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Chapter 5 Delivery of key processes

Performance in the delivery of key processes was adequate with strengths just outweighing weaknesses.

East Dunbartonshire had developed good written information on services. Duty arrangements and assessment pathways were confusing and sometimes involved duplicate assessments.

Our file reading results showed that most case files contained an assessment and that care plans were regularly reviewed. There was a key strength in social workers engaging with service users in a spirit of partnership and the service was working hard with colleagues from other agencies to improve services further. The quality of assessments was mixed, however, and single-shared assessments were not well-used across community care. There were risk assessment tools but staff were not using these well enough.

We found good examples of social work proactively reviewing key processes and putting improvement plans in place.

Access to services

Information about services

We found there was a high standard of information leaflets and guides to services provided by or through social work, in the local authority. Children's services provided more information than adult social care. Respondents to our survey with physical or sensory impairments and mental ill health were the most likely to disagree that information was readily accessible to them. This was confirmed in our meetings with people who used services. For example, deaf blind people needed a guide communicator and we found that not all services recognised a dual sensory component. Some people with sensory impairments related regular difficulties with communication support, including equipment not working even after it had been reported as broken on numerous occasions.

The local authority could provide interpreters for non-English speakers. Written information about council services was available in alternative languages and formats including Braille or large print and on audio tape.

Information available to the general public and other professionals was available on the local authority website which was updated regularly. The Child Protection Committee website was unavailable at the time of the inspection and was being updated.

Information on access to services for older people did not appear to have been signed off but was in use. There was an acknowledgement by senior managers that they needed to formalise eligibility criteria across community care services. The common understanding that managers and staff were working to was based on four levels of assessed need. Only those with very high and high needs received a service. There was a standard procedure employed by the advice and response team to sign-post people to alternative sources of private or voluntary sector support if they did not meet this threshold but had an assessed need for support.

Eligibility criteria for children's services were due to be published later in 2008.

The Advice and Response Team was intended to provide the first point of contact for all new referrals. This service had been reviewed and revised in early 2007 in response to a number of concerns from other agencies and in-house staff. It was commendable that the team had made progress on the improvement action plan from the review, despite struggling with staffing problems. However, more should have been done to tackle fundamental inefficiencies which caused frustration for the staff and the public alike, namely the parallel duty systems in community care and the duplication of assessments on transfer to long-term teams.

'The system for dealing with critical situations needs to be improved. Response from staff in my situation was very confusing … I was passed from one person to another over a period of days.'
Quote from service user with mental health problems

Social work was undertaking a further review of the advice and response service. There were plans to separate out child care and community care to reflect arrangements in the long-term teams.

The child care part of the service was to be based in offices which were to accommodate all of the child care teams. There was a plan to relocate the community care part of the service to a new building at the Kirkintilloch Initiative. The Vulnerable Older people's Project, which we describe later in the report, had identified the need for a single point of entry to health and social work services for older people. There are currently no joint teams for older people but there are for mental health, learning disabilities and addictions. These differences pose challenges as to how to manage duty arrangements in the new integrated centre.

Recommendation 2
Social work should use planned changes to the advice and response service to form the basis of a wider review of duty arrangements. Partners should be consulted and involved as appropriate.

Out-of-hours services were provided by the West of Scotland Standby Service. Sixty-five per cent of staff who took part in our survey told us that they considered there were effective links with the out-of-hours service with only 7% of staff disagreeing with this view. In comparison to findings from other authorities East Dunbartonshire recorded a higher proportion of satisfaction with out-of-hours services. This contrasted with the view of partners and stakeholders, where only 19% (out of 21 respondents) considered that service users and carers were well-served out of hours.

People who used services and their carers were not on the whole satisfied with out-of-hours services. Fifty-seven per cent of service users and 38% of carers who took part in our surveys agreed that they got a good response in the evenings and at weekends. Many authorities have poor responses to this aspect of services.

