Councils may have to outsource low-level assessments to free up social workers for more complex cases and deal with a big hike in demand arising from care funding reforms.
That was the message from the Association of Directors of Adult Social Services (Adass), the Local Government Association (LGA) and council chief executives’ body Solace, in their response to the government’s consultation on the reforms, under the Care Bill.
Councils are expected to assess an additional 180,000 to 230,000 people and carry out an additional 440,000 to 530,000 reviews in 2016-17, because the reforms will incentivise many more self-funders to approach their council.
Only by having their needs assessed and regularly reviewed will self-funders be able to take advantage of the £72,000 cap on their eligible care costs that is the centrepiece of the government’s funding reforms. This would provide them with an “independent personal budget”, setting out what their council would spend on their care if it were meeting it, which would accumulate in a “care account” until they reached the cap.
The government has previously estimated that the assessment and care management costs of the changes would be £200m a year. However, the three associations warned that it was “extremely difficult to model this cost” and called on the government to publish as much detail on costings “as quickly as possible” so that the sector can analyse the implications.
Triage system for assessments may be needed
Whatever the level of additional government funding, the associations said the delivery of assessments would need to change. It suggested that a “triage” system may need to be created to divert people without eligible needs away from approaching their council for an assessment, while providing them with information and advice.
It said this could be outsourced to national third sector organisations, though it would have to be made clear to these providers that their role would be to provide information and signposting, not advocacy for people to access services from their council.
Third sector bodies, or care providers, could also take responsibility for carrying out low-level checks on the needs of people who simply required an assessments to start their care account.
Freeing up social workers and alleviating pressures
“This would free up professional social workers to conduct the more complex and ‘technical’ assessments and alleviate capacity pressure.” Such outsourcing echoes the government’s own thinking on the way the hike in assessment demand would be managed.
Adass, the LGA and Solace also backed government suggestions that service users may undertake more self-assessments, with the help of family members or friends.
“If a two-tier system of assessment develops we will need to work swiftly across central and local government to develop guidance on what different levels of assessment might look like,” said the consultation response.
The associations also strongly criticised draft government proposals for national eligibility criteria, which they said were rooted in a “deficit model” that provided support to people on the basis of what they were unable to do. This was in “inherent tension” with the rest of the Care Bill’s focus on building a care system that focused on promoting independence and well-being, for example through new duties on councils to provide preventive services, information and advice.
Financial risks to councils
Much of the response is concerned with the possible financial risks to councils of the reforms and what the associations see as the lack of government funding for them. They warned that:-
- With councils having taken £2.68bn out of adult social care since 2011, the system is substantially under-funded and the reforms will be difficult to implement without improving baseline funding levels. However, current government funding plans will not address this, as council budgets are set to fall year-on year.
- The £335m provided for councils to prepare for the funding reforms in 2015-16 is not sufficient, nor is it new money as it is simply taken from from the government’s funding settlement for councils for that year.
- While the proposed national eligibility threshold is designed to be equivalent to the current ‘substantial’ band used by most councils, the associations believe that it is closer to the lower ‘moderate’ threshold, meaning implementing it will carry “a significant cost implication”.
- Councils will be exposed to significant risks from the establishment of a universal deferred payments scheme to enable homeowners to retain their homes after moving into residential care by taking out a low-interest loan from their council against the value of the house. The associations raised concerns about debts being unpaid and about lost council tax receipts from these homes, and called on the government to underwrite the risks facing councils.
- There is no definition of ‘care and support’ in the Care Bill, meaning that councils could become liable for providing a wide range of support through the social care system as a result of legal challenges that effectively lower the threshold for eligible needs.
Despite their concerns, the associations said they remained “committed to overcoming these challenges and mitigating these risks” through dialogue with the Department of Health. This has been enabled by the creation of a joint programme management office for the implementation of the Care Bill, including DH officials and staff from Adass and the LGA.