Key outcomes for people who use services
Outcomes for adults, carers, children and families who use services
The Social Work Inspection Agency defines outcomes as the improvements in people's lives that result directly from the services that they receive. We found that East Ayrshire's performance in this area was adequate, with strengths that just outweighed weaknesses.
Service outcomes for older people were positive. The provision of effective home and day care services enabled an increasing number of older people to live at home. No delays were being experienced in discharges from hospital and people were quickly provided with any equipment they required.
Outcomes for people with learning disabilities were generally positive. Some positive aspects included assistance with life planning, support through advocacy, community short breaks and alternative day opportunities. There needed to be more opportunities for training and employment.
There was limited information about outcomes for people with mental health problems, disabilities, sensory impairment, dementia and for people who misuse substances.
Whilst trends were moving in the right direction, outcomes for looked after children needed to be better. We found that the educational attainment for looked after children was much lower than the Scottish average. Improvements were also required in pathway planning processes, access to employment, further education and suitable accommodation for young people leaving care.
Our survey and focus groups showed that the majority of carers felt that services had improved the quality of life for the person they cared for. However, they felt that more could have been done to improve the quality of their own lives. This was particularly true for parents of children with disabilities.
Social work services were promoting choice by increased use of direct payments.
On balance, we evaluated key outcomes as adequate.
Measuring outcomes is not yet common practice. National and local performance measures and targets are sometimes used as proxy measures in this chapter. We use a consistent set of indicators for all councils, as well as other significant measures and targets.
Measuring outcomes was established practice in East Ayrshire and linked to performance management frameworks. These processes in turn were reflected in the single outcome agreement ( SOA) that had been developed by the council and its community planning partners.
Within social work services, the resource manager oversaw the collection and collation of information about performance across the range of services and provided service managers with regular reports. Whilst much of this was positive we identified some things that could be improved. For example, commissioning arrangements for services purchased by the council did not include enough detail about the desired service outcomes.
We also found that managers, particularly in children and families services, were not using all the available information about outcomes for children to inform their practice sufficiently well.
Social work services should build on existing systems to improve the range, quality and consistency of the information they collect about outcomes for all people who use services and their carers. These outcomes should be embedded in all social work service plans and used to consider the range and quality of the services.
Views of people who use services on outcomes
We asked people who used services and their carers about the difference social work intervention had made to their lives, by sending written surveys and by asking them about outcomes when we met with them on fieldwork.
According to the survey we carried out with service users 10 most people who used social work services in East Ayrshire were positive about the service they received. Social work services had made a real difference to their lives in a number of ways:
- most (79%) said that social work services had helped them feel safer;
- most (77%) said that social work services had helped them to lead a more independent life; and
- the majority (65%) agreed that social work services had helped them to feel part of the community.
This response was similar to survey results from our inspections of other authorities to date. These views were confirmed in our meetings and observations of practice.
For example, we met a vulnerable young woman who had been helped to get her own home. She was being well supported to live there. Some people told us that service delivery was slow, in some instances taking several months.
As a means of trying to measure user satisfaction in a more systematic way, the council and partners had commissioned Stirling University to develop a model to measure user and carer satisfaction of community care services. This model was piloted with a small number of people. The results were encouraging.
Views of carers on outcomes
The findings from our survey of carers 11 about social work services in East Ayrshire were broadly positive. When compared with the results from other local authorities they were close to or slightly above the average. For example:
- the majority (61%) agreed that social work services had resulted in an improved quality of life for the person they cared for;
- the majority (64%) agreed social work services had helped that person to feel safer;
- the majority (51%) said that social work services had helped that person lead a more independent life;
- the majority (56%) also felt valued and supported as carers, consulted and listened to (60%) and involved in decision-making (61%); and
- less than half (49%) considered that services helped them to have time for family, work and other commitments.
In the main, carers of older people were the most positive about the services provided. For example:
"Social work has been very supportive and the communication has been excellent, which is very important. The social worker that has taken care of us has done an excellent job."
Although based on only a small number of respondents, parents of children with disabilities were the least satisfied group. For example, they were unhappy with the availability and range of respite breaks. Our focus groups with carers confirmed this view.
Views of partners and stakeholders
We undertook a survey of partners and stakeholders. 12 Most (75%) agreed that East Ayrshire's social work services provided good outcomes for people who used services and their carers.
