SOCIAL WORK SERVICES FOR PEOPLE WITH A SENSORY IMPAIRMENT.
SOCIAL WORK SERVICES INSPECTORATE 1998.
Secretary of State.
During 1997-98 we conducted an inspection of social work services for
people with sensory impairment.
The remit was to:
The legislative framework which underpins the services is contained in Annex 1.
We have also made use of current literature reports and research material in this area - see bibliography at Annex 2.
The Inspection was managed by Assistant Chief Inspector Gillian Ottley and the team included SWS Inspectors John Bishop and Jean MacLellan. Ron Partington was the lay member, Elaine Samuels the researcher and Linda Brennan, Alan Nicholson and Iain Fitheridge handled the administration.
The team was assisted by consultancy with Lynne Hawcroft, Tom Muldowney (Head of the School of Vision and Rehabilitation Studies, Guide Dogs for the Blind Association) and Bob Peckford (Director of Communication Skills, Council for the Advancement of Communication with Deaf People). Their input was helpful but the responsibility for the findings and conclusions in this report lies with the Inspectorate.
We would like to thank the many people with a sensory impairment who agreed to be interviewed during the course of this inspection. We also want to acknowledge the assistance of all those staff from social work, health, education and voluntary organisations whose contribution has allowed us to undertake our work. We have, without exception, met considerable cooperation and support.
This report sets out to assist those involved in social work with people
with a sensory impairment to put into place robust, adaptable, models of
service delivery for the future. In our view it is essential that
future services cover the range of needs from the simple to the most complex
and to the highest standards. Underlying all our recommendations
is the belief that people who use services should be at the heart of developments
in those services. Their active participation in shaping the future
will ensure that opportunities are made available for them to lead ordinary
lives as valued members of society.
Angus Skinner
Chief Inspector of Social
Work Services for Scotland
NOTES ON TERMINOLOGY
Sensory impairment
This is the broad term used to cover visual impairment, deafness, being hard of hearing and deafblindness.
Visual impairment
This is a term used to cover the spectrum of those who have some residual vision to those who have no sight at all. The terms blind and partially sighted are also frequently used in the report. Blind in the context of a person being registrable has a specific meaning, being so blind as to be unable to perform any work for which eyesight is essential. It does not necessarily mean that the person concerned will have no vision at all.
Deaf people and those who are hard of hearing
The Deaf Community is generally used to described those Deaf people who use British Sign Language and who feel they share a culture with other Deaf people. There are a larger number of people who are also profoundly deaf, many of whom will have become deaf during the course of their lives and who will acquire a variety of new communication skills. The largest group are those who are hard of hearing, many of whom acquire hearing loss as they become older.
Deafblindness
Deafblindess, or dual sensory loss, refers to people with a combination of sight and hearing losses which can cause difficulties with communication, access to information and mobility.
Other terms used in this report are defined in the glossary (Annex 4).
CONTENTS.
How Many People Use the Services
1. Accurately estimating the numbers of people who have a sensory impairment and who may need a social work service is not straightforward. Authorities are grappling with this and tend to use a mixture of registration (where this exists), prevalence data, local records and active contact.
2. In Scotland in 1997 there were 22,788 people who were registered blind and 11,0512 others who were registered as partially sighted. However, RNIB research in 1991, undertaken at a UK level, indicated that the numbers of people on registers is some 23% of those eligible to be registered3.
3. For the same year the Scottish Association for the Deaf (SAD) had
12,127 people listed on their voluntary register. There exists little
guidance as to how best to develop estimates of need of people who are
deaf or hard of hearing. This is an issue for all service providers.
The Social Services Inspectorate (SSI) has suggested using the table below
which is taken from the Informability Manual4. Authorities would
apply the relevant percentages to their own populations.
5. Community care plans represent one source of strategic thinking. Guidance on these requires the needs of each care group to be set out together with a description of how they are to be met by social work, health and housing. Of the 22 available plans that we saw covering the 1997-98 period, only 8 had a section relating to people with a sensory impairment. A further 6 authorities incorporated sensory impairment sections under the broader heading of physical disability. Four authorities were able to go further and provide a description of services and identify current shortfalls in these.
6. Twenty-two authorities actively involved people who used services in shaping them. The extent of that involvement was less easy to ascertain. Many staff acknowledged that there was a fine line between tokenism and no involvement and that their selection of the people they consulted made it difficult to say that they were truly representative.
People with a visual impairment
7. There was some evidence of delays in assessment of people with a visual impairment. There was also a wide variation in the quality of initial assessments, making it difficult to judge in some cases whether a more comprehensive assessment was needed. Some of these difficulties may have been attributable to skills' deficits in some specialist teams, in terms of the numbers of both qualified social workers and qualified rehabilitation staff. A few authorities were unable to provide qualified mobility training and in many areas people were having to wait for long periods for training support. Good information services are linked to the existence of resource centres for people with a visual impairment. Access to resource centres also affects a person's ability to learn about and test specialist equipment. Council budgets for equipment vary. This does not seem to have a major impact on people's ability to obtain lower priced items.
People who are deaf and hard of hearing
8. Social work staff have little understanding of deafness and communication with people who are deaf or hard of hearing. People who are deaf or hard of hearing are often referred to specialist staff for assessment and, whilst their sight loss needs are well assessed, their broader social care needs may not be addressed.
9. The direct employment of interpreters within social work services needs to be reviewed in the light of the importance of maintaining the distinction between the social workers and interpreters. Again, equipment budgets vary with opportunities to try out equipment being fewer in rural areas.
People who are deafblind
10. Arrangements for assessment and review are nearly always led by specialist sensory impairment staff. In larger authorities where there are separate assessment procedures for visually impaired and hearing impaired people, coordination of arrangements can be ad hoc. In smaller authorities the requisite skills and knowledge are not readily available. There is no distinct local authority provision and services are provided alongside existing ones for people with a sensory impairment. SENSE (Scotland) has questioned the capacity of small authorities to track, identify and prioritise the needs of deafblind people who have substantial additional disabilities. There are elements of service which require a distinct response, eg, communication, information and mobility. At the time of the inspection these services were not widely available.
Voluntary Organisations
11. It is evident that national voluntary organisations fulfil a number
of different roles:
13. Contracted services are generally subjected to greater scrutiny by commissioning authorities than their inhouse counterparts. The financial baseline for continued funding is historical and exemplary performance does not appear to result in any greater reward.
14. The diverse role of some voluntary organisations can cause unease for both commissioners and providers. In the negotiation of all the service level agreements the key sticking point was the contract price. The local societies consistently sought an increase in funding, either to compensate for inflation or other increased costs. In contrast, contract officers set the contract price primarily by reference to the authority's financial position. In practice, this means that the price paid for the service remained static or was even reduced.
15. Some voluntary organisations have both recreational and welfare
functions and have built up reserves over years. In some authorities
these are being taken into account when the contract price of a social
work service is being decided. There is also little common agreement
about the management information that may be useful for monitoring contracted
services.
16. More generally, in terms of joint working, social work, health and education staff had a variable understanding of each other's roles and tasks. There were many examples of positive collaborative working that led us to believe in the importance of developing better working links across professional boundaries. In particular, education staff expressed concerns around the preparation for, and follow-up to Future Needs Assessment.
17. Finally, training needs for staff are many and complex but training personnel vary considerably in their ability to identify and meet these needs.
18. Against this backcloth, our survey of 169 people who use sensory impairment services showed a high level of satisfaction with what was provided. Whilst this is reassuring, the results should be treated with caution as the level of expectation may be low and many of the needs that were met were simple ones like requests for equipment.
19. The next chapters outline our findings in depth and our proposals
for the way forward.
COMMENTS BY THE LAY MEMBER.
The inspection team was assisted by Mr Ron Partington who was recommended to us as a lay member by Scottish Business in the Community. We have involved lay people (ie people who are not professional social workers or employed in the agencies being inspected) in all our inspections since 1993.
Mr Partington brought extensive experience from industry having been a senior executive with Marks and Spencer plc. Prior to retirement he was seconded to the voluntary sector. During this period he established contacts with community organisations, social work departments and companies in setting up short term secondments for specific voluntary sector projects. He continues to be an office bearer in a local branch of the Parkinson's Disease Society.
Numbers of people with sensory impairment
"It is vital that reliable information on numbers is to hand when planning future services.
Local authority statistics of the number of people with a sensory impairment were in the main an extrapolation of figures provided by national organisations, allied to local databases, some of which related to previous authority areas. All local authorities agreed that the numbers quoted were estimates, that they were unsubstantiated and unreliable.
I was concerned that insufficient attention had been given to establishing realistic figures which would take into account the inevitable variations in pattern across the country, particularly as some service providers believed that an appreciable number of people were currently excluded from services. The paradox is recognised that increasing the number of people using services puts an extra strain on resources."
