by Andy McNicoll and Rachel Carter
A council has been accused of “deception” after a confidential report revealed it used a ‘questionable’ strategy to boost performance against a government personalisation target.
Auditors were called in to review Somerset council’s actions after the number of service users it said were receiving personal budgets rose dramatically from 7% in 2012-13 to 33% in 2013-14. At the time councils were under pressure to meet a government target for 70% of service users to be put in charge of their own social care support by April 2013.
The report, carried out by South West Audit Partnership – a firm jointly owned by Somerset council and 12 other local authorities, reveals the sharp rise in the council’s performance “unfortunately” drew attention. This forced Somerset’s chief executive Pat Flaherty to request an audit after he took up post in May 2014.
The report was kept secret but has finally been released almost two years after Community Care requested a copy under the Freedom of Information Act. The document reveals:
- Somerset’s improved performance was based on a claim that 3,000 more homecare service users had been moved on to personal budgets in 13-14.
- This claim was “questionable” as the 3,000 homecare recipients had in fact only been sent a letter telling them how much the council spent on their care.
- The letter only met one of three official criteria required for someone to be classed as receiving a personal budget (see box below).
- The council’s claim that “an immense amount of work had been undertaken” to improve performance was misleading as “in reality we had sent out 3,000 letters to homecare clients with little expectation that there would be any take-up, or that the process would add any true value”.
- The approach had allowed the council to report a “satisfactory number” without providing meaningful budgets to service users.
- Staff felt under pressure from the council’s then chief executive to improve the self-directed support figures as Somerset had the worst performance in the country against the indicator in 2012-13.
- The actions to improve the figure were taken with the full knowledge of the then chief executive and followed discussions with sector leaders, including the Association of Directors of Adult Social Services (ADASS).
- Feedback from national leaders suggested Somerset’s approach “was not inconsistent” with that of other councils. The report does not specify which national leaders provided this advice.
The performance figures were collected as part of the official social care data collection – the Adult Social Care Outcomes Framework (ASCOF). The government has described it as a “robust” measure of performance that fosters greater transparency and supports ministers in discharging their accountability to the public and parliament for services.
Liberal Democrat MP Norman Lamb, who was care minister at the time of Somerset’s dramatic improvement, described the audit report findings as “alarming”.
He said: “It totally undermines trust in the data. The approach they’ve taken makes no positive difference to anyone’s life. It completely fails to deliver what personalisation is trying to achieve – this should be about a genuine transfer of power from bureaucracy to people.
“If organisations think that they can hoodwink people by looking good on paper but changing nothing of substance then it’s a total failure on their behalf. It amounts to a deception really. It is an outrage and it’s alarming that it appears other councils are doing similar things.”
ADASS declined to comment on the report’s findings that Somerset’s approach was taken after seeking advice from the organisation and similar tactics were deployed by other councils.
No records of the advice national leaders gave Somerset council at the time were kept.
The authors of the report approached the ADASS personalisation network co-chair and the former director of Towards Excellence in Adult Social Care (TEASC) for their views as part of the audit. The report states: “As expected, neither individual would commit to an endorsement of the approach taken by Somerset council, both stating that it is for the council to decide whether the approach adopted is appropriate”.
Simon Duffy, a personalisation expert and director of the Centre for Welfare Reform, told Community Care the approach adopted by Somerset was widespread at the time, chiefly because it meant councils did not have to change their contracting arrangements.
“This was commonly understood to be the quickest and easiest way of getting high numbers of personal budgets, without having to do anything real,” he said.
“What was at stake here for councils and people committed to an old fashioned way of doing social care were the commissioning arrangements – they didn’t want to change the contracts they had with domiciliary care providers and other service providers.
“If they had moved away to either direct payments or individual service funds, those things would have changed radically.”
Another factor for councils would have been embarrassment, Duffy added.
“The policy was driven by people who were primarily interested in things appearing to be different, even if substantial change was not achieved, and for local authorities – this is the case with Somerset as well – it would be embarrassing not to have figures that are along the same lines as their peers. What happens in this situation is a form of peer pressure.
“As far as I understand it everyone saw this as a straightforward mechanism to raise their figures.”
Dispute over target
Duffy said the Department of Health’s implementation strategy for personal budgets was “flawed to begin with” and the 70% target was “meaningless”.
“The Department of Health should be held to account – they set the system up and it was designed in a sense to be a meaningless exercise, so I think ultimately the responsibility is with them,” he said.
“They knew what people were doing, everyone does it – so this is not really to do with councils. The reality is senior civil servants did not like this policy and their role at the time was to make it as easy as possible to achieve the targets, without having to change anything fundamental.
“Everybody looked good, but nothing real was happening – and that’s where we are today.”
Lamb defended the introduction of the “ambitious” personalisation target and said setting objectives was an important part of driving change.
“But you always have to be aware of the risk of gaming. Sadly in any system you will have cynical people who think they can just meet a target and get people off their back using a mechanism like this,” he added.
“You have to address that and expose it like you’re doing today. Hopefully by exposing it, this will force the council to rethink its attitude and give people genuine power and control [over their care and support].”
A Somerset council spokesperson said in light of the report’s findings it had “downgraded” its 2013-14 figure from 33% to 12% and take up of personal budgets had “steadily increased” since then.
The ASCOF dataset for 2013-14 has not been revised and Somerset’s performance remains recorded as 33%. The personalisation outcome measures were altered from 2014-15 onwards meaning comparable data for subsequent years is not available.
A spokesperson for NHS digital (formerly the health and social care information centre), which publishes the dataset, said it offered councils guidance on recording but “local authorities are ultimately responsible for the accuracy of their figures”.
How Somerset’s letter fell short
What were the criteria?
Somerset had to meet three criteria to record a person as receiving a personal budget:
1. The person (or their representative) has been informed about a clear, upfront allocation of funding, enabling them to them to plan their support arrangements;
2. There is an agreed support plan making it clear what outcomes are to be achieved with the funding and;
3. The person can use the funding in ways and at time of their choosing.
These have since been superseded by the Care Act 2014 statutory guidance, which uses different wording, but broadly demands the same of local authorities.
What did the auditors find?
The report concluded that “it could be argued” that Somerset’s letter met the first criteria, because it informed service users of the value of what the council spends on their care.
However, it did “not necessarily reflect” the full amount spent on an individual for all of their care needs, the report said.
The auditors did not undertake any testing to confirm Somerset’s compliance with criteria two.
The letter contained a series of FAQs, including ‘What is my care and support plan?’
The 3,000 clients were in receipt of a home care package, so it’s possible to assume that they all had a care plan in place. However, the report concluded that it was unclear whether the wording in the letter was “an implied acknowledgement that not all users have been given a plan, or whether this is an invitation to get an up-to-date plan produced”.
The crux here is that the care and support plan should be agreed through a meaningful conversation between the individual and their social worker. Personalised care planning should identify what is most important to a person for them to achieve a good life and ensure that the support they receive is designed and coordinated around their desired outcomes.
The auditors said it was “questionable” whether the letter satisfactorily meets criteria three.
In the letter, direct payments were referred to and explained, but there was a lack of detail about the choices available to people with a personal budget, the report said.
“It is not likely that this will be fully understood by the recipient to enable them to make an informed choice,” the auditors concluded.