Foreword

During 1997-98 we conducted an inspection of social work services for people with sensory impairment. The remit was to:  

• examine the planning, delivery, commissioning and management of social work services for people with a sensory impairment;
• clarify how social work services for people with a sensory impairment link with a wider range of services provided by health, education and voluntary organisations;
• understand the separate concerns of people with a visual impairment, people who are deaf or hard of hearing and deafblind people;
• identify the training needs of staff.

During this inspection we:  

• circulated all local authorities in Scotland with a detailed questionnaire and commissioned an analysis of the 27 completed questionnaires;
• analysed all authorities' community care plans;
• invited submissions from a wide range of organisations active either in working with people with a sensory impairment, or in staff training and development;
• convened meetings of 4 focus groups;
• commissioned a literature review.

We also conducted fieldwork in 6 (note 1) local authorities where we:  

conducted a survey of 169 people with a sensory impairment who were receiving social work services;

interviewed some families of people with a sensory impairment;

examined the case files of specialist teams;

interviewed a range of staff in the social work, education and health services as well as voluntary organisations.

In selecting the 6 authorities we sought a balance between urban and rural areas, and between specialist services that were provided in-house and those that were contracted out.

The legislative framework which underpins the services is contained in Annex 1.

We have also made use of current literature reports and research material in this area - see bibliography at Annex 2.

The Inspection was managed by Assistant Chief Inspector Gillian Ottley and the team included SWS Inspectors John Bishop and Jean MacLellan. Ron Partington was the lay member, Elaine Samuels the researcher and Linda Brennan, Alan Nicholson and Iain Fitheridge handled the administration.

The team was assisted by consultancy with Lynne Hawcroft, Tom Muldowney (Head of the School of Vision and Rehabilitation Studies, Guide Dogs for the Blind Association) and Bob Peckford (Director of Communication Skills, Council for the Advancement of Communication with Deaf People). Their input was helpful but the responsibility for the findings and conclusions in this report lies with the Inspectorate.

We would like to thank the many people with a sensory impairment who agreed to be interviewed during the course of this inspection. We also want to acknowledge the assistance of all those staff from social work, health, education and voluntary organisations whose contribution has allowed us to undertake our work. We have, without exception, met considerable co-operation and support.

This report sets out to assist those involved in social work with people with a sensory impairment to put into place robust, adaptable, models of service delivery for the future. In our view it is essential that future services cover the range of needs from the simple to the most complex and to the highest standards. Underlying all our recommendations is the belief that people who use services should be at the heart of developments in those services. Their active participation in shaping the future will ensure that opportunities are made available for them to lead ordinary lives as valued members of society.

Angus Skinner

Chief Inspector of Social Work Services for Scotland

Notes On Terminology

Sensory impairment

This is the broad term used to cover visual impairment, deafness, being hard of hearing and deafblindness.

Visual impairment

This is a term used to cover the spectrum of those who have some residual vision to those who have no sight at all. The terms blind and partially sighted are also frequently used in the report. Blind in the context of a person being registrable has a specific meaning, being so blind as to be unable to perform any work for which eyesight is essential. It does not necessarily mean that the person concerned will have no vision at all.

Deaf people and those who are hard of hearing

The Deaf Community is generally used to described those Deaf people who use British Sign Language and who feel they share a culture with other Deaf people. There are a larger number of people who are also profoundly deaf, many of whom will have become deaf during the course of their lives and who will acquire a variety of new communication skills. The largest group are those who are hard of hearing, many of whom acquire hearing loss as they become older.

Deafblindness

Deafblindness, or dual sensory loss, refers to people with a combination of sight and hearing losses which can cause difficulties with communication, access to information and mobility.

Other terms used in this report are defined in the glossary (Annex 4).

Chapter 1  Overview

How Many People Use the Services

1. Accurately estimating the numbers of people who have a sensory impairment and who may need a social work service is not straightforward. Authorities are grappling with this and tend to use a mixture of registration (where this exists), prevalence data, local records and active contact.

