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

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CHAPTER SEVEN ROLE DEFINITION, ACCOUNTABILITY, SUPPORT AND FUTURE DEVELOPMENT

INTRODUCTION

This chapter explores how well the LAC role is defined in each authority, particularly in relation to social work and care management. LACs' views of how their job is seen by colleagues in both local authorities and other agencies, and progress in developing working partnerships, are discussed. The chapter then sets out findings about supervision, steering groups and support. The final section presents LACs' suggestions for future developments, both locally and nationally.

Clarity of role definition

LACs were asked how clearly their role was defined in their authority. This question elicited a high response which, broadly speaking, can be grouped into four main categories, set out in Table 5.1, although there is some overlap between them.

Table 5.1 Primary perception of LAC role within authorities (as reported by LACs)

Perception of role

Number

Well or reasonably well defined role/has become clearer over time

8

Role not well defined and not fully understood by managers

9

Well defined role, understood by managers but not by care managers

6

Clearly defined, but not a LAC role

1

In only five authorities did LACs report that their role was well defined and generally clear to others within the local authority. LACs in three further authorities considered the role to be reasonably well defined and/or it had become clearer over time. In nine authorities, LACs believed the role was not clearly defined, and that middle and/or senior managers did not fully understand what it should be. For LACs in six other authorities, who felt clear about their role and believed management also understood it, the main issue was lack of clarity among social workers/care managers. However, this was also an issue faced - not surprisingly - by several of the LACs who reported their role was ill defined by management. For one authority this was a difficult question to answer: their role was clearly defined and generally well understood but it was a care management role. Lastly, it should be added that one of the authorities who reported that the role was clearly defined by all did not in fact appear to have a LAC role but something closer to a service development post within the social work department.

Looking at the eight authorities where the LAC role was said to be well or reasonably well defined, a number of common points emerge. First, several reported that they had clear job descriptions, a clear set of principles to work to and well defined criteria regarding whom they should work with. In some cases the authority had made preparations before the LAC took up post, putting in place some infrastructure and informing people about the appointments. Often there were one or two committed senior managers who had championed the introduction of LAC. The LACs then had protected time for induction and networking. Interestingly, none of them was located in a social work office, although in three authorities, the base was an adult resource centre. In addition, all were quite clear that they did not take on care management tasks. These points are not unique to those LACs who reported their role was clearly defined and generally well understood. However, it may be a combination of several factors which promoted clarity.

In contrast to the above, a recurring theme in those authorities where LACs felt their role was poorly defined was lack of groundwork prior to their appointment, 'vague' job descriptions, few written policies or procedures, and little or no time for induction or introductions. A few had been expected to 'hit the ground running' or 'just get on with it'. Some were asked to undertake what they considered to be inappropriate tasks such as working within other areas of the service, meeting an identified gap in services or carrying social work cases. In one authority, the LACs reported that their posts had been set up by an enthusiastic senior but that person had now moved on and the role had become increasingly blurred. Several respondents believed that their authority had only introduced LAC because they felt obliged to do so by the Scottish Executive but with little real commitment to or understanding of the role. Some LACs reported open hostility towards their role and one service manager had questioned the LAC as to whether there was any need for such a post.

Relationship with care management

There were some examples of LAC and care management working alongside each other well. Sometimes this was because the LAC was previously known to the care management team, or after initial difficulties had been smoothed out. A couple of respondents reported that social workers locally were seeing benefits from LACs' work with families and saw the LAC as an 'asset' or an 'extra pair of hands' (to work with people who were not a priority for care management). In one area, care managers were said to be using LACs to challenge other services, such as housing or welfare benefits. A few LACs believed there was great potential for supporting social work, if social workers would only introduce them to more people.

While confusion among social workers/care managers appeared to be the dominant issue in six authorities, LACs in two thirds of the authorities reported some on-going confusion or tension between their role and that of social work/care management. Here again, there were many permutations. As already indicated in this report, some LACs never carried out formal assessments, did no care management and were clear that they held no statutory responsibilities. Other LACs carried social work cases, took referrals through the usual social work allocation channels, undertook single shared assessments, called reviews, completed social work paperwork, had been asked to cover for social workers on sick leave, attended social work meetings and/or were drawn into best value reviews.

