Chapter 5 Working Together

121. In this chapter we review the working links between specialist staff in social work services and other professionals working in the health and education services.

Health

122. Specialist social work staff consider their key partners in the health services to be the staff in hospital based specialisms, primarily ophthalmology and audiology. We looked at the quality of their working relationships and the availability of information to people with a sensory impairment.

Ophthalmology and Low Vision Aids (LVAs)

123. The presence of social work staff from specialist teams or agencies and volunteers, in hospital eye clinics was widely supported by health service staff. It provided an opportunity to both share information about community services with patients and staff and identify the kind of assistance that people may be seeking or needing. Unfortunately, such co-location is not a common practice. In Aberdeen and Moray the consultant ophthalmologist would have welcomed the presence of GSB staff at the clinic. He commented that a clinic operating with a social worker present would represent a "gold standard".

124. Many elements of good practice in joint working were evident in the Glasgow Western Infirmary Outpatient Department Eye Clinic. The clinic provided an effective bridge between health and community services and had close links with specialist social work services in Glasgow and West of Scotland Society for the Blind. The clinic was nurse led and people were helped to understand their medical condition, what certification and registration involved and where and how to get other assistance. Senior nurses had received training in counselling and the clinic housed an LVA assessment unit. Information about services is available in both written and audio taped formats.

125. Good collaborative working was also in evidence at the Low Vision clinic at the Victoria Hospital in Kirkcaldy. This "one stop shop" combined eye examinations with the provision of LVAs. FSB had a member of staff based there, the Vision Services Officer, who was introduced to patients as a member of the clinic team. She provided information about the registration procedure and available community services and would assist patients to try out aids.

Practice elsewhere was characterised by a lack of joint working resulting in:

• people leaving hospital having been told "there was nothing more to be done";

• little or inadequate explanation about registration;

• poor links with social work services;

• no offers of counselling.

126. Written information about social work services was available at clinics we visited and able to be handed to people and their carers.

127. There is no doubt that social work staff could do much valuable work in relation to information-sharing, welfare benefits advice and counselling at the point of registration and at LVA clinics. The significance of this social exchange is well summarised by one person who described her feelings at the time of her eye examination:

"Doctors are very good at what they do and I do not want to criticise them. When I found there was nothing to be done ... I felt very isolated and alone. A friendly face and a chat would have been helpful at this stage."

Audiology

128. People who are profoundly deaf may have little need for ongoing contact with audiology. Those who have some residual hearing are likely to have different contact with the health service as they may benefit from more conventional hearing support and be referred to audiologists.

129. We found audiologists used specialist social work staff to provide practical support, e.g. the provision of environmental equipment and benefits advice. Specialist teams were not generally perceived to have counselling skills.

130. Audiologists said that introducing social work support needed to be done sensitively. In Glasgow and Oban audiologists thought their patients would not accept social work assistance because of the perceived stigma. However, where the service was provided, its high quality was praised. In Ayr and Kirkcaldy social workers were routinely introduced to patients by audiologists as one of the team who was specially trained to assist.

131. A pro-active approach to joint working is well illustrated by a pilot project in Ayr Hospital. A course (note 35) aimed at maximising communication for 10 patients who used hearing aids (aged 50-75 years) who had hearing loss, ranging from moderate/severe to profound was established. Patients had been using monaural and binaural hearing aids for a minimum of 10 years. Course content included introduction to lipreading, training videos, demonstration of environmental aids and talks. All but one person confirmed that the course had improved their communication ability. Another project begun in 1997 is intended to raise staff awareness in both the health service and the community to the needs of people with a sensory impairment and hopes to provide the necessary skills and services.

132. In Aberdeen both social work and technical officer staff from ANEDS attend a specialist hearing aid clinic. Social work students, on placement at the Society, are provided with an opportunity to visit the audiology department as part of their training. There are further examples of collaboration in the community. Audiology staff have been involved with ANEDS in developing hearing aid routine maintenance classes. In Glasgow, audiology staff have developed deaf awareness training, jointly with social work and RNID staff. In Fife audiology staff have promoted training with social work home care and day care staff.

133. The availability of information about social work services differed between audiology clinics. In Aberdeen the local Society's leaflets were prominently displayed. In other clinics information was rarely on public view but leaflets sent by social work staff to audiology staff, describing how to contact the specialist team, could be provided directly by clinic staff to people using the service. An attractive display of RNID literature was seen in 4 of the clinics visited and compared favourably in presentation and designs with publicity materials provided by some specialist teams.

Social work, ophthalmology and audiology

134. In Fife there are growing links between ophthalmology and audiology clinics. Both are aware of a proposal to develop a common location for FSB staff and the social work communication support team. This collaboration between social work services appeared to have been the stimulus for closer working between the two health specialisms. The social work staff welcomed this because of the growing numbers of older people who have dual sensory loss attending both clinics.

Education

135. This section looks at working links between those education and social work staff who are concerned with children with a sensory impairment. We have looked specifically, but not exclusively, at work to assist children and their families to plan for the children's lives after they have left school.

