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

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CHAPTER TEN CONCLUSIONS AND IMPLICATIONS FOR POLICY AND PRACTICE

INTRODUCTION

The aims of this study were to:

  • examine lessons from the implementation of LAC across Scotland
  • explore (in broad terms) the outcomes of LAC work
  • assess the scope for its future development.

As this report illustrates, there is considerable variation in the implementation and operation of local area co-ordination across local authorities, with a number of authorities choosing not to use this model of provision. Where LAC has been implemented, the expectations of local authorities, managing organisations and LACs themselves can be seen to vary considerably. LAC is intended to operate as a 'process' rather than a 'service', with the emphasis on community building rather than service development. There have been a number of difficulties which have accompanied conceptualisations of this.

Some LACs attempt to adhere as best they can to the values and principles of local area co-ordination as first envisaged. For others, emphasis is given to adapting the original aims and objectives of local area co-ordination and applying them pragmatically to the local context. There is enormous variation in almost every aspect of the organisational arrangements for LAC in Scotland. While flexibility was seen as an important part of the LAC role, some of this diversity was seen by respondents as indicating a departure from the principles and ethos intended to underlie LAC and was experienced as problematic by many LACs. This included LACs who were satisfied that their own practice followed the LAC ethos but who nevertheless were critical of deviation from the original model in other local authorities. These distinctive practices have ranged from the practical to the conceptual.

For both 'purists' and 'pragmatists' (by no means mutually exclusive groups) the LACs represented in this study appeared committed to supporting the individuals and families they worked with, to enhance their lives. Similarly, as our case studies illustrate, regardless of the variations in implementation and operation of local area co-ordination, individuals and families agreed that this resource had made a positive difference to their lives. What remains unclear is the extent to which the positive changes which people referred to had come about due to local area co-ordination per se, or as a result of the commitment and support provided by these dedicated workers. It may be that the flexibility of the LAC role and opportunities for innovative working practices provided workers with an environment in which they made full use of their skills and knowledge. Nevertheless the broader context within which LAC is located has had a significant impact on both implementation and operation, as this evaluation has illustrated. The three aims outlined above are discussed in turn.

Implementation of LAC

In 2002, the Short Life Working Group on LAC ( SLWG, 2002: 1) expressed concern that:

"Local area co-ordinators will be performing very different functions in different areas and in some cases may not be following essential principles."

The survey conducted by SLWG (2002) revealed that:

  • Coverage of some local authority areas was patchy
  • Elsewhere, local area co-ordinators were supposed to cover large areas and/or populations
  • Some were targeting specific population groups and/or excluding children
  • The relationship between LAC and care management remained unclear
  • Some LACs had no basic facilities such as a phone or a desk
  • In some cases, line management arrangements undermined LACs' independence. In others, the LACs' organisational base distanced them from individuals and families
  • In some areas there was a watering down of both the role and the underlying principles and values of LAC.

The difficulties identified in 2002 do not appear to have been completely overcome despite the significant increase in LAC appointments during the interim period. Indeed, as this report has illustrated, all the difficulties identified four years ago still pertain. Although most LACs now have basic facilities like a phone or desk, two were still using their own homes as a part or full time office base.

The need for standardised pay scales was identified by about two thirds of LACs as an issue which needed to be addressed. It was one of the issues attracting most agreement among the sample, concern about current inequities being voiced by respondents irrespective of their current level of remuneration. This study would support that view: LACs need complex and diverse skills, the ability to be self directing and highly motivated and the confidence and authority to challenge other service providers, sometimes at managerial level. Yet it is difficult for LACs to obtain credibility in a professional environment if their post is not appropriately acknowledged and remunerated.

This evaluation has highlighted the broad view expressed by respondents that LAC should be extended to include all age groups and people with all types of impairment/mental health issues. LAC has an important role in providing a service for people who may not otherwise be able to access relevant support: there was wide appreciation of the way that LAC supported individuals with Autism and Asperger's syndrome where other forms of support are minimal. Similarly LAC was seen to be preventive, providing support before situations perhaps escalated and statutory service provision was required.

LACs identified several distinctive features of their role, noting the importance of its person centred value base (although many other workers in human services would lay claim to that). The non-bureaucratic and preventive aspects of LAC and its remit to challenge where appropriate were also highlighted. All the LACs agreed on the importance of promoting inclusion, but there were different understandings of what that meant and how it should be achieved. Most were wholly supportive of the LAC ethos - indeed for some it almost seems to be a more of a vocation than a job. However, a small minority thought there was an idealistic, even an unrealistic, strain within the ethos.

