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Chapter 3 Outcomes for people who use services

Social work services performed to an adequate standard in achieving positive outcomes, with strengths just outweighing weaknesses.

We define outcomes as the direct benefits in people's lives from the services they receive.

In child care we found that positive steps had been taken to increase the likelihood of good outcomes such as being nurtured and achieving potential. In key areas such as child protection, youth justice and community placements for looked after and accommodated children, there was evidence of planned and managed improvement over time. They needed to do better at supporting young carers and providing quicker access to services for children with special needs.

There were big challenges facing the council and it's partners in relation to increasing demand for services for older people, against a back-drop of relatively low levels of provision. Outcome data for adult care groups was mixed. Older people who were receiving social work services said that these had made a positive difference to their quality of life. Other adult service users told us that social work could do more to support them to live full and active lives.

Criminal justice services performed strongly in relation to meeting national standards. They needed to do more to set out whether goals for change agreed with offenders at the beginning of supervision, had been achieved.

Measuring outcomes

During the inspection we asked service users and carers about the difference social work intervention had made to their lives. We did this by sending written surveys and by asking them about outcomes when we met with them on fieldwork.

We also examined information about East Dunbartonshire's performance on national indicators and local improvement targets.

In common with other authorities East Dunbartonshire social work services did not yet routinely measure outcomes for all care groups. There were two parallel developments at the time of the inspection which should bring a clearer focus to measuring the difference made by social work intervention. Social Work were introducing a Performance Improvement Framework, based on the SWIA performance inspection model, across all parts of their service. At the same time, the local authority were developing their single outcome agreement ³ which was to include the social work-related measures identified in the national framework, together with local outcome targets.

Views of people who use services and their carers

We asked service users to report on the following outcomes in our written survey: ⁴

• whether social work helped them achieve more independence
• whether social work services have helped them feel safer
• and helped them to feel part of the community.

Eighty per cent of respondents agreed that social work helped them to lead a more independent life, which was similar to survey results from other inspections. On the last two measures the levels of agreement from service users were 66% and 52% respectively. While service users were positive on the whole about their experience of social work services, these results on service outcomes were the lowest achieved in our inspections to date. They also chimed with what we heard from adult service users on fieldwork. Most told us that social work services were helpful in supporting them to address their needs or problems, but needed to do more to enable them to be socially included and to overcome barriers to employment. We heard this from service users affected by physical disability, mental health problems, learning disabilities and addictions.

Overall, carers who responded to our survey were positive about social work services in East Dunbartonshire ⁵. Compared to other authorities inspected so far, the results for East Dunbartonshire sit comfortably in the upper half of the range of responses.

Sixty-eight per cent of carer respondents agreed that social work services had resulted in an improved quality of life for the person they care for. The majority felt valued and supported as carers. When carers were asked whether social work services meant they had more time for family, work and other commitments, 51% of respondents agreed that this was so.

We found that local authority planning on how best to support adult carers was well developed. Social Work contributed core funding to Carers Link, a support and advocacy service for adult carers. Carers Link were key partners in the development of the current carers strategy and had representation on the joint planning groups. Most carers valued the support they received from Carers Link, and they told us that the opportunities they provided for peer support were particularly helpful in supporting them to cope with their caring responsibilities.

The young carers we met with were also positive about feeling and coping better as a result of being involved with the young carers network. We were concerned that many of the referrals to the network came from social work but there was little or no dialogue between social work and young carer workers, prior to young people attending the network or during the time they spent there. There was no monitoring of what difference it was making.

File reading analysis

The file reading ⁶ findings on key outcomes were positive.

There was a care plan in 77% of the files we read. In 83% of these there was good evidence that objectives described in the plan were being achieved and that the needs of service users were being met completely or mostly in 68%.

In 78% of the files read, the individual has been helped to access mainstream services.

There was evidence in 69% of files that the individual's circumstances had improved during the period under scrutiny. Most files provided evidence that changes in whether someone became more or less dependent on social work support, were in keeping with the needs of service users.

