Focused review of. Caerphilly County Borough Council Social Services

Transcription

1 Focused review of Caerphilly County Borough Council Social Services March 2009

2 Caerphilly County Borough Council A Focused Review of Social Services Introduction We are pleased to present this report of a Focused Review carried out by the Care and Social Services Inspectorate Wales (CSSIW) and the Wales Audit Office (WAO). The overarching purpose of the Focused Review is to determine the Council s strengths and areas for improvement in delivering social services and report these findings to the public. The Review sets out to answer two key questions: Does the Council have effective arrangements in place to protect vulnerable children and adults and to promote their independence and social inclusion? Is the Council well placed to sustain and improve its performance in social services? This report sets out the Review Team s assessment of the Council. It outlines the most important evidence gathered throughout the Review, setting out strengths and good practice as well as areas for development. It seeks to give an overview of the way in which the Council carries out its responsibilities for social services in the areas examined by the Review Team. It is not intended to deliver a detailed critique in every area of work. The Focused Review of social services in Caerphilly County Borough Council was carried out by a team comprising Norman Host, Jill Lewis, John Llewellyn Thomas, Val Connors and regulatory inspectors Sandy Pearce, Celly Morgan and Lynne Burlow. On-site work took place in August and September A drawing conclusions meeting with the Council to discuss the findings from this Review was held in October

3 Many individuals and groups collaborated in planning and supporting the review process. The Focused Review Team would like to thank everyone who contributed by sharing their experiences and views. The Council has been asked to produce an action plan in response to this report and will also be expected to take the findings of the report into account in developing their business and improvement plans. Both CSSIW and the WAO will undertake further work as part of their usual work programmes to evaluate the progress made in delivering these actions and the outcomes for service users and carers. Rob Pickford Chief Inspector Jeremy Colman Auditor General for Wales 2

4 Summary 1.1 Conclusion The focus for this review was decided at an issues analysis meeting held with the Council and partner agencies where it was agreed that the Review Team would focus on the following themes: Capacity to deliver effective assessment, care management, review and safeguarding arrangements Impact of the modernisation agenda in delivering better outcomes for service users Promoting independence including transition planning Carers and their experience Shaping services Providing direction (see Appendix 2: Methodology) In exploring these themes, the Review Team concluded that the services provided by the Council were becoming increasingly effective. Reviewers found evidence of consistent improvement in the Council s delivery of a range of social care services since the last CSSIW service reviews of There is now a greater focus on providing services that help promote independence and provide better outcomes for individuals. Good progress has been made in developing safeguarding and partnership arrangements for vulnerable children and adults. Changes to the structure of access and assessment arrangements in adult and children s services have been successfully implemented and embedded into practice. However, a number of improvements are required, including the need to address the timeliness and quality of assessment, care management 3

5 and review, and the need to increase the pace of change in terms of modernising services. Capacity issues will also need to be addressed through more effective workforce planning and management. This will enable the Council to tackle the current waiting lists for assessment and service provision in adult services and to address issues of assessment and service quality. Services for children Assessment, care management and review arrangements for children in need of protection have improved since the last children s service reviews carried out by CSSIW in 2004 and 2006 and are generally satisfactory. However, attention is needed to address the time taken to complete initial and core assessments where this exceeds the required timescales of 7 and 35 days respectively. All children on the child protection register and children who are looked after by the Council have an allocated social worker. The Caerphilly Local Safeguarding Children s Board, (LSCB) has been established with a clear work programme to assist partner agencies in their safeguarding role. However, more frequent attendance by partner agencies at strategy group meetings and core group meetings is needed in order to strengthen partner agency input to children s safeguarding arrangements. Care management and review arrangements for children looked after by the Council are generally working well, although further measures are needed to ensure that timelier statutory visits are undertaken and that looked after children (LAC) have personal education plans in place. Whilst there is evidence that the modernisation of fostering services has improved local placement choice for looked after children, challenges remain in providing sufficient placement choice for the more hard to place children, such as teenagers and individuals with behavioural difficulties. There are a range of good services for young people leaving care, most of who are in contact with their social worker and are in suitable accommodation. However, further opportunities need to be provided in order to ensure that these young people have better access to education, training and employment. The commitment from the Council and its partner agencies to improve services for disabled 4

6 children, and to develop effective transition arrangements for young people moving into adulthood, needs to be taken up a gear in order to translate plans into action to deliver much needed improvement. Services for adults The Council has set out a clear agenda for the modernisation of its adult social care services and is making steady progress in delivering services which promote the independence of older people. Such developments reflect a move away from a traditional support and dependency model to that of a culture of reablement and creating opportunities for independence and social inclusion. The Council will now need to take a similar approach to developing services for other adult groups such as those for people with a learning disability, mental health problems and physical or sensory disabilities. This will need to include addressing the working arrangements with health partners in joint field work teams. Attention will also need to be given to further developing an outcome based approach to assessment and care management, while action is needed to tackle waiting lists for assessments and service provision. The Council has worked hard to develop and strengthen adult safeguarding arrangements, including establishing the Adult Area Protection Committee and providing considerable investment into developing a dedicated Protection of Vulnerable Adults (PoVA) team. More frequent attendance at the Adult Area Protection Committee by managers from partner agencies is needed to strengthen partner agency ownership of, and engagement in, adult protection arrangements. Support for carers Whilst there is evidence of good support for carers, further work needs to be done to increase the numbers receiving an assessment in their own right and to develop the range of services on offer. Assessments, care plans and services are in place to support young carers. 5

7 The Review Team concluded that the Council is in a good position to continue its service improvement programme. There is clear and effective leadership and management within social services, with many skilled, knowledgeable and committed staff and managers. The Directorate has made considerable progress in delivering social services within an integrated resource, planning and commissioning framework. This now needs to be built upon in order to more succinctly align needs analysis, service provision and planning with that of financial planning and future commissioning intentions. There are increasingly effective financial management systems in place and the Council has made good progress in developing reliable performance information. However, further work is needed to fully embed a performance management culture across all managers and staff. The other main challenges for the Council in continuing its service improvement agenda include: the need to put in place effective recruitment and retention measures for key staff to address capacity issues; and the need to retain the engagement of key health stakeholders during major changes to the National Health Service in Wales. Social services has become more integrated within the Council with greater alignment and ownership of the social inclusion agenda across other corporate directorates. There is on-going cross party political support for social services and the Review Team found evidence of strong leadership by the senior management team within social services. The Council will need to ensure that the vision and future direction for social services is shared and agreed corporately and politically and that service users, carers and staff are informed about and engaged in, the modernisation and service improvement agenda. This will require a balance between preserving the overall vision while paying close attention to detail and the impact of change on individuals. 6

