CHAPTER ONE INTRODUCTION
BACKGROUND TO THE RESEARCH
The emergence of local area co-ordination
As part of its core funded programme for the Scottish Executive, the Social Work Research Centre at the University of Stirling was asked to conduct an evaluation of the implementation of local area co-ordination in Scotland. This 11 month study ran from October 2005 to August 2006. Local area co-ordination ( LAC) emerged in rural Australia in 1988 in response to long standing difficulties meeting the needs of people with learning disabilities and their families living in remote areas. Due to the lack of service infrastructure locally, individuals had to leave their families and communities to move into residential homes in cities many miles away. LAC was seen as an innovative way to support individuals and their families to build a 'good life' and to work with local communities to strengthen their capacity to include disabled people, based on the principles of user control, empowerment and self sufficiency 1. Within the Australian model, LAC can be seen as:
"A generalist or eclectic approach, insofar as it contains elements of case management, personal advocacy, family support, community development and direct consumer funding. The aim of LAC is to make disability services and supports more personal, local and accountable, and to support local people with disabilities and their families in their local communities." (Bartnik et al, 2003 p12).
In 1999, LAC was introduced to Queensland, Australia, in pilot form. Disability Services Queensland issued a short paper (2001) outlining the core elements in LAC, described as 'seven signposts on the road less travelled.' These are:
- The quality of the relationship between a local area co-ordinator and the individuals/families with whom they work
- Working with families and individuals across all ages and life stages and all types of impairment
- A focus on developing and maintaining informal supports, natural social networks and facilitating access to mainstream services
- Community building
- A local community base, community connection and geographic boundaries, defined by place
- A supportive management framework
- An agreed value base and set of principles as the basis of decisions and actions.
The review of services to people with learning disabilities in Scotland
Towards the end of 1998, the Scottish Executive embarked on a wide ranging review of services to people with learning disabilities. Eighteen months later, it published a report entitled The same as you? setting out its findings and conclusions (Scottish Executive, 2000a). The report was based on principles central to supporting people with learning disabilities to lead full and active lives: these emphasised that people should be valued, respected and included within communities; that their individuality be recognised; that they should have choices and opportunities to realise their potential; and be able to use mainstream services wherever possible. Thus the report draws heavily (although not explicitly) on theories of normalisation (Wolfensberger, 1972, 1983), inclusion (O'Brien, 1987) and an 'ordinary life' (Towell, 1988).
While the review was being carried out, Scottish Human Services, an independent not for profit organisation promoting innovative ideas around supporting people, invited Eddie Bartnik, the Director of Metropolitan Services Co-ordination in Western Australia, to visit Scotland. He toured the country, talking about the Australian model of local area co-ordination to practitioners, managers and the Scottish Executive. Issues identified during the course of the learning disability review included problems experienced by families trying to obtain information about services, a lack of knowledge among professionals about people with learning disabilities and failings in care management. Those responsible for the review were impressed by the idea of local area co-ordination, and its offer of:
"A specialist worker dedicated to working with a small number of families using services in one area [to] help people and their families through the current maze of systems." (Scottish Executive, 2000a: 19) .
The same as you? made 29 recommendations, including:
"Health boards and local authorities should agree to appoint local area co-ordinators for learning disabilities from current resources used for managing care and co-ordinating services." (ibid: 20) .
It was envisaged that each LAC would support about 50 people, would cross traditional boundaries between housing, social work, health, education and other agencies, provide information, co-ordinate services and have access to some funding which could be passed on directly to individuals and families. In addition, local area co-ordinators would have a role in supporting individuals to build up strong networks and work with other agencies and local community groups to promote inclusion.
Curtice (2003: 38) writes:
"The adoption of LAC signalled the review's vision of a radical change in how people with learning disabilities are seen and receive support. LAC should lead to investment in different forms of support in the community, to more direct control by individuals and families over the support offered, to opportunities to develop people's strengths rather than merely meet their support needs and to the development of capacity and trust in communities."
As well as setting out the role and tasks envisaged for LACs, The same as you? made proposals for organisational and management arrangements, with initial training for LACs scheduled to begin in Autumn 2001. At the same time, the Scottish Executive left scope for local authorities and health boards to decide on the details. In England, the review of services to people with learning disabilities culminated in the publication of a White Paper, Valuing People (Department of Health, 2001), which set out a strategy for the delivery of services for adults and children. The Scottish Review, The same as you? set out 29 recommendations. Accordingly, local authorities were encouraged but not obliged to implement LAC. The key principles of LAC are listed in Annex Six.
In order to clarify LAC, Curtice (2003) notes that one of the best ways to do this is to describe what the person does and what skills are needed. She outlines "key features of LAC" (2003: 40):
- Strong local connections
- Is committed to community
- Provides information that explores all the options
- Is stable, personal and consistent
- Works from where people are at
- Works with people in their homes and in the community
- Acts as a bridge and links people together
- Is not an 'authority', not always having an answer
- Is non-judgemental and non-discriminatory
- Is committed to long-term relationships
She goes on to say LAC is not:
- Heavily bureaucratic
- Targeted only on people with certain levels of need/ages etc
- Primarily a service co-ordination role
- A part-time function or task of another professional (Curtice, 2003: 40, Box 2).
Progress in implementing LAC in Scotland
Progress towards implementation appears to have been slow and uneven across Scotland. A survey by a Short Life Working Group on LAC ( SLWG, 2002), part of The same as you? Implementation Group, reported that five authorities had appointed a total of eight local area co-ordinators and five more had plans to appoint. The Scottish Executive also carried out some investigations (reported in the SLWG document), visiting some authorities which had no plans for LAC, and encouraging them to appoint. The Executive concluded that by Autumn 2002, there should be 57.5 LACs in post in 24 local authorities. Eight authorities did not plan to appoint local area co-ordinators, in three cases because they intended to achieve similar outcomes through different means (see Chapter Nine).
