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Evaluation of the Implementation of Local Area Co-ordination in Scotland

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CHAPTER NINE ALTERNATIVES TO LAC: VIEWS OF AUTHORITIES WITHOUT LOCAL AREA CO-ORDINATION

INTRODUCTION

Seven authorities did not have LAC at the time of writing (hereinafter referred to as non- LAC authorities). As mentioned in Chapter One, although Scottish Executive statistical returns (Scottish Executive 2006a) report that, in 2005, 27 local authorities had implemented LAC, our research found only 25 such authorities, the remaining seven telling us they had no LACs . The aim of including these authorities in this evaluation was to explore the reasons for not implementing local area coordination; what barriers or pressures, if any, there may have been to implementing LAC; what alternative provision was currently in place; whether these authorities had any revised plans to develop LAC in the future and finally, what their concerns were, if any, about implementing LAC.

As described in Annex One, telephone interviews were conducted with managers from the seven local authorities which did not have LAC involvement at the time of the fieldwork. The interviewees were all at management level, comprising senior staff from adult services, community care, learning disabilities and development services.

During the course of the fieldwork for this evaluation, it was suggested by some non- LAC authorities that they should be more fully included - for example by being considered as case study areas in their own right, not least because, these authorities argued, they were achieving comparable outcomes to the LAC authorities, albeit offering such support and services via different channels. Careful thought was given to this suggestion and advice taken from the Social Work Research Centre Advisory Group. The strong consensus of opinion was, however, against including a non- LAC authority in the case study areas, partly because these were designed to explore what was distinctive about LAC, not to evaluate alternative ways of supporting people, and partly because there would have been methodological difficulties in drawing comparisons between areas with and without LAC: the study is not using an experimental design and it would be impossible to control for the wide range of variables present in 'real life' social settings of this kind.

Perceptions of the LAC role

Most of the respondents were familiar with the role of LAC and could identify readily the key factors associated with its ethos. The majority (five respondents) suggested that the role was to offer support and access to services for people and to build up links and relationships, not only with individuals and families but also with other agencies working in the locality. Integration and social inclusion were mentioned by four of the respondents and three suggested that choice and fulfilment were important aspects of the role that LACs could achieve for individuals, as well as developing their local networks and being a resource bank for information and advice. Three respondents also mentioned that LAC should be able to either divert people from, or reduce the need for, mainstream services, as one respondent explained:

"… it is something that diverts people away from mainstream services, from social work services, if that's not what they are needing, so it can actually help people see what's around locally, help them accessing [services] without them necessarily needing to go to statutory services."

One other respondent implied that LAC should be separate from the statutory sector for similar reasons:

"… the LAC would be separate to [social work], wouldn't be managed within that sector, it would be kept out of that because they get pulled in to day-to-day stuff probably, so it would be a discrete function."

Such a 'discrete function' would have the capacity and autonomy to work more proactively with individuals, families and agencies, to promote change and to co-ordinate or facilitate supports or services. One respondent described the role in the following way: 'influencing and shaping the way communities and services develop to respond to what people want'. It was thus implied that the LAC role should be as much about campaigning and building capacity more widely as about co-ordinating opportunities or services on the ground.

Most respondents were familiar with the guiding principles of LAC and found them not only useful but complementary to the ethos of social work more generally. The main principles mentioned were inclusion, support, information sharing, valuing people's needs and wishes, enabling them to 'live the life they want to lead', making community links and building capacity, equal partnerships and working with people with all types of impairment, from the cradle to the grave. However, all the respondents could envisage problems in implementing LAC, as discussed in the final section of this chapter. Meantime, the following section on why LAC was not implemented in these authorities will go some way towards highlighting what those problems may be.

The rationale for alternative provision

It should be noted that one authority had previously employed a LAC but discontinued this resource while another was about to implement LAC. Nevertheless, of the seven non- LAC authorities, five said they had wanted to develop LAC posts based on the recommendations of The same as you?, but that either there was no money available at the time, or creating such posts was not a priority within the Council more broadly. One authority had gone to great lengths at the time of the The same as you? recommendations to consult widely, both within the local authority at senior management level (health and social work) and with neighbouring authorities who had experience of LAC, about the possibility of implementing it. They had earmarked the monies required and were in discussions with Eddie Bartnik's team in Western Australia when it became apparent that an unusually high and unexpected number of children with profound impairment and/or complex health needs were leaving school that year and would require all the resources that had been set aside for the potential LAC project; thus the plans for LAC had to be subsequently shelved.

