Chapter 5: Building capacity to deliver personalised services
"We expect services to make a positive difference to our
lives. We are people first. The outcomes we want include having
power and control, being able to take risks and contribute to
society. This means that there needs to be a shift in power away
from people who commission and provide services to service users
Users and Carers Panel
Doing more of the same won't work. Chapters 2 and 3 set out the evidence for that conclusion, summarising some of the demands that will drive all public services in the coming decades. We also concluded that solutions for the future will need both to build capacity across the whole public sector and partners in the voluntary and private sectors and make more effective use of the resources of individuals, families and communities. This chapter sets out the basis for a new approach to service delivery, aiming to build capacity to deliver the help that people need, when they need it.
We live in a time of great choice and opportunity. Increasingly this means that we want and expect personalised services. Whether we are a young offender or an older person with mental health problems, we want public services to be able to help us, or at least not hinder us, in achieving our goals. We want to be treated with respect, as an individual with our own aspirations, hopes and fears. Personalising the delivery of public services is an explicit goal of Scottish policy as set out in A Partnership for a Better Scotland (2003). Of course it is not always possible to achieve, particularly in social work. Some people will have unachievable goals. Others will need to have their liberty restricted because of the risk that their behaviour poses to themselves or others. Nevertheless, even those people who are subject to compulsory intervention from social work can benefit from a personalised approach, one which recognises that they have strengths and works with them through the use of a therapeutic approach to make changes and regain their independence.
Increasing personalisation of services is both an unavoidable and desirable direction of travel for social work services. Unavoidable in the sense that both the population and policy expect it; desirable in the extent to which it builds upon the capacity of individuals and communities to find their own solutions and to self care, rather than creating dependence on services. Personalisation puts the person at the centre as a participant in shaping the services they get, and allows them to work with professionals and their carers to manage risk and resources. This is not a new approach to social work, experience of moving people from institutional care towards independence has already demonstrated how much can be achieved. However, we need to go further, to devise collaborative forms of provision which are person centred, flexible, adaptive and supportive, while also being affordable on a mass scale.
The recommendations we set out in this report will therefore provide the foundations for more personalised services, including:
- a greater focus on prevention;
- approaches to delivery across the public sector and partners in the voluntary and private sectors;
- flexible service delivery;
- more effective use of social work skills;
- more empowered users of services; and
- increased community capacity.
|In the In Control initiative for people with learning disabilities in North Lanarkshire Council, money for social care is given directly to the families annually to purchase care, treats, outings, technology or transport. A care package centred on the person, their needs and their aspirations is drawn up after an intensive process of consultation between the client, their family and the social worker.|
At this stage, we cannot fully assess the implications of organising services around the principles of personalisation. We know that it will challenge the way that we organise both social work and other public services and call for new roles for workers. We do not know how much it will cost, nor is it clear how far the principles of personalisation can be applied to people subject to compulsory measures of supervision.
|The Tayside Criminal Justice Throughcare Network has brought together HMP Perth's Family Contact Development Officer, Criminal Justice Social Workers, and the voluntary organisations Crossreach and Families Outside to develop a more personalised and inclusive approach to the support of prisoners families and family visits. This enables prisoners and their families to maintain closer links, a significant factor in reducing re-offending. The scheme also promotes the involvement of families in assessing and managing the risk posed by the prisoner.|
However, we believe that this is the desirable direction for the future of social work services, therefore it is important that services are developed to test our understanding of the principles of personalisation in the different contexts of children and families, community care and criminal justice. These approaches should be developed in partnership with the people who use services, their carers and workers. Thus ensuring that people are active participants in shaping, creating and delivering their care, in conjunction with their paid and unpaid carers, so that it meets their distinctive needs and their hopes for themselves (Leadbeater and Lownsbrough (2005)).
