Social Services Research Group
Editors' note: This section contains reports and abstracts from three of the workshop presentations at the 1999 Annual Conference.
Workshop 1: Phillip Cunningham of Essex Social Services Department describes a successful information system initiative in relation to hospital discharges in the County.
Workshop 2, Jabeer Butt and Leandra Box of the Race Equality Unit outline their national study into the use of family centres by Black families before highlighting some of their key findings.
Workshop 3, Jill Manthorpe and Gary Craig reflect on the experience of local government re-organisation and draw out the lessons to be learned from their research.
Information special study: Good practice example
Phillip Cunningham, Essex County Council, Social Services Department
What is the Initiative all about?
What commissioning issues and problems are being addressed?
The causes of delayed discharges have been identified across a number of Trusts. There has been a clear linkage to demand and levels of Social Services funding available for placements or community packages in different parts of the county, as well as other practice and resource issues. The system has also validated data that Trusts were using to press for further funding given apparent increases in demand.
What has become clear is that as hospital systems have become more efficient, people reach the point when they need community care packages earlier.
When was this initiative set up?
A discharge monitoring system had been in place for some time but reliability and validity needed improving. A cross-agency working group made proposals which were put into place in December 1995 when data collection first started. Improvements to the reporting mechanisms were agreed later and final chief officer approval given in 1996. Following further refinement full confidence in the data and the system was finally established in July 1996.
Particular efforts were made to inform practitioners and their managers about the new system, how it would
work, their role and responsibilities. It was designed to be as straightforward as possible, keeping administration to a minimum by using a simple form to collect the raw data for each ward and another for providers to aggregate information across their Trust. Guidance on how interpret the different categories was also crucial. Periodic checks were built in to ensure the reliability of the data which included cross referencing with SSD records.
What information does it give?
The DOH common information core is based on eight categories and counts only the numbers of patients and the number of bed days involved. In this system there are seven categories linked to assessment, twelve linked to service provision issues (such as availability of funding or places) and one 'reason not known' category. When more than one category at a time is applicable, guidance has been provided as to which one to use as the primary cause of delay. Figures are reported weekly at ward level and monitored for thirteen, four week accounting months. The management reports reduce the information down to fourteen categories and provide detail at hospital, trust, health authority and county level.
How is the information being used?
How have consumers benefited?
By helping to identify what causes delays, the system has allowed agencies to focus on blockages and their solutions to ensure patients are discharged at the right time. It also re-enforces both good practice and the inter-dependency of health and social work teams thus achieving a more consistent approach to discharge planning. One further consequence is that it encourages professionals to focus on the consumer and their pathway through the system rather than on separate treatments or agency responsibilities.
How has the information improved effectiveness?
It quickly highlighted the need for a faster turn-round of hospital assessments and the establishment of key-worker arrangements for a number of wards. The need for rapid response services to avoid unnecessary admissions and a safe return home for those who attended casualty units was also identified. Finally it has demonstrated to SSD managers where the pressures were at any one time, enabling funds to be moved between different localities to deal with particularly high levels of delays or emergency admissions. As a result the level of delays have become more evenly spread across the County.
Questions from answers?
Good information often leads to as many questions as it answers, which means that the systems need to evolve and develop. The Essex experience quickly led to separate details being provided for each Trust as well as separation of adults and older people with mental health problems, who are often 'forgotten when it comes to thinking about delayed discharges. Questions were also raised as to what were reasonable and tolerable levels of delay and whether it was possible to predict average lengths of stay in order to plan further ahead for discharges.
Contact name, address & telephone numbers for further information:
Philip Cunningham, Operational Development, Essex Social Services, PO Box 297, County Hall, Chelmsford, Essex CM1 IYS Tel: 01245 434821.
Mike Davies, Senior Analyst, North Essex Health Authority, Collingwood Road, Witham, Essex CM8 2TT Tel: 01376 532572.
Jeffory Francis, Strategy Manager, South Essex Health Authority, Arcadia House, Warley Hill, Business Park, The Drive, Warley, Brentwood, Essex CM 13 3BE Tel: 01277 755294.