Two of these authorities have since tried to match the ethos and remit of LAC through existing structures and within existing budgetary limits:

"We have spent quite a bit of time trying to look at the principles [of LAC] and how we might still try to provide local area co-ordination or the aims of local area co-ordination without actually having a co-ordinator in post."

Both these authorities had identified the additional supports or services that might be needed in order to fulfil the basic requirements of LAC. These included: personal life planning; information and advice; a 'transitions' social worker; a supported employment scheme and leisure services.

The remaining two authorities felt that their existing services did not need any specifically LAC-oriented additions but could nevertheless replicate LAC. In one authority, a review that had taken place prior to The same as you? had resulted in changes being made to adult services and staff were moved from day services to community bases and their remit changed to providing a direct community support service to individuals and families. Although these staff continued to have links with day centres, they were based in social work offices, in small teams, and their work included organising care packages, volunteering work for individuals, health and fitness opportunities, higher education and independent travel training. Because of this change of emphasis, it was not felt appropriate to make further changes towards a LAC approach without first letting the community-based support teams 'bed in' and test out their effectiveness. However, there was also a presumption at that time that LAC may not be necessary given the wide-ranging remit of the new teams:

"We felt that actually local area co-ordination wasn't really adding anything in particular to what we already had… we have toyed from time to time with just renaming them local area co-ordinators, but that would be slightly, you know, we know that they are not entirely because, as I say, they [currently] offer a direct service. But [they] do have a kind of community building role, they do work with the private sector and they do try and stimulate opportunities in the community. So… we felt that we were probably going to be able to evidence the same outcomes as a local area co-ordinator… We built up our care management team… and they do a lot of co-ordination, for example, around services for people with learning disability and they link with day centres, the voluntary sector, a fairly flourishing voluntary sector… and the private sector too. But apart from that, we have invested quite a lot in advocacy you know, so if you put all that together, it kind of fits very largely into the local area co-ordination role. There is probably not… a lot left over for an LAC to do."

In the other authority, there were already staff in post who were deemed to be doing very similar work to that proposed within LAC. They had a worker who focused on young people in transition, supported employment services for people with learning disabilities and local day services:

"We don't have local area co-ordinators but we do have local area co-ordination. We agree wholeheartedly with the tasks and with the role that was ascribed to local area co-ordinators but what we didn't do was go down the route of appointing that person because what we feel is we've got a range of key posts which were in fact already in place… we haven't appointed a local area co-ordinator, we've changed our structure such that we think we've done it in a more far-reaching way."

Barriers to implementation of LAC

The main barrier to implementation of LAC in the authorities that would have liked to implement it was predominantly financial, not least, they said, given the original suggestion by the Scottish Executive that the recommendations of the The same as you? should be adopted within existing budgets. Despite acknowledging the role of the Change Fund, local authorities often had different priorities, a moratorium on new posts, or a preferred need for additional social work staff.

One of the smaller authorities also suggested that LAC was not attuned to the rural and cultural demands of that particular local authority, which seemed ironic given the Western Australian LAC experience which suggests that rural areas can benefit greatly from LAC. In this particular rural authority, specialist services have to be accessed through the more urban centres within neighbouring authorities because demand within the authority cannot justify an in-house service. However, accessing such specialist resources from elsewhere in Scotland can be costly, not least in terms of travel.

As well as the rural nature of an area being a barrier to LAC, as cited above, another authority also suggested that the LAC ethos itself was a barrier because of the costs involved in implementing it along the lines of the Western Australian model. For example, the Australian model suggests that the premises should be separate from social work and local to the communities served, but this incurs additional expense in finding an office (or several offices) outwith social work premises already in operation within the relevant communities. It is also advised that the management and supervision of LACs should be kept separate from local authority control, and again this was seen as an additional strain on limited resources.

The perceived need for LAC

When asked whether they thought there was a need for LAC in the future in their respective local authorities, three respondents argued that there was a need; two that there was a need for the functions, although not necessarily for the posts per se; one suggested that there was no need, because they were providing a similar service already; and one was not sure, preferring to wait until the outcome of this current evaluation. Indeed, several respondents mentioned the evaluation as being potentially pivotal in their future plans for LAC.

