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CHAPTER 5: Delivery of key processes

Performance in this area was weak, having important weaknesses.

There was reasonable access to local offices but we thought that more information about services could be made available in a range of formats.

The availability of services caused us major concern and we have made a number of recommendations in this report designed to address this. Eligibility criteria ensured that there were proper priorities but there were still people with critical and substantial need waiting for service. This was over and above the many people waiting who were not in these categories.

Much more work was needed on effective planning for children and reviewing the needs of adults and older people.

We saw evidence of risk assessments and a governance tool was in place for auditing purposes. However, associated guidance for staff, training and evaluation needed to be further strengthened and improved.

The social work division needed to do more to demonstrate a commitment to equality and social inclusion.

We saw evidence of effective multi-disciplinary and partnership working.

Access to services

Comprehensive information

Midlothian had an easy to follow website which contained a significant range of information regarding social work services. However this was not matched by complete information in leaflet form in area offices. At the time of our inspection public information had been reviewed and senior managers told us that information leaflets were to be produced in a range of formats. The council had not made adequate provision for deaf people by way of information or access to text phones.

In relation to adult protection, the council acknowledged the gap and had taken measures to improve the availability of information available. The council had also introduced a number of initiatives to promote public awareness of child protection issues, including posters and leaflet distribution.

Referral and out of hours systems

Both children and families and community care services operated duty systems which dealt with all new referrals and requests for services. In community care there was an access team covering the whole council area, based at the Loanhead social work centre. The team undertook urgent assessments and/or service provision as required and would not usually be involved with an individual client for more than 12 weeks. If input was required beyond that time, the team transferred responsibility for the person to the care management team. A dedicated children and families duty team was in place, supported by a duty rota for joint interviews (drawn from locality based staff specifically trained for this purpose).

For out of hours services, Midlothian was part of the joint emergency social work service provided by City of Edinburgh Council for Edinburgh, East Lothian and Midlothian. Our survey of service users showed that less than half (48%) of those who responded agreed that they got a good response from this service whilst respondents to our carers survey were more negative (22% agreed). These results were comparable with most authorities inspected to date.

A stand-alone Midlothian service was set up in January 2008 for supporting home care out of hours, as the Edinburgh-based service found referral demand was disproportionate and resources were required elsewhere. This was co-ordinated by the Midlothian Council out of hours service (known as Midcon). There were still some problems caused by the change over at the time of the inspection. There was no access by Midcon to the social work information systems. Midcon did not have dedicated staff to deal with home care referrals and home care staff were not on call nor required to go out if contacted by Midcon.

Access to offices and units

The two main fieldwork offices were Dalkeith and Loanhead social work centres, which were centrally located in each town with ready access by public transport. Both offices were accessible for persons with disabilities although the telecommunications were not adapted for use by people with a sensory impairment. The waiting area and other public access areas at the Loanhead centre were particularly well maintained. There were a number of other offices, including the council headquarters, and units visited during the course of our fieldwork and each was found to be accessible and maintained to a reasonable standard.

Day-to-day planning and resource allocation

A number of focus groups for practitioners and for managers in all services stated they had waiting lists for assessments and for a variety of services. When we met with service users and carers, both groups stated that services were difficult to obtain. Team leaders reviewed lists of people waiting for services on a regular basis and submitted weekly reports on unallocated work to senior officers of the council. However, one senior manager stated that the approach to monitoring waiting lists was 'unsophisticated' as it relied on manual counting.

Prioritisation and allocation systems

Both community care and children and families services had eligibility priority allocation systems in place, managed by team leaders and monitored by service/practice team managers.

Team leaders in one focus group stated that, due to the lack of experience and knowledge in their teams, they had to allocate complex cases to inexperienced workers. We also heard about problems transferring work from the access/duty teams to care management and locality teams, including child protection cases. These teams could not always allocate these immediately or as quickly as required by their priority, although both services reviewed the waiting lists weekly. Where necessary, intervention was provided by the access/duty service.

