In Camden, specialist and locality teams have been ditched in favour of a single service designed to avoid clients being passed from pillar to post in search of social care support.
Two of the chief sources of the bureaucracy that has undermined personal budgets are the volume of paperwork that social workers have to process and the number of different practitioners people have to deal with as they travel through the system.
Both factors were identified as problems for Camden council in a wholesale review of the self-directed support process two years ago that found they was leading to delays in setting up personal budgets and frustrations for people seeking support in having to repeat their stories.
The review, which was set up to help deliver savings, concluded that the council’s adults’ services departments had far too many teams – whether specialist or locality-based – fragmenting the process and leading to unnecessary “hand-offs” of cases from practitioner to practitioner. Excluding learning disabilities and mental health, customers had more than 10 different points for accessing adult social care support from the council.
In addition, the review found that the council used 17 different forms to capture information from potential customers, leading to much duplication and unnecessary form-filling for practitioners.
“We wanted to have a focus on what it is we do that really adds value to the person,” says Lyn Romeo, now the government’s chief social worker for adults but until this month Camden’s assistant director of adult social care.
Single access point
As a result of the review the council has made significant changes on both fronts. It now has a single adults’ service with one access point for people seeking support, excluding learning disabilities and mental health. Practitioners who take initial phone calls from potential service users will go out and assess them. The only hand-off people now face is if they require ongoing support, in which case they will be transferred to a professional working on long-term cases.
“Instead of one team working with someone for a short period of time and then transferring them to another team, we attempt to keep the customer with us,” says Shannon White, lead practitioner for direct payments and personalised support.
The 17 forms have been cut down to five, covering referral, assessment, support plan, reassessment and support plan review, and the council intends to get rid of the reassessment form so that reviews are carried out using the assessment form. The forms have also been revised to reduce tick-box elements and increase scope for free-text responses from service users, providing them and social workers with greater discretion. In addition, the former points-based resource allocation system has been scrapped in favour of a simpler ready reckoner model that calculates the person’s indicative budget on the basis of existing service costs.
“There’s no complex algorithm to explain to service users [anymore],” says personalisation implementation manager Paul Kelly. “It’s the simplest form [of RAS] you can have.”
Camden’s efforts have been recognised by the Think Local Act Personal partnership, which has selected it as one of 20 case studies published today of good practice in reducing bureaucracy in the personal budgets process.
Positive response from social workers
Social workers have been critical to devising and implementing the changes, which were initially tested by a small group of staff, and have generally welcomed the results. “Most social workers will say things are a lot better than they were two years ago,” says Shannon White, lead practitioner for direct payments and personalised support. This is in part because managers have been responsive to their concerns during the implementation process.
For example, in January 2012, the council eliminated the divide between practitioners doing intake and short-term case work and those handling longer-term cases so that all social workers took initial phone calls from clients and could then follow through cases that required ongoing support. However, this did not work, says White.
“Some people tend not to like being on the phones and prefer working on longer-term care management,” she says. “We have to have a balance between what’s right for the customer and how the service is going to cope; staff have to be happy to.”
So the council reinstated the divide between short-term and long-term work. However, it intends to increase the number of practitioners doing intake and short-term work over time to help reduce the number of hand-offs, but White says this will take time.
“We’re trying to change a culture and that doesn’t happen over time,” she adds.
Retaining specialist knowledge
The elimination of specialist teams created a risk that expertise would be lost in these areas. The council’s response was to appoint lead practitioners for areas including occupational therapy, safeguarding, health and long-term conditions and personalisation, to provide a resource for other social workers. White’s role is one of these.
“Our role is to be approachable and visible so people can come and talk to us and not feel shy to ask what they may see as silly questions,” she says. She gets a number of questions each day and tries to spot patterns in the issues practitioners are raising so that these can be raised with senior management, if necessary. She also sends practitioners monthly email updates.
Another issue created by the removal of teams was that it made it more difficult to share information across the department, a role that team meetings previously fulfilled. Camden’s answer has been to create five supervisory groups, each headed by a service manager and operational manager or lead practitioner and consisting of a group of practitioners who are supervised by the operational manager/lead practitioner. This also helps allocate work more equitably between staff , says White.
“Every day I’ll have an email saying, ‘Shannon, can any of your staff take work,” and I’ll say ‘yes, this person can take one and that person can take two cases’. If you have different teams you can end up with one team being chockablock and others having spare capacity. That’s a real benefit of having one service.”
There still remain problems with the self-directed support process, however. While the ready reckoner resource allocation system is much simpler than its points-based predecessor, basing indicative budgets on the costs of existing services can lead practitioners to focus on more traditional forms of support during support planning.
“When you are talking about existing costs of services there can be a tendency to just think about those services,” says Kelly. “That’s our next challenge, to get people to think differently.”
Picture credit: Rex/Image Source