In order to develop a new model of service, we will need to exploit and develop the capacity of the whole public sector and of the individuals and families who use public services. Such an approach will involve:
- social work services designed around the needs of those who use services and their carers;
- more differentiated care pathways, recognising and nurturing the potential that many individuals, families and communities have to find their own solutions and to self care;
- refocusing resources on multi agency prevention and early intervention strategies and being prepared to take a long term view of the benefits this will bring;
- exploiting the full potential of integrated services to reduce the duplication that exists across public services and to deliver new evidence based solutions drawing on the totality of available resources; and
- taking advantage of the many opportunities presented by the mixed economy of public, voluntary and private care.
Our five recommendations aim to make the best use of existing human and financial resources in social work services and across all sectors. They will start to focus our resources on doing the right things and doing these consistently well. The first recommendation describes the significant changes we expect to see in the way services are designed and delivered to meet the needs of people who use services and their carers. The following four recommendations make proposals about how we can build capacity to achieve this.
|1. Social work services must be designed and delivered around the needs of people who use services, their carers and communities|
Improving access to services
The difficulty of accessing services, or reliable information about them, has been a consistent message from both people who use services and the general public. Findings from our public attitudes survey (Mori, 2005) showed that most people have a limited knowledge of what social work services can and cannot offer, meaning that some have unrealistic expectations, whereas others, who do need help, don't realise that they could seek it. Moreover, it identified that social work services are regarded as a service of last resort, with people feeling that they were a failure if they had to seek help. Developing modern, effective services requires as a starting point a well informed public, who feel empowered to use services appropriately. There is a need for a consistent and open approach, with easy access to information and advice as well as a simple means to contact services and a prompt, helpful response. This should be underpinned by the development of national standards covering:
- information about services ; what, when, how and who they can help must be readily available in a wide variety of formats and using different media;
- methods of contacting services through a variety of media, including telephone, internet, e-mail, and text messaging;
- multiple points of entry to a single system of service delivery to signpost people to the person who can best help them;
- eligibility criteria should be explicit promoting fairness and transparency;
- planned services available when people need them , matching known need with service hours, using intelligence and technology such as geographical mapping to ensure that services respond to need; and
- responsive unplanned services , user led and better integrated with mainstream social work services and other emergency services including police, health, housing and benefit agencies.
|The Criminal Justice Social Work Development Centre is working with the Scottish Institute for Excellence in Social Work Education's learning exchange to produce an electronic throughcare map for prisoners, families and agencies. This will provide easily understood information on prison life, family contact, early release and post sentence supervision. It will be interactive and will include relevant scenes performed by actors portraying prisoners, prison officers and social workers.|
"We want to have trusting relationships with workers whom
we can be confident have our interests at heart and can help us
find our way through the 'system'. Social services workers should
communicate well and know how to build and maintain a long term
Users and Carers Panel
Participative and empowering assessment
Successful services will only be possible if those who use them start to play a much larger role in assessing their own needs and devising their own plans, often through consultation with professionals. Assessment must move from a system for gate-keeping resources to the basis for agreement of what is needed. It must be proportionate to the needs of the individual, involving the person and their family, identifying strengths, needs and risks and resulting in a fair reflection of circumstances with a direct connection between the assessment and the actions that result.
Many people who use services are able to assess their own needs. Others have parents, relatives and friends, with detailed knowledge of their needs, whom they would wish to act on their behalf. Others will continue to need the assessment skills of professionals. Developing new approaches to self assessment will not only give people greater control over how they are supported, it will also free up practitioners time to do more complex assessments and develop therapeutic relationships.
|In Kent County Council, people over 18 years or members of their family can complete an on-line self assessment for a range of services against published eligibility criteria. Services ordered are then delivered within 28 days. Purchase cards are being piloted where once a person's needs have been assessed and the care plan costed, this amount is placed on a credit card for the person to pick and mix from all available care services.|
Self assessment may only be the starting point. In future some people will make their own plans, complete their own financial assessments and self-review. The introduction of direct payments is the beginning of a move towards people having more purchasing power. People will increasingly expect to determine the services they will use, be they delivered by public, private or voluntary sector organisations or by directly employing their own care staff.