Local government reorganisation
"It may be necessary to take more difficult and painful decisions in order to lay the foundations for an appropriate and cost effective service.
The reorganisation of local government in 1996 presented the new authorities with many challenges, particularly in the allocation of resources under tight budgetary constraint.
I was impressed to note that some local authorities had taken these changes as an opportunity to review all aspects of their responsibility, including staffing structures and numbers. Some innovative ideas and plans to ensure best value were evident.
Other authorities appeared to be trying to adjust inherited staffing structures and facilities to meet new and differing needs, but had little flexibility to bring about necessary change to create best value."
Management
"In some areas there is a possible over dependence on the provider to meet service targets and to be responsible for communicating future needs. There is consequently a danger that delegation of responsibility to a partner can be an act of trust that may be misplaced. Control has to remain with local authorities.
Management teams were under considerable pressure of work to meet the complex and competing demands in their areas. Whilst recognising this fact, it was disappointing to find that the knowledge of some senior managers, about their services to people with a sensory impairment, was poor. This lack of appreciation was reflected at times by middle management, particularly where services were contracted out.
It was encouraging to note the chief executive of one local authority, recognising the need to improve sensory impairment services, had set an example which was reflected in an awareness throughout his management team. His positive approach to sensory impairment was to be commended7."
Sensory impairment teams
"The dedication and hard work of all the teams was impressive both in and outwith the social work department. They were professional, sensitive to people who use services and striving to provide a good service, despite financial constraints.
There are three issues affecting the efficiency of the teams.
Communication
Despite the problems of finding time for individual discussions or team meetings, some managers should review their practices, if they are to get the best from their workers.
The need for effective two-way communication between management and staff is recognised as essential in any modern organisation.
There was considerable variation in the attention given to this aspect of management, due to the overall demands on individuals. Where little time was devoted to two-way communication there was evidence of depression within the teams. There was concern about the future and the ability to satisfy the requirements of people using services going forward. Some teams felt their views were not heard or valued by their supervisors. Many seemed unaware of current or future strategy of their authority, relating to their areas.
Staff Appraisal
Management should have the ability to assess their staff against agreed performance criteria.
I was surprised to learn that job descriptions do not exist for all staff.
Staff appraisals and assessment procedures appear to be haphazard. Appraisal is a positive approach to determining how workers may improve their performance through training, counselling and encouragement.
Training
Often training budgets are seen as the soft touch in financial reviews but staff development should be retained as an essential priority, to achieve and maintain the delivery of quality services.
Most members of the teams were well aware of the skills and knowledge required to deliver a comprehensive service. It was evident in trying to meet needs some workers were learning the hard way - by experience sometimes outside their normal competence.
The training of staff and developing them to their level of potential
is key in:
"The dissemination of good ideas and working practices by networking would be beneficial to all concerned. It would also produce greater consistency in dealing with providers working across local authority boundaries.
Many of the contracts for this financial year had not been completed five months after the commencement date, although providers had been given an understanding of what was required of them and the value of the contract. This practice needs to be eliminated, as it is unprofessional and unfair to providers.
Local authorities do not possess sufficient information about the detailed costs or quality of services to effectively evaluate the efficiency of providers. This observation applies outwith and within social work departments.
Some information is available from service agreements, often historically based, but it is insufficient to give a complete picture. Lack of monitoring makes even this information open to debate. There are few parallel details available for internal service provision.
Uniform 'across the board' financial arrangements, at the time of the review of agreements, will penalise the best providers.
The subsidising of service agreements from the financial reserves of a provider appears to be a fact of life, but it is neither fair nor reasonable.
A great deal of effort has been put in by a number of contract officers to review and revise current documentation. The aim is to make all types of contract or service agreement easier to understand and more meaningful in the description of the quality of services to be provided. In addition greater attention is being given to monitoring and evaluation of services.
This development work is essential to make assessment easier and to
produce more accurate and comprehensive costings. I was surprised
to note that contract officers are often pioneering within their own areas
having little contact with other local authorities who had similar problems."
"I endorse the overall observations and recommendations of the report.
I felt privileged to be a member of the inspection team and found the experience to be both interesting and instructive. I wish to thank my team colleagues for their advice and forbearance together with their sensitivity in getting me through a steep learning curve.
I also thank everyone whom I met on the inspection including members
of the local authorities and service deliverers, voluntary workers and
people with a sensory impairment, for their courtesy and frank expression
of views."
RON PARTINGTON
CHAPTER
2 , SERVICES FOR PEOPLE WITH A VISUAL IMPAIRMENT.
20. In this chapter we introduce the national voluntary organisations working with people with a visual impairment. We also examine local authorities' performance in assessing need and their provision of key services in relation to information, advice, equipment, rehabilitation and mobility. Local authorities provide specific services and information about these and the services of others under the relevant legislation (see Annex 1). The 1995 Disability Discrimination Act demands that information is provided in accessible formats.
NATIONAL VOLUNTARY ORGANISATIONS
21. National voluntary organisations for people with a visual impairment are largely organised on a UK basis. GDBA, in addition to its traditional work, has been instrumental in providing substantial capital and revenue funding for local projects. These have included the provision of premises, rehabilitation staff and low vision equipment, usually in partnership with local societies. GDBA's contribution to the development of some resource centres in the East of Scotland has been significant. It also underwrites the Glasgow School for Vision and Rehabilitation Studies which trains rehabilitation workers.
22. RNIB are a major representative organisation for people with a visual impairment providing a wide range of services. Their direct expenditure on services in Scotland is approximately œ2 million per annum with additional input in the form of nationally sourced services, eg, Talking Books, publications in Braille. They are major partners in the Glasgow Resource Centre where they provide the specialist equipment as well as a multi-media production facility, support for students and for those seeking employment. RNIB has developed the Springfield Service Centre in Glasgow and has supported specialist employment and technical projects elsewhere.
23. SNFWB operates on a Scotland wide basis without full-time paid staff. At present it undertakes tasks that are proportionate to its limited resources. SNFWB have developed standards8 for organisations providing services for people with a visual impairment. Membership includes both voluntary and statutory, national and local organisations.
ASSESSING NEED
24. Most people with a visual impairment will receive a clinical assessment, normally from an ophthalmologist, in a hospital eye clinic. This assessment can lead to certification (of blindness or partial sight). The certificate is called the BP1. When the details on this certificate pass to the local authority, if the person wishes, they can be put on a register and they are then considered to be a registered person. The case for registration made by authorities and organisations representing people with a visual impairment, is that it brings tangible benefits to people such as social security benefits, tax relief, travel and postal concessions. While there are no direct social work service benefits flowing from registration, it can serve as a way of identifying people who may benefit from social work support. However, reliance on this procedure as a gateway to social work services would be misplaced as some young and older people are reluctant to be labelled disabled or blind and do not wish to be registered.
25. The importance of an early visit by social work staff soon after registration has been stressed by people who use the services, social work and health staff alike. This visit can provide practical help and encouragement, advice on welfare benefits, provision of equipment, counselling or rehabilitation, including mobility services.
26. We found a wide variation in the time that elapses between the local authority's (or agent's) receipt of the BP1 and the first contact made by social work staff with the registered person. The gap in time could be 2 weeks or as long as 4 months.
27. From our examination of the files we also found different practices
in relation to this first contact:
"There was a nice lad who left a pack of information, but no-one ever called again. Someone should be in touch to at least ask if I require help."
The second approach was common to many inhouse services, and to some contracted services. This is acceptable where the needs of the visually impaired person are straightforward, for example, for information or simple equipment. However, we did not find anything in the files that allowed us to conclude whether or not a fuller assessment was required. Nor was there any indication of the assessor having made that judgement.
29. Our examination of the case files - supported by some of the interviews - suggests that a significant minority of people with a visual impairment required a fuller assessment (and support) than had been provided. For example, one case file told of a blind older woman with multiple sclerosis who was depressed. The file contained no comprehensive assessment of the person's needs, although boxes relating to the equipment and information provided had been ticked on a standard assessment proforma.
30. Most assessments are undertaken by specialist staff unless the person has severe additional disabilities or is subject to either statutory child protection or mental health intervention.
31. The responses to our local authority questionnaire indicated that the skill mix in specialist local authority teams varied. It included qualified social work9, rehabilitation staff, unqualified social workers and technical support staff. The teams have, therefore, differing abilities to undertake comprehensive assessment. However, we found little evidence that specialist teams used other qualified staff to support their assessment work.
32. People with a visual impairment who had additional disabilities, could be assessed at the RNIB Springfield Service Centre. The Centre focuses particularly on the impact of visual impairment on the person's other disabilities. In 1997 the Centre provided up to 14 places per day for people largely from the West of Scotland. Attendees come on average for 1 or 2 days per week. The costs of approximately œ86 per day have forced some authorities to withdraw placements due to financial constraints.