8 1.2 Strengths and achievements Services for children The Council has worked hard to put in place arrangements and services to promote and safeguard the wellbeing of vulnerable children and those looked after by the Council. The new organisational structure for the first contact and fieldwork teams has led to improved performance in a number of key aspects compared with 2007, including a more effective risk based approach to access, assessment and care management. This was confirmed by the case file analysis where the majority of assessments and care plans were found to be satisfactory or good. The implementation of the Public Law Outline 1 in April 2008 has been well managed by the Council with effective joint working between the legal department and children s services. Support services for looked after children are generally good, with all cases allocated to a social worker. The Council has made progress in developing and improving its fostering services. Placement stability has shown a marked improvement over the last year with no looked after children being permanently excluded from school during 2006/07. Care planning for looked after children was found to be generally satisfactory and reviews are mainly carried out within the statutory timescales, assisted by input from Independent Reviewing Officers. The leaving care team is fully Munby 2 compliant, with the team providing good support for care leavers. All relevant young people leaving care have a social worker and an independent personal advisor. Most of these young people are in contact with their social worker and placed in appropriate accommodation. 1 Public Law Outline (PLO). This was implemented in April 2008 following the review of the Protocol for Judicial Case Management in Public Law Children Act Cases, This complements revised statutory guidance for local authorities (The Children Act 1989 Guidance and Regulation). The key objective of the PLO is to streamline and simplify case management processes for care proceedings. 2 Ruling by Judge Munby J. v Caerphilly County Borough Council (2005). This case raised important issues about the need for leaving care assessments and care plans to be meaningful and specify who will do what, by when. The case made it clear that assessments that do not meet these standards can be challenged through the courts. The case also indicated that personal advisers for care leavers must be independent from the care manager. 7

9 Services for adults The Council is making progress in promoting the independence of older people aided by a service improvement and modernisation agenda to improve outcomes. There has been effective project management of the changes in the way adult domiciliary care services are provided. This includes ongoing evaluation of the impact on individual service users and carers and analysing how lessons learned can inform future service improvement. There has been continuous improvement in performance relating to the number of older people the Council helps to live at home. The Council recognises that it now needs to take forward the modernisation of services for adults aged with a physical or sensory disability, a learning disability or mental health problems. Considerable progress has been made by the Adult Services Duty and Information Team in effectively managing an increasing number of initial contact and referrals. Similarly, the introduction of a dedicated review team is beginning to make significant inroads into reducing the backlog of adult cases which need to be reviewed. Factors contributing to good performance Staff interviewed by the Review team reported a strong supportive and learning culture within social services, with managers being accessible and operating an open door, no blame culture. Reviewers found evidence of regular staff supervision within adult and children s services and a roll out of an annual appraisal process, along with a committed approach to staff development and training. There is an improving culture of performance management and sound partnership, planning and commissioning arrangements have been developed. There is a clear vision and effective leadership from the senior management team in setting out the service improvement agenda for social care services. The Social Services Directorate is viewed as a trusted 8

10 corporate partner and has been given priority by the Council in terms of resources. 1.3 Priorities for improvement The Council should: Formalise the vision and direction for social services ensuring that this is agreed and shared corporately and politically; Effectively engage all staff, carers and service users in the service modernisation and improvement agenda. Further develop commissioning and contracting processes for the service improvement and modernisation agenda by; better aligning service planning with commissioning and de-commissioning; identifying the resource base required to meet projected need and provision within the medium term financial plan; improving the management of relationships with independent service providers; identifying and systematically aggregating unmet need into service planning and commissioning intentions; engaging and involving service users in service planning and development. Set out and implement measures to address recruitment and retention issues to ensure appropriate capacity at practitioner and manager level across adult and children s services; Develop a more consistent approach to assessment and care management in children s services by improving: contact with children during initial assessments; the timeliness of initial and core assessments; the quality of assessments, analysis and care plans; 9

11 the timeliness of service reviews; supervision and management oversight arrangements, particularly in safeguarding vulnerable children. Improve arrangements for child protection work by: securing partner agency attendance at child protection strategy and core group meetings; developing more outcome based child protection plans through the core group. Improve performance in assessment and care management in adult services by: reducing waiting times for assessments; reviewing and rationalising assessment formats and eligibility criteria between social services and health services; improving management quality assurance of assessment and care planning, particularly consistency of risk assessment; increasing the number of annual case reviews. Promote carers assessments more effectively and develop a fuller range of services to meet carers needs; Continue to promote independence and social inclusion and improve life chances of children and adults by: setting out a new timetable to implement the agreed integrated service for disabled children improving the educational attainment for looked after children developing and promoting opportunities for young people leaving care to access education, training and employment implementing transition partnership processes, arrangements and service choices for disabled young people, including those with complex needs; 10

12 developing and promoting the provision of Direct Payments for children and adults. 1.4 Areas for further examination The Focused Review Team identified a number of other priorities that warrant further examination in future review and inspection activity. These include: The arrangements between adult teams and children s teams in relation to the provision of specialist parenting assessments where there are child protection concerns in the family. The effectiveness of communication systems to engage and inform service users and staff as to what service modernisation means for them; The implementation of the Integrated Children s System (ICS) and its impact on workload management on fieldwork teams; The Focused Review: Detailed Findings 2.1 Review approach An Issues Analysis Workshop (see Appendix 2: Methodology) was held on 24 July 2008 and involved officers representing the Council; representatives from the Local Health Board and NHS Trust; the Cabinet Member for Social Services; members of the Review team; senior staff representing the Care and Social Services Inspectorate Wales, and the Wales Audit Office. A presentation was made by the Review team to promote discussion, which was based upon an analysis of the evidence provided by the Council in its self assessment, the results of surveys undertaken for the focused review, key performance indicators and evidence presented by other regulatory bodies. The discussion concluded with an agreement that the following issues would form the basis for the fieldwork element of the Review and subsequent reporting: 11

