Contact: Yvonne Le Brun Ext: 7790 or Peter Knight Ext: 7144

1. Introduction

1.1 Care management is the process through which people access and receive community care services from their Social Services department. Within Hampshire this is currently provided primarily through the Social Services Department. The key elements of this process are:

· providing information about the services and how to access them

· determining who is eligible for services and signposting to other agencies as appropriate

· assessing the needs of vulnerable people and their carers

· determining which services could meet the assessed needs

· arranging for the services to be delivered

· monitoring the delivery of care

· reviewing at specified intervals whether the care is appropriate and still needed

1.2 There is a legal requirement for the local authority to undertake an assessment of need for anyone whom they consider might be eligible for their services. Reference to this and descriptions of entitlement and services offered are enshrined in the following Acts:

· National Assistance Act (1948)

· Chronically Sick and Disabled Person's Act (1970)

· Disabled Person's Act 1986

· The NHS and Community Care Act (1990)

· The Carer's Act (1996)

· The Human Right's Act (1999)

· The Carer's Act Amendment (2001)

1.3 The care management process is defined by "Care Management: a practitioner's guide" and "Care Management: a manager's guide" (HMSO, 1993) and eligibility for assessment and services are covered by case law (e.g. Barry v. Gloucestershire County Council, Penfold v. Avon County Council) and Department of Health notes of guidance (e.g. "Fair Access to Care").

2. Strategic objectives

2.1 The aim of the department is:

"to work with the people of Hampshire to ensure that their assessed social care needs are met with high quality, cost effective services, within available resources. In doing this we want to offer users and carers the greatest possible choice and to preserve their dignity, safety and independence".

New Directions - Departmental Plan 1999-2004

2.2 The department has prioritised six overarching objectives to meet this aim and provide a focus for our work. Our success in delivering on these objectives are measured within a range of government performance indicators, the most important of which are within the Performance Assessment Framework (PAF) and Referrals Assessments and Packages of Care (RAP). Both of these are national reports against specified criteria which are evaluated by the Department of Health .

The stated objectives of the Department which inform the operation of care management, and a description of the performance indicators designed to measure our success against these, are attached as Appendix 1.

3. Aim of the review

3.1 The aim of the review is to:

(i) Evaluate the efficiency and effectiveness of the care management service within Hampshire.

(ii) Provide costed options to improve these services from the perspective of users, carers and partner agencies. Based on consultation activities with stakeholders, the most important area for improvement is about quicker and easier access to care management services.

(iii) Identify 5% efficiency savings in the way that these services operate

3.2 Initially it was anticipated that the Out of Hours service would be

encompassed within this review, but this has not been possible. The prime reason for this is the volume and breadth of activity associated with the main review. Therefore it is proposed that the Out of Hours service be part of a subsequent full Best Value review.

3.2.1 At the scoping stage of the review, areas for improvement in care management were identified and prioritised. Three key themes emerged

· The best use of care management time against increasing demand for services from the public, and performance levels that were failing to meet both internal and external targets.

· The challenges of recruitment, retention and morale amongst care managers are impacting negatively on several fronts.

· Maximising the effectiveness of our partnerships.

These themes formed the focus for the review.

4. Consultation

4.1 Before undertaking new consultation activity in support of this review, it was felt to be important to analyse previous activities with stakeholders and the messages arising from these. These included:

(i) Performance Assessment Framework (PAF) questionnaire to 700 users and carers who had recently had an assessment of their needs (2001).

(ii) MORI poll of staff working for Hampshire County Council (1999)

(iii) Care Management Conferences (2001) .

4.2 Additional consultation, in support of this review was used in order to clarify some of the issues raised through previous consultation and to develop an action plan of proposals. The following consultation exercises were undertaken:

(i) Consumer Audit: 40 in depth interviews have been conducted by this independent organisation with users and carers to elicit their experiences of care management

(ii) Internal stakeholder focus group: composed of 14 team and care managers

(iii) External stakeholder focus group: 18 representatives from external partner agencies, including Consultants, General Practitioners, Community Nurses, District Nurses, Hampshire Care Association and 2 representatives from a local user group.

