Personal budgets process ‘cuts social work productivity’, finds research

The implementation of personal budgets has reduced social workers’ “productivity” by adding new processes to traditional care management, finds critical research published today.

The model of providing people with an indicative budget following assessment, with which to support plan, was fundamentally flawed as, in practice, councils were carrying out a separate process to calculate the final budget after costing the support plan, the research claimed.

As a result, social workers and care managers across England were each assessing, reviewing or supporting far fewer people because of the extra bureaucracy that self-directed support had added to their role, said the paper, The study, by service user activist and social work professor Peter Beresford, social care consultant Colin Slasberg and statistician Peter Schofield, is based on two new pieces of evidence:

• A study of three councils in England comparing the value of indicative budgets and final allocations for newly assessed service users in 2011-12, based on Freedom of Information (FoI) requests;
• An analysis of changes in the volume of assessments, reviews and professional support packages delivered by councils in England from 2007-8, the year before personal budgets were rolled out, to 2010-11, and in the number of field work staff employed by adult social services departments, based on local authority statistical returns to the Health and Social Care Information Centre.

Significant disparity between indicative and final budgets

The FoI-obtained data comparing the costs of final and indicative budgets found that the average ratio between them was 2.45, 2.59 and 2.81, respectively, in the three councils. This means that there was a two to threefold difference between indicative and actual budgets across the 5,000 cases covered, with a mixture of cases in which the indicative or the final budget were higher. The 2.45 ratio in the first council could mean that a person given an indicative budget of £245 a week may receive a final budget of £100 a week, or vice versa.

Researchers also obtained data from Hartlepool Council dating back to 2009, drawing on research by In Control into its implementation of personal budgets; this showed a 3.84 variation between indicative and actual budgets.

Though they admitted the sample size was small, the researchers concluded: “[This] suggests that the sign-off of the budget appears to be not so much a quick check on whether the figure created by the up-front [indicative] allocation is enough but an entirely separate decision that stands alone from the up-front process.”

Loss of social worker ‘productivity’

The study also found that, from 2007-8 to 2010-11, the number of annual reviews of existing service users carried out by councils in England fell by 14%, the number of service users receiving professional support each year from council social workers and other practitioners fell by 27% and annual numbers of assessments were stable.

However, over the same period, the number of full-time equivalent field work staff in adult social services, who would typically carry out these three roles, rose by 8.6%, suggesting lower levels of “productivity” per worker.

Bringing the two findings together, the researchers concluded that the implementation of personal budgets had made assessments more time-consuming through the process of establishing indicative budgets; as field work staff were spending more time on each assessment, and the number of assessments had remained constant, they were unable to carry out as many reviews or deliver as many professional support packages.

“[The findings] point to the likelihood of a significant increase in bureaucratisation since self-directed support was formally introduced, resulting in major losses of efficiency,” it said. “The evidence strongly suggests that far from the up-front allocation process replacing existing processes, it has simply added to them.”

Social workers bemoan bureaucracy

The findings chime with the results of successive Community Care surveys of social care professionals on personalisation, in which a majority of respondents have said that its implementation has added bureaucracy to their role, citing the assessment process as a particular cause.

Social care leaders, through the Think Local Act Personal (TLAP) coalition to support implementation of personalisation, have acknowledged the problem and made reducing unnecessary processes a priority, including by ensuring a closer fit between indicative and final personal budgets.

A framework for minimising processes produced by TLAP in October 2011 said: “The indicative allocation amount should be as close as possible to the final
approved budget – if it is not then there is a high risk of wasted process (as well as frustrated staff and customers). Adjustment to the [resource allocation system] may be required.”

Proposals for ‘meaningful personalisation’

In the last section of the paper, the authors put forward proposals for delivering what they call “meaningful personalisation”. They said most service users valued choice over how mainstream services were delivered more than the ability to purchase services from the market.

This meant that councils needed to work closely with providers – both traditional providers and user-led and community organisations – to develop flexible and responsive services.

People would receive an assessment that identified the full range of needs they had to meet “reasonable expectations of well-being” and would be able to draw up a plan on this basis. Though it would currently be unaffordable for councils to meet all these needs, a new eligibilty framework would help them make “sensible and fair” decisions about which they could and could not afford.

Practitioners would work with them in a person-centred way to agree outcomes and the best way of achieving them within the resource framework.

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