33. Visual impairment is often caused by a degenerating condition and
impairment may become partial or total loss of vision over time.
This may require a regular return to an eye clinic and highlights the importance
of local authorities or their agents conducting regular reviews of social
care services to ensure they are still adequate to meet people's needs.
The highest number of new registrations relate to older people with deteriorating
eyesight. One study10 of people over the age 65 with a visual impairment
demonstrates close links between developing visual impairment and other
disabilities. Sixty-three per cent of older people, with a sight
problem, reported having more than 5 other difficulties in sustaining their
daily living. This study highlights:
35. Both local authority inhouse and externally contracted services recognise the importance of conducting annual reviews of people's needs but are finding it increasingly difficult because of the many demands on their resources.
THE SERVICES
36. Many people we spoke to who received services whether inhouse or
contracted were very positive about the service they received. "Efficient,
friendly and professional", was one comment.
Figure 1. Overall Quality of Service Provision
38. The chart suggests that 3 out of 4 people receiving services consider them to be of "good" or "good-medium" quality. Nevertheless, these quality ratings need to be treated with caution as our survey also provided evidence that expectations of the services may be low.
The following services were provided to our interviewees:
39. Information and advice on services is a core need of many people with a visual impairment. The RNIB Needs Survey12 indicated a significant lack of knowledge amongst people with a serious visual impairment about the services available to them.
40. We asked people who used the services to assess the quality of the
information provided by the social work department or agency.
42. The range and quality of information available in the authorities we visited varied considerably. We were impressed by the availability of information in Aberdeen, Fife and Glasgow. In each of these areas there is a resource centre which has the capacity to develop, produce, distribute and display literature and provide this in relevant formats, including audio-tape. Information services for people living in Argyll & Bute rely on close links with Glasgow's Resource Centre. The council does not purchase a service from the Resource Centre but they are joint users and fund it, according clients unlimited access. Moray's services are provided by Grampian Society for the Blind (GSB), and have a close link with information sources at the Moray Resource Centre. East Ayrshire Council has a new service which has yet to develop information services: a new full time post devoted to this work, across all sensory impairments, has recently been filled. The newsletter of GSB received consistent praise from recipients as it provides a source of information and stimulation to many people.
Equipment.
43. The provision of appropriate environmental aids and equipment can make an important contribution to the quality of people's lives, including promoting their safety and independent living. Aids vary from the straightforward, such as a frame for cheque signing, to the more sophisticated such as a computer.
44. Where resource centres are able to display equipment and provide a local facility for Low Vision Aids (LVAs), this is ideal. In many areas people with a visual impairment do not have easy access to resource centres or have access to centres with a limited range of provision. There are resource centres in Aberdeen, Fife (Kirkcaldy) and Glasgow (at the new Partick Centre). Each is able to display equipment, and in particular provide a local facility for LVAs. These facilities were not available in Argyll & Bute and East Ayrshire. The sensory impairment team in Argyll could access the facilities at the Partick Centre, but travelling long distances is a problem for many older people. East Ayrshire is developing a sensory resource within the Dalsalloch Centre at Auchinleck. People with a visual impairment in Moray may use the Moray Resource Centre where there are limited facilities, together with GSB's mobile resource centre.
45. All authorities were asked to provide information about budgets for the provision of equipment. Our analysis of responses suggests that in cash terms there is a considerable variation in the equipment budgets allocated by authorities.
46. The amount of equipment that people with a visual impairment are able to obtain is not related to the size of equipment budgets. In Fife, the Society for the Blind receives œ2,250 per annum from the council and this is used primarily to purchase low cost items. These items would be uneconomic to sell and are provided to people with visual impairments without charge. Other equipment is normally purchased by people themselves either from the Society's stock, or where available at a lower price, from high street retailers.
47. Generally, once they were assessed, people got low cost equipment quickly. Equipment and resource centre staff adopted practical and pragmatic ways of ensuring that such equipment was provided, either by way of loan or by means of a purchase scheme based on people's income. By contrast, we were consistently told of problems in the providing of expensive, often hi-tech equipment, such as home computers to assist with school work.
Rehabilitation and mobility
48. There are specific and practical ways to help people with a visual impairment to sustain both a high quality of life and maintain their independence and mobility. This is the work of rehabilitation and mobility staff who can provide training in new skills and who often advise on the necessary equipment.
49. A full rehabilitation and mobility service would include a number
of components. We asked all local authorities whether people with
a visual impairment had access to such support in their area. Table
2 illustrates the responses from local authorities about whether services
were provided directly or purchased.
50. Our survey of people who used the services indicated a higher level of dissatisfaction with rehabilitation and mobility services than with services overall. Twenty percent of those asked felt rehabilitation services were poor, compared to 12% who said that services overall were poor. These findings are reinforced by RNIB assertions that "less than half of those registered as blind have received mobility training"13. One person commented:
"Steps and kerbs make me feel nervous. I know I am on a waiting list [for training] but I do not want to stay sitting in doors."
51. The non-availability of a service and the lengthy waiting periods are likely to be due to the low level of rehabilitation and mobility officer posts, evident within inhouse specialist teams in local authorities. Of 14 local authorities providing services directly, 3 authorities had no qualified rehabilitation and mobility staff, 9 had the equivalent of one person full time, and only 2 (Glasgow and Renfrewshire) had more than one.
52. Consistent information about staff in contracted out services was not available. The two agencies we visited had contrasting staffing arrangements. In GSB there are more qualified social work staff than rehabilitation officers. In Fife, rehabilitation staff outnumber qualified social work staff.
53. A 1995 telephone survey of Scottish authorities14 concluded that Scotland has a shortfall of 90 rehabilitation officers. In their submission the GDBA15 argued that authorities, or their agents, were meeting their requirements to provide assessments for rehabilitation and mobility, but that the needs of people with a visual impairment were not being met.
SUMMARY
54. This chapter introduces the national voluntary organisations who work with people who are deaf or hard of hearing. We also examine local authorities' performance in assessing need and in providing communication support, information and equipment services. Local authorities provide specific services and information about their own services, and the service of others, under the relevant legislation (see Annex 1). The 1995 Disability Discrimination Act requires that information is provided in accessible formats.
NATIONAL VOLUNTARY ORGANISATIONS.
55. National voluntary organisations for people who are deaf or hard of hearing are largely organised on a UK basis. These are the BDA, RNID and Hearing Concern. BDA and RNID have specific Scottish offices. BDA employs two staff in Scotland, a Youth and Community Officer and a part-time Community Advocacy Officer. The latter post is part of the Visible Voices (Scotland) project. BDA mainly identifies with those deaf people whose preferred language is sign language.
56. SAD operate on a Scotland wide basis. They have a small full-time staff group. They have developed a national registration scheme for people who are deaf or hard of hearing. SAD includes national and local organisations, both voluntary and statutory, in its membership. The Scottish Association of Workers with Deaf People has undertaken the task of drafting standards for work with people who are deaf or hard of hearing16. The recently formed Forum of Providers of Social Work Services to Deaf People (Scotland) will also have a role to play in the future. SASLI also makes a vital contribution through its training of interpreters and provision of an interpreting service.
ASSESSING NEED
57. Local authority specialist teams (or their agents) undertake a wide
range of assessments:
60. When interviewed, specialist staff were alert to the social and emotional needs of many people who were deaf or hard of hearing. This awareness was not matched by what was recorded on files.
61. Whilst some case files had good quality assessments with care plans clearly linked to assessed needs, good quality assessment for people with complex needs was not widespread. For example:
An interview with one deaf person revealed that her needs were complex. Her marriage had ended and she was grieving over recent losses. She also needed equipment to help her in her role as carer to her father who was incontinent. Her case file had no assessment of her needs either as a deaf person or as a carer or of her father's needs.
62. A combination of qualified social workers and staff with good communication skills17 is essential to good quality assessments for people who are deaf or hard of hearing. (Of the 27 local authorities which responded to our questionnaire, there were 19 inhouse specialist teams, only 3 of which had qualified social workers in them.)
The evidence from our fieldwork supported this view:
In Aberdeen, The Aberdeen and North East Society for the Deaf
(ANEDS) has qualified social work staff, with specialist communication
skills and knowledge as well as a Sign Language Interpreter (SLI).
In Moray there is one unqualified social work assistant.
63. Few social workers were confident in their knowledge of deafness and few had specialist communication skills. We found social workers involved in undertaking assessments in all areas of social work, to be either unaware or poorly informed of the support a specialist team might offer. Only Glasgow, Aberdeen and East Ayrshire provided guidance to their staff about the use of interpreters.
