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CHAPTER 6: Management

This chapter looks at three areas for evaluation:

• Policy and service development, planning and performance management
• Management and support of staff
• Resources and capacity building.

Policy and service development, planning and performance management

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

The social work division had worked hard and in short timescales to put new strategies, policies and procedures in place. The strategies were generally clear and well written. We found sound arrangements for the review of policies and procedures.

The social work division worked well in partnership with other agencies and particularly with the NHS on the planning and delivery of mental health services.

We found good examples of service user and carer involvement in the planning of services.

We considered that progress on developing shared services was adequate.

The range and quality of services was variable.

On the whole systems for performance management and quality assurance were effective.

Policy review and development

Comprehensive policy frameworks for all services

Midlothian Council's planning and performance management framework linked strategic and operational planning and made sure that performance information was used to drive improvement. The corporate strategy and divisional plans were monitored by the corporate management team, performance review committee and the cabinet. The council also had a code of corporate governance.

The Best Value Audit ²⁶ undertaken by Audit Scotland concluded that the council needed to take a more strategic approach to community planning. Whilst the council's political structures provided a sound basis for elected members to scrutinise performance, scrutiny arrangements needed to improve. Elected members and senior officers needed to focus more on continuous improvement and implement plans to improve key services, including child protection.

We considered that strategies in the social work division were well written including the joint mental health strategy, the partnership in practice agreement, the Midlothian strategy for older people and the Lothian joint physical and complex disability strategy.

The policies and procedures of other councils' social work services were researched in 2007 to discover whether there were any gaps in the policies and procedures in Midlothian's community care and children and families services.

We found that there was a good range of documented policies in Midlothian's social work division. The risk assessment policy was a clear and well written example. The social work division tracked progress with the writing of strategies, policies and procedures using the 'Prince2' project management system ²⁷. The policy and procedures group said this system ensured that strategies, policies and procedures were written on time. The social work division had made great efforts to put a range of policies and procedures in place and had also done work with its partners to write strategies. All of this had to be done quickly to deal with deficits in this area.

We read the social work divisional plans for 2007-08 and 2008-11. We found the objectives in the plans were reasonably SMART²⁸ though, like other councils we have inspected, they made little reference to outcomes for service users. Priorities were not always linked to financial information and the extra staff needed.

Staff in the social work division were required to confirm in their staff supervision sessions that they had read relevant policies and procedures. Some front line staff and team leaders we met said this system did not always work in practice. We considered that the use of the supervision system to do the checking that staff had read policies and procedures was a positive development although some more work was needed to ensure the system operated effectively. For example, staff should be given enough time to read new documents.

We found children and families services had a comprehensive range of strategies, policies and procedures. The social work division provided us with a GIRFEC integrated assessment and planning framework. Local structures had been developed to support GIRFEC including:

• Forums for children under 12 and over 12. These forums decided which children required multi agency planning and could also resolve disputes.
• Multi agency resource panels. These panels made decisions about the allocation of resources.

There was also a good range of community care strategies including:

• Midlothian strategy for older people 2007-10
• Midlothian joint health improvement plan
• Midlothian partnership in practice agreement (learning disability services) 2007-10
• Lothian joint mental health strategy 2005-10

A key element of the Lothian joint mental health strategy was the move from in-patient provision to community based provision. Social work and NHS community teams were set up, based in the same building.

In services for people with learning disabilities, we found that there were key strategic documents available including:

• The partnership in practice ( PIP) agreement 2007-10
• The Lothian learning disability strategy 2008
• The Lothian joint physical and complex disability strategy 2007

Scottish Government policy is however that each council should have one strategy for services for people with learning disabilities, which should be written by the council, the NHS and other partners.

There were a number of multi-agency groups which had oversight of action to implement the strategic aims of services including the work of the social work division. These groups included the Midlothian adult protection committee; the joint mental health planning group; Edinburgh, Lothian and Borders Executive Group ( ELBEG); the critical services oversight group; the children's services executive group; and Midlothian community care partnership. We did not see much evidence of how these groups were managing their strategic intentions in terms of progress, evaluation and resources. We comment further on partnership arrangements later in this chapter.

Regular review and updating of policies

There were good mechanisms in place to review and update the policies. This was a feature that we have not seen on inspections of other councils. We attended the policy and procedures group which had the function of reviewing and updating the social work division's policies and procedures. Each policy and procedure had a review date and a named officer responsible for doing the review.

The council and its NHS partners did not have an up to date community care plan. Senior managers said that the council had strategies for community care client groups rather than an overall plan.

The adult protection procedure was due for review. The procedure needed to be updated to incorporate the provisions of the Adult Support and Protection (Scotland) Act 2007. Scottish Government guidance was awaited.

Operational and partnership planning

The council's planning and performance management framework linked strategic planning to operational planning. The council used this system, along with the public performance reporting framework, to inform stakeholders about performance. Staff across the organisation received regular performance bulletins.

The social work division used the EFQM model in its review of service performance and its forward planning. There were business plans and action plans 2007-08 for children and families, community care and business services.

Our survey of social work division staff showed:

• 69% of respondents agreed that Midlothian had a clear set of local social work priorities, while 4% disagreed
• 57% of respondents agreed that their team performs well against local service targets, while 6% disagreed.

These results are comparable with the other councils inspected to date.

The stakeholder survey was sent to all key partners and stakeholders, including the independent sector. Our survey showed:

• 65% of those who responded agreed there are effective planning structures and processes for social work services that engage all major stakeholders.
• 71% of those who responded agreed there are clear plans and strategies in place for social work services.

Operational plans for every team and unit

At the time of our inspection, operational teams were in the process of writing their plans. The self evaluation questionnaire stated that team plans will link to the plans for the business units and in turn to the strategic plans. There was a supervision policy for social work division staff. Where staff had personal development plans ( PDPs) the intention was to link individual staff objectives to the business and unit plans.

Commitment to joint planning

There were positive developments in relation to joint planning, both around work with children and with adults.

Children and families services had an action plan for improvement. Joint planning mechanisms had been revised. The council and its partners had set up a children's services executive group and a children services forum to lead strategy and implementation.

There was good representation on the GIRFEC steering group from other stakeholders such as NHS Lothian. Social work and education jointly chaired the GIRFEC group. This group was a sub group of the children's services planning group.

We met the authority reporter to the children's panel who was involved in joint planning for children's services and was a member of various planning groups. She met regularly with the social work division's head of children and families services. There were quarterly meetings between the reporters and the team leaders in children and families services.

The elected member, with the brief for social work and health, chaired an overarching executive group. This co-ordinated the work of local planning groups as well as other joint forums such as the joint community care management group. Other community care planning groups included the learning disability joint planning group.

There were Lothian-wide joint planning systems for a range of services.

Involvement of stakeholders in planning and service development

Involvement of people who use services in planning and developing services

We met an enthusiastic group of young people who had been involved in the planning of throughcare services. The young people had made a DVD and thought their views had made a difference to the quality of throughcare services.

Senior managers told us that the acting director of the social work division had given a clear instruction that there should be a service user representative on all the community care planning groups. We were encouraged to learn that this instruction extended to the adult protection committee. We heard there were some reservations from staff about people with learning disabilities attending the adult protection group.

When we met with the learning disability joint planning group, we found this was a good example of well thought out service user involvement. The service user representative on the group was well supported to participate in meetings.

In mental health services, progress of the 'choose life' and respite programmes was reported to the responsible joint planning group. Each of the joint groups had representation from a range of stakeholders. Service users and carers got good support to be involved in these groups. Overall, we found that people with mental health problems were involved in the planning, delivery and evaluation of their services.

Representatives of VOCAL²⁹ told us that there were good arrangements for consultation with carers and for involving carers in the planning delivery and evaluation of services.

The planning group for older people was working well and had a number of carers as members.