File reading analysis
Overall, the findings of our analysis of case files 13 for key outcomes were positive and were either higher or in line with the average responses from other inspections to date. 14 In particular:
- in almost all (90%) of those case files where there was a care plan there was evidence that its objectives had been, or were in the process of being achieved;
- in most of the files (79%) there was evidence that the individual had been helped to access mainstream services;
- in the majority of files (72%) there was evidence that the individual's circumstances had improved; and
- in most of the files (86%), changes in dependency were found to be in keeping with the needs of the service user.
Service outcomes in adult files were more positive than in children and families files.
Services for children and families
Children in need
The East Ayrshire children and young people's service plan 2008-11 set some ambitious targets for improving outcomes for children and young people. These included the creation of opportunities for learning and social development and improved health and community safety.
We found good collaboration between health, education and social work to develop prevention and early intervention initiatives. We visited one family centre and we heard that they supported local parents in managing very young children.
The council worked closely with the East Ayrshire carers centre. The centre supported over 90 young carers. We met with a group of young carers, who attended a group once a week. They told us they liked the various activities at the group and described having had holidays and short breaks.
Good practice example
East Ayrshire carers centre, funded by the council and partner agencies, had acquired Dalmellington House, and set up a social enterprise company to provide respite/conference facilities, an information/advice service and training unit for young carers to enable them to access work.
East Ayrshire's youth strategy service worked with children and young people whose behaviour at school was problematic, to help them to continue their education and, wherever possible, to resume mainstream schooling. The service routinely collected information about attainment; achievement; re-integration and destination of youth strategy pupils, including looked after children. Staff provided evidence in respect of reductions in school exclusions and improvements in educational achievement.
We discuss the timing of reports submitted to the children's reporter in Chapter 5.
Children with disabilities
East Ayrshire was ranked 18 out of the 31 local authorities 15 on the provision of overnight respite provided for children per 1,000 population. The council was ranked 31 out of 31 local authorities on the total day time respite hours provided for children per 1,000 population. 16
Our earlier multi agency inspection of learning disability services identified some positive outcomes for young people with learning disabilities, particularly in the management of transitions. We met staff from the children and adult support team ( CAST). This team worked with children with disabilities, aged up to 18 years. The team was at an early stage in its development. We were told the team had not yet agreed ways of collecting performance information.
National statistics showed that at 31 March, 2008, East Ayrshire Council had the names of 83 children on its child protection register, equal to 3.8 per 1,000 population aged 0-15. This was greater than the Scottish figure of 2.7. The figure represented a steep rise from the previous year when the names of 45 children were registered. The trend over the preceding four years was one of smaller percentage rises. On 30 September 2008, the names of 86 children were registered. Of these:
- 58% were under four years old;
- 55% had been registered under the category of 'physical neglect'; and
- 31% under the category of 'physical injury'.
The Child Protection Committee ( CPC) was examining the reasons behind this recent steep rise in registrations. In the authority's view, the main trigger for many of these registrations had been an increase in parental substance misuse and early identification of risk through the multi-agency vulnerable pregnancy protocol. This was consistent with evidence of high substance misuse in East Ayrshire. It was the highest of the three Ayrshire councils. 17 The authority thought that the large number of children in some families, whose names were all on the register, had contributed to the rise.
In 2008, there were 299 child protection referrals, which was equal to 13.8 per 1,000 population aged 0-15, while the figure for Scotland was 13.5 per 1,000 population aged 0-15. Of those 299 referrals, 163 had resulted in case conferences (7.5 per 1,000 population aged 0-15). This was significantly higher than the rate for Scotland (4.7 per 1,000 population aged 0-15).
There were 98 child protection de-registrations in 2008, which was equal to 4.5 per 1,000 population aged 0-15. The rate for Scotland was 3.5 per 1,000 population aged 0-15.
The authority also collected statistical information about the percentage of children who were on the register for more than one year. Recently the quarterly figures had fluctuated, rising to as high as 22% before falling to 10%.
These figures and percentages are not in themselves 'outcomes'. They did however reflect professional views and public concerns about children's safety and well being. Given the statistical evidence available, the CPC had arranged a seminar in order to examine in more detail these statistics against other information, such as substitute prescribing rates and migration into East Ayrshire, given anecdotal evidence that these may be contributing factors to the fluctuations of these figures.