64. One submission18 and both focus groups stated that social workers involved in undertaking assessments were insufficiently informed about the needs of both people who are deaf and those who are hard of hearing. This is said to lead to poor assessments and poor care planning.
65. None of the 6 authorities we visited provided written guidance on joint assessments by specialist teams and other social workers, suggesting that managers think this a low priority.
66. East Ayrshire has decided not to employ qualified social workers in their specialist sensory impairment team. It had planned provision of deaf awareness training to all relevant social work staff.
67. The incidence of hearing loss rises with age. According to RNID, 3 out of 4 people who experience a hearing loss are over the age of 60. RNID estimates that 60% of people over the age of 70, and 84% of those over 85 have a significant hearing loss. Our own survey reflects similar findings.
68. People with a hearing loss in our survey received the following
from social work services (or their voluntary sector agents).
70. Deaf people in rural areas say they feel socially isolated. In Argyll & Bute and in Moray they described how they had little contact with other people who were deaf or hard of hearing, eg the nearest deaf club for people living in Oban is in Fort William.
THE SERVICES
71. There were a number of positive comments about services made by
people in our survey.
Figure 2. Overall Quality of Service Provision
The chart suggests that nearly 4 out of 5 people receiving services consider them to be of "good" or "good-medium" quality.
73. These quality ratings need to be treated with caution as our survey
also provided evidence that expectations of the services may be low.
With this caveat in mind, we found:
74. Communication support includes a wide range of human and technical aids to communication such as sign language, lipspeaking and other aids that support communication.
Sign language support
75. Of the 27 authorities who responded to our questionnaire 3 do not
provide any sign language support. Of those who do, the most advanced
recognised qualifications amongst inhouse staff are:
77. In Argyll & Bute, Moray and Fife, social work staff with basic sign language skills appeared to be used extensively as interpreters in situations where higher skills will be commonly required. For example, we learned that social work staff qualified in BSL Stage 2 were interpreting at hospital clinics. Moray also accessed interpreters in Aberdeen North East Deaf Society.
78. Sign language interpreting services continue to evolve in Scotland, albeit slowly. In 1990 there were 25 SLIs overall. In 1997 there were 27 registered SLIs and 16 associate or trainee interpreters20. The demand for interpreter services has consistently outstripped supply, and in Scotland there is some evidence that the demand is increasing with more children having used BSL at school in recent years.
79. Only a quarter of our responding authorities21 had guidelines about the use of interpreters. Interpreters provided assistance for a wide range of activities, particularly in health education and court settings. Indeed the work of the interpreter is more likely to be outwith the social work setting rather than within it. Many SLIs operate on a freelance basis. Two of the authorities we inspected - East Ayrshire and Glasgow - employed interpreters, as does ANEDS, for work in Moray and Aberdeen. Argyll & Bute Council has unlimited access to SLIs, being a joint funder of the service with Glasgow.
80. The task of the interpreter needs to be distinguished from that of the social worker. The documentation in Glasgow illustrates this distinction:
"The SLI's interpreting task should not involve situations where intervention, participation or advocacy is required on behalf of the user."
The importance of maintaining this distinction has led to moves to increase the separation between interpreting and social work services. This separation is well established within Glasgow, but not always elsewhere.
81. There is a common expectation that interpreters employed by the social work department will intervene, or advocate on behalf of the people for whom they are interpreting. This breaches the code of conduct of registered SLIs. There is also an expectation, in some authorities, that specialist social workers with communication skills will undertake the work of an interpreter.
Lipreading and lipspeaking
82. Lipreading is a skill used by deaf and hard of hearing people in conjunction with hearing aids/residual hearing, which can be developed by attending lipreading classes taught by lipreading tutors.
83. Lipspeaking is a communication support service provided to lipreaders by a trained hearing person who, a few words behind the speaker, will devoice and use appropriate intonation, rhythm, phrasing and clarity to convey accurately the content and intent of the speaker's message.
84. Lipreading and lipspeaking support is important to an estimated 20,000 deafened people without BSL and to many people who are hard of hearing who require additional communication support. It has considerable benefits for older people who may use lipreading as their main means of communication when their hearing fails.
85. There are reportedly 24 trained lipspeakers in Scotland22, of whom only 8 are regularly used. Of these only one is stated as being employed in a local authority. Twenty authorities claim that lipspeaking is provided directly or purchased.
86. The Scottish Sensory Centre runs a course for teachers of lipreading which is always over-subscribed. Adult education classes in lipreading are available but have not received widespread support or funding.
Other aids
87. The wish of one person using services that the "social work department had its own web site" may take time for some local authorities to achieve. A few authorities such as Moray already have one. New technology has introduced additional and alternative means of supporting communication, particularly for deafened and hard of hearing people who use English rather than BSL. Specialist teams in most larger authorities (and contracted agents) enable access to new equipment such as text phones and computerised speech/text facilities. However, only 13 authorities provide this sort of equipment, 9 purchasing it from voluntary organisations.
88. Communication is Your Responsibility23 recently reviewed communication support throughout the UK. It preceded the 1995 Disability Discrimination Act which places the responsibility on authorities to provide accessible communication. In Scotland SASLI recently published a specific follow-up of this report and concluded that "many professionals are unfamiliar with the communication needs of people with a hearing loss.24
89. Communication support was appreciated by all those we interviewed who received it. However, the quality of the service was questioned with just over half describing it as reliable and only 35% saying communication support was available when required.
Information
90. The importance of providing information is best illustrated by one satisfied person:
"They gave us information - we did not realise how much help was available."
91. We asked people who used the services to assess the quality of the
information they received:
93. The information needs of people with a visual impairment appeared to be consistently better addressed than the needs of those who are deaf or hard of hearing. This may reflect a reliance on oral rather than written communication in explaining the existence of services. A recent report25 about the information needs of older people is a helpful document for authorities seeking to address this deficit.
Equipment
94. Equipment is important in maintaining safety in the home, sustaining communication and improving quality of life. This includes flashing lights, loop systems, personal listening aids and new technology such as vibrating pagers and fax machines.
95. Social workers and external agencies view the assessment for, and the provision of, equipment as a core function of the specialist teams. Specialist staff, including technical officers, view the provision of equipment as a possibly important introduction to a range of other services.
96. All authorities were asked to provide information about budgets for the provision of specialist equipment. Our analysis of responses suggests in cash terms there is considerable variation in these budgets across authorities. There are different charging policies, and people are encouraged to purchase their own equipment where their income and preferences allow.
97. Budgets can influence practice. East Ayrshire spoke of inheriting a backlog of referrals for equipment which would require budgetary consideration. Glasgow staff reported significant unmet need for want of funds. The length of waiting lists for assessment varied between authorities. In Fife the existing waiting list for assessment was exacerbated by a 30% rise in requests in 1997-98. Both Moray and Aberdeen (ANEDS staff) indicated that a request for assessment was normally met within 2 weeks.
98. The opportunities for people to try out equipment are limited. There are few resource centres addressing the needs of people with a hearing loss. Some of those that we did visit appeared to have a restricted range of equipment on display, and were less attractive than the centres established for people with a visual impairment.
SUMMARY
99. In this chapter we introduce the national voluntary organisations who work with people with a dual sensory loss. We also examine local authorities' performance in assessing need. We believe individual assessment with the full involvement of the deafblind person, and their carer, is the cornerstone for providing care26 27. We go on to examine local authorities' performance in responding to requests for assistance with communication, information and mobility. Local authorities are under the same obligation to provide services to people with a dual sensory loss as they are to people with a single impairment.
NATIONAL VOLUNTARY ORGANISATIONS
100. Deafblind UK (Scottish office) and SENSE are the 2 national organisations working with people who are deafblind in Scotland. Like those they represent, they advocate that dual sensory loss is different from visual impairment, deafness and being hard of hearing. It should not be hidden under the shadow of work with people with a single sensory impairment.
101. Deafblind UK (Scottish office) and SENSE have a reservoir of knowledge and experience unlikely to be attained by the largest local authorities. Smaller authorities (those with a population of less than 125,000) may have as few as 50 deafblind people within their area. They are unlikely to be in a position to develop local expertise to provide specialist services required by deafblind people.
ASSESSING NEED
102. Good assessment practice does exist in some Scottish local authorities. For example:
A deafblind woman in her mid-fifties was receiving community-based treatment for a psychiatric condition. Her only son was her full time carer. Health and specialist social work staff together with Deafblind UK (Scottish office) assessed the needs of both people. Care planning resulted in an excellent range of assistance including communication support and respite care.
103. Authorities differ in their arrangements for the assessment of deafblind people. The numbers of deafblind people are small so they do not fit easily into one team's set of responsibilities and the definition of what constitutes deafblindness also varies. Some authorities only consider those who have been deafblind from birth to fit that category. Anyone with a hearing impairment who then becomes visually impaired would not be thought of as deafblind. If they are already known to the social work department, they are likely to continue contact with those who provided the original service. They may not be referred on unless there is an effective review procedure in place.