We met with representatives from the independent sector. They had mixed views about the relationship with Midlothian Council. They said there were some good examples of joint planning such as the independent sector's involvement in the Lothian strategy for people with physical and complex disabilities.

Advocacy agencies worked with the social work division on the planning of services. These included People First Scotland, the Consultation & Advocacy Promotion Service ( CAPS), Voice of Carers Across Lothian ( VOCAL) and Who Cares? Scotland.

Developing integrated services

Shared planning of joint or integrated services

As part of their strategy of community based provision, social work and NHS community teams for mental health were set up and based in the same building.

The social work and NHS substance misuse staff were also co-located. Senior managers told us that they had planned to have an integrated substance misuse team but this had not yet been achieved.

Senior managers from the NHS and the social work division agreed that joint working between the social work and NHS learning disability teams was not so well developed.

Overall, we found that integrated services for older people were not well advanced. The community care service and its NHS partners were however in process of establishing an integrated rapid response team. This social work and NHS team will support older people who are discharged from hospital and stop older people going into hospital, by supporting them at home.

We were concerned about aspects of the partnership between social work and housing. We commented on the work with vulnerable families in Chapter 5. Despite some good liaison at senior manager level, we found housing and social work services were not always working together effectively on the accommodation needs of care leavers. Housing staff told us that young people leaving care usually ended up in bed and breakfast accommodation in Edinburgh. They said there was little chance of young care leavers being offered accommodation in Midlothian. We consider that the outcome for young care leavers should be suitable good quality local accommodation and not bed and breakfast.

Sound governance arrangements

The extended local partnership agreement set out the arrangements for the oversight of the community health partnership ( CHP). NHS Lothian had taken significant steps towards creating a single management system for both the Midlothian CHP and the East Lothian CHP. There was one general manager for both CHPs and a number of other managers who had responsibility for staff and services in both CHPs.

The council's cabinet member with responsibility for health and social work told us he supported the single management arrangements as they could promote the sharing of services between Midlothian and East Lothian councils. Senior social work managers were however concerned about less capacity for the planning and managing of joint services.

Where social work and NHS teams were based together, the professional support arrangements remained with the employing agency.

Range and quality of services

Overall, service users in Midlothian were positive about the social work services they received, particularly with the quality and reliability of services. Carers were mostly positive as well. However, service users and carers were less positive about the responsiveness of services in the evenings and weekends.

Of social work staff who responded to our survey, 62% felt the quality of social work offered by their team had improved over the last year. Most felt that there was a fair geographic coverage of services.

Services for children and families

We found that there were some good services for children and families in Midlothian. However, there were also gaps, including provision of local foster carers and permanent carers, as well as services for children with disabilities and their families. There were shortfalls in accommodation for care leavers which needed to be addressed corporately by the council.

Assessment and care planning services were delivered through five locality teams. From 2007, these were aligned with health and education boundaries and the three agencies came together in local forums for the under and over 12s. The social work division also had a specialist youth justice team and had very recently established a specialist team for children with disabilities.

Looked after and accommodated children

A joint service had been developed with education to enable young people in difficulty to remain in mainstream education services, thus preventing them becoming accommodated. There had been a significant increase in the numbers of children and young people cared for by kinship carers. Less positively, we heard more investment was needed in kinship care so that more vulnerable children and young people could benefit from this option. Regular information concerning need and budget position was provided to the corporate management team and council.

There were not enough local foster carers in Midlothian, resulting in children and young people being placed with carers outside the area. Senior managers told us that 53 out of 73 children were with Midlothian foster carers. There needed to be better recruitment of permanent carers, and earlier and sustained planning.

An advocacy service for looked after an accommodated children and young people was funded by the council and provided by a worker from Who Cares? Midlothian Debate, a group of young people supported by the throughcare and aftercare team, had developed an advocacy role through campaigning on issues affecting looked after and accommodated young people.

Children in need

There was one day service centre for pre-school children, run by the social work division. This provided a service for vulnerable children, including some in need of protection, and children with disabilities. The service was highly valued by parents and was well regarded by child care professionals in other agencies. However, the service did not have the capacity to meet demand and it was not easily accessible for parents living in some parts of Midlothian. Surestart provision was available across Midlothian. There was a waiting list for places in the day centre, including some children subject to child protection arrangements. These children were prioritised for placement and were receiving outreach support from centre staff.

We heard that the division had a small scheme to recruit registered childminders to provide day care for vulnerable children which could usefully be expanded.

A befriending project was funded by the council to provide support to children and young people who were looked after or at risk of offending. There was a big demand for this service, and at the time of the inspection it had a long waiting list of 33 children and young people.

Children with disabilities

We met with several focus groups of parents of children and young people. Parents were almost all very negative about the range and quality of services they received. This was the case even when families were receiving very high amounts of respite. The major gap they identified was a shortage of local residential respite. Some parents had experience of family based respite but this was not well developed. The service had only six day carers for children with disabilities and these were all long established carers. No new carers had been recruited. We commented on waiting times in Chapter 3.

The numbers of families of children and young people with disabilities who required support exceeded the capacity of the newly formed children with disabilities team. We refer elsewhere to the introduction of eligibility criteria to bring about greater fairness in access to respite.

Young carers

Midlothian had a young carers support project delivered by Children 1st and funded by the council. This was a good project which supported around 74 young carers. It placed an emphasis on therapy and group support rather than simply social activities. We met young carers who were very positive about the benefits of this service.

Care leavers

We received positive comments from a parent during an observed practice visit about the quality of the service provided by the throughcare and aftercare team and refer earlier in the report to good outcomes in terms of numbers with pathways plans and numbers supported in employment and training. We observed staff and first line managers taking a person centred approach and an imaginative approach to supporting young care leavers.

The social work division should continue its efforts to improve services for children and families. We have made recommendations elsewhere in this report in relation to permanency planning and housing need as well as wider improvements to services for looked after and accommodated children.

Community Care

Overall, we found community care services in Midlothian to be less good than children and families services. However, mental health services was a notable exception. We have made recommendations elsewhere in this report in relation to older people, people with dementia and those with learning disabilities.

Older people

We have already referred to the balance of care information from sources including national statistics and the JPIAF. Although the most recent JPIAF showed that the balance of care was moving in the wrong direction, the social work division was making efforts to improve this. Evening and weekend home care was relatively low but increasing. We comment elsewhere on waiting lists of older people in critical and substantial need for services. Repeat emergency hospital admissions of older people in Midlothian were rising, and the range of joint services to prevent this was not in place. There was not yet a clear focus on rehabilitation across care settings. Social work and health had agreed to put in place a rapid response service and this was at a relatively early stage of development.

The council had redesigned its home care service from April 2008. The intention was to make home care more flexible by shifting from practical tasks to personal care, and extending out of hours cover. One result of the review was a decrease of in-house home care capacity because home care hours were reduced in order to fund the review within existing resources. This reduction meant that, in the short term, there was disruption of service delivery and continuing waiting lists for service. Senior managers told us that in the period following the inspection fieldwork, steps were taken to increase the capacity to deliver personal care at home, funded through a combination of resource transfer from the NHS and a supplementary budgetary allocation by the Council to enable the social work division to meet critical and substantial needs.

We visited the council's new care home in Gorebridge. The Stirling Dementia Services Development Centre had been involved in the design of the building, which had many features to accommodate the needs of people with dementia.

We were told by community care managers that there was a good range of sheltered and special needs housing for older people in Midlothian, and as part of the council's older people's strategy, more specialist housing provision was being built. The council had also embarked on a programme to invest in telecare and smart houses. This initiative was viewed by staff and many local organisations as a very positive development.

The council had only one registered day care resource for older people, attached to one of its care homes. It provided 10 day care places offering service to 43 people. However as detailed in Chapter 5 there was a range of additional places provided in partnership with the independent and voluntary sector.