13 Capacity to deliver effective assessment, care management, review and safeguarding arrangements Impact of the modernisation agenda in delivering better outcomes for service users Promoting independence including transition planning Carers and their experience Shaping services Providing direction The fieldwork for the focused review took place between Tuesday 5 August 2008 and Thursday 11 September The first phase involved an analysis of case files and resulted in the selection of a number of cases for follow-up work. The second phase of the fieldwork included the case file follow-up with service users and carers and interviews with their case managers. In addition there were a number of interviews with frontline staff, key managers, partner agencies and group discussions. CSSIW regulatory inspections of the Fostering service and Domiciliary Care service were carried out concurrently with the focused review: key findings from these inspections are incorporated into this report. The Focus Review themes 2.2 Capacity to deliver effective assessment, care management, review and safeguarding arrangements New arrangements for access, assessment and care management have led to some improvements in performance. However, difficulties in recruiting and retaining suitable staff and managers in some frontline teams means that there are capacity issues which are contributing to waiting lists for assessment and services particularly in adult services. The quality, timeliness and continuity of the assessment and care management service also needs to be improved across children and adult services. While progress has been made in developing the 12

14 safeguarding arrangements for vulnerable adults and children, the attendance of partners at strategy and core group meetings is patchy and this needs to be addressed by the Local Safeguarding Children s Board. Strengths Well developed access, contact and referral arrangements Case transfer protocols and arrangements Progress in developing safeguarding arrangements and partnerships Many skilled and experienced practitioners, team and service managers Areas for improvement Ensuring more effective analysis and care planning Undertaking reviews of adult care plans in a timely fashion Developing more systematic quality assurance systems including more effective case management oversight Reviewing and rationalising adult assessment formats and eligibility criteria between social services and health services Working through the LSCB to improve the attendance of partner agencies at child protection strategy and core group meetings Working with partners to improve their attendance at the AAPC Tackling the impact of recruitment and retention issues through more effective workforce planning and management Improving the timeliness of assessments where these exceed required timescales. There are well developed access, contact and referral arrangements in place for members of the public and partner agencies following the introduction of 13

15 the dedicated Adult Services Duty and Information Team (ASDIT) and children s services Contact and Referral Team. There are clear service eligibility criteria in both teams, with a well developed risk based approach to decision making, and both teams have a range of service options in addition to assessment and care planning arrangements. There are clear arrangements in place for managing adult and child protection issues with specialist input available for safeguarding work for both teams. An additional senior practitioner post and specialist domestic abuse post have been funded in the children s team although at the time of the review both posts were vacant. There is access within the ASDIT to specialist mental health input. ASDIT and the Children s Contact and Referral Team have a range of options for referring individuals on to other agencies, and there are tracking processes to assist managers in both teams to monitor, evaluate and manage workflow and outcomes for all contacts and referrals. There are well established links with other agencies, including notification processes to inform referring individuals and agencies as to the outcome of their referral. The Council has developed sound working arrangements between ASDIT, the children s Contact and Referral team and the South East Wales Emergency Duty Team (SEWEDT) that provides an out of hours emergency service for the Council and other neighbouring Councils. Whilst the availability, range of formats and quality of information in local offices and on the internet is generally sound, materials need regularly updating. There was evidence of a range of practical measures to enable service access for hard to reach individuals and groups which are incorporated into partnership plans. Social services has its own communication and information strategy, overseen by the Customer Services team. In children s services, decisions on 98.5% of referrals during 2007/08 were made within twenty four hours, rising to 99.5% in April June Protocols and arrangements for case transfer from the Contact and Referral Team to 14

16 the locality Assessment teams generally work well, although this is variable when linking to adult service teams. In March 2007, the Council reorganised from two assessment teams that covered the whole of the authority to three locality-based assessment teams. The locality teams make effective use of eligibility criteria, with systems to assist prioritisation of case allocation and assessment. There was evidence of fluctuating numbers of unallocated children in need cases across the teams over the summer of 2008, up to 36 unallocated cases at one point, attributable to capacity and caseload issues: there were few unallocated children in need cases at the time of the Focused Review. A risk based approach to the review and management of unallocated cases is carried out on a daily basis, with team managers working hard to have no unallocated cases. There are clear protocols and arrangements in place for the transfer of cases from the three assessment teams to the seven locality child care teams involved in long term working with vulnerable children and their families, including those in need of protection and individuals who are looked after by the local authority. The timeliness and quality of initial and core assessments in all children s services teams has shown improvement since the last children s service review, although more consistent use of case summaries and appropriate chronologies is needed. The percentage of initial assessments carried out within 7 working days increased from 52% in 2006/7 to 62% in 2007/8, falling to 60% during April June The percentage of core assessments carried out within 35 working days rose slightly from 65% in 2006/7 to 66% in 2007/8, rising during April June 2008 to 74%. The average time to complete required initial and core assessments, where they are outside of the regulatory timescales, over the last two years rose by five days for each, up to 20 days and 58 days respectively. During 2007/8, the percentage of initial assessments where there was evidence that child was seen by the social worker was 51%, although the target was 75%. In only 6% of initial assessments was the child seen alone although the target was 25%. The Council needs to put in place more robust targets and quality 15

17 assurance measures for improving the timeliness of completing assessments and to ensure children are seen and their views, wishes and feelings are fully integrated into assessment and care planning. Only 48% of children in need who have been assessed and have a care plan in place have an allocated social worker. This is significantly below the performance of other Councils in Wales and should be reviewed. Thirty per cent of children in need cases are allocated to someone other than a social worker where the child is receiving a service in accordance with their assessment and care plan. All children in need plans were reviewed in 2007/8, chaired by a team manager or senior practitioner. The percentage of reviews of children in need plans carried out in accordance with statutory timescales was 100% during 2007/8. This has fallen to 58% in April June 2008 and the Council needs to put in place measures to address this downturn. All looked after children have an allocated social worker and care management and review arrangements are generally sound. The percentage of first placements for looked after children during the year that began with a care plan in place has shown consistent improvement in the last 5 years, rising from 95% in 2004/5 to 99% in 2007/8. Over the same period, the percentage of looked after children where there was a plan for permanence at their second review rose substantially from 36% in 2004/5 to 93% in 2007/8. The percentage of looked after children who had a Personal Education Plan within twenty days of entering care or joining a new school was 41% in 2007/8, down to 38% during April June This needs to be addressed and performance indicates that more effective joint working with schools is needed. Placement stability has improved as has the percentage of looked after children reviews held on time, up to 96% at the end of June The percentage of statutory visits to looked after children carried out within statutory timescales during 2007/08 rose slightly to 73% in 2007/8: this needs to be addressed in the coming year if the statutory target of 100% is to be 16

