Chapter 7 Conclusions And Recommendations

General

172. We found that:

• the quality of individual assessment and service provision varies;

• the arrangement for collaboration between specialist and other social work staff is not always clear, particularly in complex cases;

• some social workers seem reluctant to acquire the basic knowledge and skill necessary to work with people with a sensory impairment but are willing to work alongside specialist staff when required;

• care managers who may have the least detailed understanding of individual need may be holding the purse strings for care packages;

• specialist social workers may be disadvantaged by not always being offered the same training opportunities as their other professional colleagues in respect of child protection and mental health work. They may be less confident in these aspects of practice.

173. With services for people with a visual impairment:

• registration is not a reliable method of identifying needs;

• there are delays between people being seen at eye clinics and by social work staff at home;

• some people receive poor assessments, and others need fuller assessments (which include an assessment of their social care needs) than they are currently given;

• the provision of information and equipment is a task which is achieved relatively well, particularly within authorities with resource centres.

174. With services for people who are deaf and hard of hearing:

• a good quality assessment of need is unlikely because:

• the information needs of people who are deaf or hard of hearing are poorly addressed;

• financial support for the purchase of specialist equipment is uneven and the opportunities to try out specialist equipment are limited;

• the role of interpreters within social work services needs review.

175. On services for people with a dual sensory loss:

• assessment of the needs of deafblind people can be ad hoc and, in smaller authorities, the requisite skills and knowledge are not normally available.

• the expertise available in many authorities to assess and review the needs of deafblind people with additional disabilities, is limited. The work of SENSE (Scotland) in this area is excellent.

• Deafblind people may require distinct support for communication, information and mobility; Deafblind UK (Scottish office) play an important role in providing this service. Think Dual Sensory (note 41) suggests there are 3 strategies for authorities to develop distinct services for deafblind people:

The Need for Coherent Local Strategies

176. While many community care plans refer to the needs of people with a sensory impairment, the basis on which aggregate needs are calculated is not sufficiently accurate for planning services effectively. Authorities do not know exactly how many people living in their area have a sensory impairment. A consequence of inadequate information is that innovative commissioning is not widespread and service development is often ad hoc rather than planned.

177. Both in-house and contracted team leaders in specialist services have high personal and professional standards and demonstrate considerable integrity within their span of control. They, in turn, supervise specialist social work staff who have widely differing knowledge and skill and who have limited opportunities to develop professionally because of inadequate specialist training opportunities. In organising and delivering services, managers need to balance developing knowledge and skills amongst their staff and retain the skilled and knowledgeable specialist. Most senior social work managers did not prioritise this area of work. We found little co-working across specialist and other professional social work teams but there were some exceptions to this where the quality of work was high.

178. Contracting creates tensions because of the conflicting needs of many commissioners and providers. The former are said to be largely concerned with keeping within strict financial boundaries, while providers assert that discussions on quality rarely go beyond price. We are also concerned that contracted services are more rigorously scrutinised than their in-house counterparts. We conclude that the contracting process requires attention in many local authorities and that transparency and even-handedness are essential.

179. Participation of people who have a sensory impairment in service planning and delivery is limited. Representatives' voices are often selected by staff. People who use services told us that they were reluctant to complain. Whilst our survey suggests that many of those using the service are satisfied, we were concerned that this may be because their expectations were low. The contribution of carers in supporting those with a sensory impairment was evident but did not feature strongly throughout the course of this inspection. We know this does not reflect the valuable role they play.

180. National voluntary organisations can be significant partners with local authority and other staff. They can bring added value to the work of local specialist teams, through joint working. They can introduce expert services, information, knowledge and sometimes, additional financial support.

181. There is not one strategy that would suit all authorities.

Recommendation 1

Local authorities should take the lead in establishing multi-agency strategy and resource groups for services for people with sensory impairments. These resource groups should be in place by April 2000.

1. These will provide:

• agreed service specifications and standards;

• clear assessment procedures;

• a forum for meaningful involvement of people who use services and their carers to influence what is offered;

• joint service planning, commissioning and review across local authority boundaries.

All multi-agency strategy and resource groups should ensure that:

• self-assessment is encouraged;

• people who use services on a long-term basis have their needs formally reassessed at regular intervals;

• there is a communications support unit for people who are deaf or hard of hearing;

• a qualified rehabilitation and mobility service is established;

• guide/communicator support for those who are deafblind is available;

• interpreting service provision is appropriate;

• opportunities exist for improved joint working with colleagues in education and health, including interprofessional training;

• targets are set for, and meet training needs;

• specialist information is provided;

• there is access to equipment and pooling of equipment budgets in co-operation with health colleagues.

A variety of structures are feasible but local authorities should take the lead in this initiative. Partnership size may vary according to local need and geographic constraints. Networking and pooling of resources to avoid duplication will be key. The extent to which parties commit themselves will be negotiated at the outset and regularly thereafter. Some may choose to set up a joint working base, e.g. a resource or administrative centre.

Membership would consist of:

• representatives of local and national organisations of people with a sensory impairment;

• senior managers in local authorities, voluntary organisations, health boards and Trusts;

• local authority and health board commissioners;

• providers from local authorities, voluntary sector and health care Trusts.