There were separate structures for social work and NHS services for people with dementia and staff told us that multi-disciplinary working was good. However, we did not consider that dementia services were well developed and we considered that this group should be a much greater priority for the social work division and its partners.

There was no joint strategy in place for end of life care, and the social work division needed to work with its NHS partners to put in place suitable joint services.

Other community care groups

There were very good services for people with mental health problems, which had been jointly developed as part of a hospital redesign programme. There were joint mental health teams providing intensive home support at times of acute illness and recovery, and a continuing service for those with severe and enduring mental illness. The range of community supports included supported housing delivered by the voluntary sector, and the Orchard Day Centre, which had transferred from council to voluntary management four years previously. We considered that the physical quality of the centre was poor and needed attention, although a good range of services was delivered from it. These included an early intervention support service, as well as a range of advice, therapy and practical supports.

Examples of other high quality services for people with mental health problems were advocacy services and psychological therapies. The Scottish Association for Mental Health ( SAMH) supported people with mental health problems to help them to get jobs.

We met people who had physical disabilities who were satisfied with the range of supports they received. They were very positive about home care services, including service users who had complex disabilities and large packages of support. They felt that services helped them to be as independent as possible. Staff told us that the joint equipment store worked well and waiting lists and times were reducing. We have already mentioned that Midlothian had a local area co-ordinator working specifically with people with physical disabilities. There were no day services for people with physical disabilities in Midlothian although the Council purchased some day services in Edinburgh.

The council commissioned services for people with sensory impairment from the Royal National Institute for the Blind ( RNIB) and Deaf Action.

Addiction services in Midlothian were managed separately by the NHS and the social work division, although the teams were co-located in 2007.

Advocacy services were in the main reasonably resourced and accessible, although there were some people with a learning disability waiting for advocacy.

Quality assurance and continuous improvement

Performance monitoring framework

The council had a performance management system ('covalent' ³⁰) and each division prepared a regular performance report.

Elected members and corporate senior managers we spoke to said that the social work division had made major progress on performance management. At the time of our inspection around half the staff in the social work division had personal development plans, making it the best division for this internal performance indicator. The council's corporate head of performance management told us that in the last reporting period the social work division had achieved 80% of its essential performance targets.

We learned that the council's chief executive got detailed weekly performance reports from the social work division, including the level of unallocated work. He looked for trends which formed the basis for discussion during regular meetings with the acting director. Senior managers gave us two examples of resources resulting from the chief executive's scrutiny.

The social work division was developing a new management information system called 'framework i'. The social work division used UDSET to find out what service users thought about services and if the services they got improved their quality of life. This work was at an early stage. Framework i and UDSET were promising developments. These tools needed to deliver good quality meaningful, usable data within a reasonable timescale. Senior managers were working to improve performance reporting across the division and had put practice governance measures in place. This involved managers at different levels inspecting files on a regular basis.

Quality assurance and standard setting

We found a strong commitment within the social work division to the EFQM framework which was used for assessing the quality of service delivery. It enabled teams to judge how well they were performing on a self evaluated basis.

In 2007, Midlothian Council and NHS Lothian carried out a satisfaction survey with a small sample of people who used substance misuse services. For drug services the majority of service users either were very satisfied 37 (49%) or quite satisfied 11 (30%). Eight (22%) said that they were not very or not satisfied although their needs related primarily to substitute prescribing rather than social care services. For alcohol services, 100% of the alcohol service users were very satisfied with the help they got.

We described earlier in this chapter the evidence of service user involvement in the planning of services which we thought showed a positive commitment to quality assurance. Complaints are a further source of information about service quality. Midlothian Council had placed emphasis on trying to resolve complaints informally with the service provider or manager. In 2006-07 there were 30 formal complaints, two of which went to the council's Review Committee. Twenty-three service users had their complaint resolved satisfactorily. There was no available data about how many complaints were resolved informally. We heard that there were at present insufficient resources devoted to complaints to allow time to be given to promoting the lessons which can be learnt from them.

Management and Support of staff

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

There were workforce strategies for both the council and the social work division which were being implemented.

The social work division had put in place enhanced conditions of service for social workers and occupational therapists and at the time of the inspection were able to recruit to fill vacancies in these key posts. However, there had been significant turnover in the past two years and many posts had been filled with inexperienced temporary staff. Staff absence levels were a cause for concern.

The social work division used the corporate recruitment procedure to ensure that all staff recruited to work with vulnerable service users were appropriately screened before commencing employment.

There was a range of corporate HR policies to support staff and ensure their health and well being at work.

There were appropriate job descriptions for all staff and these were being revised to comply with the implementation of single status job evaluation.

Staff deployment and teamwork were found to be less well managed.

Staff development was in evidence but there was still work to do.

Recruitment and retention

Workforce plan or strategy

In 2006, Midlothian developed and agreed a corporate workforce strategy which recognised the need to address skill shortages in social work. In 2007, the social work division jointly commissioned with two neighbouring authorities, East Lothian and Scottish Borders, a review of workforce strategy by consultants. The consultants identified that the lack of complementary overarching strategies for recruitment and retention and workforce development applied particularly to Midlothian.

This did not apply to recruitment and retention of professionally qualified social workers and occupational therapists where an incentive package had been in place for three years. This was comparable with most local authorities but not as generous as some. The council did not believe this had affected their ability to recruit adequate numbers of staff. An advertisement in 2008 for nine social workers for children and families had achieved eight appointments, for example.

Less than half (45%) of the staff in our staff survey agreed that Midlothian was able to recruit sufficient staff. This is comparable to results in other authorities inspected to date.

Sound recruitment practices

Recruitment practices were subject to the corporate policy and procedures for all council services and although they did not include a reference to 'Safer recruitment through better recruitment', they did include appropriate checks before appointment for staff likely to have contact with vulnerable groups. Social work services stated that their interview processes complied with the safer recruitment guidelines and the corporate human resources manager and managers in focus groups involved in interviewing staff confirmed this.

We found an inconsistent approach to induction training with a corporate programme only and a variety of locally based induction programmes for the social work division. The consultant's report referred to above also commented adversely on the separate induction programmes which it concluded was inefficient and gave a very poor impression to new staff. The council expectation was that all new staff should attend the corporate induction training and each division would supplement this with its own programme. The training and development section stated that an induction programme for the division was one of their planned priorities. We saw a good example in one fieldwork office of a local induction programme provided to all new staff which was appropriate and tailored for that work base.

Supporting and retaining staff

The total number of whole time equivalent social work staff in Midlothian decreased from 572 in 2006 to 535 in 2007 ³¹. The vacancy rate had decreased from 8.6% in 2006 to 2.8% in 2007. This compares favourably with the national figures of 8.6% and 8.5% respectively and shows efficiency in the use of available resources. We also noted however that social work staffing decreased from 7.2 per 1,000 population in 2006 to 6.7 in 2007 compared to the increasing Scotland figures of 8.1 and 8.6 respectively. Both Midlothian's figures were below the Scotland averages. We had concerns that these comparatively low levels of staffing would impact adversely on the delivery of social work services.

The total number of social workers in Midlothian increased from 70 in 2006 to 72 in 2007 while the vacancy level for social workers had decreased from 13.2% in 2006 to 5.3% in 2007 which was below the Scottish averages of 7.5% and 7.4% respectively.

There had been significant turnover in children and families staff since 2007. Figures provided by the social work division showed that nine children and families social workers left during 2007-08 out of a maximum of 24 in post in any given quarter. The council decided to increase the staffing establishment in children and families by 25% as well as filling the subsequent vacancies.

The division engaged a specialist agency to assist with recruitment of social workers from overseas. Staff with varying levels of experience were recruited. There remained a significant number of temporary staff. This gave rise to additional pressures for operational managers and other problems for agencies, services users and carers.