18 achieved. No looked after children were permanently excluded from school over the last eighteen months and the average number of days spent out of school by looked after children on fixed term exclusions fell from 10 days in 2006/7 to 6 days in 2007/8. The Children with Disabilities team, (CWD), takes on all assessment and care management arrangements involving disabled children, with access to the team based on strict eligibility criteria. In some instances, this leads to some tensions between child care teams and the CWD team as to the provision of care management of children in need cases that fall outside of CWD eligibility criteria, including children on the autistic spectrum. There are also disabled children who meet the CWD team eligibility criteria who receive services but do not have an allocated social worker. These two areas should be reviewed to ensure equity of access and effective service input to children and families. The occupational therapy service within the team presents a mixed picture. While there is an effective rapid response duty, the wait for the assessment for longer term provision can be six to nine months, causing frustration for parents and carers of disabled children. The Council needs to address this issue as part of its service improvement agenda for disabled children. The Caerphilly Local Safeguarding Children Board, LSCB, was established in April 2007, with a work programme designed to assist partner agencies in their role in keeping children safe and promoting their welfare. The LSCB has set up six sub groups to help achieve its objectives. Partner agency representatives on the Board are of an appropriately senior level and attend LSCB meetings on a regular basis. Dissemination of learning from serious case reviews for children has taken place with presentations to adult and children s service management teams, highlighting the need for a more integrated and holistic approach to safeguarding children between children and adult services. There is a well developed protocol setting out partner agency working on domestic abuse and child protection issues. A multi-agency One Stop Shop service for adults 17

19 and their children affected by domestic abuse is part of the safer Caerphilly Multi-Agency Centre (MAC) that was opened in February An additional post funded by children s services and placed within adult services has been developed to assess and provide support to parents who misuse substances where there are concerns for the safety of children. The impact of this post is yet to be evaluated. Caerphilly Local Safeguarding Children Board: examples of good practice 1. The Board has a remit to raise awareness about safeguarding issues with professionals, children, families and the wider community. As part of this the Board held a consultation event with children and young people about safety in the home, school, community and on the internet. The key issues identified by children informed the Board s business plan for 2008/9. A consultation event for professionals identified virtually the same concerns raised by children. 2. Development of a range of leaflets on safeguarding issues for children, parents and carers, members of the public and professionals, to be published in Autumn The Serious Case Review Sub Group undertook a review of a young person who had serious alcohol misuse problems and was at risk of sexual exploitation. The Review Sub Group worked with practitioners across a range of agencies that led to improved understanding of inter-agency work roles and responsibilities. 4. The Board recently established Practitioner Forums that allows practitioners from different agencies to come together to share information and best practice. There are joint working arrangements between children s and adult service teams in safeguarding and care planning work. This includes very recent reciprocal arrangements for attendance at Safeguarding Children s Board and Adult Area Protection Committee by managers in adult and children s services, the effectiveness of such arrangements needing review over the 18

20 coming year. Further attention regarding information sharing at a practice level between children s and adult services is needed. All children on the child protection register have an allocated social worker. The timeliness of initial and subsequent child protection conferences and reviews show steady improvement since the last children service review. The percentage of initial core group meetings held within 10 working days of the initial child protection conference was up from 52% in 2006/7 to 82% during April June 2008 and needs to be sustained to ensure the required target of 100% is achieved. There has been a falling off of attendance at strategy meetings, with more marked non-attendance at core group meetings by agency representatives identified as key core group members. This latter area was identified by service reviews in 2004 and 2006 as requiring improvement: this now needs urgent action by the Caerphilly Local Safeguarding Children s Board to improve safeguarding practice. Good practice: Implementation of the Public Law Outline There has been a significant improvement in the quality, availability and input of legal advice and support, particularly in respect of care planning and safeguarding arrangements. This is well evidenced following the introduction of the Public Law Outline on 1 April 2008, which the local authority is effectively integrating into its care management and planning for permanence arrangements. The timeliness and quality of assessment and analysis, care management and planning being taken forward within the Public Law Outline process were of a high standard and could be used as exemplars to inform best practice across children s services. While the Review team found some good examples of assessments and care plans on a number of children s case files examined the quality overall was variable and requires further improvement. Team managers sign off case recordings, assessments and care plans, although recordings of case discussions and decisions made during supervision was often minimal, making it difficult to track team manager input and their impact on care planning, decision making and required actions. This is a key area in terms of 19

21 quality assurance, particularly in respect of child protection work. Supervision needs to be more analytical and reflective, and at times challenging, to assist care managers to work more effectively, with such discussion being recorded and placed on file. Key themes from case file reading were: For children looked after by the Council, the quality of practice and care planning was variable, some care plans being rather basic although there were good examples of good quality Court care plans and Placement with Parent plans. The good working arrangements between specialist health, education and social work staff needs to be inclusive of schools in order to deliver improved educational attainment for looked after children. The LAC review system appeared to be working reasonably well. Child protection work was generally satisfactory with children deemed to be at potential risk being seen by the social worker with their parent/s and also on their own. Child protection plans were informed by the core assessment and formed the basis of care management and service input, although plans would benefit from greater clarity in terms of outcome measures, timescales and identifying which agency has responsibility for providing the key service input needed to secure safe parenting. This is a key role for Core Group members. Children in need work was predominantly allocated to and case managed by social care staff rather than a social worker. The quality of the work was generally sound though with variable quality and timeliness of care planning and review. Staff and managers in children s services welcome the forthcoming introduction of the Integrated Children s System ( ICS), seeing it as a way of reducing what a number of staff described as inappropriately time consuming and repetitive work that sees social workers spend nearly four times more work doing paper work than that spent working with children and families. 20

22 The impact of ICS will need to be monitored and evaluated by managers to assess its effectiveness. Social workers and other frontline staff also indicated that additional administrative support is needed. In adult services duty officers in ASDIT undertake an initial assessment of referrals: where there is an assessment of high risk, or where care arrangements and support are at risk of breaking down, the case is passed through to the appropriate adult service team for allocation. There are clear protocols and arrangements in place for case transfer to appropriate adult service teams. The percentage of referrals that triggered an assessment in 2007/8 was reported as 17%: while this is significantly lower than other Councils, the authority considers this to be the result of more effective screening by the ASDIT. A Joint First Access Team for individuals with mental health problems has recently been implemented. This provides information and or advice on services as well as initial and short term assessments for service users accessing mental health services for the first time. Individuals assessed as requiring longer term support and intervention are referred on to one of three Community Mental Health Teams. ASDIT has also worked effectively with the local health services including nurse care managers within the Joint Hospital Discharge Team. These arrangements have played a significant role in reducing the delays in hospital discharge for older people. 21

