Tips for social workers for when care arranged by clients breaks down

Where a person takes responsibility for arranging their own care, through a direct payment or self-funding arrangement, they may still need support from a care manager or other professional if care breaks down.

There are predictable circumstances that can lead to the breakdown of care, such as the sickness on the part of care staff or changes in the service user’s needs. These should be identified and responses agreed as part of the contingency section of the service user’s support plan.

Case example

Joseph lives alone, but is supported at the weekends by his daughter. As she works full-time, Joseph receives a direct payment to purchase his support during the week. He has arranged to purchase this from the Wonderful Life Care Agency. For the past six months, he has received care from Jenny, with whom he gets on well and with whose support he is happy.

One day, a new carer arrives to provide support for Joseph. He was unhappy with this as he has had no warning from Jenny that she wouldn’t be coming to see him as usual. The carer explained that Jenny has gone on holiday and that she is her temporary replacement.

Joseph complains to his daughter about this and she contacts the agency.  As far as it is concerned, Jenny is working as usual. Joseph’s daughter contacts his social worker to advise her of the above. Further enquiries by the agency reveal that Jenny has gone on holiday and asked a friend, who has no previous experience or training as a carer, to cover her work without telling the care agency because she didn’t want to lose her wages.

What should the social worker do?

The social worker should raise a safeguarding alert with regard to Jenny as she has put Joseph at risk of harm from an untrained and inexperienced carer and has breached her conditions of employment. On the information available, it would appear appropriate for the Wonderful Life Care Agency to carry out an internal disciplinary investigation and report back to local safeguarding agencies, under the safeguarding procedures, as to its findings and resulting actions, which could include the dismissal of Jenny and her referral to the Disclosure and Barring Service.

Tips for preventing the breakdown of care

• Ensure the service user’s support is kept under review, including through informal reviews as necessary.
  
• Ensure the service user and their family know how to contact you or their care manager/social worker to report changes in circumstances.

Tips for responding to cases of care breaking down

• Work to empower the service user in the management of their support by working with them to identify how continuity of care and support can be restored.
  
• This may entail arranging services on their behalf in the short-term alongside the relevant commissioning authority.
  
• It may be necessary to raise a safeguarding alert depending on the circumstances leading to the breakdown of care, for which you must refer to local safeguarding procedures.
  
• If the cause of the breakdown in services has implications for other service users they or relevant commissioners will need to be informed. Use your professional judgement as to when and how to do this.
  
• It may also be necessary to inform the regulator depending on the circumstances leading to the breakdown in care.
  
• Ensure your practice is Mental Capacity Act-compliant and that you support service users to take decisions for themselves.
  
• Clearly record your actions and the decision-making that led to them.

Guidance in using this briefing

This briefing should be used as a guide only and a trigger for reflection on specific situations; where relevant practitioners should seek advice from their organisation’s safeguarding lead and legal services. This guide should be read in conjunction with accompanying guides on how social workers should respond to cases where care arranged by a service user is poor or unsafe.

Pete Morgan is chair of trustees at the Practitioner Alliance for Safeguarding Adults UK and has produced this guide on its behalf. A qualified social worker since 1980, he is also independent chair of Worcestershire Safeguarding Adults Board but this article has not been produced in that capacity.