In January 2008, HMIe completed a joint inspection of services to protect children in East Ayrshire. Whilst inspectors found key strengths, for example in areas of public awareness and partnership working, they identified areas for improvement in the assessment of risks and needs. They also thought that services to meet children's needs could be improved.
As part of our file reading, we read a small number of children and families files where the main trigger for assessment was to prevent abuse or neglect. We found that the quality of the risk assessment/management plan was good or better in just over half these files. This finding supported the earlier HMIe finding about the need to improve risk/needs assessment and care planning, both of which were crucial to achieving good outcomes for children at risk of abuse and neglect.
Looked after children
On 31 March 2008 there were 470 looked after children and young people in East Ayrshire. This was equivalent to 1.8% of the population (aged 0-18) slightly more than the national figure of 1.3%. East Ayrshire's figures had been consistently above the national average for the previous five years. The council had a higher proportion of looked after young people aged 16 and over than Scotland (19% compared to 13%).
The accommodation types were in line with the national average with 91% (430) young people in a community setting and 9% of young people (40) in residential care (the comparable Scottish figures were 89% and 11%). At the time of our inspection, six young people were in secure care, a comparatively high figure given the size of the authority. Three of these young people had been placed there by the court and funded by the Scottish Government.
Continuity of care is important for delivering good outcomes for looked after children. Of the 276 children looked after away from home on 31 March 2008, 215 (78%) had been in placement for one year or more and 67 (24%) had had three or more placements. For Scotland, the figures were 71% and 31% respectively.
Educational attainment is critical to improving children's life chances. In 2006-07, 15% of all care leavers obtained a qualification in maths and English at Scottish credit and qualifications framework ( SCQF) level 3 or above (the Scottish figure was 34%). Of those who had been looked after at home, 16% had gained qualifications (Scotland 26%). Of those who had been looked after way from home 13% had gained qualifications (Scotland 45%). These figures were much lower than the Scottish average. 18
As yet unpublished figures supplied by the authority showed some improvements in 2007-08, but they were based on very small numbers. Of the 20 young people who ceased to be looked after at home, we were told that five had attained maths and English at SCQF level 3 or above. Of the four who ceased to be looked after away from home, two had gained similar qualifications. Although there were some improvements, these numbers were still low.
Staff were aware that the educational attainments of looked after children needed to be improved and they pointed to the efforts they were making and to an upward trend. They said that more children had gained both general and credit grades at standard grade level and that some children who had not sat standard grades were helped to access relevant vocational courses. There were dedicated staff in every school to support children who were looked after. All looked after children had a personal educational plan. Through the corporate parenting 19 action plan, the authority and partner agencies were committed to making available a choice of training, job opportunities and work experience for all young people who were leaving school.
Adoption and fostering services
On 31 March 2007, 49 young people were in permanent fostering placements and 29 were in long term placements. Twenty-seven new placements were made between 1st April 2006 and 31st March 2007. The Care Commission undertook an inspection of the council's fostering service in January 2008. It followed up eight recommendations from a previous inspection. At the time of our inspection most of these recommendations had been addressed.
In 2008, the council placed 93 children with the council's own fostering service and 36 children with externally commissioned foster care places. More work needed to be done to recruit and support local foster carers and we noted that work on a fostering campaign was underway. Discussion had taken place with the two other Ayrshire local authorities about increasing their pool of foster carers.
External foster placements were one of the main budget pressures for the council. The council had set up a sustainability board, which comprised senior managers from across the council, to examine how the council could provide services that would continue to meet people's needs and that were financially sustainable. We discuss this in Chapter six.
East Ayrshire had supported a link carers scheme since 1996. Sixty-three extended family carers were in receipt of a link carers allowance with respect to 98 children, at the time of our inspection. The council was concluding the development of its kinship care scheme, in line with government policy.
The Care Commission inspected East Ayrshire's adoption service in January 2008. It found that the service had strengths and it had followed up appropriately on one requirement and a number of recommendations set out at the previous inspection. There had been delays in permanency planning arrangements. We discuss this in Chapter 5.
Throughcare and aftercare services
In 2007-08, there were 38 care leavers in East Ayrshire. National statistics reported that 26% had a pathway plan and 100% a pathway co-ordinator. The figures for Scotland were 55% and 57% respectively. Eleven per cent of care leavers were in employment or education, compared to the Scottish figure of 42%.