Team leaders had to provide additional support and induction to these staff unfamiliar with policy and procedures. Other agencies reported that it made joint working more difficult. Service users and carers found language, lack of local knowledge and cultural differences a barrier to communication.

Midlothian Council had flexible and family-friendly working arrangements. The majority of staff (67%) who responded to our survey agreed that these were in place. Most staff (97%) who responded to our survey stated that they were aware of their responsibilities set out in the code of practice for social service workers. Similarly, most staff (84%) who responded agreed that their employer was fulfilling its responsibilities under the code of practice for social service employers. This level of agreement of these latter two issues was among the highest of any of our inspections to date.

The council had a range of corporate policies and procedures to support staff and ensure their health and wellbeing. These included prevention of work related stress; prevention of harassment at work; prevention of violence at work; lone worker policy; family friendly policy and work/life balance initiatives. Staff in focus groups confirmed that they were aware of these policies and that they were applied appropriately.

Staff absence levels were an area of concern for the council and the social work division was among the poorest performers in the council. Overall, social work had an average level of absence at the end of the last financial year of 7.74% compared to the council average of 5.6%. Although this was a reduction from the previous year of 0.25%, the social work division needed to do more. During our fieldwork we were told by corporate human resources that the division had issued staff newsletters and arranged briefing sessions for managers on their responsibilities under the policy. Senior managers told us that the divisional absence management group was developing initiatives to address specific issues around stress and muscular skeletor disorder.

Corporate human resources had developed a programme to support divisions experiencing problems managing absence and were about to implement the programme within the social work division. However, the corporate HR manager recognised that the absence management policy required review to make it more focused and then applied more consistently by providing more training and support. The social work division also had a supporting staff group.

Staff deployment and teamwork

Clarity about roles

We found that all staff in social work had job descriptions. The council was reviewing them as part of job evaluation and single status. We saw a good example of this process in the job description for the team leaders created last year. The job description described this post 'as critical to good practice and delivery of quality service to users and carers and the profile of social work in the community'. A focus group of middle managers confirmed the council's expectations of team leaders describing them

' as pivotal in delivering the new agenda and taking a great deal of the strain in the organisation as they stand between the policies and directives which come from the top and the staff who have to deliver them'.

We found similar sentiments expressed about this post in a number of focus groups with team leaders. Given the importance and expectation of this post, we were concerned to find one such post was only a part-time post filled on a job-share basis by a worker who worker the other half of the weekly hours as a qualified social worker in the same team as that for which she was the team leader.

One focus group with team leaders stated that they felt undermined at times by the number of review groups and resource panels to which they had to defer. They felt these groups detracted from their decision making role.

Appropriate staff mix in teams and units

Recent changes had taken place in the structure of various services within the social work division designed to meet policy changes, local partnership arrangements and job evaluation/single status requirements. The biggest such changes were in the home care service, residential services and the establishment of duty teams in fieldwork services. Significant changes were also proposed for services to adults with disabilities and day services.

The home care service changed the grading of staff to two grades of carers - one to provide personal care and the other to provide more traditional home support. The council will phase out the latter over time as it does not take on new service users. The council achieved these changes at no cost but this had resulted in a loss of more than 10% of the capacity of the service. As a result there had been greater use of the independent sector but budget constraints had curtailed the ability to purchase services. Staff in focus groups told us that social work managers had restructured the home care service over a very short time period which left many staff confused and uncertain. However senior managers describe how implementation was preceded by a series of staff briefings and two trade union ballots over an extended period. Staff in the service reported that they were not ready for the changeover and described the operation difficulties encountered. Senior managers confirmed that the changeover occurred over a short time frame in order to avoid getting caught up in job evaluation and single status which would have delayed the process.

The changes in the deployment of residential care staff were ongoing at the time of the inspection as a consequence of the opening of a new council care home for older people. This involved the closure of an existing council care home and an independent sector care home with staff from each transferring to the new care home. It was too early evaluate the outcome of these changes but we found staff in residential care to be enthusiastic about the changes and moving to the new premises.

Day care staff were also facing changes and we found a mixed response from staff. A range of options was still under consideration for day service modernisation.

Teamwork

In fieldwork services, the creation of duty/access teams and the appointment of additional team leaders had impacted on staff deployment and team work. The positive response to the separation of duty from longer work was that staff found they could plan their work more consistently by having more focused and less chance of disruption to planned work. The different teams had more in common in terms of operational and other issues. However, concerns were expressed both by front line staff and first line managers, and confirmed by more senior managers, that a consequence of this separation of responsibilities had resulted in some service users not getting a service for a time during the transition of responsibility from duty to long term teams. These anomalies should be addressed by the social work division to ensure greater clarity of roles and responsibilities.

The social work division did not have a standard workload management system in place and team leaders and staff in focus groups advised that they included workload management as part of supervision. Our survey showed that most of the staff who responded (75%) agreed that their workload was manageable within normal working hours.

Development of Staff

Training and staff development strategy

The workforce development action plan 2007-10 highlighted gaps in induction and integrated workforce development. It was not clear from the plan how these gaps were to be systematically addressed. In our survey most staff who responded (79%) agreed that they received adequate training to fulfil the responsibilities of their job. This was comparable to all authorities inspected to date. Staff focus groups also confirmed that access to training courses was good in Midlothian and time off to attend courses was not a problem. The division had identified leadership and management training as a priority for team leaders and others, provided in partnership with Stevenson College.

Personal development and supervision,

We found the social work division's staff supervision policy, approved two years ago, to be a sound policy and procedural document. It made reference to the Scottish Social Services Council expectations as a driver for change in this area of policy. The policy set out its basis with a definition based on accountability, responsibility and support and went on to detail the minimum standards expected of supervisors and supervisees with useful lists of supervision functions, elements and skills. Our staff survey found that most staff who responded (72%) agreed that they received an adequate level of supervision. This was comparable to all inspections to date. In numerous staff focus groups across a range of grades and posts we found staff were very familiar with and complied with the policy and procedure. All grades stated that they received regular supervision as described. We did find that unqualified fieldwork staff were less satisfied with the application of the policy. Social care workers stated that no one aggregated training needs identified in supervision and collective training courses did not happen as a result. Administrative staff stated that supervision did not happen as frequently as it should whilst home care staff were concerned that their line managers did not go on to the next stage and do personal development plans for them. We think that this should be rectified.

The council had a sound policy on personal development plans with a target that all staff should have personal development plans. We found the social work division, where 50% of the staff had a personal development plan, was well ahead in meeting its obligations with regard to the corporate policy.

Resources and Capacity Planning

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

The links between the operational plans and the financial plans were found to be generally satisfactory but some further work was required to ensure that the plans and links were in place by the start of the financial year. Budgetary control was well managed, although consideration should be given to further devolvement of budgetary responsibility.

While progress had been achieved in the development of asset management planning, further work was required to ensure that corporate strategies and objectives were properly supported by asset management plans in the longer term.

Risk management systems were well advanced at corporate and social work service level whilst health and safety areas required further improvement and development

The council was investing significant resources to upgrade its social work information system. In the meantime there were information gaps and limitations.

Partnership arrangements were found to be generally satisfactory and there were some areas of joint working within the council. However the financial/budget monitoring aspects of this joint working had not progressed to any extent and required to be further developed. There was evidence of good partnership working with education and with neighbouring councils. There were also strengths in corporate working in some areas.

A strategy for commissioning social work service had been put in place and further work was needed to ensure its consistent application across all services. Commissioning for children's services needed to be developed. Commissioning plans for older people, people with dementia and learning disabilities all required further attention. The social work division needed to take a more systematic approach to option appraisal. The service was working hard from a very low base to improve arrangements for service procurement and contracting.

Financial management

Financial planning

The budgeted spend for social work services as a whole was higher than grant aided expenditure ( GAE) for the three years to 2007-08 - over 10% higher compared to the overall Scottish variance of 6.5% over the same period.

