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For Scotland's children report

Chapter 4 issues in current services - the experience of service providers

Introduction

The Action Team organised structured discussions with a variety of interest groups and visited many different types of provision. This section of the report describes the main issues that were raised in relation to integrated children's services. The agencies identified problems that fall broadly into four categories.

• Policy - the problems associated with how policy is developed and how it is translated into plans and strategies.
• Defining Need - the lack of appropriate information at the disposal of agencies to help them to define need.
• Resources - the lack of financial and staff resources.
• Fragmentation - how services are fragmented as a result of things that happen to them but also because of their relationships with other services.

Policy

There was a feeling on the part of agencies that the policy agenda was being set by the Scottish Executive and was driven by separate funding streams which came with separate planning and reporting arrangements. There was a feeling that agencies were beset by too many initiatives, plans and reporting arrangements and that too much energy was being diverted to explaining how relatively small amounts of money for children's services were being used.

There was a feeling that these initiatives came from separate departments of the Executive. Although the Executive was good at identifying what needed to be joined up, by and large it was left to agencies working on the ground to make the connections.

Joint Incomes

Agencies felt that joint outcomes which were shared by local authority services, health services and the voluntary sector were key to integrating services. However, there was very little evidence of this in practice. Agencies were struggling to identify agreed outcomes and targets.

Positive Developments in the Policy Field

Agencies were optimistic about a number of initiatives by the Executive:

• The action that had been taken to develop a strategic framework for children's services and rationalise planning arrangements under the Children's Services Plan - bringing early education and childcare and Sure Start Plans under the CSP umbrella and removing the need for a separate review of day care services for under-8s.
• The move to pilot local outcome agreements on children's services which could, if successful, introduce different ways of ensuring that the shared objectives of local authorities and the Scottish Executive are achieved and allow local authorities greater flexibility in the use of funding streams.

The Action Team also heard from people involved in social inclusion within local authorities about the opportunities arising from the power of community initiative to create more flexible and relevant partnerships within the context of community planning.

Defining Need

The Action Team was told a number of times about the lack of accurate available information to help agencies plan and target services. That message came from a variety of sources including the agencies themselves, Drug Action Teams, SIPs, and workers working with black and minority ethnic children and families.

Children in Need

There is a general problem in that, although local authorities have a statutory responsibility in relation to Children in Need, no one has defined exactly which groups fall within the category of "Children in Need". There is certainly no common understanding of which groups we are actually talking about. So from the outset there is disagreement on definition.

The Reliability of Information

There was a feeling that there was a lot of information gathered. But was it the right information? People questioned the systems; the training and skills of people involved in data input and as a result the reliability of that information. There was a desire on the part of agencies to obtain robust information that could inform effective service delivery.

Shared Assessment

The Action Team did come across examples of agencies attempting to develop mechanisms for sharing assessment material although those examples were few and far between. Agencies were struggling with the demand to produce something that was of value to all agencies, reduced the requirement on the service user to undergo several assessments but also produced something that was not unwieldy, bureaucratic and problematic in relation to confidentiality. The issue of confidentiality was a recurrent theme.

"Confidentiality remains a big issue...Someone has to bite the bullet on this to address the issues arising from human rights and data protection legislation."

Staged/Tiered Intervention

The Action Team also saw some attempts by agencies to develop a hierarchy of responses - staged or tiered intervention - identifying at what stage it would be appropriate to involve which agency. In doing so agencies were attempting to ensure that there was a measured and appropriate multi-agency response to need - to the circumstances of individual service users. Again, those examples were few and far between.

The consequence of these findings is that agencies do not have good information about need. That has a knock on effect in terms of their capacity for effective planning and shaping services to meet the needs of users.

Resources

Agencies complained about shortages of resources generally - both financial and staff resources. Many examples were given but work carried out by ADSW is illustrative of the point. ADSW had undertaken an analysis of the funds available for children and families through GAE. They found that they had reduced since 1993 by £35 million in real terms. ADSW estimated that local authorities were now spending over £100 million in excess of their GAE on children's services. It might be expected that a shortage of resources would lead agencies to share their resources in order to make the most of what they had. In fact, the opposite is true. A shortage of resources was seen to have had a detrimental impact on the objective of integrated children's services. A member of the Action Team's practitioner/manager group described it in the following way,

"Services are stretched and therefore they hold on to what they have and what they do rather than sharing resources with other services and working collectively."

Hypothecated Funding Streams

There were also problems around hypothecated funding - both actual and notional. In the context of the general shortage of resources for children's services, hypothecated funding streams to develop very specific areas of children's services were seen as problematic rather than an opportunity. This was particularly so since hypothecated funding is time limited, often arrives at short notice with little time to plan an effective way to invest those funds and to do it in the context of partnership and in the context of linking those funds to other short term funds. Hypothecated funding streams tend to lead to a project based response - developments at the margins of activity rather than driving real shifts in resources or real change.

Staff Resources

Staff resources were also a problem. One authority reported that they were short of 44 social workers and that they were restructuring to reallocate some of the tasks carried out by social workers to unqualified staff. At various meetings we heard about shortages of social workers, health visitors, psychologists, child and adolescent psychiatrists and, of course, teachers in certain subjects.