We read a small sample of social enquiry reports and files relating to offenders on supervision (probation, parole and non parole licence and community service.) Nearly all supervision files had an initial plan which focused on agreed actions between worker and offender to tackle offending behaviour and offending-related problems. Reviews were carried out at the appropriate times in the majority of cases but records showed that this dual focus was not being sustained over the supervision period.

Outcome measures

Measuring service outcomes was not yet common practice. We therefore looked for proxy measures, for example whether services met nationally identified targets and performance indicators, and any performance targets that the authority sets itself.

Children in need

We found good collaboration between health, education and social work to develop prevention and early intervention initiatives.

The range of supports covered the spectrum from protected early years/day care provision to more intensive services to avoid reception into care or secure accommodation. There were counselling services in schools and home partnership working when problems at home were contributing to problems in school. Some services had been inspected by statutory bodies, others had been the subject of commissioned evaluation. These reports were positive on the whole but it would be helpful to evaluate all of the services against some core outcome measures.

As well as service developments we found that the last two years had seen an increase in agencies coming together in a range of screening groups, in which concerns about vulnerability or problems could be picked up and addressed by one or more agencies at the earliest opportunity. There were also more inter-agency protocols, such as those on parental substance misuse, to heighten awareness and foster a sense of shared responsibility.

Families and professionals in social work, early years education and health all spoke very positively about the Triple P programme, which supported parents in the development of parenting skills. The extent to which this training had been rolled out to include so many people concerned with aspects of child care, health and early years education, was impressive. The universal approach to participation was especially good.

Child and Adolescent Mental Health Services ( CAMHs)

There was some lack of clarity about access to CAMHs from people we spoke to on fieldwork. Residential child care staff told us that access to the specialist service for looked after and accommodated children, located in Glasgow, was straightforward. They said that the support children received appeared to be very helpful. Family placement staff thought that children in foster care did not have such ease of access.

Child care staff also felt there was lack of clarity about referrals criteria for CAMH services provided through the child and adolescent psychiatry service.

Senior managers in child care should investigate the reasons for this mixed picture and work with partners to ensure that any obstacles to referral and receiving a CAMH service, are addressed.

East Dunbartonshire appeared to be working with health colleagues to meet their responsibilities to provide mental health training to staff concerned with looked after and accommodated children. Foster carers were being provided with books and training events which focused on emotional and psychological issues which could affect the children they were looking after. Kinship carers were included in some training.

Residential child care staff were able to access the training made available to all staff. It was not clear how tailored this was to potential mental health issues related to children who have been received into care.

Looked after children

As at 31 March 2007 the proportion of looked after children (both at home and accommodated) in East Dunbartonshire was lower than the average for Scotland as a whole - 0.4% of the population aged 0-18 compared to 1.3% nationally. Twenty-one per cent of looked after and accommodated children were in residential care, which is higher than the national average of 12%. The Children's Services Plan 2005-08 identified shifting the balance of care from residential to community placements as a key improvement objective. Social work had recruited more foster carers and used more placements during this period but they had also purchased more foster placements outwith the local authority.

Their residential provision comprised three houses which could accommodate up to nine children between them. A new unit was being built which would allow a re-configuration of the service to offer reduced capacity and improved facilities.

Of the 61 children looked after away from home on 31 March 2007, 69% had been in placement for 1 year or more and 28% had 3 or more placements. For Scotland as a whole the figures were 72% and 29% respectively. Out of authority residential school placements remained at much the same level between 2006 and 2007 but numbers were small.

Educational attainment

In 2006-07, 48% of all care leavers in East Dunbartonshire obtained at least one qualification at SCQF level 3 or above, which was less than Scotland's average of 52%. This was a decrease of 15% from the figures for the previous year but the numbers (23) were small. In the core subjects of maths and English, 35% of all care leavers obtained qualifications at SCQF level 3 or above, which was marginally above the Scottish average.

Young people looked after away from home achieved better results than the Scottish average while those looked after at home achieved lower results by a greater margin. Improvements in learning and achievement for vulnerable children was one of the eight priorities of the current children's services plan, with specific actions focusing on looked after children. These included a protocol between education and social work for looked after and accommodated children at risk of school exclusion. Further improvement actions were being taken forward by the 'We Can and Must Do Better' working group, which has been meeting since mid-2007.