104. Where there are separate services for deaf and visually impaired people, as in the larger authorities of Aberdeen, Fife and Glasgow, deafblind people whose first impairment is visual are likely to be registered. They will then be known to either specialist inhouse teams or local societies for the blind.
105. Deafblind people whose first impairment is being deaf or hard of hearing may also be known to specialist teams, or agencies. Specialist teams for the deaf are especially sensitive to younger deaf people who may have Usher Syndrome. This is a genetic condition affecting 5% of congenitally deaf people, linking deafness with the degenerative eye condition, retinitis pigmentosa.
106. When specialists workers in Aberdeen, Fife and Glasgow established that there had been a second sensory loss, they linked with the other specialist teams. None of these workers had written procedures for sharing work. Links were established on a case-by-case basis. This can lead to a partial meeting of need, as the following example illustrates:
A registered blind person who was diabetic was experiencing a deterioration in his hearing. Although he was in touch with the local social worker for the Blind for computer tuition he had not been put in touch with the social worker for the Deaf and had bought a sophisticated private hearing aid from his own resources.
107. Our survey suggests robust support is available in Glasgow for people with a learning disability who are deafblind. In contrast, deafblind people without additional disabilities in Glasgow and Fife appeared to receive less well coordinated support and relied heavily on family carers. In Aberdeen where much of the work for deafblind people is led by the local Deaf Society, one carer commented:
"There was not much they could do for him, being blind."
108. Local authorities are not alone in pursuing 2 separate assessment routes for deafblind people. Health service staff in our fieldwork sites rarely appeared to collaborate in the interests of this group. One notable exception to this was work to achieve closer links between clinical assessment of sight and hearing loss in Fife.
109. In smaller authorities specialist workers for people with a visual impairment and for people who are deaf or hard of hearing, are sometimes combined in a sensory impairment team. This can lead to greater collaboration on joint assessments for deafblind people but not all small teams have the specific knowledge of deafblindness or communication skills. Only 10 authorities have staff with knowledge of the manual alphabet, and these tend to be larger authorities.
110. Where reviews occurred they were more likely to be on an annual basis. The need for regular reviews, probably as frequent as 6 months, is justified where both sight and hearing may be deteriorating. The lack of written guidance to staff to encourage this to happen is worrying.
111. Good practice in assessment and care planning is the foundation of much of SENSE (Scotland's) work. SENSE (Scotland) provides assessments - sometimes at their own expense - of deafblind people who have additional and, frequently profound, disabilities. Their care planning documentation reflects good practice in this area.28 It is a centre of excellence in this respect. As parents of one student living in a SENSE community house observe:
"In August 1995 Margaret29 came into the care of SENSE. Margaret was then 32 years old and had spent the previous 22 years in a hospital for the mentally handicapped. She is severely restricted because in addition to her mental handicap she has neither sight nor speech. The hospital she was leaving was known to us as a safe harbour and the staff as caring and able, so, however good the intention, the move to a community house to be cared for by unknown people was daunting....Hospital nurses are a well respected professional group with known skills. SENSE's carers were harder to categorise....Our first reaction was surprise at how young they were and at how different their backgrounds seemed to be. Our second reaction was to be very impressed by their commitment to their charges and, in Margaret's particular case, how much effort was put into exploring and trying to extend the bounds of her abilities."30
112. Both Deafblind UK (Scottish office) and SENSE (Scotland) state that deafblind people are marginalised because of their particular difficulties with communication, information and mobility. The two deafblind people described below illustrate different ways in which they feel or can be marginalised.
Bill31 has both residual hearing and limited vision. He uses either large print or "moving Braille". He lives with his parents and is physically mobile (assisted by a Guide Dog). He worked for several years before being made redundant. He does not expect to be employed again.
He has had little contact with social work staff. He had been
assessed for equipment (a Braille clock), but had not been seen by a specialist
worker for either the Deaf or the Blind. He purchased other aids
to independent living himself. He felt he was holding out a begging
bowl. He found this distasteful as he had paid his taxes. When
the social worker visited "he talked to my mum and dad, not me."
Alastair32 has been in hospital since he was 7 years old. At the age of 22 he was in a locked ward and heavily medicated because he had showed severe challenging behaviour. He would not wear clothes. He was profoundly deaf, had no vision in one eye and had lost the vision in the other eye because of his self-inflicting eye poking.
Initially Alastair would only tolerate a few seconds of staff contact at a time. He required intensive care which, over a period of 10 years, led him to accept periods of massage, to learn a little signing and to express his choices. His challenging behaviour is now only occasional, and tolerated by staff.
THE SERVICES
113. The arrangements for the provision of local authority services to deafblind people tend to mirror assessment arrangements for deaf and blind people, ie they are provided by staff teams supporting people with a single sensory loss. Of the 6 areas we visited only Aberdeen had a local organisation, the Rainbow Club, which specialised in supporting deafblind people. They received financial support from Deafblind UK (Scottish office), not Aberdeen City Council.
Communication support
114. The need for communication support for individual deafblind people varies widely. This may include the range provided to people who are deaf or hard of hearing, but adapted for the residual vision available to the deafblind person. For example a profoundly deaf BSL user with tunnel vision may still be able to use BSL within the remaining frame of vision. Someone with restricted vision who has developed deafness as an adult may be able to read large print on a computer screen. The deafblind manual alphabet may be the prime means of communication where neither vision nor hearing is sufficient to use other communication support. Twenty one authorities told us that manual alphabet support was available, 11 authorities purchasing that support from an agency, 10 providing it directly.
115. The introduction of guide/communicators, promoted by Deafblind UK (Scottish office), has been a recent development. The number of trained guide/communicators is small, but growing. Funding for guide/communicators has been made available by a few authorities, but has yet to be established on a sound footing.
116. The guide/communicator provides individualised communication support for the deafblind person. Twenty authorities said they provided guide/communicator support, and 15 authorities reported purchasing the service from Deafblind UK (Scottish office). In its submission to us Deafblind UK (Scottish office)33 stated that less than half of the local authorities in Scotland provided a guide/communicator service "of any kind".
117. According to SASLI, there are only 12 trained specialist workers in Scotland. It is not known exactly how many people who are deafblind require communication services, but it is apparent that this number is inadequate.
Information
118. If deafblind people are to make informed choices about the equipment and services available to them, they need to have information presented in formats that are accessible. For some deafblind people with multiple impairments that information may need to be communicated in a simplified form, most easily transmitted through the manual alphabet.
119. Only 2 of the 15 deafblind people we interviewed, indicated that the information they received was relevant to their needs, and only one person could use the format in which it was presented. This is not surprising as local authorities are poorly informed about the range of formats in which information may be given and received. This was also true of some of their agents.
Mobility
120. Deafblind people may benefit from mobility training and the use of established aids. This may result from assessment and training from specialist teams or agencies working with people with a visual impairment. For some deafblind people the assistance of a personal guide is the main way in which they can sustain their own mobility. Of the 15 deafblind people in our survey over half had assistance from a guide. All but one of these guides was a member of the deafblind person's family.
SUMMARY
121. In this chapter we review the working links between specialist staff in social work services and other professionals working in the health and education services.
HEALTH
122. Specialist social work staff consider their key partners in the health services to be the staff in hospital based specialisms, primarily ophthalmology and audiology. We looked at the quality of their working relationships and the availability of information to people with a sensory impairment.
Ophthalmology and Low Vision Aids (LVAs)
123. The presence of social work staff from specialist teams or agencies and volunteers, in hospital eye clinics was widely supported by health service staff. It provided an opportunity to both share information about community services with patients and staff and identify the kind of assistance that people may be seeking or needing. Unfortunately, such co-location is not a common practice. In Aberdeen and Moray the consultant ophthalmologist would have welcomed the presence of GSB staff at the clinic. He commented that a clinic operating with a social worker present would represent a "gold standard".
124. Many elements of good practice in joint working were evident in the Glasgow Western Infirmary Outpatient Department Eye Clinic. The clinic provided an effective bridge between health and community services and had close links with specialist social work services in Glasgow and West of Scotland Society for the Blind. The clinic was nurse led and people were helped to understand their medical condition, what certification and registration involved and where and how to get other assistance. Senior nurses had received training in counselling and the clinic housed an LVA assessment unit. Information about services is available in both written and audio taped formats.
125. Good collaborative working was also in evidence at the Low Vision clinic at the Victoria Hospital in Kirkcaldy. This "one stop shop" combined eye examinations with the provision of LVAs. FSB had a member of staff based there, the Vision Services Officer, who was introduced to patients as a member of the clinic team. She provided information about the registration procedure and available community services and would assist patients to try out aids.