2. In Scotland in 1997 there were 22,788 people who were registered blind and 11,051 (note 2) others who were registered as partially sighted. However, RNIB research in 1991, undertaken at a UK level, indicated that the numbers of people on registers is some 23% of those eligible to be registered (note 3).

3. For the same year the Scottish Association for the Deaf (SAD) had 12,127 people listed on their voluntary register. There exists little guidance as to how best to develop estimates of need of people who are deaf or hard of hearing. This is an issue for all service providers. The Social Services Inspectorate (SSI) has suggested using the table below which is taken from the Informability Manual (note 4). Authorities would apply the relevant percentages to their own populations.

Circumstances

% of population

Some form of hearing loss

14.00

A profound hearing loss

0.50

Use British Sign Language

0.10

Need access to telephone not using voice

0.76

Use a hearing aid

3.60

Table 1: Estimated prevalence of need in general population

4. The numbers of people with dual sensory loss are small and elusive. Think Dual Sensory (note 5) suggests that 2,000 people in Scotland have some degree of deafblindness. The same report also indicates that half the 75+ population with a visual impairment is likely to be hard of hearing. Social Work Services Group figures for 1997 indicate that there are 4,092 people in Scotland who are both deaf and blind (note 6).

5. Community care plans represent one source of strategic thinking. Guidance on these requires the needs of each care group to be set out together with a description of how they are to be met by social work, health and housing. Of the 22 available plans that we saw covering the 1997-98 period, only 8 had a section relating to people with a sensory impairment. A further 6 authorities incorporated sensory impairment sections under the broader heading of physical disability. Four authorities were able to go further and provide a description of services and identify current shortfalls in these.

6. Twenty-two authorities actively involved people who used services in shaping them. The extent of that involvement was less easy to ascertain. Many staff acknowledged that there was a fine line between tokenism and no involvement and that their selection of the people they consulted made it difficult to say that they were truly representative.

People with a visual impairment

7. There was some evidence of delays in assessment of people with a visual impairment. There was also a wide variation in the quality of initial assessments, making it difficult to judge in some cases whether a more comprehensive assessment was needed. Some of these difficulties may have been attributable to skills' deficits in some specialist teams, in terms of the numbers of both qualified social workers and qualified rehabilitation staff. A few authorities were unable to provide qualified mobility training and in many areas people were having to wait for long periods for training support. Good information services are linked to the existence of resource centres for people with a visual impairment. Access to resource centres also affects a person's ability to learn about and test specialist equipment. Council budgets for equipment vary. This does not seem to have a major impact on people's ability to obtain lower priced items.

People who are deaf and hard of hearing

8. Social work staff have little understanding of deafness and communication with people who are deaf or hard of hearing. People who are deaf or hard of hearing are often referred to specialist staff for assessment and, whilst their sight loss needs are well assessed, their broader social care needs may not be addressed.

9. The direct employment of interpreters within social work services needs to be reviewed in the light of the importance of maintaining the distinction between the social workers and interpreters. Again, equipment budgets vary with opportunities to try out equipment being fewer in rural areas.

People who are deafblind

10. Arrangements for assessment and review are nearly always led by specialist sensory impairment staff. In larger authorities where there are separate assessment procedures for visually impaired and hearing impaired people, co-ordination of arrangements can be ad hoc. In smaller authorities the requisite skills and knowledge are not readily available. There is no distinct local authority provision and services are provided alongside existing ones for people with a sensory impairment. SENSE (Scotland) has questioned the capacity of small authorities to track, identify and prioritise the needs of deafblind people who have substantial additional disabilities. There are elements of service which require a distinct response, e.g., communication, information and mobility. At the time of the inspection these services were not widely available.