The survey responses did not allow us to tell whether people were dissatisfied with the West of Scotland service or locally provided social work cover. The most recent Care Commission inspection of the Hourcare 24 service reflected concerns expressed by both staff and service users that there were not sufficient staff to provide overnight cover. The report included a requirement that staff be deployed more evenly to meet the needs of the service . The service has responded by increasing overnight cover from 1 officer to 5 by utilising staff from a pilot out-of-hours home care service.

Social work was in the early months of a year-long pilot of overnight home care which was intended to reduce admission to hospital. This was also to address long-standing concerns that the absence of such a service added to the balance of care problems in older people's services. Managers told us that this was being well-used, both to support people in their own home and for back-up to voluntary sector care home staff providing respite care for people with complex needs.

Subject to evaluation of the pilot, consideration was being given to building on the current cross-over between Hourcare 24 and the home care pilot, and developing a comprehensive 24/7 care at home and housing support service.

There were other positive out of hours developments. A new 24-hour corporate call centre was due to open, which would allow social work to up-grade and extend telecare support. The multi-disciplinary crisis response service for people with mental health problems had won a national innovation award.

Day-to-day planning and resource allocation

One of the improvement targets identified from the last review of the advice and response service was the timely transfer of cases to long-term teams within the 12-week cut-off point for short-term intervention. Managers of the service told us that this had been achieved. In child care allocated work was quickly transferred from Advice and Response to the three teams which worked with children of different age groups.

There were weekly meetings with the police to discuss vulnerable children and young people through the youth justice strategy group and the youth justice information group and discussions of domestic abuse. Neither youth justice services nor ISMS have waiting lists. ISMS have been providing a partial service to young people who did not meet the criteria of being at risk of admission to secure accommodation. Young people who were at risk of requiring secure accommodation were considered at the secure screening group.

The introduction of a standardised health referral form provided a mechanism to monitor and evaluate joint working on child protection. These referrals were considered at the Child Protection Operational Group which was attended by staff from health, education, social work and early years.

Services for children with special needs had a waiting list for a long time but recently this had been addressed and there was no one waiting for an assessment but many were waiting for services. We were given an example of 16 families who required shared care support. Families told us that they were not clear about how resources were allocated.

Most adult services had waiting lists and we found long waiting times between first identification of need and services being put in place, often more than double the national average. The process of applying for direct payments often took months from initial application.

Recommendation 3
Social work should conduct a rigorous analysis of the reasons for long delays between first identification of need and the provision of services. An improvement action plan should follow.

Criminal justice staff were meeting their key performance indicators and were able to accommodate community service placements without delay.

A shortage of home care capacity resulted in waiting lists being managed by the amount of service provided being reduced to release staff for another person in need of a service. Overtime for staff was also used which resulted in an overspend on the budget. This policy seemed to us to compound the concerns described by staff, service users and carers about home carers being rushed.

Some older people were waiting for a place in day care despite the increase in day care provision.

The Resources Screening Group, established in 2006, considered applications for services for older people in relation to the eligibility criteria. They scrutinised complex care packages where weekly costs exceeded £210, care home placements, rolling respite and they were a referral point for direct payments. Following a review in 2006 of how well the group was functioning, there were moves to broaden both the composition and the scope of the group, in order to move it beyond the limitations of 'gate-keeping' resources. The involvement of a health colleague from a rehabilitation service had helped the group examine what kinds of support could form a viable alternative to residential care.

Some staff still felt that the resource screening group was mainly concerned with gate-keeping. They felt that unnecessary delays in reaching conclusions about applications submitted to the group, were a ploy to conserve resources a little longer.

There was a monthly screening group for adults with incapacity, which mostly discussed people with dementia. The purpose of the group was to speed up what had been a slow process of arriving at a judgement about the need to test capacity, by bringing all the relevant professionals together for preliminary analysis. There were still delays in the overall process but this was a worthwhile initiative.

A pilot project had devolved care hours directly to four front-line staff, however the pilot was in an early stage and the guidelines and proposed outcomes were unclear.