Practice elsewhere was characterised by a lack of joint working resulting
in:
127. There is no doubt that social work staff could do much valuable work in relation to information-sharing, welfare benefits advice and counselling at the point of registration and at LVA clinics. The significance of this social exchange is well summarised by one person who described her feelings at the time of her eye examination:
"Doctors are very good at what they do and I do not want to criticise them. When I found there was nothing to be done ... I felt very isolated and alone. A friendly face and a chat would have been helpful at this stage."
Audiology
128. People who are profoundly deaf may have little need for ongoing contact with audiology. Those who have some residual hearing are likely to have different contact with the health service as they may benefit from more conventional hearing support and be referred to audiologists.
129. We found audiologists used specialist social work staff to provide practical support, eg the provision of environmental equipment and benefits advice. Specialist teams were not generally perceived to have counselling skills.
130. Audiologists said that introducing social work support needed to be done sensitively. In Glasgow and Oban audiologists thought their patients would not accept social work assistance because of the perceived stigma. However, where the service was provided, its high quality was praised. In Ayr and Kirkcaldy social workers were routinely introduced to patients by audiologists as one of the team who was specially trained to assist.
131. A pro-active approach to joint working is well illustrated by a pilot project in Ayr Hospital. A course34 aimed at maximising communication for 10 patients who used hearing aids (aged 50-75 years) who had hearing loss, ranging from moderate/severe to profound was established. Patients had been using monaural and binaural hearing aids for a minimum of 10 years. Course content included introduction to lipreading, training videos, demonstration of environmental aids and talks. All but one person confirmed that the course had improved their communication ability. Another project begun in 1997 is intended to raise staff awareness in both the health service and the community to the needs of people with a sensory impairment and hopes to provide the necessary skills and services.
132. In Aberdeen both social work and technical officer staff from ANEDS attend a specialist hearing aid clinic. Social work students, on placement at the Society, are provided with an opportunity to visit the audiology department as part of their training. There are further examples of collaboration in the community. Audiology staff have been involved with ANEDS in developing hearing aid routine maintenance classes. In Glasgow, audiology staff have developed deaf awareness training, jointly with social work and RNID staff. In Fife audiology staff have promoted training with social work home care and day care staff.
133. The availability of information about social work services differed between audiology clinics. In Aberdeen the local Society's leaflets were prominently displayed. In other clinics information was rarely on public view but leaflets sent by social work staff to audiology staff, describing how to contact the specialist team, could be provided directly by clinic staff to people using the service. An attractive display of RNID literature was seen in 4 of the clinics visited and compared favourably in presentation and designs with publicity materials provided by some specialist teams.
Social work, ophthalmology and audiology
134. In Fife there are growing links between ophthalmology and audiology clinics. Both are aware of a proposal to develop a common location for FSB staff and the social work hearing impairment team. This collaboration between social work services appeared to have been the stimulus for closer working between the two health specialisms. The social work staff welcomed this because of the growing numbers of older people who have dual sensory loss attending both clinics.
EDUCATION
135. This section looks at working links between those education and social work staff who are concerned with children with a sensory impairment. We have looked specifically, but not exclusively, at work to assist children and their families to plan for the children's lives after they have left school.
Future Needs Assessment
136. Children with sensory impairment who have a Record of Needs will undergo further assessment within the 2 years before they are 16, the age at which they can leave school. This assessment should identify their needs, make arrangements for any continuing or higher educational training and assess the young person's need for any social services or support to assist their transition to adulthood. These assessments known as Future Needs Assessments (FNA) are generally coordinated by education staff, with input from social work.
137. The legal framework for the FNA is the Education (Scotland) Act 1980 and the Disabled Persons (Services, Consultation and Representation) Act 1986. Additionally, children with sensory impairment are children in need under the Children (Scotland) Act 1995. They and their carers are entitled to an assessment of their needs and may be eligible for welfare and support services. Guidance on FNA and on services for children who are disabled has been issued by The Scottish Office35.
Quality of working relationships
138. All the education staff we spoke to stressed the importance of social work staff having a working relationship with children and their families prior to the FNA. They said that the earlier social work staff established a relationship with families, the better. One chief social work officer told us: "There is no use parachuting social workers in when a child is 14." An early introduction led to families developing an understanding of the role and resources offered by social work services. A late introduction could lead to difficulties as some families were suspicious of social workers. Social work was, we were told, seen to be linked to problems rather than opportunities, stigmatising rather than enabling. Without exception, the same staff also related the positive experiences of social work that children and families shared with them after having made contact. We believe that whilst early contact may be beneficial, it should always be purposeful.
139. There was some ambivalence amongst specialist educational staff about which social workers should attend FNAs. One senior psychologist questioned the ability of specialist sensory impairment staff to keep abreast of developments in other areas of social work practice like child protection. She also queried the appropriateness of budgetary decisions being made by generic care managers who knew little about specialist needs. In other areas several social workers could arrive for the FNA - from children and families, criminal justice services and the sensory impairment team, all of whom could be accompanied by their line manager.
140. Education staff described the occasional difficulties of social work staff from a children and families team being involved in the FNA, but staff from the community care team (without specialist knowledge) being charged with implementing the decisions of the FNA. They expressed concerns that planning decisions at the FNA were not being followed through when responsibility was transferred from social work staff in children and families teams to community care teams. Education staff offered the following example:
James36 is 19 years old, deaf with little speech and complex needs, attending a school in England. His family would like him to live locally which would require considerable long-term planning. The psychologist anticipated that social work funding for the school would continue without much questioning until the age of 21, but the possible opportunity for re-integration was disappearing. Her preference would have been that those who fund and those who have specialist knowledge work more harmoniously to a more satisfactory outcome.
141. Scottish Office guidance issued for implementation of the Children (Scotland) Act 199537 encourages local authorities to ensure continuity of services whenever possible for young people and their families during this transitional period. A worker, or key worker, should be identified from whichever service has most direct involvement, to whom the young person and his or her family can turn for information and advice.
Quality of information
142. The information that education staff possessed about social work services appeared to rely heavily on personal contact. People who worked together learned about each other's role. For education staff this tended to mean that they knew specialist social workers best and some children and families workers where there had been a need for their involvement. They were less aware of what other social work services were available and would have welcomed written material about this.
143. There were some examples of good practice in information giving. Research by educational psychologists in Aberdeen revealed that visually impaired people were unclear about what services existed as they moved from school to adulthood. This led to the introduction of an information pack designed by and published for young people. We noted that the pack contained the address of the offices of GSB, but not the addresses of local social work offices.
144. Local authorities have a duty under the Children (Scotland) Act 1995 to publish information about services for children in need, including children with disabilities. The importance of information covering a wide range of interests - employment, health, education, social and recreational - has been acknowledged in Glasgow. Paving the Way38is the title of a publication from Glasgow City Council that is aimed at many different children and their families, to assist them in post-school choices. We are aware of other authorities' work to produce information for children and families during transition from school to adulthood.
Strategic Approaches
145. The existence of jointly owned and developed interdepartmental strategies is essential to assist better collaboration. This can be provided by clear direction from the top such as the Fife Social Strategy. Where this joint strategy did not exist, psychologists we spoke to told us they had to resolve operational issues at a local level that should have been agreed at Directorate level.
146. A structured approach to joint working is the development of panels for staff working with people with a visual impairment and for staff working with people who are deaf or hard of hearing. The panels provide a single forum for staff across social work and education departments, bringing in others from health and voluntary organisations as appropriate. At the time of our visit panels were already in operation in Fife and being actively promoted in East Ayrshire, Glasgow and Moray.
147. The arrangements for the purchase of specialist equipment are a key issue needing interdepartmental agreement. Disputes have arisen and continue to arise as to whether an item of equipment is to be purchased for educational or social reasons. The home computer, of immense value to children with a sensory impairment, can serve both functions. "Who pays?" is the question. As more students with a sensory impairment enter further education such issues need a mechanism for their local resolution.
SUMMARY
148. Training and staff development is one way of improving service standards, increasing staff motivation and achieving best value. This chapter looks at local authorities' performance in developing and providing appropriate training opportunities for staff about sensory impairment.
Policy and personnel
149. The training of social work/social care staff is no longer a discrete function of social work departments. Many social work training sections are now amalgamated with or more closely aligned to council-wide training sections. Some staff are dedicated to social work training on a full-time basis. Some have a training remit which extends beyond social work. Others have a training remit as part of a broader job description. Not all hold a social work qualification. As a consequence, we found that the knowledge, skill and commitment of training personnel varied widely.
150. Some of the staff we interviewed knew nothing about the specific training grant for social work services available from The Scottish Office (œ4.2 million for 1997-98) or about their council's training budget. One trainer made it clear that sensory impairment training was a very small part of his remit and likely to remain so as other training concerns would continue to dominate. The availability and distribution of training budgets has also altered. It is now sometimes managed by those who know little about sensory impairment.
