How social workers can deliver person-centred reviews

When Hartlepool Council went live with personal budgets in December 2007, they were offered to anyone new coming into adult social care who was eligible, as well as to existing service users at their review. The latter cases made it clear to the authority that its review process needed to change to become more person-centred.

In the past, reviews had been about checking whether a service user was happy with a service or placement. “But a review of personal budgets focuses more on whether users have achieved what they wanted to and looks at outcomes rather than the process,” says social care transformation manager Sarah Ward,  “So, we look at what is important to and for the user, what’s working and not working.”

[Read full coverage of Community Care’s annual personalisation survey, sponsored by Unison and The College of Social Work]

The council decided that the most person-centred way to carry out reviews would be for them to be conducted by the social worker or team that had carried out the original assessment, and so they restructured their teams.

Reviews as important as support plan

Ward, who wrote the council’s guidance on reviewing personal budgets but is also a social worker who carries out reviews herself, says: “We drummed home to social workers that the review is as important as the support plan.” Social workers soon learnt that reviews were meant to be a “natural extension of support planning”. So much so that support plans are not signed off unless the review arrangement is clarified within it.

The review should take into account what needs to be in place to improve and maintain the user’s situation and achieve agreed outcomes, she says. Also social workers need to be reassured that risks are being managed and the person is being kept safe.

“By being person-centred like this, a review gives you a true picture of what is going on,” adds Ward. “And moving review functions back to the assessment team improved their knowledge and relationships with users, and made it a much more transparent process for everyone.”

No standard timescale

While 56% of practitioners who resonded to Community Care’s annual personalisation survey said reviews generally took place annually, Hartlepool is clear that reviews should not be standardised.

“Reviews should be proportionate to the risks and support needs of the individual,” says Ward. “For some an annual review is adequate, but someone else might need a review every other month to check that everything is okay. Their social worker needs to work out the frequency with the user and their family and include it in the support plan.”

Social workers are now skilled in monitoring outcomes between formal reviews, she says. “Outcomes need to be kept alive and current so there should be regular opportunities to come together and discuss how they are going.”

Social work skills

This person-centred way of reviewing means that Hartlepool social workers need a range of skills and information, from basic knowledge of the minimum wage and employment issues and the options and support that users have if they want a direct payment, to knowing about services available locally and whether they are regulated or not. It is a different approach to the traditional service-led model of support, says Ward.

“Social workers should be considering things like whether the user wants to find friends, take part in the community, learn new skills and ensure they are receiving their financial entitlements.

“Whether you are doing an assessment or a review, if someone is saying that their support is not working for them, you need to be able to support them to find alternatives.”

Well prepared

Being well-prepared for a review is vital, says Ward, and finding out how a user wants to be involved forms part of that.

“Some users complete the majority of the review themselves – they do their own paperwork and accounts and really lead the process. Others may not be able to take an active part and may need representation. You also have to consider where the review is held, it has to be appropriate for them and where they feel comfortable. A clear action plan needs to come out of a review so that everyone knows who is doing what and what needs to be achieved.”

While 24% of respondents to Community Care’s survey said that personal budgets for most clients had decreased in value in the past 12 months following reviews – compared to 15% who said they had increased – Hartlepool only cuts the personal budget allocation if it is believed an individual no longer needs the service in question.

Of course, reviews are a way of taking stock of how well people are using money or resources and some type of financial audit is necessary. In Hartlepool, users are often given a budget sheet that is easy to fill in so that their social worker can see how much money they have coming in and what they have spent it on and can quickly see if there is a problem.

Impact on finances

“We didn’t bring personal budgets in to save money,” says Ward. She says Hartlepool’s experience is that increasing spending on service users following review can lead to savings over time.

“For example, two brothers with learning disabilities were using a respite service that they and their mother were unhappy with which cost us approximately £5,000 between them each year.

“We gave them a personal budget of £9,000 to buy a caravan for short breaks which is what they wanted to do instead. It was quite controversial at the time, but within two years it had paid for [what we would have spent on respite care]. Five years later they only need a personal budget for the annual caravan site fees and for some renovations and the caravan has really improved their lives.”

“Good person-centred work around reviews that focuses on outcomes is more resource-heavy timewise, but it results in better lives for service users and often fewer transactions and interaction from the local authority over time,” she adds.