Time pressures compromising social work practice at council, finds review

Budget cuts, lack of time and “over-onerous” processes are compromising social work practice at Norfolk council, an independent review has found.

The council asked the Social Care Institute for Excellence (SCIE) to carry out an audit of its adult social care practice and processes to assess its compliance with the Care Act 2014, earlier this year. The move followed a complaint by local user-group Equal Lives, who reported Norfolk to regulators for “disregarding” its Care Act duties.

The review, based on an audit of 30 cases, analysis of council processes and feedback from staff and service users, found that staff “at all levels” were under significant pressure.

‘Disempowered’ staff

Social workers reported feeling:

• Disempowered by managers.
• Anxious about having difficult conversations with service users about meeting needs amid budget reductions.
• Frustrated with perceived bureaucracy, over-onerous processes and having to gain multiple approvals for decisions.
• Pressured by the apparent need to take on three new cases a week on top of “an already big caseload” and that this was “seriously restricting” time for meaningful conversations with service users.

One employee, whose views were shared by several others, told SCIE’s auditors that staff were keen to work with people in a strengths-based, person-centred way, but there had been “little or no recognition” from the council that this took more time than simply doing an assessment or review and arranging a service.

“Most members of staff report that they don’t have enough time to prepare or perform assessments to the standard required,” the report said. SCIE found that there was “clear evidence in practice and recording” that this was the case.

Assessments lacking in detail

The audit of cases found that assessments did not always demonstrate the necessary level of detail and evidence and tended to be problem-focused, rather than strengths-based. For example, not many assessments gave a picture of the personality or personal resources of the individual, and most did not identify clear personal outcomes for individuals.

Many of the cases reviewed, including carers’ assessments, did not have an initial review following the implementation of the support plan. This is despite the Care Act statutory guidance stating that such a review should be considered to ensure there are no issues with the plan.

SCIE also found little evidence that occupational therapists and social care workers completed reviews together or that direct payments reviews were aligned with those of support plans. Under regulations under the Care Act, people on direct payments must have these reviewed every 12 months, while the statutory guidance says such reviews should be aligned with those of care and support plans.

Budget reductions

The SCIE review concluded that “lack of time and budget reductions” had at times compromised practice and recommended that the council undertake an audit of how social work staff’s time is spent to determine whether they have enough time deal with each case they are allocated appropriately. This should also take into account implementation of the council’s new promoting independence strategy, designed to reduce reliance on care services, and the Care Act duties and principles.

The council should also explore opportunities to give staff more time to prepare for, conduct and record assessments and support plans, which must be focused on the person’s needs and circumstances and beyond the council’s financial constraints, the report said.

Genuine intent to improve

The report praised the council for its “genuine intention to improve outcomes for local people” but said more needed to be done to fully deliver and embed the Care Act.

“The opportunity now is to build on areas of undoubted good professional practice in Norfolk council alongside focusing on some challenging improvement areas, harnessing staff strengths and commitment, and ensuring Care Act principles and duties are core to all the council’s processes, systems and working styles,” the report said.

Other recommendations included for the council to:

• Change some of the terminology the department uses to avoid confusion about the council’s roles and responsibilities in relation to the Care Act.
• Improve information sharing between staff and partner organisations.
• Review the way the council communicates and engages with people who have a stake in adult social care in Norfolk, including service users and carers, to enable better understanding of the council’s financial constraints.
• Consider alternatives to the resource allocation system in determining the level of personal budgets to improve the transparency of the process, as required by the Care Act statutory guidance.

Strengthen practice

Harold Bodmer*, executive director for adult social care at Norfolk Council, said the report gave “some very helpful suggestions” as to how the department could strengthen its practice.

He said: “The Care Act provides a clear legal basis for significant change in ways of working in adult social care and is widely welcomed across the whole care sector. Like all local authorities, Norfolk is working hard to introduce and embed these changes in our practice.

“We will be presenting SCIE’s report, along with an action plan setting out what we have already done and plans to our next adult social services committee in September.”

Mark Harrison, chief executive of Equal Lives, welcomed the findings of the review but said it had failed to address the fundamental issues outlined in the user group’s complaint.

Failure to address issues

He said: “This is a professional review of social work practice but it doesn’t address any of the resourcing issues for adult social care or the policy issues that are relevant to Norfolk.

“We are yet to see any real cultural shift in the organisational practice in Norfolk and it remains to be seen whether any of the recommendations will be implemented.”

Equal Lives reported Norfolk council to the Care Quality Commission, and later to the Department of Health, for “disregarding” its duties under the Care Act. The user-group claimed eligibility thresholds had been raised and care package reviews were being used to reduce, or completely withdraw, support for people regardless of their needs.

It also said the decision to remove ‘wellbeing’ payments for personal budget holders in 2014 had had a “devastating impact” on service users’ lives.

Breach claims disputed

The council has always disputed any claims that it breached its statutory duties.

The Department of Health rejected Equal Lives’ request to authorise an inspection of Norfolk’s adult social care services. Care minister Alistair Burt wrote in a letter to the group that the government was satisfied a sector-led review of Norfolk’s practices would be sufficient.

Harrison added: “The SCIE review is not an inspection, it’s a review and makes recommendations that can be taken up, or not. An inspection would say clearly ‘you are not compliant, there are not enough resources in the system, and you have to put more in’.

“That’s what the government was desperate to avoid because this is not just unique to Norfolk – austerity dominates practice and decisions in all local authorities. Our contention is, and remains, that there is not enough money in the system to meet legal duties.”

*Harold Bodmer died on Wednesday 20 July after collapsing at a council meeting in Norfolk. This article carries tributes to him from across the sector.