(iv) Electronic questionnaire to all team and care managers

5. Comparison

5.1 Comparison has been made both internally and externally. Examples of external comparison include:

(i) Other local authorities. We are particularly grateful to officers from Portsmouth Unitary Authority, Brighton and Hove Unitary Authority, Torbay Unitary Authority and Kent County Council who have all undertaken recent reviews of their care management arrangements. They gave freely of their time for face to face meetings and in sharing the results of their local research. We have also been able to compare the relative effectiveness of the operation of care management in different authorities through national PAF data.

(ii) Evaluative work by the Centre for Evidence Based Social Services "Partnerships in Practice" project. This has compared the interfaces between primary care and Social Services within local authorities in the south of England.

(iii) Other local public sector services, notably the transformation team at Southampton General Hospital (specialists in patient care pathways) and the Defence Evaluation and Research Agency.

(iv) Literature review of existing local , national and international research evaluating differing care management arrangements.

5.2 Examples of internal comparison include:

(i) Collation and interrogation of both qualitative and quantitative data broken down by area within Hampshire. As local care management arrangements have been refined and streamlined, we were aware that distinct models of client pathway into assessment and services were operating across the County. Therefore we were keen to establish whether there were tangible benefits from individual arrangements and that users and carers could be assured of a consistent service regardless of where they make contact with Social Services. This has required the breaking down of departmental performance data into the discreet geographical areas and comparing the subjective experience of users and carers from different areas. The subjects for comparison were matched sets of users and carers from 2 areas that operate innovative care pathways with Primary Care (Basingstoke and Winchester) against a control group (Alton and Aldershot).

(ii) Comparison of the numbers of care managers employed who hold relevant professional qualifications and have completed their care management competencies, by client group and location.

(iii) Comparing the numbers of care managers available per head of population, age band and area. (Appendix 2)

6. Challenge

Challenge to the service itself and to the improvement options arising from the review were afforded through the following activities.

6.1 (i) Options workshop - external stakeholders

(ii) 2 Options workshops - internal stakeholders, 60 delegates at these 2 events

(iv) 2 working groups of team and care managers examining emerging proposals in detail and applying them to real case studies

6.2 In addition, regular liaison with District Audit has provided an additional element of challenge, both in terms of the scrutiny of performance data and in the conclusions drawn from this.

Questions repeatedly posed against the range of specific activities involved in the care management process have been:

"What are care managers best trained to do?" "What activities need to be done by the care manager?"

"Is there anyone else who could do it better?"

6.3 In answering some of these questions we are also grateful to senior lecturing staff from both the University of Southampton and Southampton Institute social work departments.

7. Compete

7.1 Legislation does not demand that assessments be carried out either by people who are qualified social workers or by people with a care management role only. Indeed, in the spirit of collaborative working, documents such as the National Service Framework for Older People (2001) encourages a single assessment process that encompasses both the health and social care needs of individuals and explores opportunities for partnership working as opposed to competition.

8. Basic facts and figures

8.1 In May to July 2001 a total of 424 care managers (373 full time equivalent) were identified across the Department plus 15 unfilled vacancies (12 full time equivalent posts), a 3.2% vacancy rate. This equates to 14,245 hours per week of care management time available to the Department when fully staffed. In July 2001 13,801 hours per week of care management time was actually available. However concerns have been raised about the validity of this information owing to the methodology used (manual head count), which may have under reported vacancy rates. Therefore a more sophisticated electronic staffing profile system is being developed to generate more accurate information on a regular basis.

8.1.1 Available care management time is also determined by the frequency and duration of personnel being unavailable for work through sick leave. However, in large part due to data definitional issues, it has not been possible to arrive at a meaningful quantification of the amount of time lost at this level of the organisation as a results of staff being on sick leave. This issue is being addressed through the development and implementation of a new personnel recording system (SAP).

8.1.2 Nationally it is of note that Local Authorities have felt the need to expand the care management workforce by 150% in the period 1987 to 1997 (from 22,000 to 33,000), at the same time as the Community Care reforms were fully implemented. By contrast the social work compliment in children's services remained static over this period.

8.1.3 The distribution of care managers across the County does not mirror the demography of Hampshire. Thus we see substantial variations in the numbers of full time equivalent care managers to the overall population in given areas across Hampshire. See Appendix 2 for further details.

