Advice for social workers for when care arranged by clients is poor

Care or support can be defined as poor if it fails to meet expected standards, without necessarily putting the service user’s safety at risk. These standards should be set out in the service user’s support plan and responses agreed where standards are not met in the contingency section of the plan.

Case example

Peter, a 50-year-old man with a chronic health condition, needs assistance with all his personal care, including washing and dressing in the morning and evening.  He receives a direct payment from the local authority to purchase his own care and has chosen to directly employ a team of personal assistants. This situation has been operating successfully for some months and Peter gets on well with his carers.

One of the carers has contacted Peter’s social worker to say that they have noticed that Peter is looking a bit dishevelled when they take over from the other pair of carers. He can smell a bit and often hasn’t had a shave or the shaving has not been done very well. Today she noticed that his clothes are not done up properly. He then tells her that he feels very sorry for the other carers. He says that they are so busy they hardly have time to help him get dressed, let alone washed and shaved. He says they also seem worried about losing their jobs.

The social worker contacts Peter who tells her that he likes his carers, that he is fine, doesn’t mind that they don’t have time to do everything that he needs every day and doesn’t want anything done this.

What should the social worker do?

On the assumption that Peter has the capacity to make the decision not to take any action about the two carers, his autonomy ought to be respected, but he should be supported to take the appropriate action to maintain his independence. This could mean reviewing his direct payment to make sure it is sufficient to purchase the care he needs and may involve making sure the carers are not exerting undue influence on Peter to prevent him addressing their performance.

The social worker should inform her manager as there is also the issue of the possible misuse of public money if Peter’s needs are not being met fully and properly. At this stage, it would appear unlikely that the local thresholds for implementing the safeguarding procedures will have been met, but in supporting Peter, the social worker may well identify other concerns regarding the relationship between Peter and the two carers which would require their implementation. Of importance is ensuring that the whistle blower feels that they have been listened to and their concerns taken seriously.

Tips on managing cases where care arranged by a service user is poor

• The prime responsibility is to empower the service user, assuming they have capacity, to ensure their identified social care needs are appropriately met to their satisfaction.
  
• This may entail negotiating on their behalf with the service provider to amend the way services are delivered.
  
• Where the poor care 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.
  
• 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 on 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 article should be read in conjunction with separate guidea on responding to cases where care arranged by a service user becomes unsafe or breaks down.

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, although the piece is not written in that capacity.