Voluntary Organisations

11. It is evident that national voluntary organisations fulfil a number of different roles:

• they represent people, e.g. British Deaf Association (BDA), National League of the Blind and Disabled, Deafblind UK (Scottish office);

• they provide specialist services, e.g. Royal National Institute for the Blind (RNIB), Royal National Institute for the Deaf (RNID), SENSE (Scotland);

• they co-ordinate provision, e.g. SAD, Scottish National Federation for the Welfare of the Blind (SNFWB);

• they fund project developments, e.g. Guide Dogs for the Blind Association (GDBA);
• they train specialist staff e.g. Scottish Association of Sign Language Interpreters (SASLI), GDBA, RNIB.

12. In the West of Scotland local authorities tend to provide sensory impairment services directly. Authorities in the East favour purchasing services from voluntary organisations. Very specialised services for deafblind people are bought from SENSE (Scotland) and Deafblind UK (Scottish office). About half of authorities had drawn up service specifications. A similar number had adopted standards but there was little consensus about the most appropriate framework to use.

13. Contracted services are generally subjected to greater scrutiny by commissioning authorities than their in-house counterparts. The financial baseline for continued funding is historical and exemplary performance does not appear to result in any greater reward.

14. The diverse role of some voluntary organisations can cause unease for both commissioners and providers. In the negotiation of all the service level agreements the key sticking point was the contract price. The local societies consistently sought an increase in funding, either to compensate for inflation or other increased costs. In contrast, contract officers set the contract price primarily by reference to the authority's financial position. In practice, this means that the price paid for the service remained static or was even reduced.

15. Some voluntary organisations have both recreational and welfare functions and have built up reserves over years. In some authorities these are being taken into account when the contract price of a social work service is being decided. There is also little common agreement about the management information that may be useful for monitoring contracted services.

16. More generally, in terms of joint working, social work, health and education staff had a variable understanding of each other's roles and tasks. There were many examples of positive collaborative working that led us to believe in the importance of developing better working links across professional boundaries. In particular, education staff expressed concerns around the preparation for, and follow-up to Future Needs Assessment.

17. Finally, training needs for staff are many and complex but training personnel vary considerably in their ability to identify and meet these needs.

18. Against this backcloth, our survey of 169 people who use sensory impairment services showed a high level of satisfaction with what was provided. Whilst this is reassuring, the results should be treated with caution as the level of expectation may be low and many of the needs that were met were simple ones like requests for equipment.

19. The next chapters outline our findings in depth and our proposals for the way forward.

Comments by The Lay Member

The inspection team was assisted by Mr Ron Partington who was recommended to us as a lay member by Scottish Business in the Community. We have involved lay people (i.e. people who are not professional social workers or employed in the agencies being inspected) in all our inspections since 1993.

Mr Partington brought extensive experience from industry having been a senior executive with Marks and Spencer plc. Prior to retirement he was seconded to the voluntary sector. During this period he established contacts with community organisations, social work departments and companies in setting up short term secondments for specific voluntary sector projects. He continues to be an office bearer in a local branch of the Parkinson's Disease Society.

Numbers of people with sensory impairment

"It is vital that reliable information on numbers is to hand when planning future services.

Local authority statistics of the number of people with a sensory impairment were in the main an extrapolation of figures provided by national organisations, allied to local databases, some of which related to previous authority areas. All local authorities agreed that the numbers quoted were estimates, that they were unsubstantiated and unreliable.

I was concerned that insufficient attention had been given to establishing realistic figures which would take into account the inevitable variations in pattern across the country, particularly as some service providers believed that an appreciable number of people were currently excluded from services. The paradox is recognised that increasing the number of people using services puts an extra strain on resources."

Local government reorganisation

"It may be necessary to take more difficult and painful decisions in order to lay the foundations for an appropriate and cost effective service.

The reorganisation of local government in 1996 presented the new authorities with many challenges, particularly in the allocation of resources under tight budgetary constraint.

I was impressed to note that some local authorities had taken these changes as an opportunity to review all aspects of their responsibility, including staffing structures and numbers. Some innovative ideas and plans to ensure best value were evident.

Other authorities appeared to be trying to adjust inherited staffing structures and facilities to meet new and differing needs, but had little flexibility to bring about necessary change to create best value."