Family Centred: a study of the use of Family Centres by Black families
Jabeer Butt and Leandra Box
Race Equality Unit
The study
The study used three main methods of data collection. These were: a questionnaire to 84 family centres in nine local authorities areas (including a Welsh authority and a health and social services board in Northern Ireland);
a series of in-depth individual interviews (with 38 parents and carers using family centres) and 15 group interviews (with a range of users including men and children).
Some findings
On needs...
On services used...
On services not used...
On the impact of services...
Implications for practice
Analysing local need:
Active engagement:
Mix of services:
Black workers practice:
User involvement:
Implications for policy
Learning from Local Government Reorganisation
Jill Manthorpe, University of Hull
Gary Craig, University of Lincolnshire and Humberside
Social services activities in almost all of Scotland and Wales and in a significant minority of English local authorities have been affected substantially by the reorganisation of local government in the 1990s. The impact of such re-organisation continues to reverberate at the level of service delivery. Moreover, the thinking behind such re-organisation continues to dog local authority social services work for ultimately it challenges the basis of local delivery and the functions of local government. The neglect of social services within local government re-organisation itself was borne out in our recent research which pointed to the multiple re-organisations affecting welfare and the lack of clarity about the scale and responsibilities of social services. With political attention focused on regional and devolution interests, local government is vulnerable to further disregard.The period of re-organisation itself resulted in major upheaval for staff within affected SSDs and in those organisations reliant on the complexities of grants, contracts or partnership arrangements. One voluntary organisation offering a supported accommodation service for 16 year olds leaving local authority care, for example, was unable to fill staff vacancies and could not budget for the year ahead. A week before re-organisation the uncertainty still reigned. In this instance, one new unitary authority wanted to work with the organisation in relation to its 'own' children but neighbouring authorities had not indicated their intentions. For the voluntary organisation the possibility of multiple different agreements with the new authorities was unlikely to benefit their service which had to be flexible and needed to respond to the wishes of the young people to move across boundaries (for example, from a rural children's home or foster family to a flat in town). This was not an uncommon experience.Despite the costs of re-organisation identified in our surveys, we found benefits in terms of greater 'localness' and focus on identified needs. Networking appeared to be improved at management and practitioner level once the dust had settled. A number of new unitary authorities have moved to more corporate styles of local government and there are potentially firmer links between social services and housing. The dissolution of some large counties has created urban and rural authorities: which have generally been identified as positive in giving greater clarity to their work and understanding of local geography and need. While relationships between old and new neighbours were strained initially, it is clear that new patterns of communication are evolving and some shared services are re-emerging. The 'group' known as CUBA is one example (Councils that Used to Be Avon).The key themes from this research are that re-organisation singularly failed to 'save' money' and that questions about the most effective size of local authorities remain. Small authorities do have significant advantages but they are vulnerable to major events (such as sudden upturns in investigations, staffing crises or reversals of policy or provision by monopoly providers They are also vulnerable to financial pressures and for users and carers these were quickly realised when, at re-organisation, charges for services were significantly increased or introduced. For some service users the small size of the authority meant that resources were no long available as there were not enough users to justify a specialist service. Some specialist staff or staff reaching certain levels in middle or senior management voiced concerns that opportunities for careers progression are limited within small authorities.Service users were generally initially unaffected (but not consulted). At the time of reorganisation staff protected them from the administrative upheaval. In the long run however it is they who will be affected by the redrawing of eligibility criteria and economy measures such as charging and contracting out services. For many service users the boundaries between authorities are confusing and the creation of new authorities has restricted some users' access to services which are now 'out of area'. Experience of consultation and partnership structures was mixed: some authorities moved quickly to rebuild user fora and multi-agency groupings whilst others gave this a lower priority.The impact of LGR is discernible at a number of level and has to be seen in the context of central government policies and central-local relationships. Much was said about the potential of LGR but this needs to be specified and monitored. At a time of other restructuring within the NHS and new partnership arrangements around local areas, the lessons from LGR are that such upheaval unlikely to save money and likely to result in major losses of experience and expertise. The purpose and role of local government in relation to social services remain unclear.
The final report of this project, funded by the Joseph Rowntree Foundation: Unfinished Business? Local government reform and social services by G. Craig at J. Manthorpe is available from the Policy Press.