8.2 A time analysis undertaken by a representative group of 41 care managers indicates that their available time is absorbed by the following activities:

Task	Time Spent
Computer imputing Direct contact with users/carers All communication with other staff All other communication (not face to face) with users and carers Other administrative tasks Travel Advice/information/screening Meetings not about clients Direct client contact about finance issues Supervision Training	27.5% 13% 13% 10% 8% 7% 6% 5% 4% 6% 1%

Training in core care management subjects delivered during the 12 month period 1/10/00 - 31/9/01 by Hampshire Training Solutions was:-

· Departmental Induction - 1 day 21 people

· ACMS basic overview - 1 day 72 people

· ACMS a working knowledge - 2 day 63 people

· Introduction to care management - 3 day 33 people

· Assessment Skills - 2 day 38 people

· Planning & Implementation - 2 day 25 people

· Monitoring & Reviewing - 1 day 31 people

This equates to 2094 hours of training (283 days) for the care management workforce over a 1 year period, an average of 0.76 days of training per full time equivalent care manager per year. However it should be emphasized that the above list details only training in the basic core business of care management. Other training opportunities are available to more experienced practitioners.

8.3 In determining the skills base of the workforce, 2 parameters have been used:

· do care managers hold a relevant professional qualification. The most widely held and recognised professional qualifications are the Diploma In Social Work and the Certificate of Qualification in Social Work. These require 2 or 3 years of full time study at higher education level,

for which a separate academic award is awarded. This latter award will be a Masters of Science, Bachelor of Science or Diploma in Higher Education depending on the nature of the institution providing the course.

· have they been formally assessed as demonstrating competency in the practice of care management.


The current profile of the workforce is as follows:

Has been awarded Hampshire's certificate of competency in care management

Professional qualification

8.4 Analysis of the staff profile by client group indicates that, proportionately, there is greater use of unqualified care managers in services for older people.

The breakdown is as follows:

· Care managers (older people) 44% do not hold a relevant qualification

· Care managers (learning disability) 33% do not hold a relevant qualification

· Care managers (physical disability) 21% do not hold a relevant qualification

This information is also expressed as a graph in Appendix 3

9. Activity data (RAP)

9.1 Between 1/4/00 and 31/3/01:

· 14,700 people had their needs dealt with at the initial point of contact -62% of whom (9,185 ) had referred themselves

· 26,503 screened contacts from clients led to assessment or commissioning of ongoing services. Of these 30% were referred from secondary health (8,068), 18% from primary health (4,857), 17% from family/friend/neighbour (4,491), 12% referred themselves (3,298), 12% from Local Authority departments (3,289) and 9% from other sources (2,500).

· 8,482 scheduled client reviews occurred

· 52.4% of clients with new care plans were given or offered a copy of their care plan

· 588 separate carer assessments were carried out and 8,881 assessments were completed jointly with the carer

· 8,713 adults received services during this period, of which 8,085 (93%) were community based services

· 22,724 older people received services during this period, of which 18,534 (82%) were community based services

10. Financial Matters

10.1 Full details of care management expenditure and income against residential, day and domicillary care have been provided by the Financial Services Unit.

10.2 These are included within Appendix 4 and are supplemented by an analysis of expenditure by client group and service type.

11. Key performance results against PIs

11.1 See Appendix 5 for details of Hampshire performance against PAF indicators in 2000/1 in relation to Hampshire's official comparator Local Authorities. RAP returns give the strongest evidence that the current care management service is failing to meet some of it's own standards. For example:

· 35% of all assessments took longer than 6 weeks to complete (departmental standard is 4 weeks)

· 17,920 scheduled client reviews were not carried out last financial year.

11.2 A degree of caution needs to be applied when interpreting PAF returns, inasmuch as differing Authorities have employed different counting processes to generate their returns and some services are not counted.

Thus our apparently poor performance against C29 (proportion of adults with physical disabilities helped to live at home), C30 (adults with learning disabilities helped to live at home) and C32 (older people helped to live at home) is partly attributable to the following factor:

· having developed strong links with the independent sector and Health, many services (e.g. Meals on Wheels) are not directly provided by Hampshire County Council. Thus activity data from these lower level community support services is either not recorded or under reported. Other Authorities that have retained such services in house will be counting them in this return and consequently have higher ratings.