There were different practices and differing views about whether LACs could or should work with people who already had social workers. A couple of LACs had been told that to do so would amount to a double service and thus double costs. Some believed social workers' role was to support those with the most complex needs while LACs supported people with equally important but less pressing quality of life issues. Other LACs pointed to the LAC principle of easy and open access to all. The argument was also made that people with complex needs had their day to day needs met through social work but helping them achieve their dreams and aspirations was a different matter. The example was given of a man with 'a number of complex and profound issues' who had always wanted to go abseiling:

"The reality is he has had intensive care management support for most of his life but he has never had the chance to do [abseiling]. He got the chance to do it three months ago and the look of delight on his face. And what he says…he asked to make a wee comment about local area coordination through… [his care worker]. And he said that it's somebody that listens to me and values me, and supports me to do things that I want to do. His needs have been met but here is something that was always seen as the icing on the cake I suppose. And that was somebody probably initially you would think that there would be no role for local area coordination."

Another aspect of the relationship between LACs and care management emerged in comments apparently made to LACs by social workers, to the effect that LAC is what the latter used to do 20 years ago, what they came into social work to do or are still doing now. Similarly, in the view of some LACs, LAC is what social workers should do, or would do had they the time. It was also reported that care managers see LAC as 'an added extra' without the stresses faced by care managers, but with the 'luxury' of spending time with individuals and families. Perhaps these comments say as much about the current state of social work as they do about LAC. It was suggested that care managers could feel threatened by LACs working alongside families, in some cases advocating for an individual 'against' the social work department. Raising families' expectations and increasing demands for support and scarce resources was also thought to be threatening for some social work staff and managers. One LAC argued the need for a debate at national level about the relationship between care management and LAC which, in his view, had not been clearly enough thought out in The same as you?

Relationships with other agencies

The quality of working relationships with agencies outwith the social work department was mixed, with only a few LACs reporting that other agencies had a good understanding of their role and partnerships were generally well developed. The latter attributed this to a number of factors - effective networking and publicity, having an 'open door' policy themselves, 'a lot of goodwill locally', their own location within the voluntary sector and contacts made from having previously worked in the authority. It is also likely that partnerships were better developed in authorities with a history of good interagency collaboration.

Several examples were given of good partnership working. For example, as previously mentioned, a LAC in a large rural area had supported people to set up a community café in a local recreation centre. This met the dual need of providing a service to the local community and offering training and employment to young people with learning disabilities locally, the main alternative being to attend a traditional resource centre 25 miles away. The LAC initiated a group consisting of a number of voluntary organisations, special and mainstream schools, Fair Trade, Economic Regeneration, a local councillor, parents, people with learning disabilities and a representative from the Scottish Executive programme Business in the Community:

"A business plan and funding applications were done and Café Aroma came into being. It now has a staff of four and [started] trading on 1 December 2005. The 15 apprentices have completed a 10 week college course and will over the next month begin training in the café."

The majority of LACs reported that relationships were better developed with some agencies than others. LACs in 11 authorities reported good working relationships with the voluntary sector:

"Carers' organisations, advocacy organisations, development organisations for people with learning disabilities were really interested and very keen to get involved."

"The voluntary agencies are a lot easier to work with. They accept you straight away but it's because a lot of the roles are similar and they understand you."

There were some examples of LACs working closely with schools, community learning disability teams, GPs, health visitors, an FE college and, in one area, a community policeman. At the same time, a few had encountered particular difficulties when approaching education and healthcare colleagues. Employment, transport and housing bodies were identified as key agencies with which LACs needed to develop closer links in order to achieve the right outcomes for people. It was felt that once professionals understood and accepted the LAC role, they were generally positive about it but being open to new ideas was a prerequisite. Some LACs had been surprised by the lack of awareness of The same as you? among colleagues and how LAC fits into that wider picture. A couple reported some jockeying for position among agencies, with colleagues from other organisations apparently wanting to take the lead on certain initiatives:

"We tend to think it doesn't matter a damn who does it so long as it gets done and for some people there's a culture of needing to be the lead, the lead organisation, and when that comes up, we usually just go with it."

