Social work leaders have voiced concerns over government plans to outsource care assessments to deal with a big hike in demand for them, fuelled by care funding reforms.
External agencies could carry out an increased number of assessments to fill a gap in local authority capacity to do so, said the government’s consultation on its care funding reforms, published last week. However, sector leaders warned this could lead to inconsistency and a fall in the quality of assessments carried out.
Councils are expected to assess an additional 180,000 to 230,000 people and carry out an additional 440,000 to 530,000 reviews in 2016-17, because funding reforms under the Care Bill will incentivise many more self-funders to approach their council.
Care funding cap will spur self-funders to approach councils
Only by having their needs assessed and regularly reviewed will self-funders be able to take advantage of the £72,000 cap on their eligible care costs. And many more self-funders will be eligible for help with their residential care costs under the plan to extend means-tested support to people with assets worth up to £118,000 including their home, up from £23,250 now
Councils are due to receive about £1bn a year in additional funding to implement the reforms, and the additional care management costs are expected to top £200m a year. In its consultation paper, the government set out a number of ways in which these costs could be minimised and the additional demand managed. These include:
- Greater use of self-assessment by service users;
- Greater use of online assessments;
- Integrated assessments across health and social care;
- Combined assessments of service users and carers;
- Enabling councils to start assessing service users who want to be considered for the cap six months before it comes into force, in November 2015;
- Making assessments proportionate to people’s needs, with the expectation that many self-funders will need ‘lighter-touch’ assessments than people funded by councils;
- Getting external agencies to carry out assessments.
‘Capacity and capability challenge’
The Department of Health said the increased volume of assessments would “present a capacity and capability challenge local authorities will need to respond to”. It added: “This may require new approaches, systems and tools, and the extension of the workforce to include partners who work with local authority resources to deliver the desired outcomes. This could have implications for the existing workforce.”
However, John Nawrockyi, director of adult social services at Greenwich Council, said: “I think [assessment] should sit with the local authority for the sake of consistency and equity. If you start tendering out the assessment process it could lead to a lot of different views and thresholds being applied.”
Nawrockyi is secretary of the Association of Directors of Adult Social Services workforce development network but said he was speaking in a personal capacity.
He added that the key requirement was for government to resource the increased volume of assessments effectively. “It’s straightforward, it’s a capacity issue,” he said. “We want to extend the existing system, not create a new one.”
The DH consultation paper said officials were working with the Adass workforce development network and Skills for Care to examine how the gap in assessment capacity be filled. Nawrockyi said these discussions had not yet begun.
Risk of over-reliance on the market
Concerns were also voiced by Pete Morgan, media spokesperson for The College of Social Work and a retired former local authority head of adult safeguarding, who said there were dangers that some people’s assessment needs would not be met “if you rely too much on the market”.
Morgan also questioned the assumption that self-funders may need lighter-touch assessments than people whose care is funded by their local authority.
“If [self-funders] don’t get good enough advice they will either end up in residential care when they don’t need to be there or, if people aren’t getting the services they need, they will deteriorate. When you have a two-tier system of having lesser or lower quality assessments for self-funders you are going down a dangerous path.”