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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

We define impact as the direct experience of people who use or deliver social work services or benefit from these directly.

Impact on adults, carers, children and families who use services

Performance in this area was adequate, with strengths just outweighing weaknesses.

Most service users in Midlothian were positive about the services they received. They thought there was a good range of reliable services and felt that the help they had received had helped them to feel safer and lead a more independent life. Nearly all thought they had been treated with dignity and respect.

Carers were more critical: they found it more difficult than users to get clear information about services; there were complaints about liaison with social work and out of hours services. Less than half of carers who responded to our survey felt valued and supported as carers.

The social work division did not systematically collect the views of users and carers.

Views of people who use services about their experiences

A majority (50%) of service users who responded to the SWIA survey said that it had been easy to get information about services and most (80%) said they got a good response when they were first in touch with social work services. The majority of respondents thought there was a good range of services and most thought these services were of good quality. The majority (73%) that they had been involved in deciding what help or services they should receive. These responses are comparable to most of the authorities inspected so far.

One person in our survey said:

'I have had a lot of help over the years with child care through social services which was a great help due to my mental health problems. I also get help from Aspire²⁰through social services. This has been a fantastic help to me.'

Almost all respondents to our survey felt they had been treated with dignity and respect. Most agreed the services they received made them feel safer and helped them lead a more independent life. The majority of respondents agreed they got a good response from social work services during the day but less than half agreed they got a good response in the evenings or weekends. Again these responses were comparable to those of the other twenty authorities which have been inspected.

SWIA's analysis of case files reflected some of these survey findings. They showed that in most cases there had been a good level of involvement of service users and carers in decision making and planning. Only 16% of carers had had their own needs assessed. However 46% had been offered an assessment compared to an average of 21% from inspections to date. Social work objectives had been achieved in 91% of cases and 66% of individuals' circumstances had improved.

In focus groups and in meetings with individual users and carers we heard a mixture of views about social work services. Some parents who had been involved in child protection processes were very critical of the information and help they had received before 2007. They said that in the past, even when children had been placed on the child protection register, some families had not been allocated a social worker; or they may have had several changes of worker in a short period. By contrast, nearly all of these parents were now much more positive about the help they were receiving. They praised social workers for their reliability and swift response to messages. Nearly all parents also said that their social workers had been open and honest and, even though they might not agree with the intervention planned, they were clear about what this was.

Parents who misused substances told us that they felt well supported by substance misuse services and that there was good liaison between the services.

There were mixed views about community care services. The Orchard Centre attracted many positive comments from service users for its support and activities.

People with learning disabilities and their families had differing views about the Midlothian day centres. Those for whom the centres were a base for a range of outside activities were generally positive. Some who spent a lot of time in the centres said that the routine could be boring and there were too few staff to give individual attention. Work to modernise day services will be informed by the outcomes from person centred plans. We comment further on person centred plans in Chapter 5.

Views of carers about their experiences

Carers who responded to the SWIA survey were more critical than service users. Less than half (42%) had found it easy to get clear information about services although the majority said there was a good response when they were first in contact with services. The majority of respondents agreed they got a good response from social work services during the day but only 22% for whom it was applicable agreed there was a good response at evenings and weekends. The majority of respondents found social work services reliable and of good quality but less than half (40%) thought there was a good range of services which allowed choice and enabled the person they cared for to feel part of the community. While most carers who responded said the person they cared for was treated with respect and dignity, and that services had improved their quality of life and independence, less than a half (48%) felt they themselves were valued and supported as carers. These responses are comparable to those in most of the authorities inspected so far.

We held two focus groups with parents of children with a disability. For the most part they were very dissatisfied with the social work service their family received and a number referred to having 'to fight for' the services they received. These parents complained about a lack of understanding of their children's and their own needs. They complained about inflexible and limited services, especially for respite care.

Parents were particularly critical of the arrangements for transition between children and family to adult services. They said assessments were late or incomplete and they might not know until a few days before children and family services were ending what adult services would be available. Parents and social workers told us that this was in part the consequence of resource panel delays in reaching decisions about new care packages until a few days before these had been planned.