Our public opinion survey ( MORI, 2005) showed a majority of the public expect that the state will pay for all care needs. Families have always provided care and support and will want to do so in the future. Unpaid carers currently outnumber the social service workforce by approximately 6:1, with around 115,000 people caring for 50 hours or more a week. We will have greater need for unpaid carers in the future. Carers are recognised as key partners and providers of care in the Community Care and Health (Scotland) Act 2002. However, Care 21's report on the future of unpaid care ( OPM, 2005) recognises the need to support unpaid carers, emphasising the occupational aspects and hazards of caring if carers are not well supported. Such aspects include the impact on the health of carers, the difficulties of balancing paid employment with caring responsibilities and the adverse financial implications of giving up work or reducing working hours to become a carer. The Care 21 recommendations, if implemented, will see carers as people first and will enhance the contribution unpaid carers make to society, helping to harness their contribution as key partners alongside professionals in the delivery of care.
|Stirling Council work in partnership with a local voluntary organisation Plus to provide respite care to the families of 200 school aged children with disabilities. Parents are entitled to 12-15 days per year and can determine whether to take these days in a block or spread over the school holidays. There is a high uptake of this service which is accessed directly on meeting the eligibility criteria.|
Consistency and continuity
The importance of a reliable, consistent relationship with a single worker whom they trust was emphasised by people who use services and evident in research findings (Walker 2005 and McNeil 2005). This continuity is particularly important in transitions between services. There should be a smooth transfer between services, with a named worker to support people through the process. This is equally important when ending involvement with an individual or family. People using services need the opportunity to reflect on the changes that have taken place and to be confident of informal support arrangements and know how to seek further help if necessary.
Premises fit for the future
Although there have been significant improvements in social work premises over recent years, there remains much to be done. People who use services spoke about grim and inhospitable buildings which confirmed their feelings of personal failure and worthlessness. Staff morale is also undermined by inadequate working environments. The premises in which people have direct contact with social service staff must be user friendly, fit for purpose and free of stigma. There are good examples of services being delivered in modern, user friendly buildings. These provide a model to build upon in future.
|The Dalmellington Area Centre in East Ayrshire is an innovative community initiative which provides local authority, health and police services together under one roof. It provides residents of the Doon Valley with easy access to a comprehensive range of services.|
By co-ordinating their planning and capital building programmes, public services can cost effectively maximise the delivery of services in community facilities. Appropriate use should be made of nurseries, schools, health centres and leisure facilities to deliver joined up services and co-locate staff where they are most needed.
|2. Social work services must build individual, family and community capacity to meet their own needs|
Managing growing demand for services means that we need to develop the capacity of individuals, families and communities to find solutions to their own problems. This will be done by building on strengths and skills, promoting resilience and strengthening informal support networks.
In the past 20 years there has been increasing inequality in health, educational attainment and income measurements between the most and least affluent areas in Scotland. We need long term and concentrated effort to change this, if a rise in social problems is to be halted. Social work services must play their part in informing and being informed by regeneration and community development activity.
Community social work has, in the past, been promoted as a discrete activity, conducted apart from mainstream social work practice. A new approach is now needed, which positions social work services at the heart of communities delivering a combination of individual and community based work alongside education, housing, health and police services. We found good examples of social workers' input reducing anti social and offending behaviours and producing sustainable solutions. Communities that Care, an international voluntary organisation, has been applying a model of community capacity building in the UK, including in Scotland, since 1998. The model focuses on children and mobilises communities to prepare a risk profile and produce action plans to build resilience and increase protective factors. These plans are locally owned, evidence based and sustainable. Repeat audits of such projects have evidenced improvements in underlying risk factors and a reduction in problematic behaviour.
|Having identified poor parental supervision and discipline as a problem in Leith, Communities that Care funded the training of two workers in the validated Incredible Years parenting programme. After a successful first group held in Leith Community Education Centre, this training is now being delivered to other workers.|
Building the social economy
Social work services often deal with problems rooted in poverty and unemployment which have run through some families for generations. The high proportion of young people leaving school without a clear route into education, employment or training will, in particular, require a joint strategic approach by social work, education and careers services. Proactive partnerships such as those focused on access to opportunities run by Glasgow Homelessness Network, are already showing some progress in this. Social work services have a role in connecting people with work opportunities and in building self esteem and confidence to help people into the job market.