In contrast to the difficulty experienced by some professionals grasping the concept of local area co-ordination, families generally seemed to understand the role very quickly:

"I have to say it's mostly parents and carers that have got a better understanding of the role than agencies…I think they're more open and they're not caught up in the serviceland way. Voluntary sector, that's taken on the role well. I think it's mostly people within social work that either don't understand the role or don't want to understand it."

Accountability and support

This section looks at aspects of accountability and support. Several LACs saw themselves as answerable first and foremost to the individuals and families they worked with. Other aspects of accountability or support included steering groups, line management, SCLD and other LACs.

Steering/Reference groups

Six LACs currently have a steering or reference group: this includes an authority with two separate pilot projects, each of which had a steering group (made up of professionals) and a reference group (made up of individuals and families). Six other authorities used to have steering groups but these are either in abeyance (not having met for a year or so) or - in four cases - disbanded. The remaining authorities have never had one.

Few LACs expressed enthusiasm for steering groups: those that did see them positively each had a steering group in place made up of people with learning disabilities and/or families. One pilot project had a particularly active reference group comprising 10 people with learning disabilities and family carers. It had been set up before the LAC came into post, and introduced her to people she might work with. The reference group also produced publicity, including a newsletter, and carried out a survey of families' views. In contrast, a couple of LACs reported that managers had resisted the idea of family carers joining advisory groups:

"There was no parent or individuals involved although we did try, particularly in [town], there was some parents who were … keen to be involved in the management group but managers were not at all comfortable with parents becoming involved. There hasn't been any parent or individuals involved with it and I think that is a real weakness because I think if people have to work in partnership with people who are getting services, you have got to take account of their views but if they are not around the table, they can't do that."

While some LACs did not find steering groups particularly helpful, in four authorities they had been experienced as 'intimidating' or 'hostile'. The hostility came in the form of criticism from group members who, in the LACs' view, did not understand LAC or felt threatened by it. Examples were given of LACs putting considerable time and effort into producing reports and other materials for steering groups which were then 'rubbished' or 'ripped to shreds'. In one authority, LACs had been asked how they would know when they had 'drunk enough cups of tea with someone'. Interestingly, several LACs felt unable to address the difficulties in their steering groups, and even those with ideas about how a new, supportive group could be formed did not feel it was their role to initiate it. These findings reflect the relatively low status which some LACs believed they were accorded in local authorities. Respondents were generally positive about the role of steering groups and indicated that they could be beneficial if they were focused on providing support and constructive advice. Where steering groups were perceived as hostile or unhelpful there was little evidence that respondents felt they should continue or be replicated elsewhere.

Supervision arrangements

All the LACs had an identified line manager and most had regular supervision with that person, usually every 4-6 weeks. In authorities where LACs had different bases, they sometimes also had different supervision arrangements. The majority were satisfied with current arrangements, finding their supervisor supportive and welcoming the opportunity to reflect on practice which, in itself, is an important aspect of LAC:

"I've found it very useful to have supervision because it makes me sit back and look at what I've done over the - since my last supervision session. Any issues that I have I feel confident to raise them and, given that the line manager is part of social work, she keeps me right in terms of council procedures and gives me support, advice in tackling different [issues]."

Other comments included 'very effective', 'couldn't be improved', 'really helpful', 'supportive', 'very straightforward', 'brilliant', and 'well satisfied'. Supervision tasks included going through stories about individuals and families whom the LACs worked with, as a means of reviewing progress and considering future approaches, completing a written form detailing activities and progress as a basis for discussion in supervision, and working through the Western Australian model for supervision.

Six other LACs, while finding their line manager supportive and helpful, nevertheless would have preferred to be supervised by someone else. This was either because the manager lacked knowledge and experience of LAC and/or because their location or background was not appropriate to oversee LAC. This applied, for example, to a line manager based in Children's Services who had little experience of working with people with learning disabilities, a line manager in Community Learning, again with limited experience of people with learning disabilities and two cases where the LACs thought they should be supervised by someone from outwith their own organisation. Interestingly, one was in a statutory agency and the other in a voluntary organisation: both perceived a conflict of interest for their supervisors. These findings are not unique to LAC.