The budgets for children and families services were consistently above GAE with the variance between the two having increased considerably in 2007-08 (2007-08 GAE £4,661k v Budget £9,776k). The children and families services' share of the overall social work budget had moved from 25% to 27% between 2006-07 and 2007-08. We noted also that the proportion of the 2007-08 budget allocated to children and families services (27%) was higher than the Scottish average (24%) with just over 22% of the total population of Midlothian aged 0-17 compared to the Scottish average of 20.5% (based on mid-year population statistics at 30 June 2006).

Despite the above-noted level of budgeted spend over the last three years, the council's budgeted spend per child looked after was amongst the lowest in Scotland as a whole (on average 27th out of 32 councils, average budgeted spend being £31,387 compared to the Scottish average of £38,916).

We noted that the council was considering alternatives in order to reduce the spend on the number of children were being looked after outwith the Midlothian area. We were told that financial support for kinship care placements was a further reason for the budgeted spend being so much greater than GAE. The council and Children 1st were working together in this area. There were also large numbers of looked after children, and children on the child protection register. We were told that the children and families services had been understaffed and that this had resulted in delays in removing children from the register.

The budgets for older people's services were slightly lower than GAE for the 3 year period (2007-08 GAE £16,265k v Budget £15,813k) and the proportion of the social work budget allocated to older people (43%) was lower than the Scottish average (48%) with 16% of the Midlothian population being aged 65 and over compared to the Scottish average of 16.4%.

Officers told us that this service was closely and regularly monitored with the funding being moved between budgets according to those most in need. A multi-agency community care resource panel met weekly and the community care budget, in particular home care and the availability of care home places, was monitored in detail at these meetings.

The budgeted spend for adults with disabilities and addictions was consistently and significantly higher than GAE and we noted that resource transfer monies, (as a result of the closure of St Joseph's and Gogarburn and, to an extent, Bangour), had been allocated to adults with disabilities.

The community plan was drafted for 5 years with a corporate strategy and divisional plan for the 3 years 2008-11. The council had annual plans which supported the corporate strategy. We reviewed the annual plan for 2007-08. The plan was a comprehensive document containing the detailed aims and priorities for the year. It included a costed priority measures section which listed the corporate aims together with costs, both revenue and capital for the year.

Each division also drafted annual plans. The social work divisional plan for 2007-08 contained details of its service objectives and information regarding the division's management arrangements. Challenges were also highlighted within the plan which included managing services within tight financial constraints and growing demand. Where priorities/objectives had a cost implication, these were costed.

We also reviewed separate annual business plans for the two main services within the social work division. These plans presented the key development areas of the services. The format of these plans however was not consistent and contained no financial data but we were told at the time of the inspection that they were being updated to ensure consistency. A service plan format had recently been approved by the corporate management team ( CMT) and covalent (the council's performance management system) was utilised to draft and subsequently monitor the plans.

The aim was to have service plans developed over three years. However in the near future they were likely to be drafted for one year only but would contain a view of the service's targets over the three year period. The corporate plan was approved in February 2008 but at the time of the inspection the divisional plan and service plans were not yet finalised.

Officers we interviewed told us that regular monitoring of the budget at both member and officer level ensured that the budget fully supported the aims/objectives outlined in the service plan. If an unexpected funding issue occurred, and diversions could not be found within the service budgets, a report requesting additional funding was presented to cabinet. Officers believed that the service planning process had improved recently with no further changes in the process anticipated. It was expected that plans for 2009-10 would be finalised by September 2008.

The links between the various plans appeared, therefore, to be improving with existing plans reasonably well aligned to the financial plans. However the council should update its plans, both service and divisional, in advance of the start of the financial year to ensure that planned activity is affordable within available resources.

Budgetary management

The final outturn for 2005-06 within the social work division resulted in an overspend for the year of £447k. The actual outturn for 2006-07 highlighted an overspend of just over £102k although it was noted that the fluctuations between budget and actual in this year were far greater than in 2005-06.

Audit Scotland's report to members in 2007 stated that the council faced significant challenges in balancing revenue and capital demands and ensuring that planned activity was affordable. A balanced budget was set for 2007-08 but there was a gap of £3.2m between available resources and recurring revenue budgets from 2008-09 onwards. The council needed to establish a financial strategy that achieved balanced budgets while maintaining effective service delivery and improving underlying performance. Officers we interviewed stated that the council had been sympathetic to the issues arising from the child protection inspection and had provided additional funding for budget pressures arising from the implementation of the action plan.

The updated financial position for 2007-08, the budgetary pressures and budget variances identified to date showed an overall projected underspend of £280,000. This included a projected underspend within the youth justice budget of £376,000 where there had been uncertainty over the permanency of the funding. There was a remaining overspend of £96,000 across other social work services.

Financial overview reports were presented to cabinet on a quarterly basis to inform members of the current year revenue budget performance to date. From the papers reviewed, we were satisfied with the level of information and explanation provided to members.

Social work management team ( SWMT) met weekly but finance related items did not appear on the agenda on a regular basis. Monthly out-turn projections were prepared on a service group level and on a quarterly basis the divisional position was reviewed by the SWMT. Reporting of financial matters to the SWMT appeared to be less frequent than in other councils.

Within the social work division, financial management and support was provided by both the business services manager and the accountants based in corporate services. Working relationships between the relevant finance staff and budget managers were good. They held regular meetings, and advice on budgetary control matters could be requested from an appropriate finance officer at any time.

Budget monitoring information reports were available electronically, could be accessed easily, and provided sufficiently detailed information to allow budget holders to properly monitor their budgets.

The council's budget process had moved from an incremental budgeting approach to a more strategic process with only costed priorities moving forward into service plans. The base budget was still developed on an incremental basis, but account was now taken of unavoidable costs, options for service reductions and efficiency savings. Service plans were only finalised once they were known to be fully resourced. Work however on developing a financial strategy for 2008-09 remained ongoing.

The budget review group, which included members and officers, met regularly and identified the main areas/problems to be considered in preparation for the following year's budget construction.

Budget holders interviewed told us that they had some involvement in the annual budget preparation process. They were clear on their roles and there was guidance available on the council's intranet.

We were of the view that liaison between management and front line budget holders was generally good; however more involvement from the budget holders in the budget setting process would ensure budgets were properly formulated and achievable and that budgetary control was well managed thereafter.

We comment on partnership financial management in the partnership arrangements section below.

Capital expenditure

There were underspends in the General Fund services capital plan for both 2005-06 and 2006-07. These were mainly attributable to slippage on projects that were in progress during those years.

Council approved the general services capital plan for 2007-08 to 2009-10 in February 2007. This plan provided for £0.8m on a social work management information system ( MIS). However it was later agreed to allocate £0.1m of this budget to allow work to progress quickly on the refurbishment of the Dalkeith social work office.

The capital plan was subsequently extended to cover 2010-11 and then 20011-12. Included in the 2007-08 to 2011-12 plan was £6.145m attributable to social work social work, the major element of which was £5.431m for Gorebridge care home. The council had however identified a significant affordability gap in relation to its current capital plans and was reviewing options for progressing these over the next 4 years. As 2007-08 progressed, it was reported that the funding gap over the life of the plan had increased from £7.309m to £16.069m. One of the main changes was a provision for inflation relating to the new care home of £1.8m. Members were asked to consider how the £16.069m shortfall could be bridged by identifying projects that could be reconfigured or removed from the plan.

We noted from Audit Scotland's Best Value Audit that the council needed to set clearer priorities linked to available resources, as improvement plans had often proved unachievable.

We reviewed the quarterly reports submitted to cabinet which provided members with an update of the general services capital plans on a three year rolling basis. The reports were comprehensive with detailed analyses of variances.