Workload management

Sixty-seven per cent of staff who took part in our survey told us that their workloads were manageable within normal working hours, which is similar to the survey results from other inspections. Field staff and managers were the least likely to agree that their caseload was manageable within their working week. We followed this up in the fieldwork phase of the inspection.

We found that there had been concerted efforts in child care in particular to invest in developing caseload management and staff support. Child care staff reported manageable caseloads while community care staff told us that they were under pressure from high caseloads and long waiting lists. Front-line managers from the two sections also reflected these differences, and community care managers appeared to be facing greater challenges in managing waiting lists.

Child protection cases were distributed across the child care teams. This was both to avoid any one team being overloaded but also to develop and maintain the confidence and competence of staff in this vital area. There was not an allocation policy for staff to have an optimum number of adult protection cases.

Staff on the whole responded positively to the question about using IT in their work with 83% telling us that they made the best use of IT in their jobs. Staff views on the strength of administrative support available to them were less positive with just over half of respondents in agreement that the level of administrative support was appropriate.

Assessment and care management

Our file reading exercise found that 88% of files contained an assessment. Of these, 56% were considered to be of good, very good or excellent quality, which was at lower end of findings from other inspections. Child care files were slightly stronger than community care files on overall quality of assessments and evidence of supervision and file scrutiny by a line manager, while community care files were stronger on evidence of multi-agency working and up to date risk management plans.

The nature and content of assessments varied. In child care the service had designed and implemented a comprehensive assessment framework with partners from other agencies and in consultation with other authorities. Staff had been trained in the use of the framework, which allowed for single agency assessment and included guidance on triggers to indicate the necessity for an integrated assessment.

Reporters to the children's panel told us that the reports from East Dunbartonshire were mostly of very high quality. They particularly commended the quality of the reports from the youth justice team. They thought that the recruitment of trainee forensic psychologists to the team had improved risk assessment and that this in turn was strongly linked to well-argued recommendations.

There was a review group which regularly examined referral, recording and case management issues in relation to children whose parents were misusing substances.

Addictions staff were using a 'Children Affected By' assessment to record details of the children of service users attending their service. Both child care staff and the addictions manager spoke positively about the collaborative case management input from the children's worker based in the addictions team.

In general, we found evidence of good practice relating to the regular review of care plans in 83% of files and a similarly high percentage where the level of recording by the worker was in keeping with the needs of the service user.

In community care we were concerned that there was a muddled pathway through assessment processes which was unhelpful to staff and to the public.

When an initial referral for respite was received by the advice and response service they conducted an assessment and if the assessment concluded that respite was necessary this went ahead. If it was likely that the need for respite would be ongoing a transfer took place to the relevant long-term team where another assessment was done. Staff from community care teams sympathised with families who could not understand why this was necessary. They said that if they were on a day's duty in advice and response and were asked to do an initial assessment they were not allowed to do a comprehensive assessment even if was obvious that the need would be ongoing. Managers told us this practice was under review.

Unlike the guidance on the threshold or triggers for integrated assessment in child care, as outlined above, there were no criteria set out which would lead to a single shared assessment in certain circumstances. We were told by home care managers, for example, that judgements were made on the basis of their experience as to whether a home care assessment was sufficient. We were concerned that this could lead to complex care needs being overlooked.

A recent pilot of the IoRn (Indicator of Relative Need) tool in older people's services across both social work and health teams, had been positively evaluated. Use and follow-up use of the tool to plot fluctuating or deteriorating health and well-being was, when results were aggregated, found to be a useful means of informing service planning. Plans for further roll-out of the tool, together with a validated carer stress indicator tool, was being taken forward by a sub-group of the older people's planning group.

In community care single shared assessment was still being developed in partnership with Greater Glasgow and Clyde Health Board. It has not been embedded across community services. We were told that this was being driven by social workers and that health staff were resistant or were not persuaded of the added value, despite the efforts of social work managers. CHP managers confirmed the importance of SSA and told us that Carenap was being made available on hand-held electronic devices to make it easier for staff to use the system. Managers from both sides were exasperated with the slow progress but they needed to do more to quicken the pace of progress. Moreover, we were concerned that further delay in taking positive action will adversely impact on the plans for joint care management between health and social work staff.