23 Exhibit 1: The rate of delayed transfers of care for social care reasons per 1,000 population aged 75 or over The rate of delayed transfer of care for social care reasons per 1,000 population aged 75 or over decreased from 15 in 2006/7 to 9 in 2007/8 (Exhibit 1), and for the period April June 2008 this fell further to 4 per 1,000. Working to maintain such improvement is a key priority for the Council and its health partners. All adult Assessment and Care Management teams are fully comprised of qualified social workers. The Unified Assessment process is used to undertake assessments of individuals and develop care plans in adult social care teams, although staff within the three integrated Community Mental Health Teams use the Care Programme Approach, (CPA), which ensures that service users with mental health problems receive individualised and structured support based on their assessed needs. Staff in the Joint Hospital Discharge Team use a summary Unified Assessment process to speed up the transfer to other forms of support. Social care staff conducting individual reviews of older people 2 weeks after 22

24 discharge have found this to be inadequate for effective care planning. The comprehensive Unified Assessment form is needed to fully asses and effectively plan for older service users. The Council and its health service partners should review and rationalise these assessment processes and others used across adult social care and health services. This would assist service users and carers in having a clearer understanding of what to expect from health and social care agencies and minimise repetition during assessment processes. Through their own case file audit the Council identified that improvement was needed in the quality and associated processes for care management and reviews. This includes taking a more robust approach to risk management and improving the consistency of quality assurance by team managers. The Council are now moving to an outcome based approach to assessment and care management in recognition that this is needed as a core part of the service modernisation agenda. The average number of days between initial enquiry and completion of a care plan fell from an average 22 days throughout 2007/8 to 7 days in April June Significant improvement has also been made in reducing the average number of working days from completion of the care plan to provision and/or installation of aids/equipment, falling from an average of 15 days in 2007/8 to 3 days in April June For the year 2007/8, the percentage of adult assessments completed on time dropped from 92% to 89% (a local performance indicator for the Council). Reviewers were told that this in part reflects an increase in the number of people requiring an assessment along with staff shortages affecting capacity to undertake and complete assessments. The consequence of this has resulted in a backlog of unallocated cases for assessment and waiting lists for services. For example in August 2008 there were: around 500 unallocated cases for assessments; and around 600 service users waiting for a range of different services. 23

25 The Council needs to address staff capacity issues in order to improve its performance in these areas. The percentage of service users with a care plan that should have been reviewed which were reviewed during a twelve month period during the years 2006/07 and 2007/08 was around 29%, although for the period April June 2008 this had increased to 33%. This is way below the expected target for all adult service users which is a minimum of one review and re-assessment every 12 months after the initial review. In order to tackle this, the Council has introduced a dedicated adult service review team and will need to review the impact of these new arrangements in improving performance. In considering assessment and care management arrangements during the course of the focused review, it was clear that good practice and learning which is shared across adult services drives up quality. Such practice is set out in the good practice box below, and the Review Team would recommend that the Council involve a cross section of front-line workers in this activity to improve practice and act as champions for development. 24

26 Good Practice Box: Assessment and Care Management Practice Development Group All team managers and senior social workers across adult services meet regularly to develop practice quality in assessment and care management and outcomes for the service user. They use the occupational standards for social workers as their benchmark. They seek to evidence good practice, through a variety of methods such as developing a practice supervision toolkit for managers, regularly auditing samples of files, offering specific skills training, and going out with social workers to observe practice. The group found that practitioners were not able to use the available written practice guidance effectively, and worked to develop a more user-friendly guidance. There is a particular focus on developing the skills of newly qualified social workers. As part of developing training for social workers, they work with health colleagues, who offer different skills and levels of expertise such as Community Psychiatric Nurses. The group are aware of inconsistencies between individual social workers and across teams, for example in risk evaluation and risk management, and want to move to outcome based assessment and care management processes. Adult protection services in Caerphilly were examined by SSIW in 2004 and found to need development. Since that time the Council has worked hard to develop and implement more robust working arrangements and structures within adult services and with its partner agencies. There is evidence of improvement of Protection of Vulnerable Adults (POVA) processes and care management across the range of adult services. The Assistant Director for Adult Services prioritised adult protection work early on in her tenure, in 2007 securing a service manager s post to focus on adult protection and improving service quality more generally. This post holder works alongside the service manager responsible for contracting and contract monitoring, and they have improved the networks between partners with safeguarding responsibilities. 25

27 The Adult Protection team in its current form was established in April 2008, building on the previous structure. The team structure is likely to evolve further in time, and the Assistant Director, Adult Services would like to create a multi-agency team with wider representation from other agencies. There is a multi agency Adult Protection practice improvement group which examines a range of topics, including practice issues that lie behind incidents of alleged abuse. A particularly pressing debate continues about thresholds, and the difference between poor practice in the care sector that can be remedied, for example, through training and closer supervision, and the abuse of vulnerable adults which is the result of wilful neglect or actual harm. The Adult Area Protection Committee (AAPC) in Caerphilly is chaired by the Assistant Director of Adult Services. Whilst this is multi agency, greater consistency in attendance of appropriately senior representatives from a number of key agencies, including the Police, Crown Prosecution Service and Health agencies, is needed to more effectively deliver adult safeguarding practice. A number of adult protection multi-agency investigations in Caerphilly have highlighted potential and actual gaps in the regional operational procedures that the AAPC is addressing. This is the body that will take forward Serious Case Reviews for the area, using the South East Wales Adult Protection procedures. These procedures have not previously been used in Caerphilly and it will be necessary to review their effectiveness in the light of experience and further national guidance. The Review Team looked at a number of case files for adults where individuals had a learning disability, a physical or sensory disability, or mental health problems, with some cases having adult protection concerns. Most individuals had additional difficulties that made assessment and care planning a skilled and complex process. Whilst the majority of cases were judged satisfactory a number of concerns need to be addressed, which include: The quality and timeliness of assessment and care planning was variable 26