LACs in a further six authorities were unhappy about their supervision arrangements (and indeed two who had been satisfied thus far were concerned about forthcoming changes). Reported problems included: infrequent meetings; lack of opportunity for informal contact/discussion; lack of understanding of, and sympathy for LAC; lack of knowledge of disability issues and, in at least one case, a poor personal relationship. In these situations, LACs could feel very isolated, missing the opportunity for constructive discussion and feedback on issues arising in their work and also what one person called the 'safety net' of encouragement and support from a committed senior.

Feelings of isolation and support

Although LACs were not specifically asked to comment on how far they felt supported or isolated, many chose to comment on this during the interviews. In addition, the data about clarity of role definition, relationship to care management, steering groups and supervision all build up a picture of the context in which LACs are operating. It is probably true to say that about half the LACs we spoke to felt well supported while those in nine authorities were feeling isolated, devalued and in some cases seriously undermined. The remainder had a mixed experience; for example, one LAC felt well supported locally by colleagues in her own and other agencies and had good feedback from individuals and families. At national level, she had good support from SCLD and the LAC network. However she had received little support from management.

Of the nine LACs who felt unsupported, five of the six who were dissatisfied with supervision arrangements were included (the sixth being the 'mixed experience' example discussed above) and seven of the nine authorities identified earlier in this chapter as having poor definitions of the LAC role, with senior managers who appeared to be unclear about - or uncommitted to - it. Several LACs commented that in their opinion the authority had only implemented LAC to satisfy the Scottish Executive and not because they necessarily believed in its principles. Incidents which had given rise to feelings of isolation or being undermined included not being informed about or invited to an authority-wide forum for workers in the learning disability field, not being informed about the appointment of two new LACs in another part of the authority, lack of infrastructure, no secure base, delays and withdrawal of agreed budgets, not being consulted about future plans for LAC or included in a local review, unsupportive or hostile steering groups as mentioned above, and LAC posts being discontinued (this has happened in four of the authorities where LACs were interviewed and a fifth which no longer has any LACs). One respondent had been told by her line manager about:

"Some meetings and things that he has been at, you know, it must have been around budgeting or whatever. And local area coordination was…he said there are a number of senior managers who do not agree that it's a way forward for [authority]."

In the face of these difficulties, the LACs showed considerable persistence and commitment to the job:

"I'm not a giver-upper and I don't think I give up easily but there have been times where I've thought 'I don't think I can carry on' but the only thing that really does keep me going is the needs and desires of the people out there."

Another respondent who was deeply committed to LAC principles, had nevertheless started to feel disillusioned as a result of opposition within the local authority:

"You've got to hold on to some ideals. Otherwise you would just be completely demoralised."

However, working in these conditions could take a personal toll. Another LAC said:

"That's when I really miss having some kind of support and supervision because I don't have anything. And I think…um…that's I think where my…I lack confidence in my ability to do my job."

On the more positive side, various sources of support can be identified for those LACs who felt more secure in their posts. These were:

  • Where there was more than one LAC in an authority, good mutual support
  • Other like-minded colleagues within employer organisation
  • Commitment at management level
  • Supervision
  • Sound infrastructure/budget/adequate premises and facilities
  • Partner agencies, particularly voluntary organisations
  • Reference Groups of individuals and families
  • Positive reinforcement from individuals and families LACs worked with
  • SCLD
  • Action Learning Sets
  • LAC national support network and e-group
  • Informal regional meetings with other LACs.

FUTURE DEVELOPMENT OF LAC

The Local Context

LACs were asked if they would like to see any changes or improvements to local area co-ordination in their authority. Not surprisingly, most of the responses relate to issues already identified as problematic.

The main area in which LACs wanted to see improvement, identified by about half the sample, concerned the need for better understanding of, and commitment to the LAC role within the authority. Linked to this was the need to secure posts on a long term basis, have more supportive supervision arrangements and give more respect and value to the role.