151. It is evident from the responses to our questionnaire and our fieldwork visits that inhouse training opportunities are variable. There are only limited training opportunities available to staff who wish to know more about sensory impairment or improve their communication skills. These are described in Annex 3.
152. Only 3 local authorities explicitly recognised sensory impairment training needs in their community care plans. Less than half of the respondents to our local authority questionnaire said they had a training strategy for staff working with people with a sensory impairment and of these only 5 had a budget allocated for that purpose. Some of the senior managers we interviewed acknowledged that as a support service, training in general, and sensory impairment training in particular, got less attention than operational matters. They did not see it as their responsibility to gain a more detailed understanding of what training was available. Others were more positive, seeing training as central to the development of the organisation and of its workforce.
In-service training
153. Most authorities run basic sensory awareness courses, although these do not reach all the relevant staff. One of the key messages from our interviews and focus groups with people who are deaf or hard of hearing was:
"There should be more deaf awareness training - I feel frustrated if people forget to include me."
154. Senior social work staff, receptionists and administrators, who meet the public on a regular basis all need deaf awareness training. This might consist of learning to recognise the different communication needs of people who are deaf or hard of hearing and simple communication techniques. East Ayrshire is one authority which gives a high priority to this.
155. The way in which people who are deaf or hard of hearing experience their first contact with the local authority can be crucial. If this is a positive experience, it will develop their confidence in staff. If it is not positive, the person may not come back.
156. No authority made reference to Scottish Vocational Qualifications (SVQs) as part of a strategy for ensuring adequately trained staff.
157. Few authorities made reference to joint training initiatives, when it is likely that similar training needs exist in education and health. This failure to pool resources is surprising.
158. Of the authorities we visited, Fife had a particularly comprehensive programme. This recognised that training was shaped by management decisions about the future direction of services and also by the available financial resources. Fife acknowledged that specialist staff could provide basic awareness training for other staff and that specialist staff had their own needs. This can pose problems since specialists are a scarce resource and it can be difficult to justify diverting them to providing training rather than direct service.
159. The range of training offered included:
160. Aberdeen and Moray provided similar training including:
Nevertheless, the knowledge base of most social workers other than specialist staff about sensory impairment was poor. While some had attended basic awareness training many had not and did not anticipate doing so. The underlying assumption was that people with a sensory impairment would be dealt with by specialists so there was no need for other social workers to learn about this area of work.
The Diploma in Rehabilitation Studies
161. The principal concern of Social Workers for the Blind related to the appropriateness of the Diploma in Rehabilitation Studies which an increasing number of staff are obtaining as their qualification. In Scotland this course is offered by the School of Vision and Rehabilitation Studies which opened in Glasgow in 1993. It currently has 26 graduates with another 21 undertaking the award. Most social work staff think the qualification is a strong one which equips workers well in technical ability and in counselling skills. A minority told us that insufficient attention was paid to the teaching of traditional social work knowledge, skills and values. In our view, this course is sound and appropriate.
The Diploma in Social Work (DipSW)
162. Specialist social workers were critical of the existing DipSW. They thought it did not provide a meaningful understanding of working with people with a sensory impairment. Thirteen authorities told us they offered specialist placements for students who wished to work with people with a sensory impairment. However, only two authorities had such placements in 1996-97. Most also said that they would be willing to offer placements to students who had a sensory impairment.
Specialist training needs
163. Training opportunities available to specialist workers also vary. Practitioners are greatly influenced by the context in which they operate. Some staff appear to be unaware of who they should go to with training requests. In Glasgow, some funded their own training in BSL. On a more positive note, staff in Fife felt well integrated into the department. Their specialist needs were addressed, where possible, and efforts were made to get them on to other social work courses eg child protection.
164. How to obtain sign language skills was a top priority for many specialist hearing impairment workers.
165. Only 4 authorities were identified in the responses to our questionnaire as having attained BSL Stage 3. This is regarded as the level required to communicate effectively with those for whom this is a first language. The qualifications of those working in the voluntary sector are not known, making the statistics incomplete but the results are nevertheless worrying.
166. People who used the services had little to say about training but all those we interviewed expressed dissatisfaction with workers' ability to sign.
167. Many candidates reach Stage 1, few Stage 2 and fewer Stage 3. Failure at Stage 3 is particularly high. It may be that some candidates have insufficient opportunities to practise or that there are not enough people who have already reached this level available to support someone else through.
168. One submission39 argues that the work of specialist teams and agencies would reduce if basic training in communication skills was provided to all social work staff.
169. The examining body for BSL, the CACDP, will no longer run Stage 3 examinations from December 1998. They will be offering National Vocational Qualifications - Level 3 BSL Units - which are yet to be piloted in Scotland and may not be available here for the next two years. In the meantime, training programmes preparing people for qualification in the North of England may be accessible.
170. Staff told us that there was a dearth of post-qualifying opportunities. They regretted the demise of a specialist course that Moray House ran as well as the Open University Course on Deafness. A submission from the East of Scotland Society for the Deaf in Edinburgh mentioned the postgraduate diploma/MA in Social Work with Deaf People which is offered on a distance learning basis by Manchester Metropolitan University. The cost was said to be prohibitive and the necessary placement arrangements difficult to make.
171. There are insufficient numbers of trained guide/communicators to be the eyes and ears of deafblind people. All agencies recognise the very specialist nature of this training and work together with the 2 main organisations - Deafblind UK (Scottish office) and SENSE to meet the needs. The considerable expertise of both these groups is universally acknowledged and appreciated, but they cannot meet the existing and growing demands.
SUMMARY
General
172. We found that:
176. While many community care plans refer to the needs of people with a sensory impairment, the basis on which aggregate needs are calculated is not sufficiently accurate for planning services effectively. Authorities do not know exactly how many people living in their area have a sensory impairment. A consequence of inadequate information is that innovative commissioning is not widespread and service development is often ad hoc rather than planned.
177. Both inhouse and contracted team leaders in specialist services have high personal and professional standards and demonstrate considerable integrity within their span of control. They, in turn, supervise specialist social work staff who have widely differing knowledge and skill and who have limited opportunities to develop professionally because of inadequate specialist training opportunities. In organising and delivering services, managers need to balance developing knowledge and skills amongst their staff and retain the skilled and knowledgeable specialist. Most senior social work managers did not prioritise this area of work. We found little co-working across specialist and other professional social work teams but there were some exceptions to this where the quality of work was high.
178. Contracting creates tensions because of the conflicting needs of many commissioners and providers. The former are said to be largely concerned with keeping within strict financial boundaries, while providers assert that discussions on quality rarely go beyond price. We are also concerned that contracted services are more rigorously scrutinised than their inhouse counterparts. We conclude that the contracting process requires attention in many local authorities and that transparency and even-handedness are essential.
179. Participation of people who have a sensory impairment in service planning and delivery is limited. Representatives' voices are often selected by staff. People who use services told us that they were reluctant to complain. Whilst our survey suggests that many of those using the service are satisfied, we were concerned that this may be because their expectations were low. The contribution of carers in supporting those with a sensory impairment was evident but did not feature strongly throughout the course of this inspection. We know this does not reflect the valuable role they play.
180. National voluntary organisations can be significant partners with local authority and other staff. They can bring added value to the work of local specialist teams, through joint working. They can introduce expert services, information, knowledge and sometimes, additional financial support.
181. There is not one strategy that would suit all authorities.
RECOMMENDATION 1
Local authorities should take the lead in establishing multi-agency strategy and resource groups for services for people with sensory impairments. These resource groups should be in place by April 2000.
1. These will provide:
Membership would consist of:
The Importance of Effective Joint Working
182. Local councils could achieve better joint working both across departments and with health colleagues through clearer understanding of each other's responsibilities and tasks.
183. We have described some examples of good joint work between health and social work services which demonstrate the value of close links. Such links, whether they are with ophthalmological or audiology services, appear to bring better outcomes for people with a sensory impairment.
184. We also saw numerous examples of education and social work staff working together, to the benefit of children and their families. However, some educational professionals expressed concerns about other professionals' or agencies' preparation for, and follow up of, FNAs. Many education staff do not know a great deal about the functions or responsibilities of social work or the kinds of help and resources that social work services may offer families. Joint working is supported, in some areas, by specialist panels. Nevertheless, these have not been able to resolve some key issues such as respective responsibilities for the purchase of equipment.
185. A high level Committee on post school education and training for young people with special needs has recently been set up, under the Chairmanship of Robert Beattie MBE, by The Scottish Office. Its main focus is on improving the skills and employability of young people with special needs whose ultimate goal is employment, whether full or part-time or voluntary. The Committee will consider the wide range of needs of young people who have few or no qualifications, low basic skills and poor attitude and motivation; and young people with physical disabilities, learning difficulties or mental health problems. The Beattie Committee is scheduled to complete its work in the spring of 1999.