In mental health services staff expressed the view that the SSA form was long and cumbersome and that the expectation that it should be completed at first contact was unrealistic. Mental health service users should not be expected to reveal so much information at an early contact as this could increase their anxiety level and deter them from future service contact.

We found assessment and care management in addiction services to be limited, despite an array of assessment tools. A service user evaluation of the service in 2007 pointed up deficiencies in care planning and support to access employment. Resulting planned improvements were not yet evident during the inspection.

Transition planning from child care to adult care for children with special needs was acknowledged by managers to be an area requiring improvement. A worker from the adult learning disability team had been identified to lead on this and a counterpart was being sought in the child care team. The adult outreach team was being reconfigured to allow for more focus on this important area.

In criminal justice the overall standard of reports for the court was good. From the file reading and our observed practice, it was clear that supervising officers were putting supervision plans in place and there was some effective attention to issues related to offending behaviour. The dual focus on offending behaviour and associated problems slipped over the course of supervision.

We consider that social work has still some significant work to undertake in respect of assessment, in particular in community care services. There were plans in place to introduce the Care Assess module by June 2008.

Recommendation 4
Both child care and community care should examine and streamline current practice regarding assessment.

There was mixed evidence regarding carers assessments. Fifty-four per cent of people who responded to our survey had their needs assessed as a carer. Compared to other authorities which we have inspected, East Dunbartonshire performed well on this self-reporting measure. Further analysis of the responses, however, suggested that offering carers assessments was more embedded in older people's teams than other community care teams. Moreover, our file reading results showed that there was a carers assessment in only 10% of files where someone in the household was performing a caring role. None of the applicable child care files contained evidence that a carer's assessment had been offered. In our focus groups there was a fairly even split as to whether carers had been made aware of, and offered, an assessment.

Risk management and accountability

Effective risk management and accountability is based on sound risk assessment. The service had a number of systems in place across adult and child care services which were intended to identify and assess risk within individual cases. The number of tools may not have been helpful to the service in operating a transparent and consistent approach to risk assessment. Child care staff which we met in focus groups told us that they were often not confident about completing risk assessments and could not identify and distinguish between the different models.

Risk management had also been the subject of training input for staff. Child care managers thought that the staff skills profile, while 'improving', could be developed further and that they could support this by putting clearer expectations in place regarding the recording of plans to manage and minimise identified risks. We agree that more needs to be done to ensure that staff put risk management plans in place. The file reading results revealed that in 23 child care files where risks had been recognised as such by the worker, an up-to-date plan was present in only eight.

The older people's team expressed confidence in their risk assessment work. They had completed training and understood and valued the tools they used. This was not true of community care more generally. In-house risk assessment and management procedures ( RAMP) had been developed which were also used to inform decisions on whether adult protection proceedings were needed. Standards for adult protection had been issued to staff and a pro forma was used for recording investigations. We found both the internal and multi-agency procedures to be sound but the latter were not consistently implemented. The file reading results showed room for improvement in risk management planning. Managers told us that their own audit of files had produced similar findings.

We were concerned about some aspects of current adult protection arrangements:

• a multi-agency group had been established for over a year but have left themselves with a huge amount of work to do to pave the way for an adult protection committee in readiness for the impending support and protection statutory powers and duties. They had a 'massive agenda' (Senior social work manager) and no co-ordinator yet in post
• some important information about the number of case conferences which followed professional discussions, and whether attendance or part-attendance at case conferences was discussed with the subject of proceedings, was not captured on Carefirst
• managers have overseen the delivery of a creditable amount of in-house training, including training for trainers, but multi-agency training has not been developed
• joint investigation expectations needed to be firmed up and acted on
• staff we spoke to were not confident that the training they had received had equipped them with the skills to properly identify and address adult protection concerns.

Recommendation 5
Social work should take action, alongside partner agencies, to review current adult protection arrangements with a particular emphasis on multi-agency training and collaborative working.