11.3 With that caveat in place, the positive messages from this comparison are;

· C26 Admissions of supported residents aged 65 or over to residential/nursing care. In Hampshire 86.41 older people per 10,000 are supported to enter residential and nursing care. Although our performance in this area is towards the bottom of comparator Authorities, nationally we are seen as having the correct admission rates. Department of Health evaluation - 5 blobs "very good"

· C27 Admission of supported residents aged 18-64 to residential/nursing care. In Hampshire 2.67 people aged 18-65 are admitted to residential and nursing care per 10,000 of the population. This places us in the mid point of comparator Authorities, but in the highest bracket nationally. Department of Health evaluation - 5 blobs "very good"

· E50 Percentage of full assessments that lead to a service being provided. In Hampshire 81.18% of assessments lead to a service being provided, significantly higher than most other comparator Authorities. From this it can be inferred that Hampshire's care managers are applying the eligibility criteria for assessment effectively and screening out people who it is unlikely we will provide a service for. This can also be seen as an effective use of care management time and client expectation is not raised inappropriately. No national blob rating has been produced by the Department of Health for this indicator.

· D42 Carer's assessments. 47.23% of informal carers had their needs assessed either separately or jointly with the client. This area of performance is more than twice as good as 8 of our comparator Authorities and demonstrates that the views of carers are listened to and recorded. Department of Health evaluation - 4 blobs "good" E49 Proportion of assessments of people from minority ethnic groups. In Hampshire 1.19% of people receiving an assessment of their needs are from a minority ethnic background. Given the ethnic composition of Hampshire this represents a slightly higher (0.2%) proportion of people from ethnic minorities receiving an assessment. Thus we can say that people from ethnic minorities are not discriminated against in terms of having their needs assessed.

· E48 Ethnicity of adults and older people receiving a service. In Hampshire 1.09% of the people receiving a service following an assessment were from an ethnic minority. This also reflects very accurately the ethnic balance in the County. Department of Health evaluation - 4 blobs "good"

11.4 Bearing in mind the caveat that Authorities have been counting their returns in differing ways and we have not been able to include some services we provide, the less positive messages are:

· C32 Older people helped to live at home. Hampshire has recorded supporting 36.62 people aged over 65 to live in the community per 1,000 people aged over 65. This score is significantly worse than any other comparator Authority and is the lowest score of any Authority nationally. Department of Health evaluation - 1 blob "investigate urgently". In response to this a working group has been established to ensure that the recording of support given to older people in the community is improved.

· C29 Adults with physical disabilities helped to live at home. In Hampshire 1.58 people with a physical disability are helped to live at home per 1,000 population 18-64. This score puts us in the lowest band nationally and performing worse than the majority of the comparator Authorities. Department of Health evaluation - 1 star "investigate urgently"

· D39 Percentage of people receiving a statement of their needs and how they will be met. In Hampshire 52.3% of people received a statement of their needs and how they would be met. This score is lower than any other Authority in our comparator group and in the lowest band nationally. Department of Health evaluation - 1 blob "investigate urgently"

· RAP A6 Length of time for client from first contact to the assessment being completed. In 34% of cases relating to older people the assessment took more than 6 weeks to complete; for adults, it took more than 6 weeks in 35% of cases. Thus over a third of assessments are being completed outside Departmental timescales.

11.5 An additional level of caution needs to be applied in interpreting current PAF results against previous returns. The reasons for this are twofold. Firstly, the way in which the Department of Health has required counting to be performed has changed over time, affecting the returns. Secondly, the number of PAF indicators has grown by 150% over 3 years meaning that aggregated PAF scores with the higher new number will be different from previous data. With these caveats in mind, trend data from PAF returns appear to show a decline in the quality of the service given to the vulnerable people of Hampshire over the past 3 years. Appendix 6 gives further details.

12. Major challenges to addressing performance

12.1 Provider market

12.1.1 Nationally the amount of residential and community based resources available for care managers to purchase has been declining over the past 2 years. In Hampshire , since the 1^st of April 2001, 227 of the available residential care beds in the independent sector have been lost (4.3% reduction). In the same period 103 nursing home beds have been lost (2.9% reduction). There is evidence that the rate of both residential and nursing home beds being lost is worsening over time as shown by the following trend data.