In some cases the problem was not a shortage of available staff but the problems associated with turn over and the haemorrhaging of good workers away from operational work to management. Good social workers were said to be promoted into management and taken away from direct work with children. Psychiatrists and Psychologists were said to be moving away from direct work with children and acting more as consultants to other professionals. It was also said a number of times that social workers were moving out from local authority to voluntary sector settings.

"Workers in the voluntary sector are asked to do creative, preventative work. This freedom isn't available to social workers within the statutory sector. They are locked into crisis intervention. Social workers who want to be creative leave social work services."

- Representative Of A Large Voluntary Sector Organisation

The Action Team also found that the family, rather than only the child, was seen as the locus for intervention in many circumstances, including the most entrenched situations, but that no staff are currently perceived to be specifically trained to accomplish positive change with such families. Many of those consulted believed that social workers should become the skilled family workers within an integrated family system. Others, particularly from within social work, saw some difficulties in this, believing that there are serious issues of recruitment, training, retention, reward and professional development in social work which seem to require detailed consideration (similar to the consideration applied to teaching by the McCrone committee).

In other cases there were problems with the way that staff resources were reallocated. An example that was raised a number of times related to health visitors. Health visitors were previously attached to communities, covering a defined geographical area and visiting families at home. This changed when health visitors became attached to GPs. This was seen by some as a detrimental change. The development of Local Health Care Co-operatives and a renewed focus on community approaches to practice will help to rebalance this.

A key issue arising from these difficulties was brought to the Action Team's attention. Not only was there a lack of continuity of service to individual children and families, but often intervention was stopped the moment that a positive outcome was identified. Agencies consulted stressed the need to sustain positive outcomes, for example by maintaining a minimal level of contact.

Service Developments

Even service developments which were positively welcomed by most service providers created difficulties for some. The first tranche of new community schools, for example, had the broad support of most of those consulted, and it was generally felt that participating schools and their partner agencies were deriving significant benefits from the changes in the way of working which the pilot programme had stimulated. Some, though, were concerned that there had been a lack of engagement by some agencies, and felt that resource issues had to be more carefully considered in the roll-out of the New Community School model.

Some raised concerns about whether developments could be sustained in a wide range of schools without benefit of the new funding associated with the pilot programme. Others, particularly social work staff, were concerned about the leakage of experienced staff to attractive posts in community schools, leading to shortfalls in mainstream settings. Others expressed concern that new community schools were identifying new (or previously unmet) needs and that resources were thereby being spread more thinly. Some spoke of children so alienated from school that any service provided from within the school would be unlikely to be accepted by them. Social work staff asked how the 1,178 children and families social workers in Scotland could be expected to be involved in the new community schools approach in the 3,024 schools in Scotland, and continue to provide services to pre-5's (including child protection services).

These comments emphasise the inter- related nature of the service system and the finite resource base of qualified staff - issues which will need to be addressed in the roll-out of the new community schools approach across Scotland, and in other service developments.

Fragmentation

Agencies experienced "fragmentation" as a result of factors that were not within their control. Perpetual reorganisation was a common complaint, not just local government reorganisation or the health service moving to a purchaser/provider split and then to unified boards, but also restructuring within those agencies themselves. They complained of constant upheaval and the fact that restructuring inevitably took their eye off the ball. They also complained about fragmentation which arose from having to juggle separate funding streams.

The voluntary sector raised concerns about the contract culture which was becoming very much a part of children's service delivery. The central concern was that local authorities unilaterally decided on policy and strategy and then put out a restrictive tender so that the voluntary sector felt there was little scope for partnership working or integrated working. Moreover, there was little attempt to allow the voluntary sector input into the nature of the service that was needed.

Issues were also raised about fragmentation between services and between agencies. So far, this section of the report has concentrated on the context in which agencies are working: the difficulties, the constraints, and the problems. But there was also criticism of agencies about their failure to communicate, co-operate or work in partnership. The following quotes are typical of the comments that were made:

"I have a better relationship with the health board than I have with services in my own local authority."

- Social Work

"Voluntary organisations sometimes get caught in the crossfire when social work, education and health are at loggerheads."

- Voluntary Sector organisation

These quotations do not reflect a vision of integrated children's services. Unfortunately, they do reflect the reality of the current situation. There is no service that is a consistent culprit - the situation is different in every part of the country. The Action Team heard good examples of integrated children's services. However, the Action Team also frequently heard examples of services that would not collaborate.

The Action Team also saw many examples of good partnership working but also encountered a degree of cynicism. A large voluntary sector organisation described how they had found out that they were cited as a partner on a funding application which they knew nothing about. A member of the practitioner/manager group summed it up in the following way:

"The word partnership is sometimes simply a front for getting money in a quite Machiavellian way."

So, services are fragmented because of the context that they are working in but they also have - or are seen to have - poor relationships with other agencies. Although that is a "challenging" picture in terms of integrated children's services, there are also many good examples of integrated working in the field of children's services which are described later in this report.

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