Social care is itself an expanding job market. It may provide routes into employment for excluded individuals, combining the social and economic development needed to regenerate communities. A West Dunbartonshire
Partnership Network project focused on recruitment and training of home carers provides one positive example.
|In Barcelona the ILO- SER project identifies individuals who are estranged from the job market and trains them in care and entrepreneurial skills. They are then supported in setting up small businesses providing home care to older and disabled people both in the private market and purchased by local authorities. This moves excluded groups out of the benefit system, provides a skilled workforce in a mixed economy of care and redistributes wealth to poorer communities.|
Sport and cultural policy is increasingly being developed in a wider context. Creative, artistic and sporting activity can provide a positive identity to young people and to those excluded by barriers as a result of disability, illness, criminal record, substance misuse or other factors. Social work services must therefore contribute to and make use of advances in these fields, using such approaches to help develop aspiration and hope for people who are excluded. We have learned of good work being done in Scotland and in other countries. Such links are consistent with the findings of the recent Cultural Commission Report (2005) but need to be more widespread.
|Scotland already has some of the most innovative projects in Europe in the use of sport to promote the social inclusion of disabled people. In wheelchair curling, for example, Scotland hosted and won the 2005 world championship.|
Using tested models to increase capacity
Making best use of social work skills and resources means that we need to use and develop the capacity of individuals and families to support themselves as well as finding different solutions to meeting their needs. Two particular models of capacity building are currently being used in Scotland with particular user groups: family group conferencing with children and families; and local area coordination with people with a learning disability. Neither model in itself is a substitute for good professional practice and both require a range of service alternatives to be available. For example there is no point in a family group conference producing an action plan if the resources aren't available to fulfil it.
|Family group conferencing , a family centred and structured decision making process has produced good results internationally in diverting children from the child protection system, reducing offending behaviour and preventing some children being accommodated away from home. Children 1st is currently working with 12 Scottish local authorities to implement this approach. For example in Fife Council, of 30 children rated as being medium to high risk of becoming accommodated 26 remained in kinship care 9 months after a family group conference.|
Nevertheless, the full potential of these and other models may not yet have been realised. An evaluation currently underway by the University of Stirling Social Work Research Centre will explore the impact and potential of local area co-ordination. We will need to similarly evaluate the impact of family group conferencing.
|Local area Co-ordination has been adapted as a specialist service for people with learning disabilities in many parts of Scotland. Based on an Australian approach which provides shop front access to advice and support for disabled people, developing formal and informal support networks and providing access to resources. The Scottish model often requires referral rather than being directly accessible, with co-ordinators holding comparatively smaller budgets. For example in Argyll and Bute, the local area coordinator worked with parents of children on the autistic spectrum who have no local respite services to make funding applications and develop improved local services.|
Many social workers have skills in leading and delivering group work programmes with a wide range of people. Yet despite the effectiveness of such approaches it appears that group work is not being used to its full potential. As pressure on social work teams has risen, demand has increasingly been managed on a case by case basis rather than seeking solutions for groups of people with similar needs. Despite this, we saw programmes which were able to demonstrate success, even with groups, such as women offenders, who can be very hard to engage. Group work, can both make more effective use of social workers' time, achieve positive change and create longer term benefits, through the creation of mutual support networks.
|Social workers deliver an evidence based group work programme as part of a Barnardo's Scotland service for primary school aged children in Glasgow whose parents misuse substances. The aim of the group which runs over a 12 month period is to build resilience in children. Social workers evaluate outcomes using the Goodman's Strengths and Difficulties Questionnaire before the programme begins, mid way through and at the end. The results show promising trends.|
Volunteering, peer support and self help groups
The review found many good examples of volunteers providing a wide range of services from mentoring and befriending to more practical help. In particular, those who had previously used social work services to resolve their difficulties were able to provide positive role models for others. The growing number of active retired people able to make a contribution potentially provide a wealth of experience to draw upon.