A parent who responded to our survey said:

'When a child reaches 16 the whole system changes. Parents no longer feel valued and are excluded. Having been the prime deliverer of care, they are then sidelined.'

Some carers we met were very critical of telephone contacts with social work offices. They said that initial calls were rarely returned thus requiring several attempts.

From our file reading and fieldwork, we found concerns about liaison between children and families and mental health services. A few parents who had mental health problems, and whose children were being cared for elsewhere, told us that they felt stigmatised and unsupported as parents. They were not properly involved in their children's care plans and they thought there were very poor links between the social workers who helped them with their mental health problems and those who were responsible for their children.

There was however also praise. One parent who responded to our survey said:

' I have nothing but praise for the community mental health social workers who are involved with my daughter ….at all times they have shown respect and understanding both to myself and my daughter and take into consideration my views and concerns as a carer.'

Grandparents Parenting Again (a kinship carers group), other kinship carers and some foster carers reported much less positive experiences. They said that there were serious problems in communicating with children and families workers and failures to pay agreed allowances. They felt they had no collective voice to influence policy and practice. Carers of people receiving community care services also said that they did not think their experience of caring informed policy and practice.

Informing and involving people who use services and their carers

Midlothian Council was clear that the views of service users must inform the development of services. The council had established clear principles for consultation processes and there was a client relations officer to lead on these. There is a programme of user consultation exercises undertaken with different client groups and in relation to specific services. Examples included the strategies for older people and for people with multiple and complex disabilities and the mental health service strategy. A citizen leadership event for service users and family carers was planned for October 2008. There appeared to have been good and inclusive planning for these consultations and the reports were clear and informative. We were told by the client relations officer that consultations had resulted in some changes to proposals. For example, a plan for more psychology services had been replaced by more advocacy services. There had also been changes to a plan for partner income to be taken into account in assessing liability to pay for services.

The council was also informed of service users' views through some of the advocacy services which it supported. Representatives of CAPS (Consultation and Advocacy Promotion Service), People First, Who Cares? and VOCAL (Voice of Carers Across Lothian) told us that they thought proper attention was given to the views they expressed on behalf of service users and that some desired change was achieved.

It was disappointing then to hear strong criticism from some service users, carers and independent service providers about the impact of the recent reorganisation of home care. We heard that too little notice or explanation had been given about the impending changes and that some service users were receiving help from too many different carers and organisations. We consider that the social work division could have done more to make the transition easier for service users.

We did not find much systematic collecting and interpreting of information about service users' experiences. Exceptions included the commissioned survey of older people's views about mental health and well being and the useful internal study of the views and experiences of people using substance misuse services. More studies of this kind would allow the social work division to make proper use of feedback from service users and carers. Further development of UDSET and the 'shaping the future' planning tool will provide such an opportunity. Independent studies of users' experiences of newly established or evolving services would also assist service development provided proper account was taken of research findings.

We comment further on informing people and involving them in assessments and care plans in Chapter 5.

Personalisation of services and direct payments

We commented on personalisation of services and direct payments in Chapter 3.

The council had embarked on a programme of work to enhance self directed support. This will link person centred planning with in control and the shaping the future planning tool. Managers said the pilot would provide another opportunity to ensure people's views shape service planning and performance management.

Impact on staff

We found performance in this area to be good, having important strengths with some areas for improvement.

We found from our survey and fieldwork that most social work staff in Midlothian were motivated and committed in relation to the work they did. Most staff spoke positively of the services they provided, worked in supportive teams and had good relations with immediate line managers. Morale had improved over the last year and opportunities for training and development were available.

Staff generally had a clear sense of what they were striving to achieve in their service areas, but were less clear about the plans for social work services in Midlothian overall. A number of staff were less positive about communication and delegation from senior managers.

Motivation and satisfaction

Staff motivation, commitment and satisfaction

Most respondents (89%) to our staff survey agreed they enjoyed their job. A few (6%) disagreed with this statement. When we met with staff teams during fieldwork, we were impressed by examples of positive culture and strong team working.