Our analysis of social work case files in 2007 revealed a major challenge in dealing with unallocated work, with considerable scope for improvement in this area. This was still the case when we read files in 2008 though we noted an improvement since 2007. In focus groups with staff at various levels, interviews with senior managers and focus groups with service users and carers, we heard that there were still problems in regard to allocation. This was more due to level and experience of staff than a shortage of staff. We concluded more needed to be done to ensure assessments and cases were allocated within an acceptable timescale and service users and carers received services when they were assessed as needing them.

Figures from the head of service for children and families services in June 2008 stated there were 53 children awaiting allocation for assessment; 13 children were waiting for a service including one who had been waiting more than six months. In addition there were four financially-supported kinship care cases that were unallocated and 18 cases waiting for assessment by the children with disability team. The social work division had recently appointed a half time team leader to manage the staff who worked with children with disabilities, but it was too early to judge how this would impact on service outcomes.

We were assured there were no unallocated child protection or adult protection cases. This included the period from the decision to hold a case conference until the meeting was held.

Figures provided by the social work division for community care services stated that 167 people were awaiting an assessment and 103 were awaiting a care management service in May 2008.

Workload management systems

There was no formal workload management system in place in either service. Team leaders managed workloads during supervision and service/practice managers monitored this activity. Workloads appeared to vary between children and families (which used an indicative benchmark of 12 families as the caseload) and community care, which used the number of individuals worked with - some of whom could be members of the same family. A focus group of children and families team leaders advised that there could be significant variations in caseloads where more than one member of a family was on a statutory order. The average caseload in community care was 20 cases per worker. Senior managers told us they were developing a workload management tool.

Planning and use of resources

In community care, two resource panels, one for care home placements and the other for purchased services in the community, met weekly to balance assessed need against resources available. However, not all resource allocation went to a panel - for example, internal home care service and occupational therapy equipment and adaptations. This gave rise to inconsistencies in allocation of resources. The resource panel also considered large packages - some at the point of transfer from children and families to adult services. We heard from parents of children in transition that, despite early referral to community care services, the resource panel did not make a decision until the last minute thus raising their levels of anxiety and stress. The eligibility criteria did not include indicative timescales for receipt of services following an assessment. We considered this to be a serious omission.

At the time of the inspection the weekly resource panel had not been able to provide a service to 12 people whose assessment indicated that their needs fell within the 'critical' category. We considered this to be an inadequate response to those individuals assessed as requiring an immediate service. We also heard in focus groups and in interview with senior managers in the social work division and its partner agencies that there were a number of inconsistencies in the way the resource panels were operating. This could rise to inequitable levels of service delivery depending on the timing of applications. Some weeks there was little budget available and those with critical needs were refused a service, whereas other weeks there was more budget and people with less complex needs would get a service.

Children and families services were considering the introduction of eligibility criteria similar to that used by community care services for children affected by disability. The service had introduced the use of an indicator of relative need ( IoRN) for this group to assess need and assist the allocation of resources. It also had a weekly screening group which looked at children in need of accommodation. This group promoted the use of community-based or family solutions to problems, adopting a structured approach to the use of family group conferencing in this work. We saw a multi-agency resource group ( MARG) which aimed to reduce the number of children requiring education outwith Midlothian by offering local services through effective partnership working.

Assessment and care management

Assessment of need

Most (89%) case files we read contained an assessment, and the quality of the most recent assessment was judged good, very good or excellent in the majority (65%) of cases. The result was a slight improvement from 2007. Assessments in the community care files we read were generally of a higher standard than those in children and families' files.

Community care services

The social work division had implemented an electronic version of single shared assessment ( SSA), called 'e-assess', in September 2004. This was available to social work, health and housing to record assessments for adult service users and carers.

Team leaders acknowledged there was room for improvement with the quality of assessments and they were encouraging staff to see them as a working tool. There was now a clearer understanding of the expectation to have up to date assessments on file. This was borne out by the results of our file reading.

