Councils need more evidence on whether delegating budgetary decisions to social workers is less costly than maintaining "elaborate approval processes" for signing off care packages, a report from sector leaders said today.
While some councils saw referring budget decisions on individuals' care packages to senior managers or panels as a way of maintaining control of resources, others were devolving decision-making to the front line to cut red tape, said the study on how councils should better deploy resources in adult care.
Just 19% of practitioners who responded to Community Care's 2012 personalisation survey said social workers in their council were able to sign-off personal budgets despite concerns that the use of panels to decide on cases increased delays for service users and demoralised staff.
Reduced bureaucracy versus top-down control
"More research is now needed to compare the financial outcomes achieved...encompassing investigation of how the savings achieved by reducing bureaucracy, including budget approval processes, may be greater than those achieved through top-down control," said today's report.
A problem shared: making best use of resources in adult social care was published by Think Local Act Personal (TLAP) and the Towards Excellence in Adult Social Care (TEASC) programme, government-funded sector coalitions charged, respectively, with furthering personalisation and improving the quality of adult social services. The report is designed to help councils manage year-on-year declines in funding for adult social care due to the government's deficit-reduction programme.
'No right or wrong answers'
However, it warned that councils faced "real dilemmas, with no wrong or right answers" in reducing spending. These included balancing:
- identifying people with emerging needs and intervening early against maintaining tight eligibility thresholds;
- responding to the growing demand for intensive support from relatively people with multiple or complex needs against the need to invest in prevention;
- protecting the capacity and quality of residential services against shifting expenditure into community-based support;
- working with selected providers to guarantee a stable supply of good-quality services against increasing choice and diversity in the market;
- changing the skills mix of the workforce in council adult social services against recognising the contribution of professionally-qualified staff;
TLAP and TEASC said that savings approaches taken by many councils so far, notably increasing charges for service users and squeezing fees for providers, may have run their course. However, the report said that there were significant differences in the way councils used resources and in the way they had responded to government cuts, meaning it could not make recommendations that applied to all.
Wide variations in councils' use of resources
For instance, it pointed out that there was a seven-fold variation between councils in the proportion of home care service users with packages of 10 hours plus a week; and while three-quarters of councils had reduced the number of people receiving statutory support in 2011-12, the rest had increased numbers. This meant that "the scope to deliver further budget reductions varies considerably from one council to the next, and that solutions will also vary from place to place".
However, the report also said that authorities needed to benchmark themselves against each other to challenge themselves and support the identification of local priorities. So alongside the use of resources report, TLAP and TEASC have produced a self-assessment tool to help councils evaluate their performance.
This covers performance in six areas - prevention, recovery, long-term support, business processes, partnership working and the engagement of service users and the public. In each area, the tool provides a description of what good performance looks like, and encourages councils to score themselves on a scale of 0-3, justify their score and develop an action plan for improvement.
For example, under recovery, the tool says councils should be offering reablement as appropriate to all those approaching adult social services or discharged from hospital, and not committing to provide long-term support until maximum recovery has been achieved, and thereby reducing the numbers of people they support.
Alongside the tool, TLAP and TEASC have published a list of relevant national performance measures to help councils assess their performance against the tool's outcomes, but they also encouraged councils to use their own local measures and to use the tool flexibly.
The tool is based on How to make best use of reducing resources: a whole system approach, a 2010 resource published by the Association of Directors of Adult Social Services.
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The state of personalisation in 2012: Community Care's annual survey