· 1998/99 62 residential and nursing home beds lost

· 1999/2000 277 residential and nursing home beds lost

· 2000/2001 310 residential and nursing home beds lost

· 01/4/01 - 12/01 306 residential and nursing home beds lost

(NB these figures represent net loss of resources, offset by new homes opening)

12.1.2 In domicillary care a similar picture of over demand and under supply exists.

Whilst the total number of accredited providers has remained relatively stable, this is not an accurate reflection of the capacity of the market, as the volume of care offered by different providers may be very different. It is of note that over the past year 3 agencies that had won block contracts to supply domicillary care had to hand the contracts back, finding they were unable to recruit sufficient domicillary carers to cover the terms of the contract.

12.1.3 The effect of this is that:

· care managers must devote proportionally more time to searching for scarce resources

· non residential care packages can become more fragile, as agencies have less capacity to cover staff absence

· non residential care packages also become more fragile as more than one care agency can be involved in providing the care, hampering oversight of the whole situation

· client choice is reduced as there are fewer resources available. In some cases this can lead to residential placements being made further from the client's family and friends than would be wanted

· the process of searching for care services means that care management time is absorbed, leading to assessments taking longer to complete and care is provided more slowly

· discharges may be delayed through difficulties in finding resources

12.1.4 Discussions with comparator Authorities indicate that whilst this shortfall in care resources are a national problem, it is especially acute in Authorities in the south of England. Reasons given for this include:

· low wages associated with direct care work at a time of high employment

· higher property prices in the south making relatively low paid care work less attractive to potential employees

· higher land value in southern England prompting the sale of some large residential homes

12.2 Recruiting and retaining care managers

12.2.1 In 2000, the Local Government Management Board identified that 63% of Local Authorities experienced difficulties in filling social work vacancies. In Hampshire an analysis of vacancy patterns by the Personnel unit indicate that recruiting care managers in the north of the County is particularly problematic. This is ascribed, amongst other things, to the high cost of housing in such areas as Aldershot and Basingstoke and competition in the labour market.

12.3 Referral rates

Over the past 2 years referral rates have remained relatively stable across all client groups. Over this period the average monthly referral rate is:

12.3.2 National trend data shows that the pattern of service allocation has changed over the past 8 years, as more people with greater vulnerability are supported in their own homes. Thus whilst the referral rate has remained stable, the complexity, size and cost of care packages has risen, as has the potential risk to the client if care arrangements fail.

12.3.3 This phenomenon is most clearly evidenced in a recent Social Services Inspectorate report where it was reported that:

"Average contact hours (for domicillary care) per household rose from just over 3 hours per household in 1992 to almost 5.6 hours per household in 1997, and the proportion of households receiving more than 5 hours service a week increased from 14% in 1992 to an estimated 32% in 1997" "Social Services Facing the Future", Appendix A, section 30.

13. Options emerging from work to date

13.1 Detailed analysis of the issues and challenges facing care management, (above) gave rise to specific proposals for addressing these.

13.2 All of these proposals were subjected to scrutiny by both internal and external stakeholders via formal consultation and challenge events, through which they received validation.

13.3 The proposals detailed in Table 1 and 2 involve streamlining the care management process, so were subject to additional testing. Principally this consisted of:

· The establishment and evaluation of 2 pilot projects, each covering the activity of an entire Social Services area office. Finance specialists (Table 1) were deployed across the Winchester and Andover area. Care brokers (Table 2) were deployed across the Eastleigh area. Both pilots have been evaluated against both hard performance measures and stakeholder perceptual measures. The evidence resulting from this evaluation affords a secure base for recommending the adoption of these proposals on a wider basis.

· Using working groups of operational staff to "destruct test" each of these proposals, using current real cases. Using a variety of genuine scenarios taken from different client groups it was possible to establish the boundaries of these new roles, potential limitations and benefits. This was especially important to address concerns about introducing additional personnel to the care management process, with attendant potential problems of information transfer and ensuring the client was clear about who to contact.


See tables 1 - 4 for the full list of options and option appraisal:-

Table 1 - Options for specialist finance teams. See App 7 for some background detail.

Table 2 - Options for Care broker role. See App 8 for some background detail.

Table 3 - Options for improving recruitment and retention of care managers. See App 9 for some background detail.

Table 4 - Option for developing/improving our partnerships with other agencies.

13 Recommendations - preferred options

Consultation with stakeholders demonstrated that the way care management is practiced and the outcomes arising from the process are highly valued. However concerns were raised, both in the course of this review and the review of services to carers, about difficulties in accessing care management services.