28 The use of an Adult Service s risk assessment tool was inconsistent The quality of care management in PoVA cases was variable Assessments were often out of date, sometimes by two to three years, and reviews were needed to reflect major life changes and update care plans There were delays in providing services There were too many changes of care managers. There were however a number of good examples of assessment, care management and planning based upon sound of analysis of information, which, along with joint working, provided some effective outcome based services for individuals. A common theme were issues around the skills and abilities of staff in a range of settings and their ability to cope with and provide an effective and responsive service for individuals with complex and changing needs. The lack of an effective link between the care manager and the quality of service provision, particularly within the private sector, is an area for further consideration by the Council. PoVA case study: effective social work case management Mrs K had chronic mental health and physical difficulties. She did not have enough support from her family to deal with her problems. Social services became aware that some members of her family were making physical threats and exploiting her financially. She wanted very much to stay in her own home, so considerable efforts were made to put appropriate safeguards in place. When the risks stemming from this adult protection plan proved too great to manage, the social worker found Mrs K sheltered accommodation with constant support. The same social worker continues to work with Mrs K to help her come to terms with her sadness and confusion and to support the staff helping her, so they can provide the best care. This continued input and continuity is a very necessary part of helping Mrs K achieve a safe and best outcome. 27

29 Additional key themes from case file reading were: For adults with a physical or sensory disability, working partnerships with providers and relationships with health services, including services that involved continuing health care funding, did not appear to be particularly helpful on a practical day to day basis. The complexity of needs for individuals was such that a number of care packages could do more to promote independence and social inclusion. For older people, whilst there were a small number of examples of good practice that related to recent practice, more were judged as inadequate in terms of their effectiveness and sensitivity to service users needs and wishes. It was difficult to assess how involved case managers were in agreeing how the service would be delivered and service delivery plans are not generally placed on file. For adults with a learning disability, assessments had a clear service user perspective and use had been made of information from other agency staff and those within service settings. There was limited linkage between assessments and care plans along with delays in completing care plans following reviews. One PoVA case needed a more effective system for flagging up the cross over between children and adult services where safeguarding work is underway. In adult and children s services there are a sound range of training and development opportunities. More specialised training for experienced staff, along with more extensive joint training with partner agencies, is needed to consolidate experience and develop improved ways of working for staff and managers. Regular supervision is delivered for staff and managers and annual appraisals should be in place across social services by end of 2008/9. The staff survey showed that over 60% agree or strongly agreed that morale was good, although staff indicated to Inspectors that morale was at times negatively affected by sustained pressure by team and service managers for 28

30 compliance with performance indicators, sometimes to the detriment of quality. An example of this from a number of staff was where they were trying to complete assessments on time that they felt compromised the quality of that assessment. There are many skilled practitioners, social workers, team and service managers across children s and adult services. Over the last eighteen months there have been difficulties in recruiting and retaining staff in some fieldwork teams, with some particular hotspots in adult service teams and manager posts. While the Council has used agency staff and acting up arrangements to cover some vacancies, capacity issues overall are impacting a number of service users who are waiting for assessment and/ or services. In addition, recruitment and retention issues in frontline teams also impacts on the consistency and quality of assessment and care management practice. The Council needs to give priority to addressing these issues through more effective workforce planning and management. 29

31 2. 3 The Impact of the modernisation agenda in delivering better outcomes for service users There is effective leadership and a clear vision for improving services and delivering improved outcomes for service users. There has been sound project management of changes in the way in which domiciliary care services are provided and delivered. The Council is evaluating the impact of major changes on improving outcomes for service users, but needs to ensure that there is better communication and engagement with service users and staff as it takes forward its plans for further service modernisation. Strengths Clear sense of vision, direction and expectations from managers Good project management of change agenda Partnership working and commitment that assists service modernisation and improvement Communication newsletters Cultural shift to deliver outcome based services Planning for permanence for children Areas for improvement Improving the pace of change and improvement in some adult and children s services Ensuring the effective engagement of staff and service users in the change agenda Plans to modernise adult domiciliary care services were developed in response to three pressing issues: an anticipated major overspend in domiciliary care services; recognition that social services should actively promote the reablement and independence agenda; needing to respond to previous regulatory inspections which identified that a significant number of remedial actions were required to improve the quality of the service. 30

32 The Domiciliary Care Project Board set out its strategic intent in June An effective project management process was put in place to take forward the change agenda. There was support and commitment for the change programme from partner agencies, corporate directorates and elected members. Staff in domiciliary care services were kept informed about and engaged in the change agenda, with clear expectations of their roles and responsibilities set out by managers during the change process. Trade Union involvement was an integral part of implementing the change management agenda although there were difficulties in negotiation during the change process. Newsletters to staff and other stakeholders setting out the change agenda were part of keeping people informed of the changes. In July 2008 domiciliary care and reablement services in the Council combined to become the Home Assistance and Reablement Team (HART), with the stated aim of providing a community based service, designed to help people live in their own homes and maintain their independence for as long as possible. At the time of the focused review there was some evidence to suggest that the new service was resulting better outcomes for some individuals, but inevitably this was limited. The Council has in place monitoring and evaluation processes to assess the impact of change on outcomes and to inform future change management processes. The specialist assessment for people who require support at home for the first time is a new process and builds on the existing reablement service. It offers six weeks intensive support designed to maximise independence and selfcare skills, after which a decision is made whether further support is needed and which service provider is best to deliver it. Exceptions can be made where social work assessment indicates strongly from the outset the need for continuing support for people with longer-term needs. In these cases, the domiciliary care service may be provided without the 6 week period of reablement, either by in-house services where there are complex needs, but more likely by independent domiciliary care providers. 31

33 The developing brokerage system organises the specification and contracts based upon the personal plan of care. A Management Resource Group is in place to carry out a quality assurance role for assessments and resulting care plans. Any proposals to by-pass HART are monitored by this group, who may decide instead that reablement should be provided. This has resulted in some tension, so far unresolved, where some social workers feel their professional judgements have been undermined. Further work needs to be undertaken to address this conflict and ensure that service users get the most appropriate service to meet their needs. The domiciliary care changes have required significant restructuring of staff, with the intention of creating a more specialist in house service with better expertise and a wider range of support skills. This was to ensure that more divergent responses to needs could be created, including meeting the needs of younger people. All staff in the new Reablement service were given additional training and induction to their new roles and encouraged to undertake further NVQ training. The processes of creating service delivery plans have been amended, with office based Programme Arrangers creating the programmes for HART support staff to follow. To arrive at this, over 800 existing service users had their needs reassessed by the adult services review team. At the start of implementing the domiciliary care service changes the Council put in place special arrangements to deal with concerns and complaints made by service users and carers, although this sat out side of the Council s complaints and representation arrangements. While most of the 26 cases where concerns were raised were dealt with satisfactorily, the fact that these were not considered within the complaints process caused further concern for a number of families. Whilst the special arrangements put in place to deal with the changes in the Domiciliary Care Strategy were wide ranging, the Council should re-think the merits of not using its own complaints process at times of major service change. The implementation of service change also limited choice for a number of service users and throughout the process no 32

