Councils have been urged to replace social workers with non-professionally qualified staff in assessments and reviews, on the grounds this can save money without hurting quality.
The recommendation comes in a report today from the Audit Commission, which found that £180m-£310m a year could be saved from annual adult social services spending in England – about 1% to 2% of the total – if councils with relatively high spends on assessments and reviews reduced their costs towards the level of lower spenders.
The biggest potential area of saving was from “changing the mix of staff grades and skills that councils employ” to carry out assessments, by replacing social workers and occupational therapists with social work or OT assistants or other staff without professional qualifications.
It also suggested pay could be reduced for social workers in some areas, so long as this did not hurt recruitment and retention. The commission has provided councils with a benchmarking tool to examining how far they could change their staff mix and pay rates to the level of comparable councils..
Social work bodies’ alarm
The proposals sparked concerns from social work leaders, who said the report had not taken account of the views of social workers or service users and carers, who valued social workers’ input, or recognised practitioners’ vital role in areas other than assessment or review.
The report could spark a knee-jerk reaction that put social workers’ posts at risk from councils “with a desperate need to save money in the face of draconian cuts”, warned British Association of Social Workers England manager Ruth Cartwright.
“If you just want a tick box form completed focussing on all that someone cannot do and prescribing care in 10 minute chunks you may not need a qualified social worker to do this,” she added. “If however you want a person to be engaged in discussion about their needs and their strengths, to be helped to come to terms with any difficulties, to be part of a process along with carers and family as appropriate to enable them to receive good support in more than just the practical areas of their life, then you need a social worker.”
“Replacing social workers with unqualified staff to carry out aspects of assessment and review, as the report recommends, may result in efficiency savings, but vulnerable people must not be put at risk,” said Anne Mercer, the College’s professional adviser. “Risks, if inappropriately managed, may themselves incur costs.”
“We would have liked the Audit Commission to have been more supportive about the developing role of social workers in adults’ services other than assessment and review, including protecting adults from harm, supporting them to live independently and preventing unnecessary hospital admissions, and the coordination of care.”
Directors reject pay cuts
While welcoming the benchmarking information in the report, the Association of Directors of Adult Social Services rejected the case for reviewing pay rates “simply to make savings”.
The commission stressed that assessments of people with more complex needs should be carried out by social workers and that professionals could be freed up for these cases by passing less complex work to non-qualified staff. It also said there would need to be investment in training to equip non-qualified staff for an increased assessment role.
It also identified other sources of savings from the assessment and review process in councils with higher costs in these areas, including by increasing the number of assessments and reviewed carried out by each member of staff and improving information and advice to divert people away from the assessment process.
Behind the findings
The commission compared two groups of councils with similar characteristics in terms of the proportion of older people that receive services or that are in residential care, the time taken to complete assessments and organise care packages, and the number of reviews carried out a year.
However, for one group, which included 13 councils, the average cost of an assessment was £830, whereas for the other group, of 14, it was £2,249 in 2010-11. At the same time there were no significant differences between the groups in either quality judgements made by the Care Quality Commission in its final annual performance assessment in 2010, or in performance in a separate CQC “mystery shopper” exercise on the quality of councils’ response to first contacts from potential service users.
The Audit Commission then looked at the proportions of assessments carried out by social workers, OTs or other professionally qualified staff, and those carried out by non-professionally qualified staff, including social work assistants or OT assistants.
The latter group undertook 42% of reviews in “low-cost” councils and 30% of reviews in higher-cost authorities. The low-cost councils spent £53,000 per member of assessment staff per year while the latter spent £96,000 per staff member per year. Data from 17 of the 27 councils from the National Minimum Data Set for Social Care found annual median salaries for social workers were £3,250 lower in the low-cost than the high-cost group.
The analysis was based on information submitted by councils to the NHS Information Centre as part of their annual data returns.
Does the case for replacing social workers with non-qualified staff stack up?