Within the social work division some major projects were being planned. A new 60 bed care home was due to be opened in June 2008 and there was a second development planned for older people to replace Pentland House in the west of the county. Other plans included a new children's unit, the merging of two houses to accommodate eight children, and there were plans to expand a day centre for under 5s to provide for the increasing numbers of children with disabilities.

The capital programme in the past had been much focused on education, roads and the new housing at Shawfair, and the needs of social work services were not necessarily recognised. However the social work division now considered that it received sufficient capital funding to allow it to meet its service objectives and implement external report recommendations and there had been no significant capital projects bids that had been refused funding.

Income

We reviewed a document dated April 2007 entitled 'Social Work Division, Charging Policy for non residential and residential care services'. The policy stated that it complied with national guidance - COSLA's guidance on charging policies for non residential services that enabled people to remain in their own home. The policy set out how much service users should pay towards the cost of the services they require. The council would charge for services where there was a statutory power to do so. The detail of the policy included the services for which the council may charge and those services that were free. Social work services did not charge for community alarms, day care or transport costs. The policy was reviewed and submitted to cabinet in April 2008 for approval.

The council stopped charging for food preparation costs in October 2006 and, up until the time of the inspection, had not made any refunds to service users. No requests for refunds had been received.

Role of elected members

It is important that reports to elected members are clear, complete and unambiguous in order that, as the ultimate decision makers within local government, they may base their decisions on full and clear information.

We noted that, on a quarterly basis, financial overview reports were submitted to cabinet and then to the performance and review committee ( PRC). Further reports were presented to the PRC at two-monthly intervals. These reports provided members with an updated projection of the financial position for the year and identified budgetary pressures and budget variances to date across the division. The analysis of the budget variances was clear. Cabinet also received quarterly update reports on the general services capital plan and if there were exceptional issues these would be reported additionally. The corporate governance assurance statement within the financial statements 2006-07 highlighted, as one of the council's strengths, the scrutiny of performance. The 2008 Best Value report expressed criticisms about scrutiny as described earlier in this chapter.

We considered that the quality of reports to members however needed to be improved in relation to the community care pricing policy which set a ceiling on the cost of care at home packages. We were told by managers that the policy was approved in April 2008 and the new ceiling was significantly higher than the previous one. We examined the report presented to cabinet and did not consider that it provided members with sufficient information about the proposed changes to the policy or the anticipated impact on community care budgets. We were also concerned that at the time of the inspection, the community care resource panel appeared to be applying the previous cost ceiling rather than the limit approved in April 2008.

Following the May 2007 elections, financial training had been given to newly elected members as part of their induction process and all members were encouraged to seek advice at any time.

Financial skills

The business services manager had responsibility for the finance function within the social work division. The corporate accountants played an important role in the financial management of the division.

Budget holders had ready access to the ledger to monitor the budget for which they had responsibility. Monthly out-turn projections were prepared by officers in corporate services in collaboration with social work staff. In addition to the council ledger system, individual units monitored their financial commitments against budgets.

The scheme of devolved management was revised in March 2005 and this had led to fewer managers with budget holder responsibility. This ensured tight budgetary control, however the budget holders we interviewed were anxious about the lack of responsibility. In particular, they had little control over staffing or repairs and maintenance. Staff interviewed in the throughcare and aftercare team felt that the work of the team was hampered by a lack of delegated financial authority. There were plans to revert to devolved budgets but the process would be an incremental one over a number of years.

Little formal financial training was provided although there was some financial training material available to all staff on the intranet. For new staff, written procedures relating to budgetary control were introduced during the induction process. Training needs could be raised at the four-weekly meetings with the budget holders, the business services manager and the corporate accountants. The budget holders told us that they had benefitted from the availability of the accountancy staff.

Overall, the financial skills applicable to social work staff were considered to be adequate in terms of quantity and quality and the budget holders we met were satisfied with the support received from corporate finance and their own business services manager.

Resource management

Asset management plan ( AMP)

An asset management plan gives clarity about balancing service needs and available capital resources. It informs a sound capital planning process linking service priorities and objectives.

In June 2005, an officer/member asset management working group was set up to take forward the council's property strategy; - 'Building by building, the aim will be to reach a situation whereby 70% of all maintenance expenditure is fully planned. All resultant expenditure requirements arising from this programme will be presented as a whole to the capital evaluation group, for inclusion in the council's capital-planning regime'. However, we noted that this group met very infrequently and had not convened since July 2007.

In 2006, the council developed a framework for the implementation of asset management planning. An action plan was drawn up to develop and integrate asset management planning into the council's corporate planning regime. The council, as evidenced by the development of this framework, had been working towards implementing a council wide AMP by March 2007, however this timescale had slipped.

In a report to the council in February 2008, the overall position on capital was assessed by the CMT in the context of the developing AMP with expenditure implications of around £175m. It was believed, however, that a £24m capital plan surplus would be prioritised in assisting the situation.

A corporate asset register was held by strategic services and this was updated through the individual services. In the social work division the relevant information was provided by the business services manager. We reviewed an extract from the asset register relating to social work division.

It is difficult to be clear about the capital needs and optimum utilisation of the assets of the service without an AMP that facilitates the production of a capital plan and which is linked to the service priorities and objectives. While development work was continuing, further progress was required to ensure that corporate strategies and objectives were properly supported by asset management plans in the longer term.

The Best Value report also referred to the need for a council-wide asset management plan and corporate strategies and objectives that are properly supported by long-term asset management plans.

Risk management

The risk management policy and strategy for 2007-08 was presented to cabinet for approval in March 2007. A further report in March 2008 presented an updated policy, strategy and risk control programme for 2008-09. The Best Value report stated that the council had established a sound risk management framework.

In 2004, the council's risk manager produced an 'easy read' document covering the main aspects of risk management. It was for all staff, members, and management and was available on the council's intranet for everyone to access. A very clear and comprehensive guide for elected members was drafted in June 2007. With new elected members on the council it was felt that a new risk management guide would be useful. Further face to face training was also planned.

We noted that detailed risk registers were completed for the chief social work officer ( CSWO), children and families, criminal justice, community care and business services. The chief social work officer register contained up to 20 key risks affecting the service and was informed by all the other risk registers.

'Magique' was the council's web based risk system and contained risks, controls and actions. Risks were reported from the system into the divisional and corporate performance systems. The council had used magique for four years and social work had been proactive in using it as a key management tool with the support of the council's risk manager. At the time of our inspection there were plans to transfer all information across to covalent, the council's performance management information.

Social work officers were able to access magique reports on a quarterly basis in order to validate, monitor and review their risks and service risk registers, and these were presented to unit meetings on a regular basis. Managers were tasked with reviewing their high and medium level risks and finding new control measures to reduce risk exposure by 3% to 5% on an annual basis. Magique was also used for monitoring risks on projects such as the social work management information system project.

The risk manager met with managers on a regular basis to ensure proper risk management 'buy in', the identification of emerging risks and the location of robust measures to control risk. He also attended SWMT meetings twice a year to assist in the updating of risk registers, etc.

Like other divisions of the council, social work risks were reported to the performance review committee once a quarter. Cabinet received monitoring reports on the policy and strategy twice a year. In addition, regular six-weekly reports were presented to CMT, and the SWMT received quarterly reports on the progress of developing, and the updating of risk registers. The CSWO risk register in particular was reviewed by the Cabinet spokesperson and reported to the CMT. A corporate risk management team also met on a six-weekly basis.

During 2005 the council received national risk management awards but acknowledged that this was purely in relation to the introduction of risk management structures achieved in a relatively short space of time and starting from a low point. Since then the council had been conscious that it must further develop its structures and processes in order to fully embed risk management across the council. The council, however, had continued to make very good progress in this area. It was clear, therefore, that risk management systems were well advanced at corporate and social work division level.

Health and safety

We reviewed the council's occupational health and safety policy at work. The document was dated 1996 although it appeared to have been redrafted in 2000. Officers told us that the policy was currently under review. It was a general statement for the council of its policy on health safety and welfare for all employees.