In terms of its use by partner agencies, we found no evidence that housing and health services were completing SSAs. Problems accessing computers had been resolved but we found there was no culture of NHS staff acting as lead assessors in SSAs. A health professional told us that social workers and nurses were not willing to accept each others' assessments, leading to cases being re-assessed. Our conclusion was that not enough progress was being made. This position was acknowledged by both social work and health managers. The CHP was planning to re-launch the SSA with multi-agency training, following on from a 3-month pilot held during the previous year and was also planning to implement care management as a task to be undertaken by health care staff.

Children and families services

The social work component of the integrated assessment tool and care plan was launched in November 2007. It was introduced for teams across children and families services and it was being used as the report format for children's hearings and child protection case conferences. Front line staff were still becoming familiar with the format. Middle managers were using the case governance process ²² to monitor the quality of reports. They were confident the guidance would improve the quality of assessments, which they acknowledged were at times overly narrative and lacked analysis. This matched our findings during file reading and fieldwork.

Feedback from partners and stakeholders indicated a mixed view, but were generally optimistic. According to a number of partner agencies, assessments were not sufficiently holistic and further improvements were needed in order for the quality to be consistently of a good standard. The children's reporter identified an improvement in quality and focus on outcomes. However, the chair of the children's panel reported that although the new format was an improvement on the previous social background report and was more consistent in the areas of information offered, the quality had deteriorated since January and risked becoming repetitive.

As of December 2007, 45% of reports were submitted within target timescales to the Scottish Children's Reporter Administration, which was higher than the Scottish average of 36%. This represented an increase of 13% from the 2006-07 figure.

Care management and care plans

From the files that we read, most (76%) contained a care plan which had been completed in the last 12 months. In three quarters of case files that contained a care plan, this plan addressed identified needs and risks either mostly or completely. This was consistent with the average from authorities inspected to date. We found significant differences in the standard of care plans, with those in community care files better than those in children and families case files.

Learning disability services

Midlothian had a high rate of adults with a learning disability and services had been designed to take into account the age and needs profile of service users. Nevertheless senior managers in the social work division and health senior managers agreed that there was some way to go with the modernisation plan for learning disability services. Examples of this were:

• Midlothian had a very low number of adults with learning disabilities living independently in their own tenancies (12% compared to the Scotland average of 33%) ²³.
• There were 107 people with learning disabilities living in care homes. This was a much higher level than the average across Scotland ²⁴. This had mainly resulted from an earlier hospital discharge programme, where a disproportionate number of people had been placed in residential services in Midlothian. The social work division was committed to finding appropriate ways to continue to support people who had been resettled in care homes following discharge from hospital, based on their individual needs.
• There was a plan for the redesign of the John Chant Day Centre for people with learning disabilities but progress on putting the plan into effect was slow. Managers had taken steps since 2007 to make progress with the plan.

Midlothian had received funding to set up a person centred planning project for adults with a learning disability. Only 23% of people with learning disability in Midlothian had person centred plans and in 2007 this was well below the national average of 32%. The intention was for all plans, including those for 70 residents in St Joseph's Service, to be completed by the end of 2008. Some social workers told us they thought this was optimistic. At the time of our fieldwork, the project had increased the numbers by 140.

Senior managers told us that the social work division was working hard to improve this service through innovative approaches, for example, in developing local area co-ordination with the Thistle Foundation and in person centred planning.

Children and families services

Care planning and management for children had been significantly affected by staff vacancies, a high number of locum staff and the reorganisation of the practice teams into localities during 2007 and early 2008.

Senior and middle managers within the children and families service acknowledged the need to consolidate improved practice in planning for children. Although a permanence overview meeting meets six-weekly to review progress, we were concerned by the number of examples we found during our file reading and fieldwork where plans had drifted and children were left in short-term care arrangements. We were concerned that the family placement team were not sufficiently involved in the planning process.

Some social workers spoke about their lack of confidence in making a case for permanence and in assessing parenting. We met several families where arrangements for contact had not been well monitored and the emotional impact on the child of parental behaviour had not been dealt with effectively. Family centre staff and social work assistants currently carried out parenting assessments and reported that the involvement of practice team staff in these was variable. We consider the role of the qualified social worker as integral to these assessments. The children and families services should ensure that social workers are sufficiently involved with all assessments of contact and parenting.