186. Two of the key areas for action identified by the Committee relate to issues raised in this report:
* transitions from school to college and/or training, and ultimately
to employment; and
* enabling technologies.
We expect the Beattie Committee to review the issues and recommendations set out in this report as part of its wider considerations; and to take particular note of the concerns raised about effective joint working and the implementation of FNAs.
RECOMMENDATION 2
Local authorities and their partners in children services planning should
review their existing arrangements for FNAs. The review should:
RECOMMENDATION 3
The Beattie Committee should consider the concerns expressed in this report about effective joint working and FNAs as part of their wider deliberations.
Clarifying Issues About Certification and Registration
187. As we highlighted, certification and registration are not good indicators of assessed individual need or of the prevalence of needs in the community. Nonetheless they perform an important function. The wide variation in practice both between authorities and within authorities tends to undermine the efficiency of the schemes and sometimes to create a degree of personal confusion. This could be eased by establishing some simple norms to apply across the country.
RECOMMENDATION 4
The Scottish Office should convene a short life working group of representatives of local authorities, health services and people with a visual impairment to review, and change as necessary, the efficiency of arrangements for certification and registration.
Ensuring the Effectiveness of Assessments
188. The wide variation, and sometimes regrettable delays, in commencing and completing assessments in this field require to be addressed. The quality of assessments needs to be improved and there needs to be a better understanding within the wider staff group about how sensory impairment can impact on and/or create other social care needs. Collaboration between specialist and other social work professionals and staff needs to be improved to ensure fuller assessments of need are undertaken whenever this is necessary. This is essentially a matter for each local authority who must establish the quality standards to which they are going to work. They must also put in place management and practice arrangements to ensure that these standards are met and that corrective action is taken where services fall short. As authorities develop their Best Value regimes under the Government's initiatives for modernising local government these approaches to setting standards and monitoring performance against key indicators will come to cover all services.
RECOMMENDATION 5
All local authorities should review their assessment arrangements for people who have a sensory impairment to ensure that assessments are carried out speedily and that wider needs are considered whenever necessary. The outcome of these reviews should be reported to SWSI by April 1999. All authorities should establish and publish their timescales for assessments.
Improving Training
189. While excellent training opportunities exist in some inhouse courses,
more specialist qualifications are not being achieved. There are:
RECOMMENDATION 6
Local authorities should immediately look to:
The Scottish Office should incorporate consideration of the training
needs of those who work with people with a sensory impairment into its
wider consultations about the future development of education and training
in social work services.
ANNEX 1: LEGISLATIVE FRAMEWORK41
Legal requirements for local authorities to provide social work services for people with a sensory impairment are laid down as part of their responsibilities to people who have a disability, or as a result of the Social Work (Scotland) Act 1968 or the Children (Scotland) Act 1995.
Social Work (Scotland) Act 1968 "the 1968 Act"
Section 12
Places a duty on every local authority to promote social welfare by making available advice, guidance and assistance on a scale appropriate for their area.
Section 12A
This was inserted by the National Health Service and Community Care Act 1990. (See under that Act, section 55 on page 53.) The Social Work (Scotland) Act 1968 was also amended by Carers (Recognition and Services) Act 1995. See again page 53 under that Act.
Section 14
Places a duty on every local authority to provide domiciliary services for households where there are persons in need. It also gives the power to provide laundry facilities for these households.
Chronically Sick and Disabled Persons "the 1972 Act"
(Scotland) Act 1972
This Act extends sections 1 and 2(1) of the Chronically Sick and Disabled Persons Act 1970 (the 1970 Act) to Scotland.
Section 1 (of the 1970 Act)
Places a duty on every local authority having functions under section 12 of the 1968 Act to inform themselves about the numbers of disabled people living in their area and of the need to make arrangements for them. Every local authority is to publish general information about the services they provide. They are also to inform disabled people about relevant services that they know others provide.
Section 2 (1) (of the 1970 Act)
Lists the arrangements which can be made to assist disabled people.
These include:
Section 1
Under this section education authorities have a duty to secure the adequate and efficient provision of school education for their area. This must include provision for special educational needs which covers those with learning difficulties which may arise from a disability.
Section 60(2)
So that they are in a position to fulfil their duties in respect of special educational needs, education authorities must establish which children belonging to their area, who are 2 years of age or over but under school leaving age, have pronounced, specific or complex special educational needs which require continuing review. They must open and keep a Record of Needs for any such child who, following assessment, is found to have such needs. There is also discretionary power to carry out these functions for children aged between 16 and 18 who are still at school.
Section 65B
Places a duty on the education authority to provide a Future Needs Assessment of any child with special educational needs so that children may benefit from local authority services after leaving school.
Disabled Persons (Services, Consultation and "the 1986 Act"
Representation) Act 1986
Section 4
Places a duty on the local authority to decide whether the needs of a disabled person call for the provision of a range of services in accordance with section 2(1) of the 1970 Act if requested to do so by the disabled person, his representative or his carer.
Section 8(1)
Places a duty on the local authority to take account of the ability of the carer to continue to provide the care.
Section 13
Deals with disabled persons leaving special education in Scotland. Under this section local authorities have a duty to assess the needs of disabled children with respect to the provision of services "in accordance with the welfare enactments, and for that assessment to be carried out".
National Health Service and Community "the 1990 Act"
Care Act 1990
Section 47(2)
States that if during an assessment of need a person appears to be disabled, the local authority shall proceed automatically to a decision on services.
Section 55
This inserted a new section 12A into the 1968 Act under which the local authority would carry out assessment of needs and would then decide whether these needs call for the provision of services.
Carers (Recognition and Services) Act 1995 "the 1995 Act"
Section 2(1)
Amends Section 12A of the 1968 Act to make an independent assessment of carers needs when they request this providing that the care they offer is substantial and regular.
Disability Discrimination Act 1995 "the 1995 (DD) Act"
Section 19
Makes it unlawful for a provider of services to discriminate against a disabled person in relation to access eg to and use of information and to and use of a means of communication.
The Children (Scotland) Act 1995 "the 1995 (CS) Act"
Section 23
Introduces a new legal framework for assessment, services and support to children with disabilities, children affected by disability and their families. An underlying principle is that services are designed to minimise the adverse effect of the child's disability and to enhance the child's opportunity to lead as normal a life as possible.
Section 24
In carrying out an assessment to determine the needs of a disabled child
the local authority is required to assess a carer's ability to provide,
and to continue to provide, care for the child.
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ANNEX 3: AVAILABLE TRAINING OPPORTUNITIES
Central Council for Education and Training in Social Work
The Central Council for Education and Training in Social Work (CCETSW) is the main provider of the range of vocational, qualifying and post-qualifying awards for those working in social care and social work.
Vocational Qualifications
These are obtained through a system of assessment and are awarded jointly by CCETSW and the Scottish Qualifications Authority (SQA).
The Scottish Vocational Qualifications (SVQs) in Care at Level 3 have a core unit which is mandatory for all staff in which they demonstrate that they have promoted communication with clients where there are communication difficulties. Staff at this level often work with people with complex needs without direct supervision and are expected to demonstrate an understanding of a range of communication difficulties, including sensory impairment.
SVQs have been reviewed recently and revised versions are coming onstream which will place greater emphasis on working with specific communication difficulties. There will be a mandatory unit on promoting effective communication and relationships for all Level 3 candidates who are undertaking the specialism in promoting independence. Some optional units have also been developed.
They are:
CL2 promoting communication with individuals who have communication
difficulties;
CL3 promoting communication with others through the use of interpreting
services;
CL4 arranging and evaluating interpreting services;
CL8 promoting communication through technology.
The Diploma in Social Work (DipSW)
CCETSW are the only awarding body for the professional qualification in social work. The competences required of social workers are generically expressed, but students can provide evidence of their competence through work with a particular client group or within a particular setting. CCETSW has produced guidance for teaching institutions on visual impairment, hearing impairment and multiple impairment. It is for institutions to decide whether to offer these. A dual qualification of a DipSW and a diploma of higher education in rehabilitation studies is offered at the University of Central England, specially for those who will work with visually impaired people.
Post qualifying level
There is a post-qualifying advanced award/MA course in Social Work Studies with Deaf People taught at Manchester Metropolitan University.
Scottish Qualifications Authority (SQA)
In addition to the CCETSW/SQA Joint Awards SQA have:
Central government also funds training for staff working with people
with a sensory impairment via the specific training grant to local authorities.
A number of voluntary organisations in the sensory impairment field are
also in receipt of training grants via section 9 of the Social Work (Scotland)
Act.
ANNEX 4: GLOSSARY