Therefore the proposed improvement options (below) are chiefly designed to increase the availability of care managers to stakeholders by rationalising the care management business process. It is proposed that this be achieved through the following actions.

13.1 Specialist finance teams - Table 1

Recommendation: Option 4 - dedicated specialist finance teams.

Based on the evaluations of this approach from other Authorities and a pilot project in Hampshire, the benefits of this approach are seen to include:

- removing financial assessment and charging activities from care managers will free up an average of 8% of their working time. It is proposed to reinvest this time in the core care management business of assessment and reviewing care, to afford a more efficient and effective service to stakeholders. The anticipated result of this is to reduce the average waiting time for assessments and improve compliance with undertaking scheduled client reviews.

- recouping an additional 2% of revenue in charges from clients that is currently lost whilst care managers undertake this activity and using this additional revenue to fund the specialist financial teams.

13.2 Care broker role - Table 2

Recommendation: Option 4 - creation of a dedicated care broker role in support of the care management business process.

Trials of this approach within Hampshire and across Kent have given highly encouraging results, including:

- freeing up to 12% of care management time to enable significant improvements to the efficiency of both long term teams and Reception and Assessment teams. Within the pilot projects this approach has already resulted in a substantial reduction in the waiting list for assessment and an increase in reviews.

- Substantial improvements in the proportion of clients and agencies receiving copies of the care plan. This is currently 100% in the Hampshire pilot, compared with a County average of 52%.

- A more streamlined process that removes the duplication of activity.

- Clients and carers finding it easier to contact someone in Social Services if minor variations needs to be made to their care.

Based on activity data and the pilot project, it is estimated that 21 full time equivalent care brokers are required across Hampshire to fulfil this function, with a distribution of 1.5 full time equivalents per area office.

Following the anticipated implementation of a care management approach across Children's and Families services, we expect additional demands to be made on care brokers from this source. Dependant on the level of demand from this source numbers of care brokers may need to be expanded, although it is noted that the volume of services commissioned for children is far lower than that for adults and older people.

13.3 Recruitment and retention - Table 3

Recommendation: Option 3 - enhanced employee reward initiatives for the existing care management workforce.

This option represents the most desirable balance between cost and gains in effectiveness. It seeks to induce experienced practitioners to continue to use their skills in the workplace. It also aims to promote the recruitment of a successor generation of care managers through recognising and rewarding achievement.

13.4 Developing partnerships with other agencies - Table 4

Recommendation: Options 3 - 4 give a range of items that could form the foundation for developing partnerships with other agencies. They each address a range of issues which would support effective joint working and improved outcomes for service users. Some early developmental work has taken place for both these options, but the preferred option will be as the result of further evaluation with colleagues from other agencies, particularly health. Both the options support the government's policy direction and the National Service Frameworks currently in place. However, some knotty issues need further and deeper consideration within Hampshire County Council e.g. premises, employment status, financial risks, information sharing protocols and so on . These are currently being explored but the evaluation of option 4 will take about 12 months to be completed.

15 Areas of further work

15.1 As a result of technical difficulties, there has been a delay in profiling the RAP

returns by area. This is now due to be completed shortly. This information

will show whether there are differences in terms of outcomes for users in

relation to the assessment process in different geographical areas. Aspects of interest in this context are e.g.


· the speed of assessment

· the application of the eligibility criteria and the · outcomes of assessment in areas with developed partnership

· arrangements with Primary Health.

15. Recommendations

15.1 Evidence generated as part of this review has convinced the review team members that there are substantial tangible benefits for all stakeholders in adopting the recommended options described above. The main benefits are:

· Making the care management process simpler and avoiding duplication of effort, thereby increasing the availability of care managers to work with existing and new clients. This addresses the key result area that stakeholders saw as the greatest area for improvement in their contact with Social Services.

· Increasing welfare benefit take up amongst the most vulnerable people in Hampshire, so that they can partly fund their own care needs.

· Increasing revenue to the Department, so that we can work with more people.

· Ensuring that greater numbers of users and providers receive written copies of care plans, detailing the services that will be provided.

· Improving the job satisfaction of the care management workforce, thereby improving job retention and ensuring that we have an adequate supply of care managers to meet the needs of the people of Hampshire.

· Making joint working arrangements with colleagues from other agencies more effective, through the supply of electronic information.

· Encouraging more people to take control of the resolution of their difficulties, through providing an enhanced electronic self referral service.