Research Policy and Planning: The journal of the Social Services Research Group – Vol 17 (3) 1999
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?
- Separating fact from perception in the level and causes of delays for people being discharged from Essex hospitals.
- Managers wanting to monitor jointly the nature of the problem, the impact demand was having, particularly on waiting lists, and trends over the longer period.
- There was a need to standardise data collection, collation and reporting.
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?
- Informing policy makers about delays in discharges from hospital, the cause and the impact on waiting lists of the number of bed days being used.
- Clarity between agencies on cause and effect has strengthened relationships and dealt with tensions and buck passing issues.
- Helping inform top level thinking and the forward planning of budgets through reports to Chief Officers.
- Helping establish a clear linkage between discharge delays, eligibility criteria and continuing care policies.
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 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).
- our study found that family centres were meeting a multiplicity of needs from relationship and developmental problems, through advocacy or access, to laundry facilities.
- The interviews provided some evidence of differing needs between communities. Black communities tended to express need in terms of their children and relationships with them. Whilst this is also true of white users, they often also expressed personal needs such as those around their relationships with partners.
- Caribbean mothers were often concerned about meeting day care needs and their children’s schooling and isolation appeared to be the main concern of Asian mothers. Black men were most concerned with how to meet the care needs of their children.
On services used…
- managers were asked to complete forms on each of the services their centre provided. 209 were completed and demonstrated that whilst 63 services had no black users only 11 had no white users (and these were services strictly for black users);
- white users were also present in much higher numbers. Over 11 users in around half of the service were white, whilst black users were more likely to be represented in small numbers of one or two;
- services with large numbers of black users were mostly concentrated in particular family centres, such as a one in Birmingham where four out of five groups with over 20 Asian users resided. Large numbers of Caribbean users also tended to be present in childcare services;
- 23 family centres provided one or more specific services to a black community. All nine local authority areas had at least one centre providing a specific service, but nowhere did all centres in a particular area have specific services.
On services not used…
- groups focusing on supporting men or women that, were not exclusively for a black community tended to be poorly attended by black users;
- other types of services poorly attended by black users were respite and counselling services.
On the impact of services…
- black parents acknowledged the value of the service they took up. Benefits included better relationships with their children, safe play space for their children, and support for specific problems. Black children also praised the centre, and white mothers with black children also felt positively towards the centre;
- men, both black and white, who were the main carer in their families, suggested that family centres continued to be a ‘woman’s world’, which made it more difficult to fit in;
- despite user approval, most centres, whilst working with a black family in the recent past, do not work with black users regularly. As we noted, in the majority of services, black users are few and far between;
- black users often identified a black worker as essential to their positive experience of the centre. However it is worth noting that centres with black workers were also more likely to have targeted black communities through outreach, to have developed specific services, sometimes using outreach sites that were more accessible and to have provided services with popular with black users.
Implications for practice
Analysing local need:
- our analysis suggests that only 31 of the 84 centres had carried out an analysis of local need and only 10 had looked specifically at the needs of local black communities. However, it is only through this process that an assessment of the impact of services can move beyond looking at the impact on individuals and families to looking at the impact in terms of local needs.
- the existence of an equal opportunities policy does not automatically lead to the engagement of black families. It is necessary to take active steps: ensuring access to services in demand; developing specific services; targeting black families through outreach; allocating or identifying funds specifically for work with black families. In some cases these active steps can include opening a more accessible satellite site. In addition, the knee jerk response of ‘they look after their own’ must be avoided if active engagement is to take place.
Mix of services:
- it is important to note that users are unlikely to access services voluntarily if they do not meet their needs. Our work showed day care services to be crucial in attracting black families. Specific services also were well utilised by black users.
Black workers practice:
- many people in our study referred to the role of black workers in developing good practice. However, there were also white workers engaging successfully wit black users. Centres need to develop their workers knowledge of black communities and their needs; work to win their trust; show flexibility an responsiveness and be willing to develop their role as advocates.
- the study shows that it is unlikely that users were involved in developing, delivering or managing services. However amongst services specifically for black users, user involvement was far more likely. This achieves the twin aim of engaging black adults whilst providing them with a service that is appropriate. It also allows black users to identify their needs and how they can best be met.
Implications for policy
- through the implementation of parenting orders and the development of a new parenting institute, the Government has made clear its intentions to improve parenting skills. One of the ways this will be achieved will be through the development of, and encouraging attendance at, parenting skills classes. However, our work has demonstrated that, of the services on offer at family centres (of which all 84 offered some parenting work), work with parents is least likely to be taken up by black users. Indeed, some managers identified these courses as not able to engage with black families, and none of the black parents interviewed had attended parent programme.
- if the views gathered in our interviews are representative, then family centres are an invaluable tool for encouraging social inclusion for those families from black communities who have access to them. However, our study also suggests that black communities do not always have access to family centres and rarely access the full range of services available. While a programme like ‘Sure Start’ is a step towards developing inclusive services, the Government will need to bear in mind that inclusion can only be achieved by providing services that meet the needs of these families (day care in particular) and by reaching out to these communities.
- The national childcare strategy is another area of Government policy to have an impact on black families. Many Caribbean women in the study identified the provision of childcare as fundamental to family support, emphasising its importance in enabling them to retrain or work to support their family. This would appear to fit in with government strategies which focus on helping people off benefits and into work, and this group could potential benefit. However, there were also many black parents and carers in the study for whom the childcare provision offered by family centres is simply necessity for the support of their family.
Learning from Local Government Reorganisation
University of Hull
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.