How bureaucracy is derailing personalisation

Jeremy Dunning asks why bureaucracy is derailing personalisation and what can be done to rescue the policy

(Article updated 21 July 2011)

When an architect of a policy damns elements of its implementation, you know the original vision has been lost somewhere along the line. And so it is with personalisation.

Simon Duffy, who helped develop the original resource allocation system (RAS) concept, bemoans the “managerial nonsense” that now dogs the process for determining the value of personal budgets through assessment.

The results of Community Care’s personalisation survey commissioned by Unison suggest his complaints are echoed at the frontline; 73% of respondents (up seven percentage points from last year) say personalisation has created more bureaucracy.

The comments of one social worker who responded to the survey are especially striking: “I believe that a very sound principle has been taken by the organisation and used to manage resources. Assessments agreed by qualified social workers are questioned in funding resource panels and changed in that forum.

“The ensuing paperwork has increased by 40%. This would not matter if social workers felt that their assessments were trusted by managers.”

Assessment questionnaire

Duffy, who developed the concept of personal or individual budgets as director of In Control from 2003 to 2009, says one side of A4 is the ideal length for an assessment questionnaire – but those used by some authorities run to 40 pages.

“What’s happened is that managers started to see the RAS in the late 2000s as a tool for doing too many things – in particular as a tool to manage social workers themselves – so there’s been a failure to trust social workers as professionals who can make reasonable assessments about what a fair allocation should be,” he says.

One reason for the increase in bureaucracy is the complexity and proliferation of self-assessment forms. Many respondents to our survey said they did not have enough time with service users to effectively support self-assessment.

Professionals also say standardised assessment forms created by companies such as Face Recording and Measurement Systems are too complex, while funding panels are overly bureaucratic. A care management approach, where social workers act as gatekeepers on resources, is also a factor.

Systems

In addition, some councils are running both old and new assessment systems.

This is frustrating many social workers and users, who think form-filling is corrupting the ethos of personalisation.

One social worker says: “I don’t believe the bureaucracy is caused by personalisation. Personalisation is the only thing around that stands for real social work. Actually I think it’s care management that is hitting us with bureaucracy.

“Those of us doing needs assessments [in my authority] are under pressure to drop the way we had been working and instead do Face assessments which to us are completely impersonal, more bureaucratic and have no substance.”

However, Face Recording and Measurement Systems managing director Dr Paul Clifford says that its assessment tool has met 13 criteria set by the Department of Health for being “person-centred”. He argues that the causes of bureaucracy in personalisation lie elsewhere, in the efforts to create simple self-assessment forms for users, which fail to capture sufficient detail, leading to further assessments being required at the support planning stage. Its own assessment tool is an attempt to avoid this problem, he says. [Read Clifford’s full response.]

Users, meanwhile, see the levels of bureaucracy as a form of control over how they lead their lives, says Sue Bott, chief executive of the National Council for Independent Living.

“People are getting very frustrated because what they are telling us is they are being prescribed as to what they can use their personal budget for,” she says.

Jeff Jerome, national director for social care transformation, admits the level of bureaucracy is one of his “biggest worries” in the implementation of personalisation.

Light touch

It should be light-touch to allow people to get on with their lives, he says.

He believes the problem is endemic within councils, which encourage staff to take a “conservative and cautious approach to process, which they do to protect themselves”, though he says there are examples of good practice.

There are, however, solutions to the bureaucratic nightmare that confronts many social workers.

Jerome has long argued that resource allocation should be simple and transparent, while forms should only be filled in if there’s a good reason. Ideally, people require advice and information to help identify a set of outcomes, he says.

Ruth Cartwright, manager for England at BASW – The College of Social Work, says social workers’ lives could be made much easier if there were fewer, simpler and clearer forms containing free-text boxes for service users to outline their difficulties.

Duffy argues that social workers should not be asked to create “unduly complicated RASs” while also gathering information “in ways that are out of date or irrelevant to new ways of working”, as happens in some councils.

Both Bott and Jerome agree that the support plan should not be extensive.

“Some of the best plans I’ve seen have been where [service users] have made up their plans themselves,” says Bott. “I really can’t see what the problem is with people telling their stories.”

Efficiencies

John Bolton, the former Department of Health civil servant who led on the implementation of the Putting People First agenda to personalise care in England, points to work he carried out in Wales on achieving greater efficiencies in older people’s services.

He found that some Welsh councils had managed to direct people away from social care through a combination of providing good advice at an early stage and good reablement services.

“This means you have fewer people needing a social care assessment and more time for staff, if you retain them, to assess people who really need an assessment of their needs,” he says.

Clearly, bureaucracy needs to be re-examined and councils must ask themselves why they are conducting certain bureaucratic practices.