Throughcare

It is important that local authorities continue to exercise a duty of care to young people they formerly looked after.

In 2006-07 only 22% of care leavers had either a pathway plan or pathway co-ordinator which was a similar level to the previous year. The figures for Scotland as a whole were 50% and 55% respectively. Child care managers should investigate why pathway planning figures have remained so low.

The same period saw a lower than average percentage of care leavers still in touch with social work (75% against average 88%) although 62% were in education, training or employment, which compared favourably with the Scottish average of 38%. All young people leaving care were supported to take up the opportunity to be linked into the careers service.

Later in the report we comment on the significant challenges facing care leavers in terms of move-on accommodation within East Dunbartonshire and the very recent moves by the local authority to look at possibilities of offering training or employment opportunities to care leavers in council services.

Scottish children's reporters' administration ( SCRA)

Social work services should provide SCRA with assessments and reports on children in need or at risk to themselves or others, within target timescales. This was an area where East Dunbartonshire have achieved sustained improvement in recent years. In the nine months to December 2007 services submitted 79% of reports on time, which was more than double the national average, and the best performance of any local authority on this measure during this period.

The timely submission of offence-related reports from the youth justice team was a particular area of improvement, and the Reporters we spoke to, commended the high quality of youth justice reports for their well-evidenced analysis.

Youth justice

The number of children in East Dunbartonshire referred to the Reporter on offence grounds as a percentage of the population aged 8-16, was 1.4% in 2006-07. This was less than half of the national average of 3%.

The number of qualifying persistent young offenders decreased from 14 in 2003-04 to three in 2006-07. East Dunbartonshire therefore exceeded the national target of reducing numbers by 10% in 2006-07.

The Intensive Support and Monitoring Service ( ISMS) won a national Care Accolade last year. As well as the reduction in the use of secure accommodation since the service was established they have also had success in reintegrating young people into mainstream education. The service has the capacity to support up to six young people at any given time but were supporting 3 who met the criteria at the time of the inspection. Six other young people were being provided with a partial service to address particular needs.

Children with disabilities

Of all the carer groups surveyed, respondents who were carers of children with disabilities were the least satisfied with the range and quality of services available to their child and to meeting their needs as a carer. Evidence gathered throughout the inspection lent support to their view that not enough was being done to enable quicker access to services.

Overnight breaks for children with disabilities declined from 41.3 to 36.1 (nights per 1000 population) between 05/06 and 06/07, giving East Dunbartonshire a ranking of 23 out of 31 authorities. The self-evaluation questionnaire identified this as an area in particular need of improvement.

Residential short breaks were not the only gap in services identified by parent carers in our survey or our field work meetings. Most commonly raised was the pressing need for day-time breaks, the latter including both after-school and during school holidays. Despite an increase in the number of daytime short break hours from 736.7 to 824.8 per 1000 of the population between 05-06 and 06-07 - giving a ranking of 11 out of 31 authorities - there was a general acknowledgement from management and staff that there was not nearly enough to meet demand.

The social work team responsible for children with disabilities recently conducted a planned exercise to clear their long-standing backlog of assessments. However, the shortfall in services has largely resulted in shifting the log-jam from assessment to service provision.

Child protection

As of March, 2007, East Dunbartonshire had 25 children on the child protection register. This figure was equal to 1.3 per 1000 of the population aged 0-15, while the Scottish figure was 2.5 per 1000. Total referrals increased by 39% between 05-06 and 06-07, while registrations doubled from 18 to 37 in the same period.

Fifty per cent of investigations proceeded to case conference, from 40% the previous year. Sixty-two per cent of children on the register had been on for more than two years in 2005. This had been reduced to 0 by 2007, a significant shift in practice. Between 2006-07 4 children who had been removed from the register were re-registered within two years.