The SLWG report (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 revealed that:
- Coverage of some local authority areas was patchy
- Elsewhere, LACs 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 paper also contains a helpful account and clarification of the key elements of LAC, its principles, intended outcomes, 'added value' and relationship to care management. Attached to the report was a person specification which authorities could use as a model for recruiting LACs.
The authors recommended that the Scottish Executive issue guidance on implementation of LAC. A circular letter addressed to Directors of Social Work, Chief Executives of Health Boards and Directors of Housing (Scottish Executive, 2002) was distributed. This letter summarised developments in implementing The same as you? and 'urged' agencies to appoint local area co-ordinators by December 2002. The SLWG paper was attached to the letter.
A number of national training events have been held for local area co-ordinators. The first, run by SHS Trust, took place in Erskine in April 2002, comprising the six local area co-coordinators then in post, along with parents and other professionals. The course was led by Eddie Bartnik from Western Australia and Anne Cross from the Queensland project (see Partners in Change, 2002). The following year, a week long residential training programme took place in New Lanark, again led by Bartnik and Cross (see SHS Trust, 2003). This time 20 local area co-ordinators took part. A third national training programme took place in May 2005 with Eddie Bartnik, run by SCLD and integrating both training and Action Learning Sets. Since 2003, the Scottish Consortium for Learning Disability, charged with helping implement the recommendations of The same as you?, has run two-day Action Learning Sets ( ALS) every three months, bringing together LACs from across Scotland to exchange information and ideas and learn from each other. The ALS provide structured training aimed at developing reflective practice and consist of a combination of formal presentations and experientially-based groupwork exercises.
In 2005, the Scottish Executive published statistical returns which indicated that, by September 2004, 23 authorities had introduced local area co-ordination. The most recent figures issued, for September 2005, suggested that 27 authorities had LAC, and that almost 2000 adults across Scotland benefit from it (Scottish Executive, 2006a). These figures are based on local authority returns for the two years prior to this evaluation and do not concur with our research which found that only 25 authorities have local area co-ordination, at the time of writing (August 2006). Three of the authorities recorded in the Scottish Executive statistics as having LAC, including two apparently working with high numbers of people, do not have any local area co-ordinators: in this study, they have told us why they decided not to implement LAC. Another authority shown in the statistics as having no local area co-ordinators actually had two. The latter error may be due to a late data return but the other discrepancies most likely reflect the ambiguity surrounding definitions of local area co-ordination in some local authorities.
Local area co-ordinators as such have not been introduced elsewhere in the UK2 although, after a visit from Eddie Bartnik in 2002, the Ulster Community and Hospital Trust in Northern Ireland appointed three Community Disability Co-ordinators ( CDC), with a similar brief 3. One CDC works with people with learning disabilities, the other with people with physical impairment. This is a bottom-up initiative, not part of a national policy, and was described as a low-key 'filleted' version of the LAC role (personal communication, Alan Vincent, Ulster Community and Hospital Trust, 2006). The CDC use person-centred approaches to promote inclusion by setting up groups for disabled children (but not necessarily inclusive groups) in mainstream settings.
The Social Work Research Centre was asked to conduct an independent national evaluation of implementation. This was considered necessary by the Short Life Working Group on Local Area Co-ordination in order to assess the effectiveness of LAC in the context of Scotland in the 21 st Century, to ensure that lessons were learned from the first phase of implementation and to inform the future strategic development of LAC. The aims of the study were:
- To examine the lessons from implementation of LAC across Scotland
- To explore (in broad terms) the outcomes of LAC work
- To assess the future scope for LAC.
A literature and policy review was conducted 4: this is presented in Chapter Two. Data was collected from:
- 44 information forms completed by local area co-ordinators in 24 authorities 5
- Interviews with 35 local area co-ordinators in 24 authorities
- Interviews with 14 managers in 13 authorities
- Interviews with a manager in seven authorities without LAC
- Four case studies of LAC practice.
The case studies of LAC practice in four authorities were intended to explore the views and experiences of individuals and their families about LAC, to explore specific aspects of LAC (these varied in each area) and to gather evidence about outcomes in relation to individuals, families and communities. They provided opportunities to explore the implementation of LAC in a rural setting, an urban setting, the voluntary sector and across traditional 'service user' boundaries. Each case study was spread over two or three days. The approach was based on that used in a review of day opportunities for people with learning disabilities (Cole et al, 2006) and involved talking to individuals and families, LACs, managers, and staff in other agencies. Unfortunately, our intention to include a member of People First Scotland 6 in the visiting research team was not realised.
A more detailed account of how the research was carried out, along with the various data collection tools, can be found in Annexes One, Two, Three, Four and Five.
Local area co-ordination originated in Australia and was introduced to Scotland in the form of a recommendation in The same as you? Evidence to date suggests implementation has been uneven, with some modifications to the key elements of the role and ethos as practised in Australia. The aims of this study were to examine the lessons from implementation of LAC across Scotland, explore (in broad terms) the outcomes of LAC work and assess the scope for its future development.
Chapter Two presents the findings and issues arising from the literature and policy reviews. Chapter Three sets out an overview of LAC posts while Chapters Four and Five provide case-studies of the operation of LAC in four local authority areas (Dundee, Argyll and Bute, Stirling and Midlothian). Chapter Six examines some of the issues arising from LACs day-to-day working environment while Chapter Seven provides a more detailed examination by considering the themes of role definition, accountability, support and future development. Chapter Eight outlines the perspectives of managers while Chapter Nine considers the views of key respondents in authorities without LAC. Chapter Ten concludes the evaluation and considers some of the implications for policy and practice arising from the findings.