For one of the authorities that felt there was a need for LAC, the reason given was partly around the limitations of existing services to be able to provide the LAC role in full, given their small size and limited resources, as illustrated in the following quotation:

"Without a local area co-ordinator… what would be hard to deliver is the outreach, although we are clear that we want our transitional worker to do that, but certainly not at the level that a local area co-ordinator would do, if they were free from assessment and care management in particular. And I know that trying to sustain both has been found not really workable elsewhere. And the long term one-to-one relationship with wider numbers of people, we know that that's going to be difficult without a co-ordinator."

For those who deem resources to be a problem, one answer has been to try to fulfil the functions of LAC without actually employing additional staff with a specified LAC remit. As seen above, a couple of these authorities feel that they are adequately fulfilling the role under a different name, and one further authority implied a similar logic when its representative said:

"I think undoubtedly there's a need for the functions. Now whether that's, you know, actual appointed posts or whether it is, you know, identifying these functions and looking at where and how they're carried out… Yes, I do believe quite, quite firmly that we do need, you know, the functions, the ethos, the principles of local area co-ordination."

This particular authority also reported, along with one other, that individuals and families had raised the issue of why local area co-ordination was not available in their local authority, although perhaps not necessarily specifying LAC by name. In consultation exercises, individuals and families had identified gaps that LAC would be best able to fill:

"Service users are quite clearly telling us and so are the families that they need or would like, you know, less professionals involved in their life and… a better relationship with their, they're still calling them their 'care managers' because that's all they know or whatever, but what they're basically saying is they need, they need, you know, more contact, more regular contact with the same person, and building up a relationship, getting to know them better or whatever, so there is a lot coming back about the need for that function."

Pressure to implement LAC

Four local authority respondents stipulated at interview that they felt under pressure from some quarters, notably the Scottish Executive, to implement LAC. Other sources of pressure that were mentioned included individuals and families and elected members. As reported in Chapter One, following the Short Life Working Group's survey of implementation in 2002, the SWIA contacted non- LAC authorities to investigate what their future plans might be 23. The Scottish Executive received sharp criticism in two cases in particular, with one respondent commenting that there were 29 recommendations in The same as you? and some were as deserving of, or conceivably more urgent than, implementation of the LAC recommendation, and were also equally eligible for Change Fund resources.

There was also concern from this same respondent about the wording of the statistical return forms that the Executive requires local authorities to complete annually viz a viz implementation of The same as you? recommendations. She perceived this as implying that, if the LAC box was not ticked, then the inference was that the work being done in that authority was 'at best inappropriate or at worst inconsequential'. This may explain some of the discrepancies, noted above, in the most recently published statistics. This local authority representative had felt under undue pressure from the Scottish Executive following heated conversations with various civil servants about why they had not implemented LAC even though the authority had received money from the Change Fund and whether in fact it understood the implications of The same as you? in relation to LAC:

"There was a lot of pressure about 'you are not following the recommendations in The same as you?, you've got money from the Change Fund, you should be doing this'. But I'm saying, The same as you? says a lot of things, The same as you? talks about employment, The same as you? talks about integration. What we are saying is that we are looking at these and prioritising what we are doing with the amount of money that we've got.'"

A second local authority felt similarly under pressure from the Scottish Executive' This respondent concluded that: "there was no doubt the Executive, I think, were not particularly happy with our stance on LACs". It will be recalled from Chapter Five that in a number of authorities where LACs suggested that senior managers were not committed to LAC , and they themselves felt unsupported, it was also said that LAC had been introduced to 'satisfy' the Scottish Executive.

Future plans

Four of the seven authorities suggested that they would continue to pursue the possibility of implementing LAC in the near future - one of these authorities was due to put a contract out to tender at the time of interview and the second was preparing the workforce to meet the demands of LAC in principle if not in practice:

"We've been re-skilling our workforce big time, you know, for the past three years and looking at things like community mapping, community presence, community integration, you know, and focusing on the enabling role and not doing things for people and taking control, but allowing people to take as much control as they can and doing things with them and just helping [the staff] support individuals and families to decide what their needs are and to choose their own supports."

The third was waiting to see the results of this evaluation as well as to monitor their current arrangements, whilst the fourth was in further discussions with their elected members to possibly develop LAC involvement with an existing user-led network. The two authorities who felt that their existing structures and staffing arrangements could replicate the LAC role at the time of The same as you? recommendations, were currently planning to develop and improve their programme within the local communities that they served. The seventh authority intended to move their community-based support teams out of social work premises and into more independent and localised offices, thus adhering more closely to the LAC ethos.