The policy stated that it was supported by divisional health and safety policies in the form of divisional health and safety manuals. They detailed the organisation and arrangements in force to ensure that the aims of the council policy were met. Directors were responsible for preparing and revising the divisional health and safety policies as often as necessary and preparing an annual report evaluating the health and safety performance of their divisions. The policy stated that the policy and any revision of it would be drawn to the attention of every employee of the council and new employees as they were recruited.

However, we established that there was no policy document specific to social work services. Officers told us that the development and publication of divisional policies was being planned to form part of divisional safety manuals. It was expected that each director would be encouraged and supported in developing a local health and safety policy.

Furthermore, we found that there was no annual report produced by the director of social work covering health and safety performance. The divisional safety group monitored key health and safety aspects on behalf of the director and reported progress thereon.

We were satisfied that health and safety information was disseminated to employees by various methods including the council's intranet system.

We reviewed the corporate health and safety plan for 2007-11. This updated plan, with eight key objectives, reflected both the outstanding issues from the original plan and the measures required to meet the objectives in the COSLA/ SPDS health and safety framework and the health and safety executive's 'fit3' initiative.

The plan stated that a monitoring process was in place and that the corporate health and safety plan would be kept under review annually and revised as required. Monitoring was both proactive and reactive. Proactive monitoring was progressed through management safety audits on individual units and activities across the council. Reactive monitoring was undertaken by means of accident/incident analyses, where details were collated and circulated to senior staff within each division on a regular basis.

The plan further stated that an annual progress report, to be produced by the senior health and safety advisor, would be submitted to CMT and the joint consultative group ( JCG). The council contingency planning group chaired by the chief executive would also fulfil a clearing house/ monitoring role.

We also reviewed an up to date health and safety group work plan for the social work division which listed objectives together with action required and names of lead officers.

Management information systems

Modernisation of the social work information system was underway at the time of the inspection. In 2007, the council took the decision to purchase the corelogic framework i system. The project was being well managed and was overseen by a board chaired by the acting director of social work. There was a strong emphasis on operational staff contributing to the project. This informed the development of staff training programmes. The first phase of the project was due to go live in Autumn 2008. Steps had been taken to ensure that the new system had the capacity to link to the joint eAssess system for electronic sharing of single shared assessments. In the meantime capacity to share information would be limited.

At the time of our inspection, the main social work information system was the client index database, which held information about service users and details of events. It linked to an electronic document store and also to financial systems. It was easy for staff to view service contract, supplier and budget details for each service user. Staff and managers could run reports from the client index system.

Range and quality of information

We refer to the performance reporting framework in Chapter 6. In addition to statutory performance Indicators, the social work division had identified a large number of performance measures. These reflected social work divisional priorities. It produced regular reports about performance on some of these divisional priorities. The reports showed areas where data was not routinely collected.

In common with many other authorities, information was collected about activities rather than outcomes. The division relied on stand alone systems and manual counts for a significant amount of performance information. Information managers recognised that data quality was an issue which the division was working hard to improve. Overall, the range and quality of information available to managers was patchy and the division anticipated significant improvements when the new information system was implemented.

Use of information

We found evidence of management information being used regularly to provide information about social work performance to senior managers, the chief executive and elected members. Performance reports were scrutinised and questions were raised about the information provided. However, the level of analysis and explanation contained in reports was limited. Again, the division expected this to improve once the new information system was in place.

In community care, financial information was used to give a breakdown of the services supplied to individual clients and this was used to manage budgets and to plan services. Similar mechanisms were being developed within children and families, but were not yet in place.

Information was produced about unmet need from waiting lists of people with critical and substantial need for community care services, including people waiting to be discharged from hospital. This information was included in routine performance reports. However, the reports did not include information about the length of time people with critical needs had to wait for services. They did not spell out the circumstances of people waiting or the implications for carers. Neither did they show the impact on increasing rates of multiple emergency hospital admissions. These were significant reporting gap. We have made a recommendation in Chapter 3 on the need for more prompt remedial action to reduce critical waiting lists.

Starting from a low base, the social work division had made significant progress in improving information about the services it purchased through contracts and service level agreements, as well as services funded by grants. It was working closely with the council's corporate procurement officer to further develop and improve the information held about external provided services.

Managers in the children and families services needed better information. For example, information about waiting lists and allocated cases required to be strengthened. Some improvements had been made on information given to team leaders about unallocated work. Senior managers told us that the new management information system would greatly improve the situation.

Partnership arrangements

Strategic approach to partnerships

The overall framework for partnership working in Midlothian was in the community plan. This had been recently revised and covered the period 2007-11. A partnership agreement had been adopted and covered issues of governance, scrutiny, risk management and financial arrangements. It had not yet been rolled out to all partnership groups. The community planning partners had also agreed a joint planning and performance management framework.

Partnership arrangements were generally working well in Midlothian. We were told by officers that NHS partners were involved in joint planning working groups with the council. We found evidence of regular review of partnership structures to ensure fitness for purpose as well as to explore new opportunities for partnership working.

Public protection

There were well developed partnership arrangements for public protection, which operated at Lothian level through ELBEG. Midlothian had a critical services oversight group ( CSOG) which had leadership and governance responsibility for child protection, adult protection and multi agency public protection arrangements. These partnership arrangements were working well and attracted positive comments from a number of stakeholders who responded to our survey.

Children and Families

Children and families services revised its partnership arrangements in 2007. A chief officers' executive group was set up and senior managers met in a children's services forum, supported by a number of joint sub groups. The child protection committee reports to CSOG.

Community Care

We found partnership structures for community care services were well developed. The social work division contributed to Lothian wide joint planning structures for the main care groups. Midlothian and East Lothian community health partnerships had recently combined their management arrangements, supported by Midlothian elected members. In Midlothian, an overarching executive group was chaired by the elected member who was the council spokesperson on social work and health. This group co-ordinated the work of local planning groups as well as other joint forums such as the joint community care management team and the telecare working group.

We comment earlier in this chapter on strengths in partnership working on mental health which originated in the redesign of NHS psychiatric in patient services. This resulted in improved community health and care services in mental health. It was intended that some of the learning from mental health services would be used to strengthen partnership working for other care groups.

There was joint working in terms of delayed discharge planning and resource allocation through the resource panels. There was also some joint working in terms of services such as the emergency social work service, the Midlothian alcohol and drug action team ( MDAAT) and the community equipment store. The rapid response team was being developed as a joint service hosted by the social work division. The council was a member of these management boards and in some instances members were on the board as well as officers.

We found little evidence of financial frameworks being in place for joint working arrangements. There were no pooled or aligned budgets. The management boards identified the funding to be obtained from the council and other partners, with NHS Lothian, for example, simply transferring the appropriate funding to the council. In most instances of joint working Midlothian Council hosted the funding. The funds were spent by the council in accordance with what was agreed at joint planning meetings. Separate cost centres within the council's ledger system had been set up for jointly provided services where NHS Lothian funding was hosted by the council.

We found no evidence of financial monitoring other than through the council's own reporting processes. There was some discussion of financial information at the joint planning meetings but there was no joint reporting. The council was duty bound to report to NHS Lothian, on an annual basis, that the funding had been spent, but beyond this there was no further reporting.

We noted that there were some areas of joint working within the council but that the financial/ budget monitoring aspects of this joint working had not progressed to any extent and required to be further developed. No joint financial reports had been produced and presented to elected members, nor was there much evidence available of financial or budget issues being discussed at any meetings of officers. There was no joint management group overseeing budgets and financial planning.

Other key partnerships

The social work division was open to forming new partnerships to improve services. The council was exploring shared services with neighbouring councils and NHS Lothian. One example was a joint innovation project with East Lothian to develop person centred supports for people with learning disabilities. There were also examples of collaborative working on learning and development involving East Lothian and Scottish Borders.