34 independent advocacy was offered to service users and their families; the Council could consider the merits of doing so in the future. Some of the concerns identified related to individuals with complex needs who were unhappy about moving from in-house home care to external provision. These concerns were about the quality of service delivered by the new provider, and there were also concerns about liaison between social care services and the provider. These concerns were also identified through the regulatory inspection of the Council s domiciliary service which is the subject of a separate report. The Council needs to ensure that it has robust arrangements in place to ensure the quality of services delivered by all its providers of domiciliary care. There are a number of lessons that can be learned from staff and service users in implementing major changes. Key elements which can be integrated into future project management processes include: An effective communication strategy that fully informs, engages and involves key stakeholders Sharing the evaluation of the change process, including celebrating good news stories, with all stakeholders Better engagement with private sector providers Better engagement and involvement with staff and their Trade Unions in the change process and the impact and opportunities of change for staff Engaging and informing elected members about service changes across adult and children s services, including cost/benefit analysis, and how change promotes independence and social inclusion. Elected members as Change Champions could be core facilitators for the change agenda. Notwithstanding the above, a number of staff say they have been energised by the service changes: they have gained greater job satisfaction, feeling such changes should have happened earlier. 33

35 As this was a Focused Review of Social Services there were areas that the Review Team did not consider in detail. These included services for adults with mental health problems, physical disabilities and sensory impairment and for those with a learning disability. However, these services have been identified by the Council as being in need of improvement and modernisation, and will be informed, in part, by the evaluation and lessons learned from the modernisation of domiciliary care services. The pace of change for these services needs to step up a gear in order to deliver service improvement. Two independent reports from the Wales Audit Office, WAO, (2005) and a research team commissioned in 2007 by the Council highlighted the need for significant improvement to services for people with mental health problems. Taken together, these reports indicate that there is still a lot to do to provide effective mental health services. Concerted, timely and coordinated action is needed by the Council and health services to ensure people with mental health problems get an effective service that reflects national policy and fully address local needs. An independent review of learning disability services commissioned by the Council in 2007 also identified some key areas for improvement. Currently social care services, when assessing adults with learning disabilities, use the Unified Assessment eligibility criteria of need and potential risks to independence, whereas healthcare services continue to restrict their services based on IQ levels as well as function. This significantly impacts on the ability to provide effective integrated services for people with learning disabilities and is a matter that needs to be addressed with some urgency by the Council and its health service partners within the context of service modernisation. In children s services there has been ongoing modernisation and improvement in fostering and adoption services following the children s service reviews of 2004 and There are effective management 34

36 arrangements in place to ensure that all requests for children to become looked after by the Council are fully considered. This is undertaken through the Placement Panel, recently expanded to include senior health and education staff to ensure agreed holistic and timely multi-agency decision making takes place to address how to best to meet a child s needs. There are now two teams within the fostering service, one team covering recruitment and assessment of new foster carers with the other team providing support and review arrangements. Recruitment arrangements for new foster carers, including training and assessments of potential foster carers, have improved. The Council has made great efforts to retain approved foster carers in the face of considerable pressure from independent agencies, reflecting good work by managers and practitioners. There has been a gradual improvement in placement choice via local authority foster carers, with an emphasis on trying to achieve placements that minimise a change of school and or disruption of children s links to their local community and friendships wherever this is possible and appropriate. An area for further development is to develop a fuller range of placement choice for a number of hard to place children, including teenagers and those with behavioural management difficulties. Support to foster carers is of a good quality and review arrangements are now timelier. Foster carers express commitment to supporting Caerphilly children and see working with the Council as worthwhile. There is a dedicated out of hours service for foster carers who generally reported that they are well supported by the fostering service, are listened to and generally appreciated and valued by the Council. One key message from foster carers was that they need better information and contact from locality team social workers. Measures need to be put in place to improve educational attainment for looked after children. Regulatory inspections of the Council s fostering service took place in early 2008 and at the time of this focused review. The findings were that the service is improving and meeting its regulatory requirements. An area for improvement identified in the CSSIW Regulatory 35

37 report of April 2008, and now being addressed by the Council, is the quality and timeliness of foster carer reviews going to the Fostering Panel. In addition, information for children becoming looked after by the Council for the first time is inadequate: this needs to be addressed, and could usefully include young people currently looked after by the Council. Family members applying to be kinship carers indicated to inspectors that they needed more regular contact from locality team social workers during the early weeks of placement. The Council is a member of local consortia arrangements that look to ensure best placement choice and value for money where out of County foster care and residential placements are needed. Children s services staff work hard to ensure children and young people in such placements are effectively supported and their placements robustly reviewed to ensure they continue to meet the needs of individuals. The adoption service is improving, implementing service changes following the introduction of the Adoption and Children Act There are sound processes and service arrangements in place, including post adoption support services. The Council is sensitively reviewing a small number of placement breakdowns to identify and implement areas of service improvement, covering assessments, linking and matching arrangements and possible support service needs of children and their adoptive family. The Council have established a multi agency project board to develop an integrated service for disabled children. However, reviewers were told that plans to modernise services for disabled children have stalled. These plans were intended to build on a number of existing services across the authority including some effective joint services. At the time of the focused review there was a consultation with parents of disabled children to seek their views on a new service, although this was a year after the decision was made to develop the new service. Action is now needed urgently to take forward service improvement some of which was identified as far back as