In 2007-08, all care leavers were in touch with social work services, which was greater than the overall Scotland figure of 72%. We held a focus group with a number of young people who were involved with the throughcare and aftercare team. Some were on training courses but none were in employment. Some had experienced a period of homelessness.
In 2007-08, there were 465 children and young people referred to SCRA on offence grounds, which represented 3.51% of the population aged 8-16. While decreasing year on year since 2004, this figure was still higher than the overall Scotland figure of 2.64%. The figure had been above the Scottish average for the last four years.
Forty-eight of the young people were defined as persistent young offenders. This number was lower than in 2004-05 and 2005-06, but represented a significant increase on the baseline 2003-04 figure of 26. The percentage of local referrals attributed to qualifying persistent offenders in 2007-08 for East Ayrshire was 38.2%, while for Scotland, this figure was 32.1%.
Youth justice services were the subject of routine monitoring in respect of service outputs but not outcomes. This was just one part of a wider picture across the range of children and families services where management oversight of statistics was not sufficiently pro-active.
Community care services
In 2007-08, the average time taken to provide community care services from the first identification of need to first service provision for East Ayrshire was two days. This was significantly less than the overall Scotland figure of 23 days. This was an improvement on 2006-07, when the average time was 12 days (the Scotland figure was 22 days). East Ayrshire was one of the top performing councils in this aspect of service provision.
Older people's services
In line with the implementation of the council's strategic direction of older people's services, the objectives of the joint future partnership to shift the balance of care from institutional to community based care and following a best value review, East Ayrshire re-provisioned residential care services.
As of March 2007, there were 21 care homes for older people in East Ayrshire provided by the private sector. There were 905 places in care homes and there were 697 older people placed at the time of the inspection. This was equal to 34.5 places per 1,000 population aged 65 and over. This was significantly less than the Scottish average of 44.1. Over the past five years, care home places had reduced by 26.3%, a much bigger reduction than the 4.9% seen in Scotland as a whole. Out of area placements were only purchased if the older person and/or their family chose such a resource.
In terms of respite for older people, East Ayrshire was ranked 15 out of 31 local authorities on the number of overnight respite hours provided per 1,000 population in 2007-08.
As of March 2007, 286 older people attended registered day care services run either by the council or by voluntary sector or private providers. This was equal to 14.2 per 1,000 population aged 65 or over and very close to the overall Scotland figure of 14.1 per 1,000. The council was ranked 10 out of 30 local authorities on daytime respite hours.
East Ayrshire provided a relatively high level of home care and people were generally satisfied with the service. As of March 2007, 1,480 older people received home care. This was equal to 73.3 per 1,000 population aged 65 or over, which was above the national figure of 67.1 per population aged 65 years or over. Of the 1,480 people who received home care, 1,315 received free personal care. This equated to 89%, which was higher than the Scottish average of 73%.
In 2007-08, for people 65 years and over, the council was ranked:
- 7th out of 32 local authorities on the total number of home care hours as a rate per 1,000 population aged 65+;
- 9th out of 32 on the number of people receiving personal care as a percentage of all clients;
- 5th out of 32 on the number of people receiving care in the evenings and weekends as a percentage of all clients; and
- 3rd out of 32 on the number of people receiving care at the weekends as a percentage of all clients.
As of March 2007, 25.3 per 1,000 of the population aged 65 or over received 10 or more hours of home care per week. This figure was well above the figure for Scotland as a whole (17.3 per 1,000).
As of March 2008, 123 people used telecare services to support them to live at home. This exceeded local targets and had particularly helped people with complex needs and people with dementia to continue living at home, enabling them to live more independent lives.
There were no delayed discharges in East Ayrshire at the time of the inspection and there had been no delayed discharges for over a year. East Ayrshire performed strongly in this area. At a focus group, we heard from older people that there had been no delays in receiving the necessary equipment for discharge from hospital.
Joint performance and assessment framework ( JPIAF)
The Scottish Government gathers information from local authorities and the NHS about how effectively they work in partnership to deliver aspects of community care. During the relevant reporting period the system for doing this was the joint performance and assessment framework ( JPIAF). The system had changed in 2007-08 so that outcomes were evaluated within the national community care outcomes framework. This related to the wider SOA negotiated between central and local government.
For the last two years to which the JPIAF framework applied (2006 and 2007), East Ayrshire was assessed as making 'good progress' both in shifting the balance of care and in achieving its local improvement targets ( LITS). For 2008-09, East Ayrshire Joint Future Partnership continued to use the local improvement targets, grouping them under the six interlocking themes in the new national community care outcomes framework.
