Liberating social work from the shackles of care management

There’s light at the end of the tunnel for social workers and service users fed up with the bureaucracy surrounding the design of personal budgets. Mithran Samuel reports

Personalisation was supposed to liberate social workers from the shackles of care management by enabling them to empower service users to shape their own support.The reality for many has been different: social workers have become bogged down in bureaucracy as new assessment processes have been added to old. They have also seen their judgement on budgets and support plans questioned by funding panels.

And some personalisation advocates report that many social workers are still planning care and support for people rather than enabling them to do so themselves.

Over the past two years, a project has been seeking to deliver on the original vision by providing social workers with more freedom but reducing their direct role in support planning to give greater responsibilty to users.

Developed by disability consultancy Paradigm and think tank the Centre for Welfare Reform – headed by former In Control chief Simon Duffy, one of the pioneers of personal budgets in the UK – the “new script for social work” has been tested in York, North East Lincolnshire and Blackburn with Darwen councils.

Under the model, social workers provide service users with an indicative personal budget immediately following assessment and are able to sign off on it up to a certain value.

They then encourage the person to start planning how to spend it, if necessary with the help of family, fellow service users or community organisations such as faith groups or, in some cases, the social worker themselves.

“At the beginning there was a lot of anxiety for care managers – they were asking whether it was really right to be suggesting other people to do support plans,” says Ralph Edwards, group manager for adult social care at York Council.

But as service users proved willing to take up the challenge, social workers’ attitudes changed. “Over time, care managers got a lot more comfortable with selling the idea [of handling their own support planning] to people,” Edwards adds.

Kate Fulton, senior consultant at Paradigm, says the model puts a lot of trust in social workers, particularly in giving them the ability to sign-off personal budgets. “It’s really respectful of workers themselves. It’s saying ‘you are in the best position to decide’.”

But it also challenges social workers to place more trust in service users by letting them take the lead on support planning.

The “new script” received a negative response from some social workers on Community Care’s CareSpace forum who said it failed to outline how personalisation could be delivered for people with highly complex needs, who make up an increasing share of caseloads.

“A lot of people I work with have fairly advanced dementia or other mental health problems,” said one contributor. “Many have no social supports at all or are supported only by older and increasingly frail spouses who are often exhausted by the levels of care expected.”

There is also scepticism that community groups have the capacity to provide assistance with support planning, particularly where this voluntary.

“I think society should be doing a lot more along these lines but that feels a long way off for a social worker who is trying to organise a package of care or a personal budget for a 90-year-old with dementia whose daughter lives miles away,” says Joe Godden, professional officer at the British Association of Social Workers England. He says there’s a “great danger” that it would lead to an increased burden on family carers.

However, a Centre for Welfare Reform report on the model last year said social workers should still directly support plan, notably with people in crisis or those who lack capacity and have no family.

It would also be up to social workers to offer their own support or to refer service users elsewhere. “Social workers shouldn’t refer to someone off a list if they are not comfortable with it,” says Claire Winfield, director of consultancy at Paradigm, who adds that providers offer a possible source of expert support planning assistance for people with high-level needs.

Paradigm and the Centre for Welfare Reform say they are receiving enquiries from other local authorities about implementing the “new script” and are hoping to develop a “community of practice” for practitioners to share ideas on it.

Making it happen is not about national policy changes, but local will, says Winfield. “It’s getting back to the fundamentals of good social work,” she says. “Let’s try to free ourselves from the other stuff that gets in the way.”

HOW THE NEW SCRIPT WORKS

● People are informed of their indicative personal budget immediately after an assessment.

● Social workers are empowered to sign off budgets up to a set sum.

● Social workers encourage people to develop support plan themselves, with family or community support, so they can concentrate on support planning for those with high needs.

● Social workers develop knowledge of available sources of help with support planning, such as peer supporters or community groups, so they can connect service users with them.

● No prescribed format for support plans.

● Reviews are ongoing and informal rather than once a year and formal.

‘It was quite an effort for me to say ‘you have a go”,’ says York Council’s Charlotte Drummond (pictured)

“It has reminded me what I came into social work for,” says York Council’s Charlotte Drummond of the pilot she took part in to test the “new script for social work”.

Drummond qualified two years ago but says she had become “demoralised doing care management” in her role in the initial assessment and safeguarding team.

“In my current role I assess people and it’s very much ‘what are their needs and how can we meet them with the services available?’ and putting that into a care plan.”

The pilot was different. Not only did she put together personal budgets but she was given the freedom to work out the best way of doing so and was able to sign off budgets of up to £100 a week.

After an initial contact, Drummond visited each client’s home to carry out an assessment. With laptop in hand, she was able to put the result through the council’s resource allocation system and give them their indicative budget there and then, so the service user could move straight to support planning.

One client developed their support plan with their family; another did it on their own but with pointers from Drummond about how they might go about it. The third wanted Drummond’s help.

“My immediate instinct was to say ‘yes I will’. However, she stopped herself and asked the woman to see what she could do herself over the next week. A week later she had developed a job description for a personal assistant’s role with the help of a local user-led organisation, which she refined into a support plan with Drummond’s input.

“It was quite an effort for me to say ‘you have a go’. She could do it; she just needed the confidence.”

There was also flexibility in what people could spend their budgets on. For instance, cleaning was not a service the council would typically fund under its eligibility criteria. However, one of the service users said a little help with cleaning could help her do many other things for herself so was able to spend the money in this way.

Drummond is clear about the limits of this approach. “The people I worked with needed a bit of time to reflect. If you are in crisis you don’t have that time.”

But she is equally clear about what made it a success: “I had the freedom to do things without having to worry about the bureaucracy and having to justify everything.”

➔ More information from the Centre for Welfare Reform

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This article is published in the 20 October 2011 edition of Community Care under the headline “Budget for freedom”