Should care managers be brokers

The adult green paper proposed that care brokers or navigators should help people buy their own care. Martin Green and Ray Jones argue for and against this role being carried out by existing care managers

Martin Green, chief executive, English Community Care Association
The white paper, Our Health, Our Care, Our Say, sets a new direction for health and social care and puts the user at the centre of the system. This approach challenges the way in which we have delivered services and particularly challenges the central relationships between user, commissioner and provider.

There is a need for independent advocacy that will enable users to make informed choices and there is a need to separate the role of assessment from that of commissioning and provision. If we are going to have real independence and accountability we need to separate and clarify the different elements. I do not believe that this will be achieved until care managers are outside local authority control.

We need a new approach to individual commissioning and advocacy where the commissioner responds directly to the user and is accountable to the user. This would lead to a situation where users received the services they wanted rather than having to conform to a particular philosophy. It would be for commissioners to respond to user need and preference, not to political dogma. In this approach we would hope to see some creative thinking and commissioners buying services, some of which may not just be health and social care.

The problem with the system now is that social workers tend to think only in terms of health and social care.

We need commissioners who can think laterally and creatively and we need a system that is independent from the assessing authority. If this service develops we will also need to ensure that it is both qualitative and accountable and it is for this reason that it should be regulated. I would propose that the Commission for Social Care Inspection, and then the merged commission, would do this, but would base the model of regulation on the Financial Services Authority regulatory framework for independent
The white paper and the general direction of policy will force some radical changes in our structures if we are to deliver more user-focused services. A new approach to commissioning is needed and I do not believe the current structure or personnel will deliver it.

Ray Jones, chair, British Association of Social Workers
Making independent advice and brokerage available is one thing: making it affordable and accountable is another.

Setting up new arrangements to provide advice and assistance separate from the need assessment – which is always likely to ultimately remain with the allocators of (scarce) resources, the local authorities – will be an additional cost. It is also likely to duplicate the discussion that will still need to take place with the local authority’s social workers and occupational therapists.

When money, time and knowledge are limited, building additional costs reduces the resources available for providing or buying assistance.

Separating the strategic planning and commissioning of services and assistance from the direct discussions with disabled and older people risks leaving the commissioners less informed about clients’ aspirations and wishes.

If the brokerage role is left with independent agencies and individual advocates, new arrangements to ensure competence, quality, probity and accountability must be established. And it is important that provider interests, or personal worker bias and fad, do not dominate the “independent” advice and then the assistance received by disabled and older people.

The Financial Services Authority model is not reassuring, with the recent scandals of pensions, investment and insurance mis-selling. And independent financial advisers do not come cheap.

We need commissioners, front-line social workers and other colleagues who listen to disabled and older people; who stay close to them at times of change, crisis and trauma; and who use their skills to help them attain choice and control.

Yes, we need more lateral thinking and we also need community development to allow disabled and older people greater access to more opportunities. Perhaps we should be championing good professional and organisational practice which is facilitating rather than setting up additional organisational arrangements at extra cost.

And perhaps we need stronger alliances between disabled and older people and social workers and others to seek to make the resource pool larger and to ensure that this pool includes the community and commercial services often denied to disabled and older people.

Further information
English Community Care Association
British Association of Social Workers