We also found good examples of peer support. For example, a senior pupil taking some responsibility on the school bus for a disabled pupil, an experienced carer supporting a new carer. There appears to be scope to use this approach more extensively.
Supporting people in setting up self help groups can also generate a new service for people with similar needs and give them a voice in influencing the way services are designed and delivered. Virtual self help groups will have greater potential in future with increasing access to the internet and could be especially supportive for people who are housebound.
|In New York City, Experience Corps recruit local retired people to work as volunteers in primary schools supporting 5-6 years olds who have reading difficulties. Trained volunteers work intensively with the same child for 1 hour, 4 days a week. Participating children do better in reading tests. Wider benefits include improved behaviour and increased self confidence in children who enjoy a significant relationship with a trusted adult.|
|3. Social work services must play a full and active part in a public sector wide approach to prevention and earlier intervention.|
With rising levels of demand, social work services seem to be increasingly responding to crises at the expense of planned pieces of work and early intervention. Services must continue to play a vital role in stepping in to help people at times of crisis in their lives. However, members of our users and carers panel spoke of the need to engineer a crisis in order to get any response. Aside from the personal toll, by the time people reach crisis point, helping people to make change can be more costly, time consuming and less effective. The evidence base for early intervention in social work is not well developed. It is difficult to make a strong economic case for the potential savings of more timely support. However, the financial costs of intervening late can be huge and life-long.
|Barnardo's Scotland and Edinburgh City Council work with 10 primary schools to support an average of 33 children with emotional and behavioural difficulties at risk of exclusion from school. The multi-disciplinary team aims to keep children in their own family and school, with an impressive success rate. Evaluation shows 87.8% of children still in mainstream school at the end of the intervention, with 76.5% still there 3.5 years after the end of the intervention, resulting in significant savings compared to the cost of residential school.|
Investing in prevention and earlier intervention
Developing sustainable, effective services for the future requires us to find ways of identifying potential problems and preventing them (prevention). We also should respond earlier to emerging problems before they reach crisis (early intervention). Achieving this goal will require a long term commitment across the public sector at both national and local levels. In particular, developing social work services' contribution will require investment, enabling a focus on earlier intervention while continuing to support people with the most complex needs.
A public sector wide approach
Much preventive work is not the primary responsibility of social work. Education, health and early years services, who have contact with the whole population are much better placed to lead this work. What is needed is a joined up approach to prevention, in which social work services better support universal services to pick up and respond to the early signs of problems as well as tackling the complex problems of some individuals and communities.
Prevention as part of everyone's job
Everyone in the public, voluntary and private sectors has a role in prevention, looking at the whole person in the context of their environment. That may mean, for example, a community care social worker taking action to support a young person whose mother is suffering from depression or a care worker being alert to health and safety hazards in an older person's home. By regarding prevention as part of what everyone does and ensuring that they are both alert to this and able to respond appropriately, services will be more aware of emerging problems and better able to respond.
"Services should be there at the outset to prevent a
crisis happening. We expect them to be co-ordinated and
accessible in the community."
Users and Carers Panel
Joined up approaches to early intervention
Walker (2005) concluded that clarifying the nature of links between social work services and other agencies was a vital pre-requisite for effective early intervention. She identified that social work interventions are more effective when:
- problems are developing rather than entrenched;
- assessments are well-informed;
- interventions are based on logical reasoning as to why they should be effective for a particular child or family and are tailored to suit individual needs;
- there is an inter-agency response; and
- a key worker provides consistency and continuity.
These principles should be used to re-design services with a greater focus on social work services' contribution to early intervention and the social worker's role within this.