Multi-agency training for child care staff was well-established, extensive and was reinforced through in-house events and quality assurance measures. Nevertheless, the file reading results suggested that these have not come together as they should in the timely employment of risk assessment tools. We were told that further guidance on risk assessment has been offered to child care staff following initial feedback from the file reading.

Advice and Response workers did not have an explicit risk assessment format which they applied to all incoming work. There was a high volume of incoming work in which risk issues were frequently discussed but not routinely recorded. The completion of risk assessments was not mandatory in the assessment framework. It would be helpful to all concerned if workers were obliged to record that they had considered the need for a risk assessment.

Criminal justice staff were using approved tools for risk assessment. These included the RM2000 and Stable and Acute 2007 to assess the risk of reconviction and harm posed by other serious violent offenders.

The police worked together with social work staff in the risk assessment and management of sexual offenders and reported effective working relationships. Social work staff told us that they would benefit from further training in working with violent and sexual offenders. They had all been trained in risk assessment. They said that the increasing numbers of social enquiry reports they had to write was affecting the time they had available for direct work with offenders and managing risk. Community service staff were observed to be diligent in risk assessing offenders for suitable placements.

Partnership with people who use services

Partnerships with people who use services take two forms, working with them on their own assessment and support planning, and consulting and involving them in service development and delivery.

There was good evidence from our file reading that service users and carers were involved in assessment and care planning processes, which matches the views of service users and carers outlined earlier in the report.

In 90% of files we found that key information was shared, people were invited to meetings in 81% of cases and their views were taken into account in 83%.

The file reading provided evidence that social work staff often worked well to involve service users in deciding on their care and support, so there were good foundations on which to build. Service users and carers in our survey were satisfied that they were both informed and influential, although people we met with had a more mixed experience.

Across the whole of social work services user involvement at planning and service levels was piecemeal by comparison. Collective advocacy was not well-developed across care groups. The addictions service referred to user involvement but the group of service users who met regularly were clear that they were doing so for social support reasons. Some of the service user consultation events - learning disability review of day services, physical disability, addictions - were not followed up with positive action or planned developments showed no signs of happening.

Home care was one service which did have a schedule of regular customer satisfaction surveys in place. Changes resulting from this feedback were identified by staff and this experience could be of help to other services.

Carers seemed to have a stronger involvement platform, and we thought there was very good support for this from Carers Link and from social work. There were a number of groups which had been established to support carers and to seek their views. Carers had been influential in the drafting of the Carers Strategy. A carers planning and performance and implementation group had been established in community care - chaired by a carer - and there were plans to have carer representation on each of the other planning and performance groups.

Inclusion equality and fairness

The council's website and publications showed commitment to reducing barriers to groups of people who experience discrimination. There was less evidence of this within social work services. Not all premises were readily accessible to disabled people. The council is providing new premises for Advice and Response and other services in the near future. The people who were least satisfied with services were often disabled children and adults and their carers, much of this was related to the shortage of appropriate resources within the council area.

There was substantial evidence of information materials in a range of accessible formats. It was up to date and attractively presented. There were a number of 'survival guides' published by the council's welfare rights service. The guides to access to various resources, e.g. mental health and disability were well written and user friendly. They began with quotes from people who used the service which created a sense of partnership and inclusion. Social work advice and response team had produced are large print guide with photos for older people, 'Choices for older people - thinking about going into a care home'.

There were also guides for looked after young people, including one on being in residential care and another on Leaving Care. People with a learning disability could have access to 'easy read' versions of information.

We observed the work of a rehabilitation worker who was seeking to maximise the freedom and independence of a young person with a visual impairment. Her role was to assist blind and visually impaired people in the council achieve inclusion through developing their skills and independence.

The service had recruited independent chairs to assist young people at looked after reviews to express their views. Nonetheless, many reviews were still being chaired by the person with management responsibility for the social worker working with the young person. In all of our conversations with looked after young people, except those attending ISMS they were very critical of reviews and meetings and told they did not feel included or that the processes were fair to them or their families. There should be an element of independence in this process it was well-established in practice elsewhere in Scotland and was clearly set out as best practice in the Guidance to the Children's (Scotland) Act 1995.

