethnic groups in its communities.

Elected members had visited some of the social work services to find out what they did and acknowledged the good publicity for some services, e.g. ISMS and home care. Elected members and members of the community viewed home care services positively. Criminal justice staff had appreciated a recent visit by elected members. Other staff said that they were sometimes aware of the presence of elected members at meetings in their office building and they felt that managers should use some of these visits to organise opportunities for dialogue with the staff working there.

Both staff and voluntary sector agencies were positive about their experience of visits from the chief executive.

Impact on stakeholders

Stakeholders who responded to our survey ⁹ and those we met on fieldwork, were very positive about the quality of services provided by East Dunbartonshire social work services and how good social work managers were to do business with.

Seventy per cent (out of 23 respondents) agreed that service users and carers receive a good service from social work, although this dropped sharply to 19% (out of 21 respondents) in relation to whether the out of hours service meets people's needs.

This positive regard for the efforts of social work staff and the quality of services, was echoed in our meetings with service providers, community forum representatives and advocacy groups. There was a general consensus that social work were committed to working positively with them to achieve improvements in services and the experience of service users.

'The main strengths of social work services is the willingness of staff to meet with, listen to and provide assistance to those who need it most.'
Quote from stakeholder organisation.

Partnership arrangements and protocols across council services were developing although for some groups this had been slow. Accommodation services for young people who had been looked after had only recently been developed. A protocol between housing and the council's addiction service had been signed off just prior to the inspection, despite long-standing difficulties with service users having to be temporarily accommodated in hotel accommodation in Glasgow.

There were provider forums in both child care and community care. Providers were generally positive about these meetings and about the quality of their relationships with the managers and staff who attended them, although private sector providers expressed concern about what they perceived as their exclusion from these meetings.

We saw records of, or heard about plans for, a number of service development events. Stakeholder involvement was neither consistent nor based on any agreement about representation. The latter would be helpful in ensuring appropriate dissemination of information through and by representatives.

A range of advocacy services was in place and plans were at an advanced to stage to develop this service in partnership with a single agency. Advocacy providers were engaged in the planning of services and found council staff to be generally responsive to the needs of the individuals that they were supporting. However, they also thought that staff needed more awareness of the role of advocacy in supporting people who use services. The tendering process to arrive at a single agency overseeing advocacy services had been protracted. Some providers told us that the uncertainty during this period had reduced the number of advocates available as they had moved on to other opportunities.

Advocacy workers and representatives from some other voluntary sector organisations, including accommodation services for young people, thought that some social work staff did not know about or make appropriate referrals to their service. We heard from several organisations that there were problems of misdirected referrals and some social workers were clearer and more positive about their service than others. This reinforces findings outlined in Chapter 4 about the very mixed experience of service users and carers regarding the information social workers give them about appropriate sources of support.

Recommendation 1
Managers should provide guidance and support to social workers to continually develop their knowledge of helping options to match the needs of service users and carers they are asked to assess.

Some early years providers felt that social work were not good at telling them if there were particular concerns that they should be alert to or getting back to them when they raised concerns about a child in their care. This chimed with the HMIE inspection finding that feedback to people making referrals was not embedded in practice. Social work should ensure appropriate sharing of information based on the best interests of the child.

Offenders undertaking community service as an order of the court were making a positive contribution to the community through a wide range of tasks, including environmental improvements and assistance to local organisations and services. Almost all beneficiaries said they would be happy to use the service again. We thought that the council could do more to publicise the benefits to the community of this work.

Community capacity

East Dunbartonshire had pockets of active community involvement. We saw a number of examples where the local authority had made real effort to involve people from the many communities.

The development of befriending services covered a range of service user groups, from children and young people through to older people.

Carers Link employed volunteers who themselves had experience of being in a caring role and we have commented earlier in the report about the high value placed by carers on being able to speak to others who 'have walked in their shoes'.

However, we also saw examples of volunteer recruitment where agencies appeared to struggle with fundamental requirements, such as that relating to the need for enhanced disclosures. It was also clear that services employing volunteers were heavily over-subscribed and some said referrals and further communication from social workers were not always good.

Social work should develop a clear strategy for the recruitment, training and support of volunteers, giving some consideration to engaging with current volunteers on the development of a handbook setting out the parameters and the value of their role.

Local area coordinators were working to build community capacity working alongside people with learning disabilities to access supported employment. People using services told us about their work and volunteering in local shops and cafes. A number of local business were supportive and offered employment to people with support needs.

Elected members and council staff were supportive of voluntary sector 'there is a fantastic voluntary sector here' and the services that they offered. Equally organisations told us that, 'Every effort is made not to cut funding to the voluntary sector'. The support to voluntary providers could be improved through offering them access to training opportunities within the council.

Social work services had been successful in the recruitment of foster carers with numbers doubling in recent years. The service had ten foster carers, five of whom were also providing respite care as required. The service was processing another eight applications. Independent agencies also provided placements.

The fostering service had a strategy for regular local advertising including local newspapers and magazines. They also held open days in leisure centres and hotels. Leaflets were distributed in libraries and other public places.

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