East Dunbartonshire was one of the authorities involved in the pilot inspections of services to protect children and young people, launched by HMIE in 2005. At that time the authority had been examining their child protection processes and were concerned about the implications of apparently low conversions of investigation leading to case conferences and of case conferences leading to registrations. By the time of the follow-up inspection in 2007 the report made clear that this internal review had made a significant contribution to the 'very good progress' made by the partner agencies in putting the structures, the processes and the training in place to promote the protection of vulnerable children in East Dunbartonshire.

Older people

As of March 2006 there were 471 older people in care homes funded partly or wholly by East Dunbartonshire, equivalent to 25.5 per 1000 of the population aged 65 or over. This was considerably lower than the Scotland rate of 39.8. East Dunbartonshire had no in-house care home provision for older people.

East Dunbartonshire had higher than average levels of supporting free personal care for self-funding residents, and had experienced a 35% increase in demand between 2002 to 2006.

Between 2006 and 2007 there was a decrease of 6.8% in registered care home places for older people in the local authority, compared to a decrease of 2.2% in Scotland overall. 53% of care home residents from East Dunbartonshire were placed outwith the authority.

In 2006-07 the average time taken to provide community care services from the first identification of need to first service provision was 41 days for older people without dementia and 64 days for those with dementia. This was considerably longer than the Scottish average of 22 days. We return to the issue of delays in access to services in Chapter 5.

As of September 2006 East Dunbartonshire was supporting 1010 people aged 65+ in home care, equivalent to 54.6 per 1000 population in this age group. This was lower than the Scottish rate of 68.2.

East Dunbartonshire was ranked 23rd out of 31 local authorities on the total rate of home care provided in 2006-07. This was an improved figure on the year before. There was a 26% increase in intensive home care of 10 hours per week or more between 05-06 and 06-07. This was partly due to the inclusion of previously unreported hours so they had been performing more strongly than earlier figures suggested.

They were ranked seventh out of 31 local authorities on the level (33.5%) of home care being received in the evenings and overnight, although a year-long pilot of overnight home care had only recently got underway at the time of the inspection. Weekend home care provision was more problematic, with a figure of 55.1% of service users overall and a ranking of 22 out of 31. Social work had just awarded a home care contract for the Bearsden/Milngavie area to address the particular problems of flexible cover there.

Of the total number of older people receiving home care, 83% received free personal care, which was higher than the Scottish figure of 71%. They also received slightly higher than average hours of care. There was no waiting list for free personal care and the council had adopted a policy to this effect from the outset. We comment on how social work have managed the financial implications of this in Chapter 8.

Despite increasing the number of day care places for people aged 65+ by 26.4% between 05/06 and 06-07 performance on waiting lists and waiting times has declined. The following factors played their part in this:

• the base-line level of provision in 05-06 was less than half the national average
• the over 65 age group with some form of disabling condition and/or single person households has been increasing, with higher likelihood of meeting the eligibility criteria
• the level of increase in referrals/demand for day services from all parts of the authority was partly the result of service users who had previously accessed services in Glasgow now looking for day care within East Dunbartonshire.

In 2006-07 East Dunbartonshire was ranked number 26 out of 31 local authorities on the total overnight respite nights provided for older people. We saw evidence on fieldwork that steps had been taken to increase provision, both in residential services and through the pilot overnight home care service. Again, however, they did not act soon enough to address the gap between low base-line provision and increasing demand.

East Dunbartonshire was one of the top-ranking performing authorities on non-day service daytime respite for older people 06-07.

Delayed discharge

In 2006 eight people in East Dunbartonshire experienced delayed discharge, two of whom were delayed for six weeks or longer. This is an area where there had been annual improvements to achieve this very low figure. From April this year the target was to have zero delayed discharges.

During the fieldwork we noted the workload pressures that can result from the universally prioritised drive to keep delayed discharge low and not to exceed the six week threshold for reporting. We were told on fieldwork that 12-14 assessments for delayed discharge patients were being distributed across all adult care teams. There were plans to bring in an agency worker to clear some of the backlog, and workers expressed concern that other important work had to be set aside to do this.