Management

"In some areas there is a possible over dependence on the provider to meet service targets and to be responsible for communicating future needs. There is consequently a danger that delegation of responsibility to a partner can be an act of trust that may be misplaced. Control has to remain with local authorities.

Management teams were under considerable pressure of work to meet the complex and competing demands in their areas. Whilst recognising this fact, it was disappointing to find that the knowledge of some senior managers, about their services to people with a sensory impairment, was poor. This lack of appreciation was reflected at times by middle management, particularly where services were contracted out.

It was encouraging to note the chief executive of one local authority, recognising the need to improve sensory impairment services, had set an example which was reflected in an awareness throughout his management team. His positive approach to sensory impairment was to be commended (note 7)."

Sensory impairment teams

"The dedication and hard work of all the teams was impressive both in and outwith the social work department. They were professional, sensitive to people who use services and striving to provide a good service, despite financial constraints.

There are three issues affecting the efficiency of the teams.

Communication

Despite the problems of finding time for individual discussions or team meetings, some managers should review their practices, if they are to get the best from their workers.

The need for effective two-way communication between management and staff is recognised as essential in any modern organisation.

There was considerable variation in the attention given to this aspect of management, due to the overall demands on individuals. Where little time was devoted to two-way communication there was evidence of depression within the teams. There was concern about the future and the ability to satisfy the requirements of people using services going forward. Some teams felt their views were not heard or valued by their supervisors. Many seemed unaware of current or future strategy of their authority, relating to their areas."

Staff Appraisal

Management should have the ability to assess their staff against agreed performance criteria.

I was surprised to learn that job descriptions do not exist for all staff.

Staff appraisals and assessment procedures appear to be haphazard. Appraisal is a positive approach to determining how workers may improve their performance through training, counselling and encouragement.

Training

Often training budgets are seen as the soft touch in financial reviews but staff development should be retained as an essential priority, to achieve and maintain the delivery of quality services.

Most members of the teams were well aware of the skills and knowledge required to deliver a comprehensive service. It was evident in trying to meet needs some workers were learning the hard way - by experience sometimes outside their normal competence.

The training of staff and developing them to their level of potential is key in:

• increasing motivation, morale and self-esteem;

• improving service standards through knowledge and expertise;
• achieving best value."

Contracting

"The dissemination of good ideas and working practices by networking would be beneficial to all concerned. It would also produce greater consistency in dealing with providers working across local authority boundaries.

Many of the contracts for this financial year had not been completed five months after the commencement date, although providers had been given an understanding of what was required of them and the value of the contract. This practice needs to be eliminated, as it is unprofessional and unfair to providers.

Local authorities do not possess sufficient information about the detailed costs or quality of services to effectively evaluate the efficiency of providers. This observation applies outwith and within social work departments.

Some information is available from service agreements, often historically based, but it is insufficient to give a complete picture. Lack of monitoring makes even this information open to debate. There are few parallel details available for internal service provision.

Uniform 'across the board' financial arrangements, at the time of the review of agreements, will penalise the best providers.

The subsidising of service agreements from the financial reserves of a provider appears to be a fact of life, but it is neither fair nor reasonable.

A great deal of effort has been put in by a number of contract officers to review and revise current documentation. The aim is to make all types of contract or service agreement easier to understand and more meaningful in the description of the quality of services to be provided. In addition greater attention is being given to monitoring and evaluation of services.

This development work is essential to make assessment easier and to produce more accurate and comprehensive costings. I was surprised to note that contract officers are often pioneering within their own areas having little contact with other local authorities who had similar problems."

"I endorse the overall observations and recommendations of the report.

I felt privileged to be a member of the inspection team and found the experience to be both interesting and instructive. I wish to thank my team colleagues for their advice and forbearance together with their sensitivity in getting me through a steep learning curve.

I also thank everyone whom I met on the inspection including members of the local authorities and service deliverers, voluntary workers and people with a sensory impairment, for their courtesy and frank expression of views."

Ron Partington