Short Reviews of Social Work Services in Scottish Local Authorities
It has major logistical problems to overcome and, despite the significant extra investment from the Scottish Executive, particularly in community care services, limited resources seem to be a major barrier to making new developments. Moreover, the Council’s services are affected by particular policies and levels of services from the health board in a way which they cannot always control. The number receiving home care has increased from 39 to 45 in the last year but is still below the 62 people receiving this service in . As a result, overall the numbers receiving a service are at best equal to and at worst below levels. However, they are moving in the right direction.
Argyll and Bute has expanded intensive home care in 2002,
crimes against humanity card game. They do not have figures but the Council acknowledges that this approach affects the services provided to other home carers. Budgets ring fenced for domestic care were used to extend personal care as Supporting People budgets assisted in providing some practical support in some cases. The mobile home safety project undertakes a home safety assessment for older people. This service works in conjunction with Care and Repair services.
The Council has put measures in place to speed up discharges. However,
cars against humanity, at times Community Hospital beds freed up are quickly filled by GPs who manage these resources locally. Working groups are exploring how to reduce the numbers of these beds, the release of which would help develop a community infrastructure. Outline business cases have been developed with health and community care groups for Mull/Iona, Jura, Cowal, Bute and mental health services for older people.
The rapid response service is provided by the Integrated Outreach Team in Oban and home care teams in Helensburgh and Lomond. Statistical evidence suggests that the service helps to keep people at home and speeds up access to care packages. The Council is planning to set up other teams in Cowal and Kintyre. There are, however, no resources for rehabilitation even though they are critical to ‘stepping down’ from the hospital into the community. The Council is setting up a new adult respite service and reducing the amount it spends on short break respite care. This could create problems in the future but at present there is evidence that the Council is meeting the need for respite care through short breaks and the use of a purpose built Unit for Adults.
Argyll and Bute have had some difficulty in managing the demand for Free Personal Care and still has 50 assessments to carry out because of staff pressures on issues. Because of pressures on the budget, the Council is considering introducing a maximum rate to ensure a Best Value approach. The introduction of Free Personal Care has raised people’s expectations so that more people want respite and intensive care in their own home. Free Personal Care along with other funding such as that for Supporting People and Delayed Discharge provide the opportunity to support people who have intensive physical needs. For example, the Council supports a number of major packages of care above 100,000.
Services for people with learning disabilities
It is very encouraging that the Council has resettled 31 people from long stay hospital and has clear plans for resettling a small number into the community. While most people leaving hospital go to individual tenancies, nine people have been moved into care homes that provide nursing care on medical advice. They have also received extra resources to help them take part in the community as independently as possible. In another very positive development, the Council has also taken eight registered care homes with 81 placements off the register. Of these 81, 65 people are moving to individual support packages.
The Council is restructuring day services to provide alternative, flexible day opportunities such as employment and further education outwith the day service centres. Four local area co ordinators each manage a flexible budget. Lomond and Argyll Learning Disability Network (shared with West Dunbartonshire) provides nursing, speech and language therapy, dietetics, psychiatry and psychology. Training from speech and language therapists is also available to improve the skills of support workers.
A recent Scottish Health Advisory Service report identified major flaws in the structure of the health service beyond the control of the Council. There are no specialist forensic services within Argyll and Bute and there is a history of problems in accessing these in urban centres south of the Clyde. The Council is holding discussions about community based services to meet the needs for forensic services and for people with challenging behaviour.
The Council is one of the partners in the MGF2 funded National Database Support Project.
Services for people with physical disabilities
More people with a physical disability received a service in than in (337 compared with 268) but the numbers are still comparatively low.
The Council is planning to appoint new Direct Payment Advisers to encourage the take up of Direct Payments, which has been low in the past. Those using Direct Payments prefer to work through third parties.
At the moment, there is no database covering aids and equipment. The Council is working with health colleagues to create a joint occupational therapy service and equipment stores and hope that these measures will make easier the setting up of the database. It is important to move this forward to monitor and improve waiting times. With no service standards in this area, all requests for equipment are prioritised using a three tier banding. An average of 60 people are waiting for assessment in each service.
People with sensory impairment
The Council’s joint planning of services with Deaf Blind Scotland is important and two social workers support those people who are deaf or blind. In addition,
cards agsinst humanity, a Rehabilitation Officer works with people with visual impairment. The Council has a deaf/blind register.
Services for people with mental health difficulties
Argyll and Bute is working with health colleagues to develop a plan to put the new Mental Health Act into practice, based on the level of statutory work done at the moment.
There are five community support projects, one in each of the main population centres, excluding Helensburgh, where support is commissioned from the voluntary sector. The supported employment team for people with learning disabilities is to be expanded. The Council bought people carriers as a way of helping with transport issues. It has provided funding for an effective advocacy service,
cards of humanity, Lomond and Argyll Advocacy Service, jointly with the NHS and West Dunbartonshire Council.
The 13 practising Mental Health Officers (MHOs) are not enough to cover the workload and the geographical pressures mean that they cannot always match need. All out of hours calls pass through the stand by service in Glasgow. This means waiting longer to speak to a GP. The Council would like to have direct access between MHOs and GPs but this would require a separate call centre.