Many needs or potential problems may be identifiable earlier. For example, research by the Scottish Children's Reporters Administration on children identified as persistently offending and involved in the recent Fast Track Hearings Pilot found that 62% of persistent offenders were first referred to the Children's Reporter on non offence grounds. 44% of persistent offenders were first referred to the Children's Reporter before they were 8 years old due to concerns about their care and protection ( SCRA 2003). With targeted support this group may be prevented from having further problems later. This emphasises the value of an integrated system of care and justice. Such anticipatory approaches are entirely in line with the recommendations of Delivering for Health (2005). By bringing together intelligence and expertise from across partnerships, social work services can be much better placed to anticipate future needs and organise services in such a way as to prevent or minimise them. Predictive technologies can help to use this data to make informed plans focused on prevention.
|In Moray, a child and family social work team in Forres worked with education colleagues to put together a transition programme for a small group of P7 pupils whose behaviour and history indicated a high risk of problems on transfer to secondary school, establishing relationships in P7 and sustaining them into S1.|
|4. Social work services must become an integral part of a whole public sector approach to supporting vulnerable people and promoting social well-being|
Social work services cannot be effective without the active co-operation and partnership of other public services. Although service integration is a major policy driver, underpinning all branches of social work, this needs to be further developed if it is to deliver increased capacity. Taking a whole system approach will require all agencies to take a shared responsibility for people in need. This philosophy underpins Getting it Right for Every Child (2005) and will need to be the foundation for future service design and delivery across all public services.
Effective community and corporate planning
Local authorities have a unique position as democratically
elected bodies with responsibility for local service planning and
delivery. Their role in improving social conditions and devising
solutions to address social malaise must be fully exploited.
However, they do not always make best use of their powers and
duties in making connections between social work services and other
local authority and wider public services.
In particular, they could make better use of social work intelligence about the needs of communities to design, plan and deliver services to support vulnerable people and communities at all levels. This is in keeping with the power to advance well-being, introduced under the Local Government in Scotland Act (2003), which enables local authorities to do anything they consider likely to promote wellbeing. This includes working with community planning partners to provide better, more joined up services to their communities. The creation of community health partnerships with a remit to promote health and wellbeing, provides an excellent opportunity for innovative joint local authority and health approaches to promoting wellbeing in communities, as will the creation of community justice authorities.
Harmonising service boundaries
Consideration of local authority boundaries and their co-terminosity with other public services was outwith the remit of the review. However, we did conclude, that partnership working and collaboration at a local level was most effective when there was harmonisation between service delivery boundaries. This may be, for example, between children and families teams, schools, health visitors and school nurses. Common boundaries assist the development of trusting relationships and effective integrated working around the needs of service users and carers.
Commissioning of services at local, regional and national levels
Providing specialist services and achieving economies of scale mean that it doesn't make sense to replicate all social work services in every local authority. Some local authorities already work in partnerships across their boundaries to develop joint services, bringing value for money and more efficient and effective services. We commend this approach and see scope to develop it further. Services can be designed and commissioned at local, regional and national levels depending on the nature and scale of the service. Different services will require different groupings of local authorities and public, voluntary and private sector partners, which must be reflected in a variety of planning arrangements.
A national integrated policy framework
Policy making within at least four Scottish Executive departments impacts on social work services as a whole. While there have been positive benefits from this approach in promoting integration around the needs of different client groups, it has created some confusion of messages and unnecessarily complex funding, planning, reporting and inspection mechanisms.
An older person with intensive care needs can have care funded from four discrete funding streams, each with its own audit and reporting process:
Assistance with personal care
? Free personal care monies
Practical support (housework, shopping etc)
? Housing support (Supporting people monies)
Day centre attendance
? GAE (mainstream social work budget)
Physiotherapy and overnight care
? Delayed discharge monies
People at all levels have spoken to us about the disproportionate bureaucracy and systems in social work. Some of this is associated with Scottish Executive reporting requirements, some with risk aversion, creating additional burdens on the whole system following something going wrong in one part.
If social work services are to respond flexibly and creatively to current and future demand, it is essential that a more integrated approach is developed. This should reduce the administrative burden on local authorities and their planning partners and ensure that the desired outcomes of current and new policy are met.