Some LACs struggled at times with the emphasis on promoting family support which, for a range of reasons, was not always feasible or desirable. As the case-studies have highlighted, there were often real issues for families in terms of day to day survival, often impacting on their ability to be open to accessing services or resources aimed at supporting them to plan in the longer-term. Nevertheless, the work which LACs carried out with families should be seen as important, clearly leading to the development of expertise around negotiation of roles between individuals and families.

This evaluation has highlighted ongoing inconsistencies around LAC. In only five authorities did LACs consider their job was clearly defined and understood, while those in nine authorities reported it was ill defined and not fully grasped by managers. About two thirds were aware of ongoing confusion and/or tension between the LAC role and that of social work/care management, although the relationship could work well where activities were accepted as complementary. In some areas, LACs have been drawn into care management procedures and it appears that in at least three authorities, LACs acted as care managers for part, or all, of their role. It was considered important by LACs that their role had the potential to support and complement care management but should be recognised as being of equal status. Some people pointed to Changing Lives, the report of the Review of 21 st Century Social Work (Scottish Executive, 2006c), arguing that the future direction for supporting people outlined in that document has many parallels with local area co-ordination. There remain however, some ambiguities surrounding the relationship between LAC and care management which need to be clarified.

The case studies highlight the contribution that LACs can make to statutory practice such as formal assessments, ensuring they are needs- rather than service-led. However, an examination of LAC practice also raises questions about who should work with individuals and families who may not otherwise receive any other form of statutory assistance, such as those featured in the Dundee case study, who, on the face of it, are living and 'coping' independently but whose lives appear to be materially and emotionally impoverished, open to risk and exploitation on a number of fronts. Working with individuals and families who require intensive ongoing support was something of a dilemma for LACs in areas where community-based services were limited.

Despite the difficulties identified in relation to the implementation of LAC in some local authorities, the benefits of the LAC role have been highlighted throughout this report. Importantly, as Chapter Two has illustrated, LAC fits neatly with current policy developments and practice initiatives and embodies many of the themes which have been recently explored on policy agendas.

Given some of the ambiguities about the LAC role and remit in some areas, managers generally recognised the need to help people understand local area co-ordination prior to its implementation. Making other service providers aware of the complexity of the role and what it entails would, it was suggested, have made things easier in the longer term. Some managers also indicated that it would have been beneficial to seek the views of individuals and families about how they would like LAC to operate prior to putting workers in post. As more LACs are recruited, and existing LACs have the opportunity to publicise their role and ethos more widely, it is likely that implementation issues may be lessened and effective operational frameworks developed - if some of the difficulties identified are addressed at managerial level.

Outcomes

Despite the difficulties in implementation reported above, there was strong evidence of a range of positive outcomes for individuals and families. LACs cited significant improvements for individuals and families in accessing services, enabling greater choice, building capacity (both within families and communities) and raising awareness of disability, improvements which they believed had not or could not have been made without the additional support of LACs. Three main areas of achievement were identified by LACs - a better quality of life for people, specific differences in individuals' lives, and particular areas of work, such as transitions to adulthood, where they believed they had made an impact. LACs suggested that their ability to provide individuals and families with more and better information could lead to improved outcomes. In this sense, it was suggested that LAC can reduce the need for substitute care services and that LAC, by making significant differences to individuals' opportunities, should not be seen as simply the 'icing on the cake'.

The four case-studies presented illustrate the operation of LAC in four distinct contexts: rural settings; urban settings; across traditional service user groups; and managed within the voluntary sector. They are not intended for direct comparison, and although representative of particular LAC contexts, the distinctive nature of LAC practice in each local authority limits any opportunity to claim generalised ways of working across Scotland. Nevertheless, in addition to highlighting pertinent issues in each setting, the case-studies provide evidence of a range of relevant outcomes. The findings from the four case-studies suggest that LACs were highly valued by all respondents, including individuals, their families and other agencies; individuals and families in particular reported that LAC had made an important contribution to their lives. Generally, it was found that individuals gained improved access to services, support and information as a result of their contact with LACs. In some cases, inter-agency cooperation was enhanced and community capacity building was seen as an important aspect of the overall work of LACs, although at different stages of development. Additional outcomes for individuals and families include the following:

  • Having time to build relationships with individuals and families, help them to identify their own needs and accordingly, to work toward change in their lives
  • Supporting individuals to actively engage in their local community
  • Assisting individuals and families, through networks established by the LAC, to mutually support each other
  • Helping individuals and families to engage effectively with other agencies
  • Enabling individuals and families to believe they have someone working in a professional capacity who is 'on their side'
  • Bringing together individuals and families from diverse backgrounds and different life experiences to work together to reach solutions within their local communities
  • Ensuring people have access to support and services, are better informed, have more choice of activities and some increase in availability of flexible supports such as holidays and day and leisure opportunities.