Their submission (July 2008) showed that nearly all of the targets were met. Performance in respect of delayed discharges was particularly strong. This should, however, be set against the prevention of re-admissions where the local target had not been met. Another area for improvement was to ensure that more carers' needs had been fully explored through the offer, and greater uptake, of carers assessments.
Taken together these figures and service user feedback showed that the council had been successful in shifting the balance of care from residential care to care at home. Within community care, East Ayrshire had developed a range of services to support older people to remain at home, for example telecare, rapid response services, home from hospital services, intermediate care and short term assessment and rehabilitation services. These resources, along with the flexible use of a range of other community based resources, had contributed to this strong performance.
Learning disability services
Information about service outcomes for people with learning disabilities was collected according to a set of national performance indicators introduced in 2003 following publication of national policy document 'The same as you?'. 20 In 2007, 519 people with learning disabilities were known to social work services. The relevant statistics showed that in 2007:
- 36% had a personal life plan (Scotland 32%);
- 60% had an independent advocate (Scotland 12%);
- 4% had employment opportunities (Scotland 16%);
- 19% were in further education (Scotland 20%);
- 3% had training opportunities (Scotland 7%);
- 27% had community short breaks (Scotland 8%);
- 32% lived in their own tenancy (Scotland 33%);
- 4% were using the services of an area co-ordinator (Scotland 13%); and
- 35% were using alternative day opportunities (Scotland 27%).
Of the 148 people who attended a day centre, 65% attended five days per week. This was considerably higher than the Scottish average of 25%.
East Ayrshire had taken steps to develop employment opportunities and at the time of our inspection, there was evidence they were making progress. The authority had appointed a supported employment co-ordinator and approved funding for three job coaches and had one job coach in post for some months. Seven people were in paid open employment and over 70 referrals had been made to the supported employment service. Twenty-six people were supported in employment settings.
We met a group of service users during our recent follow up to the multi-agency inspection of learning disability services. Seven of the ten people we met had a paid job. They spoke positively about the support they received from their advocates.
Physical disability and/or sensory impairment services
Social work services had a sensory impairment team. In 2007-08 the team received 276 referrals. They provided 178 pieces of specialist equipment for people with visual impairment or hearing loss. The team did not routinely collect information about service users' experience of the services they provided.
The joint health and social work community equipment store met its delivery timescales. Once the team received a request for equipment, they usually delivered it within one day of request, but always for high priority cases. This efficiency made a real contribution towards positive outcomes for people with physical disabilities.
Mental health services
Outcome data on mental health was limited in East Ayrshire, as in most other local authorities. Local authorities have statutory obligations to provide services that promote wellbeing and social development such as opportunities for employment and training. There was acknowledgement from both health and local authority managers that recovery focused approaches to care were under developed.
We spoke with a group of people with severe and enduring mental illness who talked warmly of the support they received from social work services including valuable assistance in sustaining their own tenancies. They valued having had the same social worker/mental health officer ( MHO) over several years, which they believed had helped their recovery.
We visited Alzheimer's Scotland day and evening service for people with dementia. The service did not collect specific information about service outcomes as there were no systems yet in place to provide detailed statistical returns to the council as part of the contract monitoring process.
Substance misuse services
In partnership with the NHS and voluntary sector providers, the council provided services for people who misuse substances. The information that the local authority collected was more about mapping the service profile than about recording service outcomes. For example, there was information about the numbers of looked after children affected by parental alcohol and drug use and what agencies were involved. There were plans to introduce a database for recovery and recovery based outcomes for service users. The service provided statistical returns on a quarterly basis to the council, but provided little outcome focused data.
Personalisation of services and direct payments
The numbers of people receiving direct payments had increased from 36 in 2006 to 64 in 2008. This was equal to 5.4 per 10,000 population, which was more than the Scottish average of 5.1 per 10,000 population. The proportion of direct payments had been greater than the Scottish average for four out of the last six years. The estimated average value of each payment was £11,600, slightly above the Scottish average.
|Client group||No. receiving direct payments|
People with physical disability
Children with disabilities
Social work services did not routinely record outcomes for people who received a direct payment.
The council had signed a Memorandum of Understanding in 2005 with the Care Commission. This allowed the Care Commission to share information relevant to protecting people and avoiding duplication in contract monitoring.