Through joint work with Children 1st, the social work division had actively promoted kinship care as an alternative to accommodating children and young people with foster carers. We saw plans to improve the financial support to these families, most of whom were grandparents. However, we found no strategic approach to monitor or support the arrangements in an equitable way. Senior managers told us they had consulted on the recently approved kinship care strategy but carers we spoke to were generally critical about communication. We found evidence of kinship care placements for looked after children awaiting allocation. We considered this to be unacceptable.

Transitions

For those young people involved with the throughcare team, we found evidence that intervention and planning was good and young people were involved in the process.

The transition planning policy for young people with additional support needs set out the process and responsibilities of the children and families and community care services. However, during our fieldwork staff from both services expressed frustration about a lack of intra-agency understanding and supports, which created barriers to effective planning. By contrast, families spoke positively about occupational therapy services responding quickly and effectively to their needs during the process of transition.

Reviews

From our file reading, most of the files with a care plan (78%) contained evidence they were being reviewed at regular intervals. Where there was a record of decision making and review meetings, almost all included a list of actions, with most identifying who had responsibility. Fewer reviews had timescales for actions. These findings were comparable with other councils we have previously inspected.

Community care services

The social work division had a reviewing policy and procedure with templates for a range of services. We observed a review of a residential care home placement that was last reviewed in 2003 and found that the checklist style ensured a wide range of needs were considered. Social workers in the reviewing team said there was no standard format for these plans. Residential staff we met reported good family and service user involvement in the reviewing process.

The adult services reviewing team was created in March 2008 to undertake 500 outstanding care home reviews and about 700 outstanding reviews of home care packages for service users that were not already open to care management. Senior managers told us that outstanding care home reviews (up to the end of 2007) would be completed by the end of July 2008. All learning disability packages of home care were reviewed, as were all hospital discharge cases after a period of 12 weeks. Other care at home packages had been considered as part of the service review of home care and service users had been told by letter of proposed changes to the service. In our view this was not a substitute for a properly conducted annual review of needs and provision, involving the service user. Senior managers told us they were looking at ways of introducing the systematic review of all care at home packages, recognising that this needed to be implemented in a sustainable way.

Care management teams reviewed all adults with a learning disability during 2007. The case governance system was intended to ensure reviews of all allocated cases were conducted within appropriate timescales.

Children and families services

Reviews for children looked after away from home were chaired by a team leader with no line management responsibility for the case, in line with national guidance. Where recommendations for permanency were being considered, we were told that a different chair was appointed to ensure greater independence. We could not see the benefit of this, and did not find any evidence that it gave any greater scrutiny of the plans.

We met a group of young people living in foster care and residential care who said their reviews were held every six months and were clear about the purpose of these. They had the opportunity to complete their own review forms and felt their views were heard. However, we found some evidence of statutory reviews being overdue. We heard mixed views from parents, some were positive about the review process; others spoke of delays and not feeling their views were well represented.

We found evidence that the review process in throughcare and aftercare was functioning well. We met a group of service users who had six-weekly reviews with their worker and a formal review every six months chaired by the team leader. Our findings from file reading supported this good practice.

Carer assessments

From the file reading we found 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. From those carers who responded to our survey, nearly 60% felt the help they got met all or some of their needs. These results were comparable with those found in other authorities.

It was possible to include carer assessments within the SSA but front line staff we spoke to felt that VOCAL provided a more appropriate service. VOCAL were clear they did not do this on behalf of the council but supported carers to complete self assessments which were then passed to the council. Although social work was seen as being committed to involving carers, a lack of resources led to delays in providing supports. We considered there was a need for a protocol between VOCAL and the social work division to clarify the process and responsibilities. Senior managers told us that this work was underway and additional resources had been identified.