In Queensland, Australia, Chenowith and Stehlik (2001) identified a number of outcomes for communities from capacity building, namely heightened awareness of disability issues, leadership development among people with learning disabilities, their families and allies, the establishment of support groups, links with other disability agencies and groups, and economic development. The last point relates to the increased numbers of people staying in their local communities rather than moving into residential or institutional settings elsewhere which, the authors suggest, also encourages the return of others who had moved away. Overall, the Scottish LACs spent relatively little time on community capacity building. In only six of the 24 authorities did LACs claim to have made significant progress in that area but where this did happen, it appeared to make a considerable impact on the experiences of individuals and families. Elsewhere, apart from lack of time and the fact that community building is a long term process, a lack of interest and sometimes resistance were reported among some local communities. Where progress had been made, this may be linked to more welcoming communities, the LACs having a strategic base in the area, their previous knowledge of the locality and/or their community development background.

Scope for Future Developments

Bartnik (2003) concluded that although LAC was highly valued by service users in Western Australia, its full potential remained unrealised. LACs were being asked to carry out an increasingly diverse range of tasks and this was reducing their ability to concentrate on the core functions - and perhaps values - of the role. Indeed Bartnik suggested that this may threaten the medium to long term sustainability of LAC, unless steps were taken to refocus the programme on its original principles, goals and functions. This is an important point, given that this evaluation has identified similar problems in Scotland. In order to obtain and monitor effectiveness, it is crucial that the correct structures are in place in relation to both the implementation and operation of LAC.

As summarised above, this research has identified many strengths within LAC, ranging from specific examples of good practice in work with individuals and families to some exciting and innovative approaches to community capacity building. The findings point to a variety of positive outcomes for those concerned. These achievements can be attributed to a number of factors but many of those involved have highlighted the LAC ethos as the bedrock which informs and inspires their work. At the same time, the research has raised some thorny questions about certain aspects of the LAC ethos as it relates to the cultural, structural and political context of Scotland as opposed to that of Australia. In thinking about the future scope of LAC within the Scottish context, many respondents suggested a need for debate at national level about how this approach can best take account of these differences, for example:

  • Scotland has a much better developed service infrastructure than rural Australia and a pride in collective provision to meet social need. Some people will always require a high level of formal (state) support. There is a need to consider how best to develop LAC without risking a reduction in the provision of social work and health services to those who need them.
  • The LAC role is values-based with preference within the original principles of LAC to promote family support as opposed to using services. While most families undoubtedly play a vital role in supporting their disabled members, and LACs have an important role in harnessing these relationships, in other cases the support on offer will be inadequate, inappropriate or - importantly - not what the individual him/herself wants. In a minority of cases, families may be neglectful or abusive. As LAC continues to develop in Scotland, there may be a need to reflect on and review the appropriate level of focus on family support.
  • Again, while many communities are welcoming and supportive, the history of social work and community work suggests there is a limit to how far some deprived neighbourhoods can offer sustained help to their most vulnerable members. This research, and many other studies, has shown that disabled people, especially those with learning disabilities, are subject to a high degree of bullying and harassment as they go about their local neighbourhoods. Therefore, while there is a need for LAC in Scotland to develop its focus on community capacity building, this needs to take a realistic approach.

Taking such considerations into account, the findings of this research have nevertheless highlighted the important benefits of local area co-ordination and the potential that this resource has to impact on the lives of individuals and families. In considering a way forward for LAC in Scotland, a number of points have arisen from this evaluation. If LAC is to be effective as an agent for far reaching and long lasting change, both at the micro level of individuals' lives and at the macro level of service provision and philosophy, then the number of LAC posts across Scotland needs to be increased. In addition, geographical and demographic constraints on the LAC role were uncovered: notably that they did not have a remit to work in certain communities or with all age groups and impairments/needs.

It was evident from some managers' comments that LAC posts were already seen as using up scarce resources that could perhaps be more usefully deployed elsewhere. Others who in principle supported the expansion of LAC nevertheless did not foresee new posts being created, at least in the short term. Financial constraints were perceived as a real barrier among those authorities which had not implemented LAC. Therefore, to safeguard and promote the implementation not only of LAC but also of the principles underlying The same as you?,a ring fenced fund (or ring fenced part of the Change Fund) for financing new LAC posts could be considered. This could be based on a formula which takes account of population size and the likely number of individuals and families LACs will work with in each authority. It was suggested by one respondent in this study that 35 is an appropriate maximum number of people for LACs to engage with. Such a development could also address the often short term, insecure nature of current funding for LAC posts.