Simplified governance and funding arrangements
The ability of local authorities and their planning partners to integrate services around the needs of people who use services is constrained by overly complex governance and funding arrangements. In practice, this often means that success is only achieved through compromise and considerable effort and goodwill to negotiate complex systems. If integrated working is to become the norm, then greater clarity and direction on governance and funding arrangements is required at national level.
|5. Social work services must recognise and effectively manage the mixed economy of care in the delivery of services|
To be fit for the future, local authorities and their planning partners will need more streamlined, flexible approaches to commissioning services that recognise and make best use of the knowledge and skills of providers in both the planning and delivery of care. They will need approaches that will support increasing personalisation of service delivery.
The social work market
The delivery of social work services has changed dramatically over recent years. The voluntary and private sectors now play a vital role in the delivery of care and support to many thousands of people. The ability of providers to respond flexibly, creatively and quickly to new demands has enabled them to develop ground breaking new services.
However, there are some very real issues that need to be addressed in making the relationship between public, voluntary and private sectors fit for the future. A multi-million pound market for social work and social care has been created and needs to be managed. Purchasing needs to make effective use of public funds through best value and good commissioning practices. It also needs to recognise that a significant part of the expertise required to commission and provide services effectively sits outside local authorities, requiring new approaches to managing the relationship between sectors.
|The social service workforce|
In total around 104,000 people work in the sector of which around 6,500 are social workers.
Of the total workforce:
The commissioning process
Large voluntary organisations described having numerous different contractual arrangements, sometimes having several with one local authority. These take up an inordinate amount of time and effort. National voluntary organisations currently have service level agreements containing the same information in different formats for delivering the same service in each local authority. Despite the demands made by local authorities, many providers spoke of contracts that remain unsigned, or reviews that did not take place within specified timescales. There is often little connection between the people who commission services and the workers at the front line, so information that could inform more effective commissioning was not readily available. More fluid commissioning arrangements that can respond quickly to changing demands and needs, enabling flexible and creative responses are required. This will pose a challenge for both commissioners and providers. A new approach to commissioning must be developed on a national basis and implemented locally. This will allow for local flexibility, while reflecting the fact that many providers work across Scotland.
|In delivering Mental Health Services, Orkney Islands Council have pursued a number of different partnerships with some services delivered locally, some from Aberdeen (where the main ferry service connects) and some in Caithness (to where a short ferry crossing operates).|
Expertise in meeting the needs of particular people and communities increasingly sits with the providers of service rather than the commissioners, meaning that commissioning can be poorly informed about need. We must explore new approaches to the commissioning arrangement that recognise this diffuse knowledge and expertise and ensure that it is brought together in the commissioning process. Essentially this requires a strategic partnership, where the expertise of all partners is brought to the table, rather than a traditional purchaser/provider arrangement. This will pose challenges, but there are some good examples that can inform a new working relationship between commissioners and providers that recognises that the expertise of each is complementary.
Meeting people's needs
The unequal status between commissioner and provider is mirrored in a status gap between the staff in each sector. This can mean that assessments by the provider are not regarded as being valid, or staff who may know the individual or family best do not contribute effectively to case reviews, resulting in ill informed decisions. It is important to acknowledge the expertise and knowledge held by people working in the voluntary and private sectors and to use this to better effect in creating a network of care around the individual, where each component part is valued. There are no legislative restrictions preventing local authorities delegating statutory responsibilities to a social worker in the voluntary or private sector. Enabling voluntary and private sector social workers to fulfil statutory functions could reduce duplication of effort, result in better informed assessment and review and create more balanced caseloads of statutory and voluntary work across social workers working in the different sectors.
|Crossreach Threshold Project in Hamilton provides a range of services, including short breaks, for adults with learning disabilities. These breaks consist of group trips to popular tourist destinations in the UK and Spain. They are cheaper than residential respite provision, allow for greater development of social and independent living skills and are regarded as more empowering and personalised by service users and carers.|