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CHAPTER 8: Capacity for improvement
We found performance in this area to be good, having important strengths with some areas for improvement.
We have based our evaluation of capacity for improvement on three key factors:
- Improved outcomes for people who use services
- Effective leadership and management
- Quality improvement and performance management
We found positive comments from staff and service users and evidence in case files of good outcomes for people who use services. The statistical evidence was more mixed.
There had been a significant turnaround in the social work division during the 18 months leading up to our inspection. This was well led by the acting director of social work and his senior management team, supported both by the chief executive and cabinet member. There was however still some way to go in achieving their vision for the service.
A new management information system promised comprehensive information on outcomes in the future. In the meantime best use was being made of the existing systems and regular monitoring and reporting arrangements had been put in place.
Improved outcomes for people who use services
Almost all the respondents to our staff survey agreed that the services their team delivered were successful in helping people lead as independent a life as possible. Most service users who responded to our survey also agreed.
When we read a sample of files the key outcomes were positive. In our survey of stakeholders, a number of the respondents thought the social work division delivered a good service and achieved good outcomes for service users and carers. A range of respondents thought that the social work division was well organised to improve these services.
In children and families services, we found improvements since 2007 in measures designed to protect children. We did however raise issues about more cases in our 2008 file reading than in 2007.
Elsewhere we noted decreases in residential school placements and increases in kinship care. More care leavers were in employment, education or training compared to the national average.
We were however concerned to learn about the number of changes of social worker for children in foster care and the relative inexperience of the workers. We were told that not all these children had an allocated social worker and there could be long delays in the planning stages to make permanent arrangements for the children.
In community care, we heard many positive comments about the quality of mental health services in Midlothian from service users. Some hard evidence was beginning to emerge to support these perceptions. Performance on outcomes in relation to other community care services in Midlothian was mixed. Sometime we found little information about outcomes such as services to adults with physical disability and sensory impairment. The figures for outcomes for services to adults with learning disability were below average.
The joint performance information and assessment framework assesses the performance of joint future partnerships. In 2006-07, the overall performance of the Midlothian Council and NHS Lothian partnership was assessed as making 'steady progress'. It concluded however that the balance of care was moving in the wrong direction and needed to be reversed. The evaluation of carer assessments was that the target needed developing and was not appropriately challenging for the size of the area.
Effective leadership and management
Midlothian council had experienced considerable challenges in its social work division since 2006.
The new administration had set out a vision for social work, along with clear values and aims. The Best Value Audit published by Audit Scotland in June 2008 concluded that, whilst the council's political structures provided a sound basis for elected members to scrutinise performance, scrutiny remained ineffective in some cases. Under these arrangements, the cabinet member for social work and health was expected to scrutinise the work of the division. We found the cabinet member responsible for social work services to be enthusiastic and committed to achieving improvements in outcomes for those receiving services. There were however major issues around waiting lists for people with critical and substantial needs.
The chief executive had actively engaged with the social work divisional management team to oversee and scrutinise a programme of improvement measures.
The acting director and his team of senior managers had taken a vigorous 'top down' approach to change. There was evidence that this approach had been effective but we also think that the service would benefit from some consolidation. From a low baseline, the service had moved a considerable distance over an 18 month period. Many improvements had taken place in relation to systems, policies and procedures designed to protect service users and ensure an equity of service delivery. Although there had been a significant turnover of staffing, the workforce was beginning to recognise the benefits of the changes. The acting director and his management team modelled a way of doing business based on trust and respect. Major effort had gone into improving communication with staff. Although this still had some way to go, there was a noticeable difference in visibility of managers from the previous years. There was also evidence of effective leadership in partnership arrangements for services to adults and children.
Quality improvement and performance management
There were examples of planned service reviews such as day services as well as efforts to achieve best value through reviews of supporting people services and externally purchased home care. In the case of the home care review, there had been considerable disruption of service at the point of implementation.
The social work division sat within the council's performance management system. Each division has a performance report. This was used by the division to manage performance and to report performance to the corporate management team, the performance review committee and the cabinet.
Elected members and corporate senior managers we spoke to said that the social work division had made major progress on performance management.
We learned that the council's chief executive got detailed weekly performance reports from the social work division and weekly reports about the level of unallocated work.
The social work division was developing a new performance management framework and piloting a tool to find out what service users thought about services and if the services they got improved their quality of life. Meantime, the range and quality of information available to managers remained patchy.
Overall, the social work division had undertaken a considerable amount of work over the 18 months prior to our inspection. Much had been achieved in terms of strategy, plans, reviews, policies, procedures and some restructuring of service delivery. Further work was needed to ensure that adequate resources were in place to realise the ambitious vision for the future of social work services in Midlothian.
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