Although a couple of respondents thought that the provision of LAC should be made a duty for local authorities, this research does not have enough positive evidence to support that view. This is not due to negative findings about LAC but primarily because it was not possible, in the course of a relatively small scale and largely qualitative evaluation, to compare outcomes in authorities which did and did not have LAC. This would require the commission of research to compare outcomes in authorities with and without LAC.

The findings also suggest the need for the Scottish Executive to issue updated guidance on the implementation of LAC in Scotland. This could include:

  • A restatement of the ethos and values of LAC, taking account of the Scottish context.
  • A clear statement about the differences between LAC and social work or care management, including the need to avoid inappropriate use of social work systems such as formal referral and allocation procedures, and inappropriate use of LACs to carry out social work tasks.
  • A clear statement about the differences between the roles and responsibilities of LACs and care managers, which also highlights the benefits to be gained when the two work alongside each other in complementary fashion.
  • A focus on the community capacity building aspects of LAC and a move away from long-term intensive work with families and individuals.
  • Encouragement to locate LAC posts outwith social work premises. Some authorities may favour an easily accessible shop front, other community venue or voluntary organisations (whether or not the LACs are employed by a voluntary agency). However, if LACs are to challenge and help change statutory services (as the ethos and practice expectations would suggest), it may be more effective to locate them in local authority community learning or recreation and leisure departments.
  • A requirement for future LAC appointments to have a relevant qualification, such as community development, community education, youth work, social work, social care or health-related. Local authorities could support LACs currently in post without qualifications to obtain one.
  • A starting salary commensurate with that of basic grade social workers/care managers, possibly with a qualification bar, and progression to an advanced salary scale, commensurate with senior social workers, for those with appropriate qualifications and experience; and then to Head of Service scales where appropriate.
  • An adequate infrastructure for LAC posts, including a budget sizeable enough to cover LAC training and developmental needs (but see also, below, our separate recommendation regarding future funding of the Action Learning Sets), to secure the basic requirements needed to do the job, and to purchase small amounts of support for individuals and families on a one-off or short-term basis.
  • A remit to work with people of all ages from cradle to grave.
  • A recognition that LAC can bring benefits to people with a wide range of needs and conditions, and encouragement to 'widen the net' beyond those with learning disabilities.
  • A proposed target number of individuals and families for LACs to work with.
  • LACs should be supervised by a senior manager with relevant qualifications and practice experience, who has received appropriate training (see below). Supervisors should also act as supportive 'critical friends'.
  • LACs should be closely involved in setting up a reference group to advise on their work, with strong representation of individuals, family members and community representatives.

Most LACs were appreciative of the support and training received through the Action Learning Sets run by SCLD but meeting the attendance costs was an increasing problem for local authorities: several were considering no longer paying for LACs to attend. SCLD already runs the ALS at a loss. Therefore it may be useful for the Scottish Executive to consider funding the training in its entirety, making it free to local authorities who would then only have to pay for accommodation costs where necessary. SCLD could then give further consideration to holding some of the training in a more northerly setting, so that certain authorities are not bearing the brunt of travel and subsistence expenses.

A few respondents argued for LACs to be employed by a single national body such as SCLD. Again we do not have sufficient evidence to indicate that either local authorities or voluntary agencies are the most appropriate employers, nor can we predict the advantages or otherwise of a national employer. However, if LACs are to be recognised as skilled professionals carrying a range of responsibilities, then it seems logical that they be required to register with an appropriate professional body: for example, the Scottish Social Services Council or Community Education (both of which would need to develop an appropriate registration framework for LACs).

To support authorities in implementing any revised guidance, and to further promote the development of LAC across Scotland, a funded National Development Worker post may be worthy of consideration . In addition, the post holder could have responsibilities for linking the strategic development of LAC with ongoing initiatives in other policy arenas.

Key to success in driving forward LAC in Scotland is the commitment of senior managers: this study has identified a mixed picture in that regard. Therefore the Scottish Executive might consider inviting senior managers to a half day seminar , with input from SCLD, to discuss the benefits and achievements of LAC, their concerns about it and how best to tackle these.

Finally, we return to a comment made by one of our respondents. In order for LAC to prosper and flourish across Scotland, and continue to bring much needed support to individuals and families, it must be consistent, resourced and valued. The proposals outlined above set out how this could be achieved.