Secondly, nearly half the sample wanted to see an improvement in infrastructure, the need for a dedicated LAC budget being the aspect most often identified. This was mentioned by some LACs who had never had a budget and others whose budgets had been reduced or removed. Funds were needed both to help support individuals and families in certain circumstances and also to support the LACs' own training and developmental needs.

Thirdly, just under half the sample wanted to see local area co-ordination extended to cover all or most of the authority. Related to this was the need to employ more LACs. One respondent took a different view - she was the only LAC covering a whole authority and would have preferred to cover just one town.

Fourthly, several LACs believed that local area co-ordination should be extended and/or made available to more people. This included people with mental health issues, older people, people with any type of impairment, 'lonely, vulnerable people', and 'anyone who wants it'. A few respondents thought their authority should make LAC available from cradle to grave.

Fifthly, a few LACs did not think they should be employed by the social work department. They would have preferred to have been in a different part of the local authority or in a voluntary organisation. Similarly, moving to a more appropriate office base was an issue for several LACs. A few also wanted a secure base in the sense that they were currently in temporary premises.

Sixthly, some LACs wanted to see a more strategic approach to development within their authority. This included being better linked, and at a more senior level, to other services, more strategic use of day services funding (away from resource centres and into LAC) and a more considered focusing of LACs' energies on community capacity building.

A number of other issues were identified, in each case by only one respondent. These were establishing a steering group, disbanding the steering group, being freed from taking on social work cases to focus on LAC, being able to initiate contact with families directly, greater recognition by Children's Services of the relevance of LAC, and the need to regrade LAC posts to take account of qualifications and experience and ensure comparability with social workers' salaries. As we shall see shortly, many LACs believed this issue should be addressed at national level.

In just one authority, LACs were of the opinion that 'the status quo would be about the best'. Although ideally they would like to see an expansion of LAC activity, the realty was that, due to resource constraints, this would mean a reduction in care management, which in turn would lead to a loss of vital services to people with learning disabilities.

The National Context

If the main changes LACs are seeking at local level are greater security and support, at national level they want more consistency and clarification - first and foremost in terms and conditions but also in remit. The need for standardised pay scales was identified by about two thirds of LACS. 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. One respondent reported that LACs in a neighbouring authority were graded as social work assistants - and thus paid less than him - while in another neighbouring authority, LACs were graded (and acting) as care managers - and thus paid more than him. Respondents also believed that salaries should be pitched at a level which would give appropriate value to the role, as in the Western Australian model. Similarly, some argued that LACs should be located strategically within local authorities, giving them appropriate recognition and status. One LAC had been directly accountable to the Director of Community Services for the first two or three years of his post. He pointed out:

"Because it was connected to the Director, you can't undervalue the impression that gives, you know…whereas in other areas you have got somebody managed by a day centre officer in a day centre. It's hard to get the credibility."

Many LACs also want to see greater consistency in job descriptions and remit. This included eligibility criteria, repeating some of the points made above about more open access to LAC locally. Related to this was a call for clarification of the relationship between LAC and social work/care management, with several respondents making the point that LAC has the potential to support and complement care management but needs to 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. They hoped the similarities would be recognised and pondered at national level:

"It is about recognising [ LAC] as a community service, so it's not just a learning disability [service] and it's about placing it in a triangle with social care and social work…but also in the context of community development regeneration and building inclusive and welcoming communities… It's like if you brought community development back into social work… LACs potentially are a bridge to engaging with the most disadvantaged people who need a bit of help to get connected into their community and then you'd hope that people would then be able to engage with the public sector community engagement strategies and be part of developing their own community so that they're not 'done to' but they are part of identifying and finding the solution and so I think if we are completely aligned with social work and social care it feels to an extent that we are another service provider, when actually I think we potentially are helping those people who are excluded to be part of the community that they live [in] and their own voice is heard."

Many LACs believed the Scottish Executive should be taking a far stronger lead in championing and promoting LAC. Several called for the Executive to issue 'much clearer guidance' about LAC and a couple were of the view that it should be made a statutory requirement. (It is possible that more people would have agreed with this had they been specifically asked). As well as outlining consistent terms, conditions and job descriptions, a few respondents thought official guidance should underline and 'safeguard' the principles of LAC: several people were concerned about the perceived dilution of the ethos in some authorities. A few LACs thought the Scottish Executive should provide more funding, or that authorities should make greater use of Changing Children's Services funds to create more posts.

