Sharp fall in reviews prompts concerns over impact of care management

Reviews may not be being prioritised by authorities in face of budget reductions, says report from Towards Excellence in Adult Social Care programme.

A sharp fall in the number of care reviews carried out by local authorities last year has prompted concerns over the quality of care management from sector leaders.

Council care managers reviewed the needs of 871,155 existing service users in England in 2012-13, a fall of 13% since 2011-12, according to social care activity figures released last month by the Health and Social Care Information Centre. This exceeded the 9% fall, to 1,332,995, in the number of people who received services from councils in 2012-13, compared with 2011-12. This means the proportion of service users who received a review fell from 69% to 65% over this time.

The sharp fall in reviews was concerning, said an analysis of performance published today by Towards Excellence in Adult Social Care (TEASC), the coalition of sector leaders tasked with supporting local authorities to improve in adult social care.

“The reduction of reviews is not consistent with an improving picture of care management, especially since reviews are valuable as a means to ensure that people are safe, and to assess and review the costs of packages of care,” said the report. “It may be that reviews are not prioritised as highly as safeguarding referrals when capacity is an issue.”

TEASC said the increased focus on outcomes in social care would suggest that reviews should be becoming more, rather than less, frequent, and said the reduction “may be seen as an increased risk” for service users, particularly those with deteriorating conditions.

It also suggested that the fall could be explained by higher turnover of cases among home care service users and an increase in the number of people receiving short-term interventions, reducing the numbers or recorded service users who would have an annual review of their needs. However, elsewhere in the report, TEASC said that a number of those receiving short-term interventions would not be recorded as service users in the first place.

The number of assessments fell by 0.5% from 2011-12 to 2012-13, according to the HSCIC, but the report revealed significant regional and local variations in the number of assessments carried out by councils. For example, in the North East and South East about 1600 adults in every 100,000 had their needs assessed in 2012-13, compared with about 1100 in London and 1200 in Yorkshire and the Humber. Also, assessment numbers fell sharply in some regions, such as the South West and Yorkshire and the Humber, and rose in others, such as the South East and East Midlands.

TEASC said that the increasing numbers of older and disabled people in the population would be expected to drive increases in the number of assessments across the board, so the wide fluctuations needed to be better understood. It said the data suggests “widening variations in the service models and business processes that councils use for assessment and support”, particularly in the use of reablement.

About the figures

The figures used in this story are taken from the HSCIC report, Community Care Statistics, Social Services Activity, England 2012-13, provisional release, with the exception of the number of adults assessed per 100,000 in each region, which are taken from the TEASC report.

The HSCIC data covers all 152 councils in England with estimates made where they have not submitted full data returns. The TEASC report excludes such estimates in calculating the number of assessments, reviews and service users in 2011-12 and 2012-13, meaning its figures are slightly different from the HSCIC’s.

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