Inequality in service provision and standards persist across Wales, according to a report by the Care and Social Services Inspectorate in Wales.
In its annual report, which looked at services for children and adults, the inspectorate said there were rising standards across the sector but that a gap between the best and worst services remained stark.
It said that safeguarding of children had been strengthened in the wake of the review following the death of Peter Connelly but that once into the system children received variable service.
It said adult protection had also improved with the number of cases where risk was removed or had been reduced rising from 45% to 56%.
However, there was a significant gap in the regularity of reviews of adult care plans with some authorities reviewing only 33% of care plans last year and others reviewing 84%.
The report was also critical of the serious case review process saying they were a costly exercise which offered “little clear evidence to show how they are leading to improvements in systems and practice to safeguard and protect children”.
The inspectorate warned that work that has led to incremental improvement following heavy investment in services would no longer succeed, as council budgets tightened. It said a “whole-systems approach” was required to drive improvements with commissioners, directors and service providers working together.
Opposition parties want to see cash
Liberal Democrat health spokesperson for Wales, Peter Black, welcomed the report’s conclusions but questioned how improvement would be paid for in the future. “Continuous improvement costs money even with partnership working, money that is not going to be forthcoming in the near future from the Welsh Assembly Government,” he said.
“Achieving high quality care services within a difficult budgetary setting will require radical restructuring of services and strong political leadership at all levels of government,” he added.
Conservative health spokesperson for Wales Andrew Davies said: “What we need is improved co-ordination of services and the better planning for patients.”
Care home staff
Concerns were raised about care home staff. A quarter of reports by inspectors over the past year showed staff lacked the appropriate competencies for their role and nearly 30% of all reports also raised a lack of regular staff supervision.
Nearly a third of reports by inspectors had requirements for homes needing to improve practice in monitoring medication.
However complaints about care homes were slightly lower than last year and there was improvement in a number of key areas such as cleanliness and service user involvement.
The variation in service provision was found to centre around services outside of child protection procedures such as care planning, assessment and early intervention. It attributed this to a rise in the level of demand and insufficient capacity to allow social workers to carry out effective work.
It found that local safeguarding children boards had not expanded to incorporate adult safeguarding as well and some had yet to work with all the agencies involved. In addition many frontline workers were unaware of them or their role in co-ordinating safeguarding responses for children.
Foster care was of particular concern with fostering services showing inconsistency in implementing child safeguards. Privately fostered children were said to be “almost invisible” to public authorities and rarely received comprehensive assessments when they were.
Service users said the initial contact with children’s services had improved with good information about entitlements, but there were problems with continuity with 61% of children having known their social worker for less than one year.