Scottish Government

CHAPTER 3 Outcomes for people who use services

Inverclyde social work services performed to a good standard in providing positive outcomes for people who use services - important strengths with some areas for improvement. In some areas, for example youth justice, delayed discharge from hospital, and services for adults with learning disabilities, outcomes were particularly strong. The council has performed poorly on the educational attainment of looked after children. In line with many other local authorities, social work services should measure and evaluate outcomes for people who use all the services it provides.

Measuring outcomes

The Social Work Inspection Agency defines outcomes as the changes in people's lives that are a direct result of social work intervention.

Like many other local authorities, Inverclyde social work services do not have a consistent system of evaluating outcomes. They have an electronic information management system, called SWIFT, that can store client and management information and make it available across the social work service. SWIFT had been implemented in all fieldwork teams and currently records initial referrals, child protection, looked after and accommodated children and criminal justice information. The implementation of SWIFT has taken longer than expected - dates are set and then moved back. IT project delays happen in many local authorities. SWIFT was not being systematically used to measure outcomes but does provide quantitative outcome information - such as quarterly management information reports.

Recommendation 1
Outcomes for people who use services should be consistently measured and evaluated. Social work services should put systems in place to do this.

Views of people who use services

We surveyed a sample of people who use social work services in Inverclyde. One hundred and sixteen responses were received. Seventy three per cent of respondents told us that social work services helped them feel safer, 74% said that these services had helped them lead a more independent life, and 62% said that social work had helped them feel a part of their community.

Views of carers

One hundred and forty carers responded to our survey. Fifty four per cent felt they were consulted and listened to, and almost two-thirds thought they had a say in how things were done. Less than half of the carers felt valued and supported, and less than half agreed that they had been helped to have time for family, work or other commitments.

Outcomes for children and families who use services

Children with disabilities

Social work services have developed a transition team for families with children with disabilities. This is funded by the changing children's services fund. Good outcomes were evident from our interviews with social workers, managers and people who use this service. We spoke to some of the young people who have a transition worker. They were very positive about the help and support they received. Funding has been secured for another year and senior managers are addressing the long-term plan for the service. An evaluation and consultation on transition workers was completed in 2005. The parents of children who had a transition worker said that the transition workers gave good support and that they felt well supported throughout the transition process.

The development of integrated services for children with disabilities is in progress. We found that staff worked well together at an operational level. However, they are not co-located due to the current issues with the NHS board. Progression towards further integration will be considered at a strategic level.

Looked after children

In 2004-2005, social work services reported to the Scottish Executive that they had 276 children who were looked after. This is higher than comparator authorities. Of these 276:

• 85% of children and young people were looked after in a community setting (at home or with friends, relatives, or foster carers). Fifteen per cent were in residential care. ³
• 75% of the looked after children and young people had been looked after for more than one year and 16% of the children and young people had three or more placements.

Social work services have started to use the Scottish Executive's performance improvement framework ( PIF) to measure performance on looked after and accommodated children. This is commendable. Performance indicators from the PIF were discussed at the social work services senior management team meeting. Here are some examples of the PIF figures:

• 30% of care leavers had experienced a period of homelessness in the past year. The throughcare team offered all of the homeless young people a service. None of the young people were roofless
• 6 out of 7 sibling groups placed in the last year were placed together
• No accommodated young women were pregnant or became pregnant during the last year.

Outcomes for looked after and accommodated children were not measured by social work services. Opportunities to systematically record outcomes in relation to looked after children were being missed - despite a wealth of information held by staff about children, young people and families, which could inform service planning and development.

Educational attainment

Over a three year period (from 2002) Inverclyde were one of the poorest performers in Scotland on the educational attainment of looked after children. Educational attainment of looked after children is the responsibility of education services and social work services. We recognise that the relatively small numbers of care leavers means that the data and the conclusions drawn from the data have to be treated with caution. The time series data is as follows:

• in 02/03 13% of care leavers got at least one qualification at SCQF level 3 or above. There was no data for children looked after at home. 13% is the lowest figure for Scotland; the Scotland average is 53% (n=60).
• in 03/04, no care leavers who were looked after at home got any qualifications at SCQF level 3 or above; the Scotland average was 35%. Thirty per cent of care leavers looked after away from home got SCQF level 3 or above qualifications; the Scotland average was 52% (n=20).
• in 04/05, no care leavers who were looked after at home got SCQF level 3 or above qualifications; the Scotland average was 37%. Thirty six per cent of care leavers looked after away from home got SCQF level 3 or above qualifications; the Scotland average was 55% (n=19).

