Elaine Aspinwall-Roberts explains how her learning disabilities team adapted to the continuing health care framework
Since the new national framework for funding continuing health care (CHC) was introduced in October 2007, my team, like others across the country, has had to quickly become familiar with the new way of doing things. As a manager of a learning disability team, I needed to quickly help social workers become confident in playing a full role in the CHC process, alongside health colleagues.
CHC introduced a two-tier set of paperwork – the checklist (to establish eligibility) and the decision support tool (to explore support and funding applications). This is paperwork has a distinctly medical model and involves scoring service users in a manner that is far from being person-centred, so is not suited for social workers.
But there is no choice in the matter, so workers have to be familiar with the forms. It doesn’t help that, for people working in learning disabilities, the paperwork appears to be written from the perspective of older people’s needs, particularly those with dementia, which can be disempowering for our service users, even when they clearly have an entitlement.
We participated in training offered by the primary care trust, but it was also important to work with the social workers on their role in completing the forms. We discussed this in depth in team meetings, looking at dummy examples, sharing people’s experiences of participating in the process, and considering “would X appear to be eligible?” scenarios. People quickly became familiar with the domains that were important for our service users, and we began to tease out the differences between, for example, being described as severe and high (for the social workers this has distinct echoes of Fair Access to Care Services eligibility).
Guidance notes from the Association of Directors of Adult Social Services have been helpful in making social workers think about what the local authority is not responsible for funding – their suggestion of score levels that would be above what a local authority should lawfully fund help counterbalance the Department of Health framework guidance about what it will fund. It is a sad irony that at a time when joint working is progressing apace, we should be pushed back into our respective, somewhat polarised funding positions. But, if this is the case, social workers need to feel confident in challenging decisions they disagree with.
Evidence and assessment
While it became clear that thorough assessment and robust evidence-gathering were essential to support an application, quality and quantity of evidence is a moot point. We have worked hard with providers of supported living to identify where their “skilled intervention” prevents a situation escalating, and recording this. The DH guidance encourages using diaries, and this is a positive tool for social workers to encourage families and carers to use to provide evidence, which might not otherwise be made explicit.
Finally, we have shared successes where the social worker’s contribution has played a significant part in establishing a primary health care need so that our service users can obtain health services to which they are entitled, free rather than social services for which they have to pay.