Risk management and accountability

Inter-agency safeguarding procedures for individuals

Midlothian used Lothian-wide procedures for the protection of children, produced in 2007, and Lothian and Borders guidance for adults at risk. Local adult protection procedures complemented these and were due for review. These comprehensive procedures were available online as well as in paper form. Most respondents to our staff survey agreed they had clear guidelines to follow when dealing with risk to/from people who use services. Almost all staff agreed their team did everything possible to keep people safe and worked well with other agencies to protect vulnerable children and/or vulnerable adults. This was at the higher end of authorities inspected so far.

The assessment and management of risk did not appear to have been a high priority before external scrutiny was brought to bear. A risk assessment policy and framework was introduced in October 2007 to apply to all social work cases and we found evidence of this in our file reading. Training was provided on the concept of managing risk, but practitioners told us that it did not cover the use of the tool and there was no written guidance available to quantify whether the risk factors identified were significant or not.

At a corporate level, we found a high degree of ownership of risk as evidenced with improvements made to the child protection committee and the well-developed adult protection committee. A critical services oversight group ( CSOG) had been established to improve corporate accountability for public protection and act as accountability for the child protection committee and the adult protection committee. This gave a strong message of inter-agency commitment.

Effective management of risk

In our file reading, we read 58 files where there were issues regarding the protection of the primary service user. We found an up to date risk assessment in 52 of these and of 54 relevant files we found an up to date risk management plan in 44 of these. We returned six cases for further enquiry where risk to the service user had not been dealt with adequately and made a recommendation about this earlier in this chapter.

Child protection

Inter-agency referral discussions ( IRDs) involved team leaders with colleagues in health and police. We found examples of inconsistent thresholds operating at team leader level and cases referred for conference at different stages by different teams; some needing an earlier response. The IRD review group offered a multi-agency management overview of IRD decisions at middle manager level. Whilst this was an effective means of establishing shared thresholds for intervention and improving the quality of information, the social work division should review arrangements for communication of case information between team leaders and IRDs.

The introduction of the independent reviewing officer for child protection had improved consistency and rigour in the management of the case conference process. We heard positive feedback from a range of professionals including front line staff, team leaders, the children's reporter and the police. We attended case conferences, which were chaired in a professional manner, with appropriate scrutiny of social work and partner agency assessments and contributions. Protection plans were improving in quality with a greater focus on risk, although assessments were not sufficiently child focused and the child's views not always represented.

Front line staff and team leaders were clear that core groups were being held regularly and inter-agency working was continuing to improve. The reviewing officer had been given a remit to evaluate and monitor core groups but this work had not yet started.

We noted that the council's chief executive had taken over as chair of the child protection committee. There was stronger representation from NHS Lothian and the CHP. Importantly, there was acknowledgement that there were ongoing concerns about thresholds for intervention. Partners and stakeholders described open communication and good leadership.

Adult protection

We considered the arrangements for adult protection to be well developed in Midlothian with structures and networks in place ahead of legislative requirements, and arrangements for different levels of training were in place.

The social work division and partner agencies had taken a decision to treat all referrals about vulnerable adults as 'adult protection'. Following initial single agency screening the inter-agency referral discussion ( IRD) review group made decisions about further action. This included whether to convene a case conference and the future status of each referral. The IRD review group was formed in October 2007 and was modelled on the child protection system. We observed the meeting, which was focused and well managed. We thought that it would have been useful to have had more social work information available for the meeting.

There was no system for independent chairing of adult protection case conferences, which was done by community care team leaders. The guidelines allowed a decision to convene a professionals meeting (without the service user being present) instead of a case conference. We felt that the social work division should assure itself these meetings meet the needs of the service users. Core groups of key staff were responsible for developing and monitoring the protection plan.

A lead officer for adult protection was appointed in January 2008. Implementation of the Adult Support and Protection Act would be the focus of work in the following year and a business plan had been prepared for the adult protection committee. The post had appropriate strategic links with other agencies across the Lothians.

We attended a meeting of the Adult Protection Committee, chaired by the Acting Director of Social Work, and comment further in Chapter 7.

Partnership with people who use our services and their carers

Involvement of people in developing their care packages

There was evidence from the files we read and from some of the fieldwork that there was a good degree of partnership with service users and carers. The survey information was rather more mixed.