Social work services and their partners have implemented a number of initiatives. For example, they have appointed a second looked after and accommodated teacher to provide support with homework, projects, preparation for exams, and in the classroom. However, the development of a policy for the exclusion of looked after and accommodated children had been discussed with the education service, but a policy had not yet been put into place. There are some schools which provide a good service and level of support to looked after and accommodated children but this is not consistent across the authority.

Recommendation 2
Social work services and their partners should urgently address ways to improve the educational attainment of looked after children.

Foster care

As a result of a successful fostering campaign, social work services are now completing eight assessments for new foster carers and there were five couples proceeding through the adoption assessment process. Social work services have trebled the number of foster carers over the past three years. The Fostering Network plans to use Inverclyde to launch "fostering fortnight" because of the successful campaign. There were 50 children placed with foster carers in Inverclyde.

Good practice example
Active Steps provided the opportunity for children who were in need, looked after or accommodated to access a range of sports, physical and cultural activities. This programme promoted inclusion by involving the parent or carer and aimed to improve relationships in the family.

Kinship care

There were 53 children in kinship placements in Inverclyde, being looked after by a non-parental family member, such as a grandparent. This is slightly higher than comparator authorities. At the time of the inspection, carers of 17 of the 53 children had their needs assessed.

The kinship care post had been vacant for a number of months but has recently been filled. Outcomes for children looked after in kinship care has not been measured and social work management have identified this as an area for development.

Policies and procedures to support and train kinship carers and a system for measuring outcomes for children in kinship care will continue to be developed and implemented when the new worker starts in post.

Children's rights

The Who Cares? Scotland worker provided independent advocacy for looked after and accommodated children. They had developed good links with schools, foster care and residential units in the Inverclyde area. The children's rights and information worker provided a vital role in helping to keep staff across the council and children informed about children's rights in Scotland. The children's rights and information worker is managed by the director of community services.

Throughcare

In 2004-2005, 16 young people left care at over the age of 16. Four of the 16 were looked after at home and twelve were looked after in placements away from home. Of these 16, nine had a pathway plan and a nominated pathway coordinator. Fifty six per cent of young people had a pathway plan (which is higher than the Scottish average of 41%) and a nominated pathway coordinator. The Scottish Executive's 04/05 figures show that 38% (n=26) of Inverclyde care leavers entitled to aftercare support are in education training or employment - the Scottish average is 22%.

The 2006 figures given to us by social work services are:

• there are 42 care leavers in the 16 to 19 age range
• of these, 17 are currently in education, training or employment, representing 40%
• almost 60% of care leavers are not in education, training or employment.

The Care Commission inspected Inverclyde's throughcare service in March 2006. The inspection report is favourable. All of the young people who responded to a questionnaire and who spoke to the Care Commission inspector said that they would have difficulty sustaining their tenancy if they did not have the support of the housing support team. The Care Commission report also says that "most young people felt they were offered flats in poor areas".

Youth justice

Social work services significantly exceeded the national target to reduce persistent young offenders ⁴ by 10%. They achieved a 20% reduction in youth offending and a 33% reduction in the numbers of persistent offenders. The number of persistent offenders fell from 21 in 04/05 to 14
in 05/06. ⁵ The number of qualifying offences by persistent offenders fell from 157 in 04/05 to
115 in 05/06. This was achieved without imposing anti-social behaviour orders ( ASBOs) on under 16s. We think this is strong evidence of effective policy review, policy development, and partnership working. The authority reporter told us that case progression meetings were a particularly effective example of multi-agency working.

Social work services had improved the time interval for submitting social background reports to the reporter and was meeting this requirement in more than 60% of cases. This was an increase from the previous year.

Good practice example
Ninety-five per cent of children and young people in trouble referred to the reporter to the children's panel on offence grounds got a comprehensive YLS- CMI assessment (youth level of service - case management inventory). Completed assessments were considered at a multi-agency case progression meeting. Information from completed assessments were held on a central database. Quarterly and annual reports were produced.
There were a range of resources available, provided by social work, education and voluntary organisations. Some resources included health professionals as part of multi-disciplinary teams. There was effective multi-agency working, both in relation to completing assessments and meeting the needs of children and young people.
Effective monitoring has shown a fall in the number of persistent young offenders, and an underlying reduction in the number of children being referred to the reporter on offence grounds.