It may be practical to have an executive which meets twice annually, whereby senior management make the future plan known and then review this after 6 months. The bulk of the work would be the responsibility of a committee of middle managers, providers and people who use services. It may also be that some short life working groups are necessary to drive forward a particular agenda.

The Importance of Effective Joint Working

182. Local councils could achieve better joint working both across departments and with health colleagues through clearer understanding of each other's responsibilities and tasks.

183. We have described some examples of good joint work between health and social work services which demonstrate the value of close links. Such links, whether they are with ophthalmological or audiology services, appear to bring better outcomes for people with a sensory impairment.

184. We also saw numerous examples of education and social work staff working together, to the benefit of children and their families. However, some educational professionals expressed concerns about other professionals' or agencies' preparation for, and follow up of, FNAs. Many education staff do not know a great deal about the functions or responsibilities of social work or the kinds of help and resources that social work services may offer families. Joint working is supported, in some areas, by specialist panels. Nevertheless, these have not been able to resolve some key issues such as respective responsibilities for the purchase of equipment.

185. A high level Committee on post school education and training for young people with special needs has recently been set up, under the Chairmanship of Robert Beattie MBE, by The Scottish Office. Its main focus is on improving the skills and employability of young people with special needs whose ultimate goal is employment, whether full or part-time or voluntary. The Committee will consider the wide range of needs of young people who have few or no qualifications, low basic skills and poor attitude and motivation; and young people with physical disabilities, learning difficulties or mental health problems. The Beattie Committee is scheduled to complete its work in the spring of 1999.

186. Two of the key areas for action identified by the Committee relate to issues raised in this report:

• transitions from school to college and/or training, and ultimately to employment; and

• enabling technologies.

We expect the Beattie Committee to review the issues and recommendations set out in this report as part of its wider considerations; and to take particular note of the concerns raised about effective joint working and the implementation of FNAs.

Recommendation 2

Local authorities and their partners in children services planning should review their existing arrangements for FNAs. The review should:

• examine how well FNAs currently identify young people's needs for continuing education, training, welfare services and other support;

• examine the arrangements for ensuring identified needs are met by all the relevant agencies; and

• identify any improvements which are necessary to ensure the recommendations made by FNAs are carried out.

Authorities should complete these reviews by April 1999 and report their findings to The Scottish Office.

Recommendation 3

The Beattie Committee should consider the concerns expressed in this report about effective joint working and FNAs as part of their wider deliberations.

Clarifying Issues About Certification and Registration

187. As we highlighted, certification and registration are not good indicators of assessed individual need or of the prevalence of needs in the community. Nonetheless they perform an important function. The wide variation in practice both between authorities and within authorities tends to undermine the efficiency of the schemes and sometimes to create a degree of personal confusion. This could be eased by establishing some simple norms to apply across the country.

Recommendation 4

The Scottish Office should convene a short life working group of representatives of local authorities, health services and people with a visual impairment to review, and change as necessary, the efficiency of arrangements for certification and registration.

Ensuring the Effectiveness of Assessments

188. The wide variation, and sometimes regrettable delays, in commencing and completing assessments in this field require to be addressed. The quality of assessments needs to be improved and there needs to be a better understanding within the wider staff group about how sensory impairment can impact on and/or create other social care needs. Collaboration between specialist and other social work professionals and staff needs to be improved to ensure fuller assessments of need are undertaken whenever this is necessary. This is essentially a matter for each local authority who must establish the quality standards to which they are going to work. They must also put in place management and practice arrangements to ensure that these standards are met and that corrective action is taken where services fall short. As authorities develop their Best Value regimes under the Government's initiatives for modernising local government these approaches to setting standards and monitoring performance against key indicators will come to cover all services.

Recommendation 5

All local authorities should review their assessment arrangements for people who have a sensory impairment to ensure that assessments are carried out speedily and that wider needs are considered whenever necessary. The outcome of these reviews should be reported to SWSI by April 1999. All authorities should establish and publish their timescales for assessments.

Improving Training

189. While excellent training opportunities exist in some in-house courses, more specialist qualifications are not being achieved. There are:

• insufficient numbers of lipreading teachers and of lipreading classes;

• grossly inadequate numbers of practitioners with BSL Stage 3;

• insufficient numbers of qualified rehabilitation workers;

• fewer deafblind guide/communicators than needed.

The quality of input on sensory impairment in the DipSW needs to be improved. It may be desirable to identify one location in which future specialist, non-specialist and joint working agendas are tackled simultaneously. Given the diversity of needs, distance learning options would be an important component in overall provision. Essential elements of the adopted model will be:

• professional social worker and rehabilitation worker training;

• postqualifying and specialist learning opportunities, including modules on BSL, lipspeaking and guide communication.

The Scottish Office will be consulting on future developments in education and training for social work services following the announcement of the establishment of a new staff regulatory body for Scotland and the proposed ending of the current arrangements led by the Central Council for Education and Training in Social Work. It will, however, be some years before these new arrangements impact directly and more urgent progress is required.

Recommendation 6

Local authorities should immediately look to:

• increase the numbers of their staff trained to BSL Stage 3, who work with people with a sensory impairment;

• provide sensory awareness training for all levels of staff, including receptionists;

• increase the number of guide/communicators.

Recommendation 7

The Scottish Office should incorporate consideration of the training needs of those who work with people with a sensory impairment into its wider consultations about the future development of education and training in social work services.