The majority of staff (67%) who responded to our survey agreed that their employer offered flexible working practices. Our survey also found that the majority of respondents (63%) agreed that they felt valued by their managers in carrying out their day to day job. This was comparable with other authorities inspected to date. We heard similar views when we met with staff during fieldwork.

As part of our advance reading we read Midlothian council's 'talkback' employee attitude survey which was conducted in 2007 across all services. In this, 60% of staff in the social work division rated morale as low.

The social work division's 2008 EFQM²¹ self assessment of service performance in the social work teams showed some improvement from 2007 to 2008. This included consideration of leadership, people management, policy, strategy, partnership, resources, processes and results. Children and families staff still needed to be convinced that the situation was improving.

The SWIA survey in 2008 found that 44% of respondents agreed that morale had been good in their team for the last six months. This was an improvement from the talkback survey in 2007. However only 36% thought that their working conditions would improve over the following 12 months. These results are comparable with other authorities inspected to date.

In our staff survey, where reasons were given for lower morale, these included change in working practices, the working environment, job insecurity, poor staff retention and staff feeling undervalued. Much of this was confirmed in our fieldwork.

During our fieldwork, we found morale generally high amongst community care staff though less so amongst the day centre staff. Administrative staff that we met during fieldwork were generally positive about working in Midlothian. There was enthusiasm and optimism from some child care staff we met, including positive views about the new locality structure.

Comments in the advance information, the staff survey and from staff we met focused on various aspects of communication. There was good communication between staff and first line managers but more criticism of contact, style and communication from senior managers. During our fieldwork, community care staff were positive about the leadership from all levels of management. Front line child care staff were positive about the action taken to improve policies, procedures and processes. Day care and administrative staff were not necessarily as content. When we met with home care staff most seemed to be in favour of recent changes to service delivery arrangements but had been given little notice.

Trade union staff told us during fieldwork that morale had been low due to heavy workloads and perceptions that the service was poor. The representatives generally welcomed the changes made since 2007.

We held a focus group with foster carers. The foster carers felt supported by their supervising social worker but felt the many changes in social workers for children had been difficult for them and the children.

Most staff (75%) who responded to our survey agreed that their workload was manageable within normal working hours. Some staff (21%) disagreed with this statement. Fieldworkers had higher levels of disagreement. The overall level of agreement was comparable with SWIA inspections to date. Factors cited in our staff survey on how improvements could be made included having adequate numbers of staff to cope with team workload and more flexible working.

Staff perception about career and professional development

Our discussions with staff in our fieldwork revealed positive views regarding opportunities for career and professional development. The staff survey confirmed this, in that most respondents (79%) agreed that they had received adequate training to fulfil the responsibilities of their job.

However less than half (47%) of respondents agreed that the annual appraisal system helped them to do their job. This level of agreement is comparable with that achieved in other SWIA inspections to date. We met with learning and development staff during our fieldwork. We were impressed by their enthusiasm for a learning culture and by their strong team working: producing effective learning and development products, with evidence of good throughput. We noted however that personal development plans amongst social work staff were only 50% complete and not yet developed into an appraisal system.

The staff achievement award scheme is a positive initiative and appreciated by staff who have worked hard to complete qualifications. Forty-three staff were at the 2008 award ceremony held in the local mining museum.

From information provided by the social work division we learned that a total of 43 staff had attended a 2 day seminar on risk assessment training. This was part of a year-long programme of seminars to develop confidence and thinking around risk and care management. We comment further on risk assessment in Chapter 5.

In our staff survey and fieldwork, we received comments that induction of new staff could be better. We comment further on induction in Chapter 6.

Staff perception about working with other agencies

Staff in the social work division held positive perceptions of colleagues working in other agencies. Most staff who responded to our survey said that their teams had good relationships with health and other social work services colleagues. The majority of respondents enjoyed good relationships with education and housing services. The majority agreed there were effective links between the out of hours service.

During our fieldwork we heard accounts of positive working relationships between social work and staff from different agencies. For example, integration managers told us that there had been a huge difference in the relationships with social work team leaders. We noted that this improvement had taken place since the introduction of the new job description of team leader during the previous year.