Child protection

On 31/03/05, social work services had 35 children on its child protection register. This equates to a rate of 2.2 per 1000 population aged 0-15, which is slightly less than the Scottish average of 2.3 per 1000. During the year ending 31/03/05, there were 102 child protection referrals, 43 of which were subject to a case conference. There were 25 registrations and 49 de-registrations in that year.

Inverclyde Council set up a working group for the quality assurance of the child protection system in November 2005. The working group arranged for an audit of child protection case files using the SWIA template for scrutinising case files. Twelve files were audited in January 2006. The audit found that in 11 out of 12 cases, the objectives set out in the care plan had been achieved or were in the process of being achieved. There were also quarterly internal audits of files.

Outcomes for people using community care services

Inverclyde Council (04/05) was ranked fourth ⁶ out of the 32 Local Authorities for the number of older people over 65 receiving personal care. They ranked 6th on the total hours of home care they provided as a rate per 1,000 population aged 65 and over. Social work services and their partners also performed well in relation to delayed discharge. In 2005, they had a decrease of over 50% in delayed discharge cases from 2004. Comparator authorities show a decrease of 11% and the Scotland figures show a decrease of 26%.

The Inverclyde Partnership ( NHS Greater Glasgow and Clyde and the local authority) submits annual returns to the Scottish Executive joint future unit on progress with joint working and outcomes for people using community care services. Some of the local improvement target figures from the 2004-2005 return show that the Inverclyde Partnership had:

• increased the percentage of older people who get more than 10 hours a week home care by 5%. The target figure was 2.5%
• achieved a 6.1% increase in the number of older people getting more than 20 hours a week home care
• decreased the number of care home placements for older people by 1.9%. This is below the target figure of 2.5%
• reduced the number of delayed discharges from hospital from 90 to 36. The target figure was 50
• reduced the number of delayed discharges where the delay is over six weeks to 22. The target figure was 46
• reduced the number of delayed discharges from acute services to two. The target figure was 22.

Services for adults with physical disabilities and sensory impairment

During the period of 2004-2005, over 4500 people were assessed as needing equipment packages. Over 900 people had a range of adaptations made to their accommodation. One hundred and twenty six people received assistance from the community rehabilitation service.

In 2004, there were over 850 adults with physical disabilities in Inverclyde, of whom 13% received a home care service. ⁷ This was an increase from the previous year.

We visited the centre for independent living, which we found to be a high quality resource for people with physical disabilities. The building was of a good standard and there was equipment available for people to try before they made a commitment to buy. We spoke to some people who used the centre and they told us they were happy with the services provided.

Aids and adaptations are provided for people with physical disabilities. In common with many other local authorities, there is a waiting list for this service due to the high demand.

Mental health services

There were 700 people in Inverclyde with an allocated care worker from the community mental health team or the older people's mental health team. The multi-disciplinary partnership between health and social work worked well. The community mental health team, used "staying well" care plans, which included contingency plans to prevent relapse. Staying well plans are multi agency plans. People who use services found these helpful. Staying well plans were not being used in the older people's mental health team. We think social work services should consider extending the use of staying well plans to older people's mental health services.

In 2004, 64% of people with mental health problems in Inverclyde received home care services (1.8% down on the previous year). This is still well above the Scottish average of 45%.

We met with staff from mental health services. They said the service was coping well with the demands of the new Mental Health Care and Treatment (Scotland) Act 2003. In order to meet the demands of the new act, social work services had two mental health officers ( MHOs) on duty. Social work services have the third highest figure in Scotland of numbers of MHOs per thousand of the population (0.19 whole time equivalents).

We were unable to read any mental health case files as part of the inspection process, as service users chose not to give their consent. We are therefore unable to comment on the quality of individual files in Inverclyde. Mental health case files were joint social work and NHS files.

Services for people who misuse substances

The community drugs team dealt with 244 new referrals in 2005-2006. The team provided advice, information and support. Comprehensive assessments were done and care plans developed in partnership with service users.

Good practice example
We visited the community drugs team. We were impressed by the team's work with people who misuse drugs. We met with a service user who described the support they had received to overcome their chaotic drug misuse and re-build their life. They gave a very powerful account of the changes made to their life. Participation in a voluntary project helped the person to get a job. They told us "if it wasn't for the drugs team, I wouldn't be alive today".

