NHS cuts put pressure on social workers over assessments

Council social care professionals are facing increased workload pressures and disputes with NHS colleagues as primary care trusts seek to cut funding for NHS continuing care.

Community Care has heard cases of adult social care teams having to undertake multiple continuing care reviews in a short timescale following referrals from PCTs, and of social workers having their initial assessments of service users for continuing care questioned by NHS colleagues.

The situation is being triggered by PCTs reviewing the eligibility of existing continuing care clients and taking a tougher approach to assessing new clients, in order to manage costs.

More than a quarter of PCTs oversaw a 10% cut in the rate of access to continuing care in their areas between January and April 2010 and the same period this year, though the national rate increased from 49.7 to 52.5 per 50,000 population.

College of Social Work spokesperson Ben Martin, a learning disability social worker in a rural area, said his PCT colleagues were increasingly questioning his initial screening assessments of potential continuing care clients.

“What has increased is the extent to which CHC assessments are disputed. They don’t tend to question the result [of a social worker’s screening assessment]. What they will question is the detail and the justification. We need to give them a written explanation of why we have given them this score which takes up a lot of time.”

The NHS was also insisting that screening assessments be carried out by social workers, rather than other social care workers in his area, increasing pressures on professionals.

“In the last week I’ve had to do three CHC assessments with people I’ve not worked with before,” he added. “So my ability to make a reasoned judgement is inhibited by the fact that we have to process these assessments.”

In other areas, PCTs have given councils just two days’ notice to attend continuing care reviews or asked adult care teams to carry out a high number of reviews in a short period of time, Community Care understands.

Martin said approaches to continuing care had changed significantly during his two-and-a-half years as a social worker. “Within my lifetime as a social worker – which is two and a half years – we’ve had four rounds of training and in many cases it’s been entirely different from what we’ve been doing before.”

He said the impact on learning disabled service users with high but not very severe needs was significant.

“The continuing care threshold is incredibly high. For people whose needs are extremely high but they are not on a respirator or connected to a dialysis machine, these people are really struggling.” He said it was difficult for clients in this position to access universal NHS services, particularly in rural areas.

NHS leaders have defended the reductions.

A spokesperson for NHS South Central, where rates of access fell from 45.4 to 37.5 people per 50,000 population from 2010-11, said the national framework for continuing care was being correctly applied in the region.

“Although numbers have declined, we rank fourth in the amount of money spent on continuing healthcare per head. Thus, the data suggest that our PCTs provide a higher level of care for a smaller number of people with more substantial need, which would seem to be in line with the government’s policy on long-term care.”

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Councils face mounting pressures as PCTs cut continuing care