Exclusive Survey: Staff pressured to deny services

Adult’s social workers are coming under increasing pressure from managers to ration services to new and existing users, an exclusive Community Care survey of more than 300 professionals reveals this week.

More than a third of social workers would be prepared to exaggerate client’s needs to ensure they met the required threshold to receive services, even though two thirds fear it may be questioned by managers further down the line.

The findings come as more and more councils reassess the criteria they use to decide who is eligible to receive adult social care and funding levels struggle to keep pace with growth in demand.

Over the past two years a third of local authorities have raised their eligibility criteria, previous research by Community Care has shown. Around 70% of councils now only fund clients whose needs are substantial or critical, and the Local Government Association believes that by 2009 few, if any, will fund care for those outside these top two eligibility categories.

This squeeze on eligibility is causing substantial public concern as those who need lower levels of care either have to fund themselves or go without. In some areas, such as Coventry, public petitions have been set up to campaign against council policy on eligibility.

Pressure from both sides

Social workers, who want to do the best for their clients while at the same time keep to council policy, are in the front line of the debate. Inevitably, they feel under pressure from both sides as Community Care’s findings show.

More than half felt under pressure by managers over the past few years to re-assess existing service users as no longer eligible for services. Nearly a third said they had been pressurised to assess fewer new referrals as eligible.

Penny Lloyd, professional officer for the British Association of Social Workers Wales, says that telling a person they aren’t eligible for a service is one of the hardest aspects of social work “because people never expect to have to pay”.

She adds: “Social workers are at the crunch point – it is not the manager or councillor that has to do it. I have heard stories of unethical goings on where the price of a care package has been put above the needs of individual clients. The pressure on budgets is affecting how needs are met.”

But Jan Evans, head of older people’s services at West Berkshire Council, says social workers have a responsibility to consider the financial implications of assessments. “I don’t think social workers should view thinking about money as distasteful when it comes to choosing between a care package of £1,500 or a care home place of £500.”

The fact that two thirds of survey respondents said budget cuts and overspends were a topic of conversation in every team meeting shows there can be little doubt growing financial pressures are having an impact on how services are delivered. Almost half said services in their area had been closed down as a result of a shift away from meeting people’s low or moderate needs.

But John Bolton, director of community services at Bolton Council, doesn’t think there is any more pressure now on social workers to ration than in the past 15 years.

“Social workers have had responsibilities to ration services since the community care reforms in the 1990s. I’m surprised people are raising such levels of concern at this point in time as social workers have always found it difficult to ensure their clients get the right service. Are we targeting resources on the right people and in the right way? The vast majority of people feel we are,” adds Bolton.

The Association of Directors of Adult Social Services says demand has always outstripped resources. James Reilly, chairman of the older people’s committee of ADASS, adds: “Pressures are definitely increasing. Social workers have had to apply creativity in targeting limited resources to those in greatest need.”

Push to fit

Colin Foster, director of adult social services, housing and health at Rutland council, recognises this: “Social workers will push people up [to fit the criteria].”

Lloyd says it is in a social worker’s makeup to want to help people rather than deny them something. “They are prepared to put themselves on the line.”

Stephen Lowe, social care policy adviser at Age Concern England, says pressure put on social workers from managers is an attempt to “restrict eligibility through the backdoor”.

He adds: “It is important social workers don’t give in to that kind of pressure. If authorities want to restrict eligibility they should publish their criteria.”

Lowe argues that authorities should be sticking to the eligibility criteria outlined in the Fair Access to Care guidance issued in 2003. “They are interpreting the criteria [differently] and rewording it.”

In the medium term, it appears the financial pressures on adult social care departments will only increase. October’s Comprehensive Spending Review (CSR) allocated an increase in money of just one per cent above inflation from 2008-11, less than half the rise needed to keep pace with expected demand.

LGA chairman, Simon Milton said: “A one per cent increase is insufficient to provide current levels of social care to an additional 400,000 older people who will turn 65 over the CSR period. To minimise service cuts, councils will be forced to raise council tax, meaning Government has transferred the burden to council tax payers.”

Reilly agrees. “Rising demographic pressures mean policy makers are fast running out of time to achieve a planned response if we are to avoid a crisis in the future.”

All believe that a public debate on where funding priorities should lie in adult social care is needed if the tug of war that social workers are caught in the middle of is to be tackled in the long term. They are hopeful that next year’s Social Care Green Paper can start to address some of these big questions.

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