Reservations about LAC

All seven authorities had reservations about LAC, although more so from a practical rather than a theoretical perspective. Individual comments are listed below, before describing a more substantive concern of several respondents:

  • Whilst it would be preferable for a voluntary organisation to take the lead role in relation to LAC, the local authority may fear losing control over the process;
  • LAC should not duplicate work that is done - or should be done - by other professionals;
  • It is important, but difficult, for LACs to have an exit strategy in direct work with individuals and families;
  • LAC would require more creative ways of working where one staff member is covering a wide geographical area, or alternatively there should be enough resources made available for a greater number of LACs to cover each locality;
  • LAC should neither be associated location-wise with social work, nor be managed by social work, but such autonomy might create a tension with the need for an LAC budget and for accountability;
  • "To offer services other than social work services which respond to the individual's needs is a very long, slow process [and] the whole person-centred ethos… is hugely expensive".

Several respondents pointed out that in the UK the governance of social work and community care, and the structure of social work provision, are markedly different from that in Australia. One respondent commented that whilst Australia may have been starting from a limited service base, not least in rural areas, there are already structures and services in place in Scotland to offer a five-day a week service to many individuals and families. This intensity of service is also under increasing pressure from the growing number of children coming through the system with complex levels of need. There was concern that not enough thought had been given to how LAC would fit with such existing services, or indeed whether, as one respondent feared, LAC implementation - especially the community capacity building element - might result in the withdrawal or streamlining of existing social work services:

"I do wonder about the capacity of communities, families, etc. to provide the range of support opportunities for people with learning disabilities that allow us to do away with the kinds of services that we have been providing."

Finally, one respondent had concerns about how the Social Work Inspection Agency would fit with a purist LAC model, given the principles of LAC being contrary to the more bureaucratic procedures inherent in local authority social work:

"The LAC role is meant to be somebody who doesn't get caught in the bureaucracy and that raises questions about things like SWIA. We've got to evidence everything and one of the things I remember from LAC seminars was Eddie Bartnik talking: 'we don't keep case records, don't keep files on people, don't need admin staff basically, you just need a phone'… and you wouldn't take sort of detailed referrals, you wouldn't be doing full assessments, you wouldn't need this chain of paper… and that's of course the first thing when you get inspected by SWIA or whoever, you want some of those case files."

As previous chapters have shown, some of the difficulties anticipated by these respondents in relation to implementing LAC have indeed been encountered elsewhere in Scotland.

SUMMARY

This chapter has examined the views and concerns of local authorities without LAC in relation to supporting people in the community in the most appropriate and person-centred way. Whilst all the seven authorities represented in this chapter were positive about the ethos and principles of LAC, many had concerns about adopting the model in practice, not least in transplanting it from Australia to Scotland where different social, cultural and governmental structures were in place. However, whilst the majority of these authorities either had specific plans or hopes to implement LAC in their authorities in the foreseeable future, others felt that they could take on board the recommendations of The same as you? in relation to LAC without necessarily creating posts with that title. This issue of the ambiguities involved in adopting, wholesale or otherwise, the values and practices of LAC within existing structures will be explored further in Chapter Ten.

Barriers to implementation within these non- LAC authorities have tended to be practical rather than ideological, with budgetary constraints and embedded bureaucratic structures being the two particular concerns for respondents. Pressure from the Scottish Executive, coupled with a seeming lack of forward planning regarding introducing LAC into existing local authority social work settings, have resulted in some animosity and anxiety amongst the non- LAC authorities with regard to the overall ethos and rationale for LAC in Scotland.

As mentioned earlier in this report, it was not possible for this evaluation to more fully explore the work being done by the non- LAC authorities in relation to support and capacity building for individuals, families and communities. However, alterative ways of supporting and promoting the inclusion of people with learning disabilities could usefully be explored in any further research commissioned by the Scottish Executive as well as comparing the views and experiences not only of former non- LAC authorities which had subsequently recruited LAC workers, but also former LAC authorities which had subsequently ceased to employ LACs. Those kinds of comparisons might address the concerns voiced above about how to measure effectiveness of LAC versus other forms of support as well as enable a fuller picture to emerge about the distinctive features of LAC that have so enthused both professionals and the public alike in the current LAC authorities in Scotland.