Joint Performance Inspection Authority Framework ( JPIAF)

The Scottish Executive required reports from local authorities and health boards about how effectively they worked in partnership to deliver aspects of community care. These were in the process of being phased out and replaced by outcome agreements at the time of the inspection.

We found evidence to show that East Dunbartonshire had worked hard with health colleagues to address their 'Improvement Required' evaluation in 2005-06. They took a number of significant steps to improve their rating and achieve better performance. These included the re-structuring of joint planning groups, the establishment of a Joint Vulnerable Older People project and resourcing improvement actions relating to increased single shared assessments and joint access to resources.

These measures met with mixed success. Nonetheless, the subsequent 06-07 evaluation of Steady Progress fairly reflected the efforts made by social work and health to tackle what they described in correspondence to the Joint Improvement Team as 'the culture of separation among key service elements'.

Adults with learning disabilities - The same as you?

In 2007, East Dunbartonshire had 390 adults with learning disabilities known to social work, equal to 4.6 per 1000 of the adult population. This was less than the Scottish figure of 5.5 for the same period.

There was a mixed performance picture in relation to supporting opportunities to achieve independence and inclusion outcomes:

• 46% of adults with learning disabilities lived in their own tenancies, higher than the Scotland figure of 33%. Staff did express some concern that supported tenancies arranged on discharge from long-term hospital some years previously, were no longer meeting needs and should be reviewed
• 20% had employment opportunities, higher the Scotland figure of 16%
• 68% had a personal life plan, higher the Scotland figure of 32% and the highest level nationally.

Performance was lower than the Scottish figures on an equal number of important measures:

• 39% of those adults attending a day centre attended full time, compared to 25% nationally
• 20% had alternative day opportunities, compared to 27% nationally
• 12% were in further education, compared to 20% nationally.

We saw evidence that this picture has improved since the appointment of two Local Area Co-ordinators. Between their appointment in 2007 and the inspection fieldwork almost a year later they had supported 24 people to create their own package of support and activity/employment. We heard very positive accounts from service users of the support the co-ordinators had provided to enable them to achieve work and leisure aspirations.

Service users and carers also spoke very highly of the short break facility commissioned by, and located in, the local authority. Since this facility opened in 2006 the availability of short break nights has improved from a level that was just below the Scottish average in 05/06 to well above average the following year. Their ranking rose to number three out of 31 local authorities in 06-07.

Adults with physical disabilities or sensory impairment

Between 2006 and 2007 there was a reduction by almost half of people waiting for an initial occupational therapy assessment. The 2007 figure was 68 on the waiting list. At the time of the inspection there were 186 people waiting for an assessment and a further 61 waiting for a service or equipment. The average waiting time for assessment was 16 weeks. Both health and social work staff told us that there was a problem of people being discharged from hospital without essential aids or equipment being in place. This seemed to be due to problems relating to direct access to joint resources from acute wards and failures to observe pre-discharge protocols. A development day which coincided with the inspection fieldwork, noted the need to roll out self-assessment to reduce waiting times.

From our survey results, respondents with physical disability agreed least that social work services had helped them achieve better outcomes. A stakeholder event in early 2007 clearly included calls from participants for the development of services that would support them to work and in work. There had been no tangible improvements in the year between then and this inspection.

Adults with mental health problems

Outcome data on mental health was limited in East Dunbartonshire, as in most local authorities. Local authorities have statutory obligations to promote and provide opportunities for constructive recreational activity and for employment. There was acknowledgement from both health and local authority managers that recovery-focused resources were under-developed. At the time of the inspection, they were planning a stakeholder event to explore a development strategy, to include overcoming barriers to employment.

A multi-disciplinary crisis response service was established in 2006 to support people who might otherwise have to be admitted to hospital, and to support patients to leave hospital as early as possible. Outcome data on whether the service was achieving success in these objectives did not seem to be kept at service level in an accessible form. Nevertheless, the data which was provided, whilst not clearly demonstrating impact, did show East Dunbartonshire performing well against other areas within the scope of the health board, on lower numbers of multiple admissions and shorter in-patient stays.