In almost all files social workers had shared key information with the service user. In most cases service users had been invited to meetings to discuss their care and there was evidence their views had been taken into account. The SWIA survey of service users and carers found similar results.

In observed practice and focus groups several service users spoke most positively about their involvement with their social workers in care planning and reviews, even when they disagreed with the outcome. Service users and carers said they had been listened to and encouraged to contribute their views. Children and young people told us they were involved in planning throughcare and aftercare; and people with learning disabilities had contributed, with appropriate support, to 'partnership in practice' plans and other service developments. Foster carers said they had been properly involved in permanency planning although they did not think that their views of the children before and after family contact were taken seriously enough.

Advocacy

The advocacy organisations we met - People First, Who Cares?, VOCAL (Voice of Carers Across Lothian) and CAPS (Consultation and Advocacy Service) - were positive about the support they received from the council. They had the resources to respond quickly to requests for advocacy and almost all said they thought social workers and managers valued advocates, referred people appropriately and took account of the views they represented. We heard that mental health officers worked closely with advocates who regularly represented people who had to appear at mental health tribunals. Advocacy organisations also told us that they would advocate for older people even though they were not funded to do this. They were critical of the lack of advocacy for older people in Midlothian although we were told by the social work division that the council provided funding to EARS (Edinburgh Advocacy Representation Service), an organisation to provide advocacy for older people in Edinburgh and the Lothians, including Midlothian.

Inclusion, equality and fairness in service delivery

Ethos and practice of inclusion

Midlothian's equalities strategy (2005) emphasised its corporate approach to ensuring fairness for its citizens. It brought together policies to promote racial and gender equality and to combat discrimination against people with disabilities. Community planning was intended to ensure inclusion for vulnerable people and minorities and the council expected equality policies to be incorporated in the mainstream delivery of services. Strategy papers about the development of services for people with complex disabilities, for older people and about mental health services all reflected these aspirations.

Comprehensive information

The council stated that clear eligibility criteria for services and the associated decision making by the resources panel ensured a transparent and fair system with equity of access through divisional overview of the allocation of resources. It was not clear, however, how this system took proper account of the particular needs of some minority or vulnerable groups to ensure their social inclusion and compliance with the relevant legislation.

The council's communication strategy, 'loud and clear' , aimed to make services easily accessible to all citizens and to remove or reduce any barriers there may to their participation in service development. All leaflets were available on request in minority languages. One positive example of this communication strategy was the presentation of agenda, background papers and minutes for meetings about learning disability services in formats which were accessible for people with learning disabilities. However, we also heard that deaf people found it very hard to access information out of hours. We heard several negative comments about the council's capacity to communicate with blind or partially sighted people.

Overcoming obstacles and barriers

Despite clear documented policy commitments, we did not find much reference to achieving equality and inclusion as part of the social work agenda and we heard of no recent relevant training.

Our file reading and fieldwork revealed some mixed outcomes for Midlothian's equality agenda. Almost all files recorded service users' ethnic origin and in the very few cases where someone belonged to a minority ethnic group, appropriate steps had been taken to remove any potential barriers arising from language, culture or beliefs. The majority of carers who responded to the SWIA survey also said that social work services understood important matters about racial or cultural background. In almost all of those instances where there might be barriers arising from sensory or physical disability these had been taken into account.

There were less positive findings about the success of social work services in assisting social inclusion. We commented on the views of service users in Chapter 3. Less than half (37%) of carer respondents to our survey thought that social work services had helped the person they cared for feel part of the community. This is comparable with other councils inspected to date.

Multi-disciplinary working

Effective multi-disciplinary working

We found evidence of multi-agency working in most (89%) files we read. The social work division featured in a number of well established multi-agency groups concerned with service delivery. Those we observed were purposeful and effective with good agency representation and an obvious commitment to joint working.