We found evidence of good partnership working at a strategic level with education, in community care services as well as children and families services. We were told that partnership working between social work and housing had improved significantly in recent times, at the instigation of the social work division. An initiative to improve collaboration on mental health was described by a senior housing officer as invaluable. Protocols were however needed to make sure the services worked effectively together in key areas such as corporate parenting, homelessness and housing for vulnerable groups. There was a need for corporate support for the social work division's efforts to improve joint working with housing.

More effective partnership working between the council and providers of services from the independent sector was an aim of the commissioning strategy for social work services. We refer to this elsewhere in this chapter.

Data sharing

In adults and older people's services, Lothian wide arrangements for electronic sharing of information were in place. There were protocols on data sharing and information for service users. Data sharing in children and families was also covered by the Lothian protocol and work was in progress to develop a specific information sharing protocol for GIRFEC and child protection.

Commissioning arrangements

Midlothian Council estimated that almost two thirds of its social work services were delivered by the independent sector. These were purchased or funded by a variety of arrangements, including contracts, service level agreements, grants and transfer payments. The council had started reviewing and modernising its commissioning and procurement activities. Although good progress had been made in some areas, implementation in other areas was still at a very early stage.

Strategic commissioning

A commissioning strategy for social work services was approved in February 2007. We found this was a good framework to guide the commissioning of social work services in Midlothian. The document set out broad commissioning principles which had been adopted by the council. The aim of the strategy was to improve the effectiveness of commissioning and ensure best value, equity, flexibility and transparency. The strategy made clear links between service planning, market analysis, partnership activity and contracting. While the strategy emphasised commissioning of personalised services, we thought that its coverage of outcomes based commissioning was an area for development. Senior managers told us that this will be incorporated in early implementer national outcome work.

Commissioning and contracting was co-ordinated by a commissioning group led by the acting head of community care. The corporate procurement manager, the council's head of finance, the senior accountant responsible for social work attended the commissioning group along with social work managers. We observed that this group functioned effectively. It provided a means to apply the commissioning strategy across the social work division and so improve consistency. Some parts of community care services were more advanced than children and families services.

Service wide commissioning

Strategic plans for the main community care groups were in place. These plans informed service wide commissioning. Some of the plans were written before the commissioning strategy was approved, and further work was needed to make sure that all strategic plans complied fully with the commissioning strategy. Managers recognised this was a huge task and we thought they should set clear timescales for making progress with it.

The social work division faced major issues in modernising its learning disability services. These included commissioning new services to replace care homes that were no longer fit for purpose, and developing a broader range of community day opportunities. It had started on an ambitious change programme with person centred planning the key mechanism to drive forward commissioning decisions. We refer earlier in this chapter to unresolved funding issues in the learning disability strategy.

There were also major issues in service wide commissioning for older people. Service commissioning was clearly not keeping pace with increased levels of critical needs and there was not enough funding. The relevant strategies identified big shortfalls in community provision, including intensive home care, evening and weekend cover, and day care which could provide personal care. The commissioning priorities were:

• to maintain people at home as long as possible, through rebalanced home care and implementation of telecare;
• to provide or procure the highest possible care provision; and
• to achieve a balance of day care, respite and long term care home provision.

One consequence of the implementation of the home care review was a planned increase in commissioning home care services from the independent sector, alongside an in-house service increasingly targeted on rapid response and intensive home care. Work was in progress to develop commissioning and contracting strategies to support a shift in the balance of care towards more intensive support.

The joint strategy for mental health of older people included dementia and functional mental illness. The division and its NHS partners had not yet examined in any detail local needs and supply of social and health care for dementia sufferers and their carers. It was anticipated that dementia would be a particular focus of a planned review of day care services. We thought this did not go far enough. The division needed to place a greater emphasis on planning and commissioning for people with dementia and their carers, and this should be done jointly with NHS partners and other stakeholders.

We heard that strategic commissioning in children and families was less well developed in key areas of foster care and residential care provision. These had major cost implications for the social work division. The division had invested in commissioning new external services to support kinship care, including family group conferences. It had successfully shifted the balance of long term care to reduce residential care and increase kinship care. It recognised the need to improve commissioning of services for children and young people affected by disability.

Contracting

Historically, procurement and contracting had been devolved to divisions in Midlothian Council. This meant that there had been a lack of consistency and poor information about purchasing in social work and other divisions. The council had appointed a corporate procurement officer and a contracts officer post was created in the social work division in 2006. There had been very significant improvements since then. Work was underway to improve information through central registers holding details of all services purchased. In the social work division, this work was at a relatively early stage.

A social work contracts panel group had been established with representation from legal services, finance and corporate procurement as necessary. The panel oversaw all contracts and purchasing and reported to the social work commissioning group. We agreed with views expressed to us by managers that this system was working very well and was being used to improve compliance with the new guidelines.

The council and the social work division recognised the need to adopt a phased approach to the task of ensuring that all social work procurement was fit for purpose. We thought that lack of capacity was likely to be a serious impediment to making further progress within a reasonable timescale. Some short term enhancement of staff resources to support procurement and contracting needed to be considered.

Early priorities for contract reviews had been decided on the basis of service areas where there was a pressing need to deliver efficiencies because of budgetary pressures, namely in supporting people and externally purchased home care.

Supporting people service level agreements had all been reviewed. After a slow start, the division had achieved considerable success by reducing costs whilst protecting essential services.

In advance of full tendering for external home care services, the division had taken interim steps to target four main private home care providers. It had been successful in negotiating a reduction in costs for a guaranteed level of business. This had resulted in significant efficiencies. Less positively, providers in our focus groups described the council having 'rushed through' its own home care review. This caused short term disruption and some providers felt it had created unreasonable pressures on provider organisations.

The position with contracts and service level agreements was very patchy. A number of agencies providing children and families' services had service level agreements with regular review arrangements. There were plans to extend the use of service level agreements and introduce spot purchase ³² contracts for some children's services. Community care had introduced spot purchase contracts in 2008 but had few service level agreements. There were firm plans to start negotiating service specifications and service level agreements during 2008 and to tender and contract for home care and supporting people services by April 2009. One area where we found good progress was jointly commissioned mental health services.

The principles set out in corporate procurement and divisional policies were partnership, openness and transparency. Despite these positive policies, we found that liaison with providers was variable.

The majority of respondents in our stakeholder survey were positive about contracting arrangements. Issues raised by community care providers included poor communication about commissioning of community care services, lack of service level agreements and service reviews and not having named contacts with social work.

Monitoring of external services was patchy. The contracts officer had introduced an annual monitoring exercise for home care and care homes. As mentioned earlier, the social work division had only recently created a review team and reviews of older people in care homes were given priority. This meant that there was no care management information to assist the monitoring of the quality of other external services. Monitoring was not yet in place for grant funded projects and some providers commented that the council appeared to be quite lax in monitoring the services it received from them.

Balance between directly provided and purchased services

The council's commissioning strategy for social work services clearly accepted the principle of parity of treatment between directly provided services and external providers. The policy was that provider selection should be based on best value and service quality. There were a number of recent examples of the division looking outwards to procure new services. There was also a recent example of the council outsourcing a tenancy support service after the supporting people review process concluded that this could be delivered more effectively by an external provider.

Community care providers and some other stakeholders raised issues about a lack of equal treatment between in house home care and externally purchased services. These included a perception that external providers were subject to higher expectations and higher levels of scrutiny without parallel transparency in the operation of the in-house service. We refer to this issue earlier in this chapter.

There were some issues around the decision making in relation to the redesign or replacement of in-house home care and care home services. The social work division was looking at future options to expand the range of services to extend care housing options and day care. We considered that the social work division should be more active in involving and consulting key stakeholders, including NHS partners, to ensure that a whole systems approach was taken to service re-design and commissioning.

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