Social work services have developed an alcohol home detox service in partnership with the NHS. Over 80% of service users reported a marked increase in well being and level of social functioning. A very small number (5%) of the 60 people using this service relapsed to a chaotic lifestyle.

Good practice example

The home detox outreach service was an innovative project developed on the basis of evidence-based practice. The service provided a support package to individuals who were assessed as suitable for this approach. Two outreach workers, along with the detox community care charge nurse, assessed service user's needs. Service users got support, advice, and advocacy and were encouraged to access mainstream community services. Workers also provided support for carers, if required.

The same as you?

In 2005, Inverclyde had 436 adults with learning disabilities known to the service. ⁸ Of those, 36% were living independently in their own tenancy (compared to a Scottish average of 28%).

Eight adults with learning disabilities from Inverclyde were still in long stay hospital wards. The national target for closure of all long stay learning disability hospital wards by the end of 2005 has not yet been met across Scotland. Social work services have commissioned a housing association to build a supported accommodation unit to facilitate the hospital retraction, but there were delays with the construction. However a site start is scheduled for July 2006 with completion due in March 2007.

In 2005, the number of adults with learning disabilities using the services of the local area coordinator had increased 3% from the previous year to 15% (n=66). In the same period, 13% of adults with learning disabilities had a personal life plan. This is less than the Scottish average of 25%. Twenty one per cent of adults with learning disabilities had an independent advocate in 2005, which compares very favourably to the Scottish average of 11%.

Fifty eight per cent of adults with learning disabilities known to social work services had community short breaks. This is the highest figure for Scotland (the Scottish average is 11%). A community short break could be the adult with learning disabilities getting support for activities in the community or the adult is supported at home. In both cases, the family carer gets a respite break.

Seventeen per cent of adults with learning disabilities attended a day centre full time. The Scottish figure is 27%. The same as you? states that no adults with learning disabilities should attend a day centre full time, i.e. five days a week.

Almost half (46%) of the adults with learning disabilities who attend day centres got alternative day opportunities (compared to a Scottish average of 28%). These could be employment, further education, training or leisure and recreation opportunities.

Sixteen per cent of adults with learning disabilities known to social work services had employment opportunities. This is slightly above the Scottish average of 14%. Many of the employment opportunities were voluntary work and non-open ⁹ employment. There were 37 adults with learning disabilities in open employment ¹⁰ in 2005.

We found no system of performance management in day services for people with learning disabilities. When we spoke to day centre staff, they told us that there were no numerical targets that they were working to achieve.

Day services are being redesigned. All those who use day services will get a personal life plan. They will get the opportunity to do more activities in the community.

Direct payments

Direct payments have been available to people with disabilities aged 18-64 since April 1997. These were gradually extended to other groups of people who use services. From June 2003, it became a duty for local authorities to offer direct payments in place of providing services to all eligible disabled people aged 16 or over, and to parents of children with a disability (or those with parental responsibility) aged 15 and under.

Inverclyde had the third lowest uptake of direct payments in Scotland. Direct payments are now being promoted but there were only 6 adults in receipt of direct payments at the time we visited. Social work services are piloting a revised care plan structure that includes information about direct payments. Outcomes for people who use direct payments were not measured.

New staff were given information sessions and a booklet about direct payments and there were information leaflets for the public available in local offices.

There were no children in receipt of direct payments in Inverclyde. This is discussed further in chapter 5 - key processes.

Outcomes for carers

Of the 140 carers who responded to our questionnaire, almost half received a service from social work services as a carer and 39% received help from another organisation. Just over half of the carers who responded agreed that they had been consulted and listened to and 48% agreed that they felt supported and valued as a carer.

The Inverclyde joint carers strategy (2005-2008), was developed in partnership with carers. It aimed to improve outcomes for carers. Because of this strategy, an information pack for carers was produced and distributed, and a carers assessment tool was piloted. A carers charter had also been developed. The council and the NHS board have adopted this.

We observed a meeting of the carers centre management committee. They told us services for carers in Inverclyde were getting better. They felt that the carers centre had helped with this. They also told us that there needs to be more flexible respite provision, particularly in crisis situations.

A young carers social worker provided a service to 41 young carers. We attended a young carers group where staff and young people spoke very positively about the benefit they got from the group.

The welfare rights service

The welfare rights service produced impressive reports on the result of benefit claims. The service also has a user consultation questionnaire.