Personalisation is changing the face of social care, but research by Community Care and trade union Unison suggests bureaucracy and job changes mean it is yet to win the hearts and minds of social workers. Mithran Samuel reports
Personalisation has had a profound effect on social work for adults in England but practitioners seem increasingly sceptical about its impact. Two years into the three-year Putting People First programme, 88% of respondents to our survey with Unison thought personalisation had had some impact on their job.
But just 40% thought this had been positive; 29% viewed it as negative. Worse, the experience of personalisation has, if anything, made practitioners more sceptical. In a similar Community Care survey in 2008 18% saw the impact of personalisation on their job as negative.
Ruth Cartwright, joint manager for England at the British Association of Social Workers, says the findings raise questions about what personalisation has achieved for users and carers.
This is also reflected in our latest survey. Although a readers poll in 2009 showed 67% felt personalisation would benefit users in the medium to long term, this was down to 51% this year.
Terry Hawkins, a consultant and former adult social care director, warns: “Staff support and motivation for personalisation is critical but Community Care’s results show there is a real danger of losing staff at this critical stage.”
Personalisation and personal budgets have always had the potential to revolutionise social work.
They entail a move from professional-led assessments towards self-assessment; from drawing up care plans to much broader-based support plans; and from placing people in available services to “brokering” services that would best deliver outcomes.
They would also involve ever closer working with health to ensure people’s needs were tackled holistically.
One explanation for professionals’ relatively downbeat assessment is the finding that two-thirds have experienced increased bureaucracy as a result of personalisation.
Perhaps reflecting this, a similar proportion say they do not spend enough time with service users to support self-assessment effectively – a key plank of personalisation.
Richard Jones, president of the Association of Directors of Adult Social Services, admits some councils have “overcomplicated” the key processes of delivering personal budgets to users: self-assessment; resource allocation, which determines the budget’s value; and support planning.
Hawkins warns that bureaucracy has increased for social workers because some councils are duplicating self-assessments and traditional community care assessments for users. This twin-track approach was identified in the evaluation of the 2005-7 individual budget pilots, when councils argued that professional-led assessments helped identify risks and the needs of carers that self-assessments might miss.
Hawkins says councils should move towards a position where traditional assessments are used only for clients with sufficiently complex needs.
But the law creates problems. The NHS and Community Care Act 1990 places a duty on councils to assess users’ needs and, in a case last year – R(B) v Cornwall CC – a council was criticised for relying on a self-assessment that was not a comprehensive appraisal of a person’s needs.
The Law Commission’s current review of the law on adult social care could provide a chance to change this, though any reforms are unlikely to take effect for several years.
National director for social care transformation Jeff Jerome says he is prepared to look at the issue of bureaucracy in more detail, saying the essence of personalisation is to reduce process.
Another concern about personalisation has been its potential to make social workers increasingly redundant as users take more control of their own needs.
Our 2008 survey found 27% of practitioners expected to see a reduction in the number of social workers in their own teams, 44% expected an increase in staff without a social work qualification, 14% more staff from a health background and 17% no change.
That survey followed Wirral Council’s decision to cut 29 social work posts and increase the number of non-qualified staff by 26, with social workers focusing on managing complex cases and non-qualified staff taking on the assessment of users with lower-level needs.
Two years on, the level of change anticipated by the 2008 survey has not taken place. One in eight 2010 respondents has seen a reduction in social workers in their teams while 16% have seen an increase in the number of non-social work qualified staff and 7% an increase in health staff; 53% have seen no change.
Cartwright says we should have seen more workforce change by now, given that “personalisation was supposed to be a revolution”. Hawkins say the results indicate that councils are avoiding some of the “tough issues” on reconfiguring staff, evidence that personalisation is “starting to stagnate”. He adds: “There should be a different skills mix and fewer social workers.”
Unsurprisingly, Cartwright disagrees, saying the importance of social workers’ unique skills for delivering personalisation ought to result in more professionals.
However, Rick O’Brien, head of branch, access and assessment at Wirral Council, says that since its reorganisation the authority now has a “fairly balanced workforce” in terms of the number of social workers and other staff. Social workers, he argues, are better deployed now, managing complex cases and handling safeguarding.
Despite their reduced numbers, he says personalisation is opening up new opportunities for social workers. For instance, he says care reviews would previously often be carried out by non-social work staff, but because they are now more focused on outcomes, social workers are more involved.
Amid the scepticism, it is clear that a number of social workers have seen the benefits of personalisation. Emma (not her real name), who works in an inner London borough, says personal budgets have helped many of her clients. For instance, one single mother with a chronic condition has bought membership for a car club so she can drive her children to school when she is too ill to walk them.
Jerome insists that the doubters are a minority. But it is clear from our survey that directors will need to strive to win the hearts and minds of their staff in the years ahead if personalisation is to truly transform care for users.
“A greater demand on staff”
Social worker Beverley Latania, 34, works for an east London primary care trust as a senior practitioner and deputy manager of a multi-disciplinary mental health team.
“Personalisation has put a greater demand on individual staff and has impacted on time management as we have to get the paperwork completed.
“There’s also been a change from the care plan approach. We are now looking deeper into what people’s needs are. It’s time-consuming to do that well and feel that the service users feel you are listening to them.
“It can take six to eight months to instigate [self-directed support] – from filling the forms in, getting a separate bank account, getting the money in there. It has to go to a panel as well. They may have questions and it may come back to you three or four times to get it agreed. It should take no longer than a month.”
➔ Watch a video interview with Latania
This article is published in the 20 May 2010 edition of Community Care under the headline “The doubts remain”