Staff views on teamwork

Almost all (90%) of 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. Similarly:

• most (76%) reported success in helping people develop their skills and abilities to the full;
• most (85%) agreed their team was successful in helping people lead less isolated lives;
• almost all (92%) agreed that their team was successful in helping people live in the community; and
• almost all (96%) agreed that their team did everything possible to keep people safe.

The overall perception of team effectiveness was reflected in positive views about the way in which most of the teams were managed. From the staff survey, most (78%) agreed that their team had a plan that provided them with a clear direction for carrying out their day to day jobs. We saw evidence of a wide range of EFQM reviews of team working. 'How Good is our Service Team?', an additional tool for assessing effectiveness, had also been deployed but this had yet to be developed into team plans. There were business plans for the social work division as a whole and for the community care, children and families and criminal justice services.

Most staff (84%) who responded to our survey agreed that they had regular team meetings with 65% saying that these meetings were purposeful and effective.

During fieldwork staff gave positive responses regarding support from their immediate managers. We noted from the advance information that some staff had felt in the past that this did not extend to more senior managers. The division's 2008 EFQM survey showed a shift in this area with people feeling that there was more direct contact with senior managers.

Staff ownership of vision, policy and strategy

Staff understanding of the council's vision for social work services

The majority (54%) of the staff who responded to our 2008 survey agreed there was a clear vision for social work in the council. This contrasted with the results from the division's own survey results in 2007 when most staff had difficulty identifying a strategy. We met with staff from a range of services who reported a clearer sense of direction and priorities.

Some (32%) respondents to our staff survey agreed that social work was highly valued by elected members and a few (13%) disagreed with this statement.

The social work division's EFQM survey (2008) and recommendations highlighted that staff were concerned with issues relating to workloads, staff appraisal, communication, staff induction, management of change and staff supervision.

In our staff survey less than half (44%) of those who responded agreed that senior managers communicated well with staff (17% disagreed). Less than half (48%) agreed that there was an effective leadership of change in social work services.

These results from the staff survey were comparable with those from other authorities inspected to date.

Staff we met during fieldwork were generally positive. When we met with front line child care and home care staff they supported management action to improve policies, procedures and processes. They said that senior managers were now visible. Other staff were more critical of the senior management style. At the same time, we expected to find evidence of main grade staff accepting responsibility for some of the difficulties that the authority had experienced in relation to child protection in 2006-07. This did not prove to be the case.

Nevertheless senior managers required to do more work to improve communication and consultation with staff. Managers should consider whether there is now scope to delegate more authority to front line practitioners and supervisors.

Staff awareness of local and national standards and frameworks

From our staff survey, almost all (95%) respondents agreed that they were aware of the standards that their team was expected to follow. A few (3%) disagreed. The majority of staff (57%) who responded to our survey agreed that their team performed well against local service targets. A few (6%) disagreed.

Impact on the Community

We considered performance in this area to be adequate, with strengths just outweighing weaknesses.

We found commitment to policy making and consultation. This had still to produce tangible evidence of public understanding and involvement. Stakeholders were more positive while elected members had still to give a clear lead in promoting social work services. There was an active voluntary sector but the relationship with the statutory agencies needed to be more clearly defined. The recent development of locality working by children and families services is a step forward.

Community perception, understanding and involvement

Recognition of the needs of different communities

The council had some good policy papers in which it set out its aspirations for including the community in service planning. These papers recognised the place of minorities within Midlothian but there was less recognition of the challenges of including other groups in community planning such as the older, long term residents and the more recently settled families who commute in and out of the area. Community planning was intended to ensure inclusion for vulnerable people and minorities and the council expected policies to promote equality of opportunity and to combat discrimination to be incorporated in the mainstream delivery of services.

There was a strong commitment in the council to consultation and much time devoted to this. The consultation papers on the development of service strategies were clear and well written and produced in various formats.