The council funds a Who Cares? Scotland worker to provide support and advocacy to looked after young people. The worker also supports a young person's forum. This was a one year pilot, when we attended the young people were positive about the role of the group. One of the members linked to the national forum created by the Children's Commissioner.

Community service staff told us that they worked hard to create placements which met the particular needs of the person, for example arranging placements at a weekend for people who were working and taking account of the needs of mothers.

Physical space to create safe interviewing spaces for children in distress or who may have been abused was lacking. Video interviews if needed were undertaken at Baird Street police station in Glasgow which could be an intimidating environment for some children. The practice of holding looked after reviews on school premises may not be in the best interests of helping the child and family to feel empowered to contribute. We attended a child protection review in a very limited space.

Recommendation 6
Social work should create a child-friendly and relaxed setting in a central location which could be used for interviews and reviews.

Multi-disciplinary working

We found a clear commitment to working with other agencies at a strategic level and in some areas at a practice level. The strongest examples at both levels were found in child care and criminal justice. In other areas there were issues to be resolved at team levels e.g. between addiction services and mental health.

Staff who took part in our survey were positive about relationships with other agencies and considered that they worked together well with key agencies. They were particularly positive about working relationships with colleagues in health - 77% thought that relationships were good. Education and housing are not directly comparable because staff from a range of services may have more limited liaison with them, but 57% of staff said they had a good relationship with education (lower end of our results from other inspections) and 62% felt similarly about housing (comparable with other results).

Partners who responded to our survey also emphasised the willingness to co-operate from colleagues in social work. Seventy-five per cent said that social workers work well with partners to provide services.

A key health partner defined the main strengths of social work as follows:

'Partnership working as a whole. Joint problem solving at tactical and operational level, willingness to listen and respond to partner views.'

In our meetings with staff and front-line managers, we found that staff appreciated the benefits of working with health and other partner agencies but had a number of comments about the need for clarity about criteria for accessing health service teams in the community and about roles and responsibilities in the joint teams.

Jointly managed co-located teams for learning disability, addictions and mental health have been created. While staff told us that there were many aspects of being part of a joint team which were good for them and for service users, they also alluded to unresolved governance issues which were limiting the effectiveness and efficiency of the joint teams - issues relating to the single shared assessment, and some mismatch between different disciplines about how they perceived the other's role. Some social work staff thought that health colleagues were able to 'walk away from' assessment or case management tasks that they were then left to do on their own. On fieldwork, health and social work senior managers said there was a need to address some governance issues in the joint teams and a health manager was taking this forward.

At a practice level interagency working with ISMS was effective, all agencies involved confirmed that they had good partnerships which helped the young people to remain in the community and take part in mainstream education. Staff valued both the strategic working which assisted the policy direction to divert young people away from custody or secure accommodation and the day to day working between social work, police, and health and education staff.

Child care, health, education and the voluntary sector worked very well together in pursuing the objectives set out in the children's services plan. There were robust structures and systems to support this spirit of collaboration. Multi-agency training on child protection and parental substance misuse were the strongest examples of bringing disciplines together for training, and there was scope to build on this approach as the seed-bed of effective joint working.

There were good examples of capacity-building from health to home care, from child protection to education, and good foundations for more effective collaboration between social work and housing through the recent development of protocols.

There was evidence in criminal justice services of effective interagency working. Criminal Justice services are part of the Criminal Justice Partnership which covers East and West Dunbartonshire and Argyll and Bute. MAPPA - multi-agency public protection arrangements - were considered by all agencies involved to work well. The High Risk Offender Group met every six weeks and the Chief Social Work Officer chaired all level 3 meetings, which were concerned with those sex offenders considered to pose the highest risk. This, together with regular input from the criminal justice service manager to the social work senior management meetings, kept knowledge and awareness of developments high across services.

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