Future Needs Assessment

136. Children with sensory impairment who have a Record of Needs will undergo further assessment within the 2 years before they are 16, the age at which they can leave school. This assessment should identify their needs, make arrangements for any continuing or higher educational training and assess the young person's need for any social services or support to assist their transition to adulthood. These assessments known as Future Needs Assessments (FNA) are generally co-ordinated by education staff, with input from social work.

137. The legal framework for the FNA is the Education (Scotland) Act 1980 and the Disabled Persons (Services, Consultation and Representation) Act 1986. Additionally, children with sensory impairment are children in need under the Children (Scotland) Act 1995. They and their carers are entitled to an assessment of their needs and may be eligible for welfare and support services. Guidance on FNA and on services for children who are disabled has been issued by The Scottish Office (note 36).

Quality of working relationships

138. All the education staff we spoke to stressed the importance of social work staff having a working relationship with children and their families prior to the FNA. They said that the earlier social work staff established a relationship with families, the better. One chief social work officer told us: "There is no use parachuting social workers in when a child is 14." An early introduction led to families developing an understanding of the role and resources offered by social work services. A late introduction could lead to difficulties as some families were suspicious of social workers. Social work was, we were told, seen to be linked to problems rather than opportunities, stigmatising rather than enabling. Without exception, the same staff also related the positive experiences of social work that children and families shared with them after having made contact. We believe that whilst early contact may be beneficial, it should always be purposeful.

139. There was some ambivalence amongst specialist educational staff about which social workers should attend FNAs. One senior psychologist questioned the ability of specialist sensory impairment staff to keep abreast of developments in other areas of social work practice like child protection. She also queried the appropriateness of budgetary decisions being made by generic care managers who knew little about specialist needs. In other areas several social workers could arrive for the FNA - from children and families, criminal justice services and the sensory impairment team, all of whom could be accompanied by their line manager.

140. Education staff described the occasional difficulties of social work staff from a children and families team being involved in the FNA, but staff from the community care team (without specialist knowledge) being charged with implementing the decisions of the FNA. They expressed concerns that planning decisions at the FNA were not being followed through when responsibility was transferred from social work staff in children and families teams to community care teams. Education staff offered the following example:

James (note 37) is 19 years old, deaf with little speech and complex needs, attending a school in England. His family would like him to live locally which would require considerable long-term planning. The psychologist anticipated that social work funding for the school would continue without much questioning until the age of 21, but the possible opportunity for re-integration was disappearing. Her preference would have been that those who fund and those who have specialist knowledge work more harmoniously to a more satisfactory outcome.

141. Scottish Office guidance issued for implementation of the Children (Scotland) Act 1995 (note 38) encourages local authorities to ensure continuity of services whenever possible for young people and their families during this transitional period. A worker, or key worker, should be identified from whichever service has most direct involvement, to whom the young person and his or her family can turn for information and advice.

Quality of information

142. The information that education staff possessed about social work services appeared to rely heavily on personal contact. People who worked together learned about each other's role. For education staff this tended to mean that they knew specialist social workers best and some children and families workers where there had been a need for their involvement. They were less aware of what other social work services were available and would have welcomed written material about this.

143. There were some examples of good practice in information giving. Research by educational psychologists in Aberdeen revealed that visually impaired people were unclear about what services existed as they moved from school to adulthood. This led to the introduction of an information pack designed by and published for young people. We noted that the pack contained the address of the offices of GSB, but not the addresses of local social work offices.

144. Local authorities have a duty under the Children (Scotland) Act 1995 to publish information about services for children in need, including children with disabilities. The importance of information covering a wide range of interests - employment, health, education, social and recreational - has been acknowledged in Glasgow. Paving the Way (note 39) is the title of a publication from Glasgow City Council that is aimed at many different children and their families, to assist them in post-school choices. We are aware of other authorities' work to produce information for children and families during transition from school to adulthood.

Strategic Approaches

145. The existence of jointly owned and developed interdepartmental strategies is essential to assist better collaboration. This can be provided by clear direction from the top such as the Fife Social Strategy. Where this joint strategy did not exist, psychologists we spoke to told us they had to resolve operational issues at a local level that should have been agreed at Directorate level.

146. A structured approach to joint working is the development of panels for staff working with people with a visual impairment and for staff working with people who are deaf or hard of hearing. The panels provide a single forum for staff across social work and education departments, bringing in others from health and voluntary organisations as appropriate. At the time of our visit panels were already in operation in Fife and being actively promoted in East Ayrshire, Glasgow and Moray.

147. The arrangements for the purchase of specialist equipment are a key issue needing interdepartmental agreement. Disputes have arisen and continue to arise as to whether an item of equipment is to be purchased for educational or social reasons. The home computer, of immense value to children with a sensory impairment, can serve both functions. "Who pays?" is the question. As more students with a sensory impairment enter further education such issues need a mechanism for their local resolution.

Summary

• Social work, health and education staff had a variable working knowledge of each other's identity, location and responsibilities.

• We found examples of collaboration which demonstrated the value of forging closer working links.

• Widespread concerns existed around the preparation for, and follow up to, FNAs. Information about social work services amongst education staff was heavily dependent on personal contact and was better in smaller authorities. Interdepartmental, jointly owned strategies assisted better working practices.