Public understanding of the range of social work services available

Despite Midlothian's efforts to consult and include the public, we did not gain a strong impression of community involvement. There were some voluntary organisation newsletters which usefully described service availability, developments and challenges although they had a relatively specialist readership. The social work division had begun to revise its information leaflets to improve their public accessibility.

Public recognition of the value of social work services

We were told by elected members, managers and representatives of voluntary organisations that they thought more could be done to widen the public's understanding of and interest in social work. We heard that social work intervention can be seen as stigmatising. Several people suggested that some public events advertising Midlothian services and plans, and focussed on particular localities, would be helpful. They thought such events, led by elected members, should include meetings with social workers and managers and should give clear descriptions of the scope and limitations of social work services. Elected members' role in promoting social work services

The council reviewed its engagement strategy in 2006 and proposed then to establish more community interest panels and to communicate in different ways with the public about the council's purposes. We did not hear much about this community engagement during fieldwork. Elected members we met had a clear understanding of social work services and how the social work division was developing. Some said they tried to communicate this to their constituents.

Impact on other stakeholders

Stakeholders awareness of the range of social work services available

Health authorities and other council divisions showed a good understanding of the responsibilities and developing policy and practice of the social work division. The cabinet arrangement contributes to this and we detected a joint commitment to make Midlothian a good place for its citizens and an understanding of the contribution of social work to this. Several organisations told us that the council's extensive and well organised publicity and training about the protection of vulnerable adults had been very helpful. The alliance of health, social work and voluntary organisations and service users in promoting the understanding of good mental health and the support of people with mental health problems was also particularly impressive.

We heard as well that meetings between children's panel members and children and families managers had been helpful in increasing understanding of the developments and confidence in the contribution of these services.

Respondents to the SWIA survey were critical of the information about social work services. Of the 19 responses received less than half thought this was available and only just over a quarter thought it was in the right places.

Stakeholders' recognition of the value of social work services

In the SWIA survey of stakeholders, a number of the 19 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.

Community Capacity

Involvement of the community in social work activities

The council funded a range of volunteer groups, some of which actively recruited and supported volunteers to carry out a range of activities. The organisations that we met told us that social workers made many referrals for volunteer help with younger families, older people and people with mental health problems. We heard about examples of invaluable long term support and shorter term interventions by volunteers. The Volunteer Centre's annual review stated that in 2006-07 over 116 people were recruited as volunteers and that volunteer activities increased by 9% compared to the previous year. However, managers and social workers were non-committal about the contribution of volunteers. We also noted that several day centres for older people which make extensive use of volunteer help were not mentioned in the background material sent to us.

We heard from some managers of voluntary groups that service level agreements were not always in place, that grants were often not renewed until well after their expiry deadline and that ' the council do not know what they are paying for'. These managers said it was fortunate for the council that their organisations did much more than had been originally agreed. They felt undervalued and insufficiently involved in the planning and development of the welfare of the people of Midlothian. They thought the potential of volunteer contribution had not been fully realised. This is not what was envisaged in Midlothian's good 'compact' (agreement) between the council and voluntary bodies. The results from our survey of partners and stakeholders were more positive about the reviewing of service level agreements.

Strategies for promoting or expanding community involvement

The social work division recognised the further work that needed to be done to enhance the community's contribution to the support of children and families. The reorganisation into five localities and the development of the children's strategic groups were steps in the right direction but social workers and managers told us that so far resources had not yet allowed time for engagement with local communities.

We thought more work could be done to recruit foster carers. Family group conferencing, which had been well used in Midlothian, offers a further opportunity to expand community involvement. We comment on kinship care in Chapter 5.

Midlothian had an expanding adult carer scheme which provided day care and activities, mostly for people with a learning disability, based in the carers' homes. We thought that this scheme had further potential.

There were a range of local advocacy services in Midlothian, including advocacy for people with mental health problems, people with a learning disability, older people and carers.

We read about a productive income maximisation initiative which the council ran between December 2005 and June 2007. This focused on isolated and vulnerable people. It dealt with an average of 30 older people a month and generated £200k in additional income for older people. A follow up survey was done with the older people concerned. Two thirds said the additional income had helped them to live more independently.

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