38 2.4 Promoting independence including transition planning The Council has made progress in providing a range of services that support people in their homes, promote their independence, improve their life chances and enable them to remain active in their local community. Further work needs to be done to develop improved transition service arrangements for young people, as well as providing greater education, training and employment opportunities for care leavers and more effectively promote Direct Payments. Strengths Partnership working that promotes independence and social inclusion Range of adult and children s services Commitment to improve transition planning and service arrangements for young people Areas for improvement Further developing and improving transition arrangements Developing more education, training and employment opportunities for care leavers Actively promoting the use of Direct Payments The framework for children s service provision, including sound partnership arrangements, has been based upon a strategic approach to planning for permanence for children in need and those assessed as being vulnerable and/ or at risk of possible harm. There are a range of services in place which are becoming increasingly effective in delivering this agenda. The Council has one children s home. The most recent CSSIW regulatory inspection shows it is well run and managed with staff working sensitively with young people and associated agencies, especially the Police and the local community. The manager of the children s home was recently put forward for a national award in recognition of the quality of his work and that of his staff over a number of years. 37

39 The leaving care service is working hard to ensure young people leaving the care of the local authority have appropriate support and guidance that will assist them achieve independence and inclusion within the community. There was however a mixed perception of the effectiveness of arrangements between different parts of children s services and the housing department in respect of suitable accommodation for homeless and or vulnerable young people. A review of arrangements by the two departments would assist consistency of best practice. In 2006/7 the leaving care team was in contact with 83% of young people aged 19 who were formerly looked after by the Council. This rose to 95% in 2007/8. For the same care leavers, 83% were in suitable, non-emergency housing in 2006/7, although this fell to 79% in 2007/8. Exhibit 2: The percentage of young people formerly looked after with whom the authority is in contact, who are known to be engaged in education, training or employment at the age of 19 The numbers of care leavers in suitable education, training and employment, was only 21% in 2007/8, falling from 33% in 2006/7. This is unacceptable and measures are needed to urgently address this performance. These should include developing a corporate approach to providing an effective range of opportunities within the Council as part of its corporate parent role. The judgement by Lord Munby found that the Council was not compliant with regulation regarding the provision and independence of personal advisors. This has now been remedied with all eligible care leavers having an independent personal advisor. 38

40 Advocacy and Children s Rights services provide support to vulnerable children and young people who use Council services. This includes support for looked after children in statutory reviews, assisting the individual to ensure their needs, wishes and feelings remain central to care planning arrangements. The IRO s bring a similarly child focused culture to the review process. The quality assurance role of IRO s in the review process needs to become more robust to further improve review and care management arrangements. Transition service arrangements between children s and adult services are informed by a transfer protocol. The lead role for initial transition planning arrangements is taken by schools, commencing when the young person reaches 14 years of age. Active involvement in the transition planning process by children s services does not generally commence until the young person becomes 17 years of age. For young people with a diagnosed physical and or learning disability, the above transition arrangements may work well, especially if they are in a Caerphilly Council special school. For those in schools out of the county, it is far more hit and miss as to whether arrangements are planned and provided in a systematic and timely way. The experience of schools and colleges, staff in children s and adult services, parents, carers and young people tells a very mixed and at times unacceptable story. For young people with complex needs, where they may have emotional, behavioural or mental health difficulties, transition service planning and or access to appropriate adult services present even greater challenges. Reviewers were told by a number of social services staff and those from partner agencies that the Transition protocol is not working consistently or effectively to provide a bridge from children to adult services. Senior managers from social services and partner agencies described the scale of improvement for transition services as one of business transformation. This will require a local, pan Gwent and all Wales approach in order to deliver effective and appropriately resourced transition arrangements. Urgent action to take forward the transition change agenda is now needed by 39

41 the Council and its partner agencies. Disabled young people and their families will need to play a central part in the planning arrangements to deliver core service improvements. Key themes on transition practice arrangements The case file analysis and visits to families identified the following common issues for people experiencing transition: Lack of consistency and timeliness of care management involvement, including too many changes of social workers from the Children with Disabilities team and or adult services. This caused real frustration for individuals and families in that they grew tired of repeating their story. Where care management from adult services were established, the quality of input and relationships were of a good quality. Concern at the paucity of positive choices for disabled young people with complex needs. Uncertainty about the arrangements for administering essential medication. Uncertainty about the level of service input in moving from children s to adult services, particularly where a reduction in the level and or quality of provision is indicated. At a practical level, attention needs to be given to the core and unified assessment processes at the time of transition. The core assessments for children and young people undertaken by the CWD team were seen by adult service staff as being too focused on medical diagnosis rather than providing a holistic assessment of needs. The core assessments on disabled children seen by inspectors during the focused review, and on previous inspections, reflected a similar style. Adult unified assessments have a clear focus on how best to promote the independence and social inclusion of individuals within their community. This represents a different culture and ethos between the two approaches that is in need of review and rationalisation. 40

42 Where transition plans were developed, these were led by social workers from adult services with input from the CWD team, and the quality was generally sound. However it was clear that the more complex the needs, the less positive choices there were for individuals. Current practice in transferring cases from children s to adult services is that care management input from adult services is based on availability of a social worker, not necessarily one from a team that would ordinarily be seen as the most appropriate team to work with the individual. This was reported by staff and managers as being a pragmatic response to the capacity issues in adult services. On-going Continuing Health Care funding arrangements present real difficulties when looking to provide continuity of service provision into adulthood. This is further complicated by having a single Gwent-wide continuing health care fund managed by Torfaen LHB on behalf of five Councils and their associated LHB s. This has resulted in a perceived inconsistency of funding across neighbouring authorities and measures are needed to develop an effective regional approach to the joint commissioning of services for children and young adults with complex needs. At the same time, significant improvement is needed in the timeliness of funding decisions in respect of supporting residential costs at colleges for young people with disabilities. Adult services have a clear vision of providing services that promote independence and social inclusion as demonstrated in the modernisation of domiciliary services. The focused review did not set out to comprehensively consider the range of adult services that are currently assisting adults to live in their communities. However, the review did identify that many adult service users are receiving services that have made a difference in enabling them to remain in their own homes and communities. 41

43 Exhibit 3: The rate of older people (aged 65 or over) helped to live at home per 1,000 population As indicated in Exhibit 3, the rate of older people (aged 65 or over) helped to live at home per 1,000 population in 2005/6 was 145, rising to 160 in 2007/8. For adults aged over, the percentage of service users supported to live in the community in 2005/6 was 95%, rising to 97% in 2007/8. Exhibit 4: The rate per 1,000 adult clients assessed during the year who are provided with assistive technology as part of a package of care The rate per 1,000 adult service users who were provided with assistive technology as part of a package of care was, 154 in 2006/07, rising to 161 in 42