With regard to the location of LACs, several people - reflecting findings already reported - argued that LACs should not be employed by social work departments, or by local authorities. There were some interesting alternative suggestions. A few thought LACs should be employed by an 'independent' national body. There was some support for SCLD adopting this role and some opposition, on the grounds that it was funded by the Scottish Executive and thus not perceived to be 'independent' 20. A need was also identified for a national inspection and regulatory body - possibly the Care Commission - with LACs possibly registering with the Scottish Social Services Council or Community Education. While some LACs perceived SCLD fulfilling a useful role in guiding the further implementation of LAC, a couple believed this could hamper development as LAC, in their view, should be open to everyone 21.

Another issue raised by some LACs was the potential for accredited training, leading to a LAC qualification. Among those who do not have a 'relevant' (eg: social work, health or community work/education) qualification, there were mixed views. One such person would have welcomed the opportunity to study for a formal diploma in LAC:

"I've had people say to me 'and what qualifications do you have?, within the council, and/or 'are you social work trained?' 'No'. 'What qualifications have you got?' And whilst I could say 'no I'm not telling you', I've always been truthful with folk and I think that [not having a qualification] lessens people's thinking of you. So I think some kind of accredited training, on the job training, it doesn't have to be degree length, it could be diploma, I don't know, but something like that I think would be really beneficial."

On the other hand, another unqualified LAC argued:

"One of the things it seems to me has been absolutely rampantly good about local area co-ordination is the, the diversity of people that's attracted in…There are people who are desperate to be churning out some sort of qualification but how can you qualify people into, to be as interesting and exciting as they [ LACs] are?"

While no LAC argued against consistency in terms and conditions nationally, a minority also argued for local variation in some aspects of local area co-ordination. They emphasised that while the ethos must be respected, some operational flexibility to suit local circumstances was healthy:

"People have to adapt to a different climate. It's a very different kettle of fish I think doing it in a rural area, maybe, to an urban area. So I think it's OK, but I think it depends what you are planting. If you think of LAC as a plant then as long as you are planting the principles and the kind of person-centred bit and all of that, then you are planting it in different soil and it will maybe grow differently."

Typical views about the desirable future direction for LAC at national level were summed up by this respondent:

"Three words that I hope would sum up what I would like to see happening, consistency for LAC in terms of who we are and what we do, and things like…what we get paid. I think we need to get that sorted out because it's no good for anyone. We need to be resourced which is not…it's inconsistent in terms of resourcing it, and I think we need to be valued. I think there is a lack of all three of them. If we get the three of them at a national level rolled out, we will have an impact…"

SUMMARY

While previous chapters have highlighted inconsistencies around LAC, the findings presented here illustrate the complexities surrounding key aspects of the role. 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. Collaboration with other agencies was unevenly developed. Partnership with the voluntary sector was generally better advanced than with statutory organisations.

Half the authorities had never had a steering group in place, of those that had, experiences were evenly divided between positive and negative. Groups comprised of individuals and/or family carers were seen as most useful while those composed of professionals were more likely to be experienced as unsupportive. Six steering groups were either inactive or had been disbanded.

The majority of LACs were satisfied with their supervision arrangements. There was some concern about the appropriateness of the current supervisor while a minority of respondents were unhappy. Overall, about half the LACs felt well supported, while those in nine authorities experienced isolation, a sense of being devalued and, in a few cases, actively undermined in their role. It was suggested by a small number of LACs and managers, for example, that LAC may have been introduced only to 'satisfy' the Scottish Executive and not on the basis of real understanding of the role or commitment to the work of LACs.

Suggestions for future development at local and national level were broadly similar although the emphasis at local level was on greater security and support while, at national level, for more consistency and clarification. Parity in terms of conditions and remit was a priority, with most respondents expressing a desire for the Scottish Executive to take a firmer lead. There were differing views about whether or not LACs should have a specific qualification but unanimity that the LAC role must be better valued and promoted.