Local authorities are expecting to assess at least an additional 180,000 to 230,000 people because reforms under the Care Act, notably a ‘cap’ on the amount individuals will contribute to their care costs, will incentivise many more self-funders to approach their council. The cap will be introduced in 2016-17, but councils are receiving £175m of government funding to start assessing eligibility for the cap from next April.
In the face of this anticipated surge in demand how can local authorities boost their assessment capacity without compromising quality? A session at last week’s Community Care conference on Care Act implementation considered that thorny dilemma and looked at some of the ways Surrey council has been considering tackling it. Here are four options that were discussed and the pros and cons of each:
1. Online assessments
The model: Essentially you’d create an online system for people to self-complete an assessment of their needs.
The benefits: A good way of boosting accessibility, very ‘scaleable’, relatively low cost for councils.
The concerns: Not everyone will be IT literate or have online access. How do you verify the information? How do pick up something like safeguarding risks? Do you lose the value of face-to-face contact? How do you handle complex cases? The feedback in the room suggested that councils could deploy this as an initial screening tool for appropriate cases but some sort of face-to-face follow-up assessment could be needed. It was also recognised that online assessments would be inappropriate for people with high-level or complex needs.
2. Third party assessors
The model: Work with voluntary sector agencies and private residential and nursing home providers to get them to carry out assessments on behalf of the local authority.
The benefits: These services have an established workforce in place who have experience of working with vulnerable people and good knowledge of community support options available locally. It could also increase accessibility and availability of assessments and, if assessment processes can be aligned where appropriate, cut down on duplication.
The concerns: One major concern here is around conflict of interest. Would a voluntary sector partner undermine their campaigning and advocacy work if they start doing assessments on behalf of councils? Likewise, would a private home present a conflict of interest given their provider role?
3. Community ‘drop-ins’
The model: The idea is to help people get assessed where they are, rather than in their own homes. Options discussed included providing assessments in GP surgeries or high street ‘hubs’ that some local authorities have. A second option was to provide a central ‘market’-type event where self-funders would be invited to come and be assessed and at the same time get information from voluntary sector partners etc. on support available in the community.
The benefits: Greater visibility and accessibility of assessors.
The concerns: You could lose the benefits of assessing someone at home. Staff say that conducting home-based assessments can help the assessor get a real feel for how someone is living. There were also concerns that the ‘market’ type event could be overwhelming for people who would be assessed and then bombarded with information.
4. A specialist self-funder assessment team
The model: This option would be see the council set up a specialised assessment team that would focus on assessing self-funders. The team would work around the county.
The benefits: The assessors would have specialist skills
The concerns: This model isn’t necessarily that scaleable, it would take time to increase the workforce and could be quite costly.
Clearly there are a number of issues that crop up with all of the models. Interestingly, Surrey is piloting a system that has elements of all of the above involved. They wanted to have a mix to ensure flexibility and assess the benefits and drawbacks of each one in practice. The council is running a pilot with some voluntary sector agencies and nursing home providers to assess a small group of self-funders.
The pilot aims to answer a number of questions: how can you assure good quality? How can information around the cap on care costs be best delivered to people? How much does each option cost? On the issue of conflict of interest, one bit of early feedback has been that voluntary sector agencies are happy to assess a person’s eligibility but they want the council to calculate the actual allowance and communicate that to service users. On the quality assurance side of things, some frontline staff have been shadowing voluntary sector assessors and the council is looking at how social care staff might work in that quality assurance role.
These dilemmas are being faced by councils across England. How is yours responding? Can you see advantages in any of the above models? Is a combination of them the way forward or should other alternatives be explored?