This comes at a time when councils are more concerned about preserving scarce resources.

And, with personalisation viewed as a means to cut services and save money, this creates dangers for true personalisation. However, as Jeremy Cooper, from consultancy iMPOWER, says: “If done well, a transformed social care process including personal budgets has much less bureaucracy and process than before.”

Kelly Hicks (above), independent social worker, Doncaster

One of the reasons I chose to leave local authority employment was because I wanted to spend more time with the actual people I was supporting.

As a local authority social worker I became disillusioned with the implementation of personal budgets and found that more and more my role was filled with sitting in front of the “risk panel” – fondly named the Dragons’ Den – trying to justify why Mr Smith chose not to go to a day centre and wanted to go fishing instead.

Social workers I speak to are often reluctant to encourage people to find alternatives to traditional care because of the very experience of the “risk panel”, and opt instead for “safe”, “traditional” proven and failed methods of meeting needs.

However, as an independent I’m not subject to less bureaucracy, and it may have even increased.

Being on the “outside” is sometimes perceived as a negative by authorities, and some have not yet understood that independent support actually frees up local authority time and expense and brings experienced guidance to support local authorities in making judgements.

But some authorities refuse to supply an independent social worker with an electronic support plan template, then refuse to accept a perfectly good support plan that is not written on their template.

Some social workers have to re-write a plan prepared by a service user onto the “official” template.

This is equally undermining for the actual service user, a model citizen empowered enough to prepare their own support plan, who is then told it must be done by a social worker employed by the local authority.

Some local authorities even refuse to agree direct payments to individuals if they wish to purchase the support of an independent worker to develop their plan.

I must add that some local authorities are much more forward thinking. Take, for instance, Sheffield Council, which is actively supportive and inclusive of the support that independents can bring to the city.

What I think has been lost is common sense, trust in social workers to be able to make professional decisions and to manage risk, and trust in service users as being best placed to self-direct their own support.

Hartlepool has engaged social workers by cutting processes, says head of service Geraldine Martin (left), who is pictured with social care officer Nicola Twydale and transformation manager Sarah Ward (right)

Geraldine Martin, head of service, Hartlepool

‘We’ve tried to keep the process as lean as we can,” says Geraldine Martin, head of service for adult social care at Hartlepool Council, which implemented personalisation in 2007 and subsequently cut back on the numbers of assessments and forms that must be completed by its social workers.

Strong and focused leadership asked questions about what was truly necessary, leading to a reduction in the numbers of assessments and reviews, she says.

When the council went live with personal budgets, Martin admits that admin was “fairly cumbersome” because it was running the old assessment process and the new one side-by-side. But this was ultimately slimmed down to one self-assessment questionnaire once it was clear that staff were comfortable with the new way of working.

The support plan process has also been kept lean and concentrates on outcomes, ensuring people are aware of how much money is involved and what will help them move forward to meet identified goals.

The council has also developed its review process so a person no longer has to go through a formal procedure if nothing has changed in their lives and their needs are still being met.

The same thinking has been extended to the financial side, meaning team managers are able to sign off personal budgets for many users without their cases having to go before the council’s risk-enablement panel.

While the panel still meets weekly, it only considers support packages for users of mental health services, people in transition from children’s to adults’ services, those with early onset of dementia and those whose plans lie outside the resource allocation system.

Combined with this, the council has also introduced a new piece of software that tracks data and has also reduced bureaucracy levels. Managers can approve personal budgets with the press of a button rather than manual sign-offs.

Martin says the overall effect is that social workers feel positive about what they are doing rather than being overly worried about risk and bureaucracy.

“Last year In Control asked me to do a bit of an update to see if the approach had engaged and it had – it was embraced by our social workers,” she says. “They were positive about how personal budgets increased people’s control and there was less care management across the piece.”

The message for other councils is to invest in supporting social workers with the systems and paperwork, she says.

But Martin is not complacent, and adds: “We could cut the bureaucracy down further.”

Read personalisation charity In Control’s report on Hartlepool’s experience.

Personalisation problems

● Too many assessment forms.

● Forms overly complicated.

● IT systems used by different organisations don’t talk to each other, requiring inputting of data.

● Funding panels overly bureaucratic.

● Increased use of standardised assessment forms that sometimes do not allow for creative packages.

 Comments by social workers

“Personalisation has greatly increased our workload, much too much computer work, having to complete tasks such as working out PA annual leave and NI etc”

“Extra work! More forms to fill in to get the budget and then justify the budget. More inputting on the computer just to prove someone has a budget and how it is spent”

More on Community Care/Unison’s personalisation survey

Social workers says bureaucracy is damaging personalisation

Support for personalisation plummets among social workers

Councils dogged by slow progress on personalisation

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