Adults with addiction problems

The picture on performance outcomes was a mixed one. On the 2007 target of 85% of new referrals being seen by the community addiction team within 21 days, this target was exceeded. Almost all referrals were being seen within 14 days. The 2007 figures from the Drug Misuse Database stated that East Dunbartonshire saw 79 new service users for every 100,000 of the population. This was low compared to 253 on average in Scotland but, unlike sister community addiction teams in Glasgow, the team in East Dunbartonshire supported more people with alcohol problems than with drug problems. Some figures produced by the team suggested that many service users did not sustain engagement beyond the initial assessment stage. One in four assessments were abandoned in 2007 and in the same period around half of service discharges were unplanned. It should be said that the community addiction team were concerned that their activity levels were not being captured by current recording and reporting, and they were looking at how to develop a comprehensive and reliable data set.

The joint planning group for addiction services were keen to focus more on support for service users to move on from the community addiction service and to secure employment.

The numbers being supported to access Progress to Work were very small (18) in relation to overall numbers of around 300 service users. The community addiction team works to the same service specification as other addiction teams in the Greater Glasgow area. We thought that these teams offered models of rehabilitation to overcome barriers to employment which the team could consider in their plans to improve performance in this area.

A development day was being planned to focus on moving to a 'whole system' or pathway approach to delivering addiction services.

Criminal justice

In 2006-07 criminal justice social work performed above the national average in respect of two of the three statutory performance indicators. 98.3% of social enquiry reports were delivered to the courts on time (the national figure was 95.9%) and the average number of hours offenders worked per week on community service was 4.6 compared to 3.5 nationally. However, only 48% of offenders starting probation were seen within five working days compared with the national figure of 60.4%.

The criminal justice partnership had established procedures for obtaining feedback from offenders about how useful they found the service in helping them stop offending. These showed a positive response from those who completed their orders. Workers' completion reports/summaries did not routinely include what they knew about the extent of any reoffending during the period of supervision. The criminal justice partnership manager had done some work to establish reconviction rates this was not broken down by local authority.

The criminal justice partnership had reduced the target for drug treatment and testing orders ( DTTOs) from ten to six to reflect the number of local offenders likely to be suitable for this scheme. Even at six the target has not been met and the breach rate was high. Managers thought that part of the problem was that the DTTO service was located in Glasgow, making it difficult for offenders to access. Discussions were taking place about the possibility of local provision.

Direct payments

In 2007, 23 service users in East Dunbartonshire received direct payments which was an increase of 2 from 2006. This was equal to 2.2 per 10000 population which was less than half the Scottish average of 4.5.

Most recipients were older people, many of whom had previously funded home support services privately. Direct payments allowed them to continue with much the same arrangements following the introduction of free personal care.

In 2007 East Dunbartonshire drafted an action plan and pledged to invest a further 30% of funding to increase the up-take of direct payments and to meet statutory obligations. The lead officer provided evidence to show that up-take had increased and recipient numbers were standing at 34 at the time of the field work. The draft action plan provided good guidance on all the strands that needed to be pulled together for systematic and sustainable progress. It should be SMART-ened up and signed off as soon as possible.

Income maximisation

The welfare rights team ran regular campaigns to maximise income, including some targeted at local communities and others targeted at people with special needs - for example, people with mental health problems and carers.

The welfare rights service generated £2,660,568 in successful benefit claims in 2006-07 and some success was attributed to a secondment initiative with the Department of Work and Pensions.

Community health staff had been involved in a pilot project to increase their awareness of benefits people might be entitled to and in turn to raise this awareness in the patients and carers they supported. The project had recently been reviewed, there were some positive findings and further actions had been agreed to achieve a more consistent approach.

Care commission

East Dunbartonshire have had a memorandum of understanding ( MOU) with the Care Commission since 2007.

A recent report produced by social work set out the findings from successive care commission inspections of their registered services.

Between 2003 and mid-2007 the report pointed out there had been a reduction in the number of requirements and/or recommendations in each of their in-house registered services, showing a commendable commitment to addressing deficits and continuous improvement. In some cases this amounted to a significant advance in the procedural framework for delivering particular services, as well as enhanced support for staff.

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