Community care services

There were a variety of joint working arrangements in community care services that appeared to work well and were well regarded by staff from within the social work division and partner agencies. These included the adult community mental health team, the occupational therapy post funded by a local housing provider, the district nurse manager involvement in the rapid response team, the resource panel and the mental health social work post within the council's homeless team. However, we found some barriers to effective joint working. For example, there was no direct referral route from social work to the dementia team other than through the GPs.

We found that staff across the community care services were generally positive about their day to day working relationships with colleagues from other teams. Front line staff and team leaders spoke positively about working relationships with the dementia team, the community learning disability team ( CLDT) and the community mental health team ( CMHT). Team leaders considered these teams had a good sense of the role of social work, although felt this was less apparent with the substance misuse team. Mental health and substance misuse team leaders attended regular meetings of the care management and access teams, which was improving communication.

We observed a multi-disciplinary review of an adult with learning disabilities. It was a good example where workers with distinct roles complemented each other in a complex care plan. We also visited the Orchard centre, a drop in centre for mental health, and found evidence of good multi-disciplinary working within the centre and with referring agencies and teams. We heard many positive comments from a range of staff about the centre during our fieldwork visit.

However, we heard mixed feedback from health staff that indicated improvements were needed. The learning disability co-ordinator felt more progress was needed to improve working between CLDT staff and social work staff, but gave some examples of good joint working with individual service users.

Speech and language therapy staff were impressed with social workers' knowledge of their service.

Children and families services

In children and families services, front line staff we met were also positive about multi-disciplinary working, particularly since the re-organisation into locality based teams. They also reported good joint work with the integration teams. We were told that relationships with community health staff were improving, particularly from the point a multi-agency response had been agreed. Examples of good work were given in relation to child protection core groups but we heard there was still a lack of confidence on occasions about when to refer to social work.

The role of the independent reviewing officer was improving the understanding and contributions of front line staff through the conference process. Health visiting staff were positive about improvements to case conferences and the increased availability of social workers. Social work attended regular nurse meetings. Midwifery staff described good individual practitioners and the benefits of restructuring into localities.

We saw good multi-disciplinary work with substance misuse staff during our observations of practice and the team were clear about their responsibilities to consider children's needs. The CMHT were similarly positive about links with teams who they said were good at giving feedback following referral.

However, we found there were gaps in practice. For example child protection issues that had not been referred to social work by health within an appropriate timeframe. We met a family where workers from different teams had not worked effectively together to consider the needs of the child. Police reported that they did not always receive feedback about all referrals. Mental health service users said they had not experienced a joined up approach when several teams were involved.

The majority (72%) of respondents to our staff survey agreed their team worked well with education services. Children 1st reported that schools were supportive of the family group conference model, attending meetings outwith term time. However, during our fieldwork we found examples where education staff were not represented at reviews or at a hearing. Reports submitted were done individually by agencies.

Front line children and families staff and team leaders felt well supported by the integration teams. A senior education manager said working relationships improved because managers were in the same building.

In terms of the GIRFEC²⁵ agenda, we considered that although the infrastructure and strategic intent were present, more progress could have been made. Agencies other than social work were not yet using the integrated assessment and plan, although guidance was being prepared for integrated chronologies.

In our survey of partners and stakeholders, the majority of respondents agreed there were effective planning structures and processes for social work services that engage all major stakeholders. However, as stated in Chapter 4, we concluded that the social work division had not realised the full potential of working in partnership with voluntary organisations. For children and families services, there were opportunities to improve operational links with organisations such as Women's Aid. Some services were sitting with capacity for additional work. The young carers project told us that workers withdrew from joint work without sufficient negotiation or preparation. In community care services managers of voluntary organisations were concerned that the contribution of volunteers in the care management process was not formally acknowledged despite the value placed on this by service users. Clear lines of communication with all providers needed to be strengthened.

A majority (59%) of those who responded to our staff survey agreed their team worked well with the housing service. Despite this, we were concerned to discover there were no protocols for early referral to prevent evictions, or to meet the needs of care leavers. There was a lack of effective liaison for middle managers and front line staff. We found examples where this had resulted in vulnerable children being disadvantaged. We make a recommendation in Chapter 6.

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