Six ways councils are trying to combat a shortage of best interests assessors

We look at strategies councils are taking to boost BIA capacity to meet a surge in deprivation of liberty cases

Today, Community Care has published the findings from our investigation into the impact that a landmark Supreme Court ruling in March has had on social work teams handling deprivation of liberty cases.

The ruling, in the cases of Cheshire West and P and Q, has led to a surge in requests to councils for Deprivation of Liberty Safeguards (Dols) authorisations, which cover care homes and hospitals. It has also put an added strain on council legal teams who need to prepare more applications to the Court of Protection for deprivations of liberty in settings not covered by the Dols, such as supported living arrangements.

The ruling’s impact is far-reaching. It has many positives in extending protections of the human rights to some of the most vulnerable people – including people with advanced dementia, brain injury or profound learning disabilities. However, it has also exposed a systemic shortage of resources to handle the surge in cases. Here, based on action plans obtained under the Freedom of Information Act from over 120 local authorities, we consider some of the key workforce implications and look at how councils are looking to respond to them.

The key social work workforce issue: BIA shortage 

As we’ve shown today, councils have seen a nine-fold hike in Dols requests since the Supreme Court ruling in March. The staffing resources required for each Dols case is significant. Each authorisation requires six assessments. Councils estimate each Dols assessment process takes, on average, between 10 and 15 hours depending on complexity. If assessments are extremely complex or require travel to out-of-area placements, they can take a number of days.

The staff group the Dols process depends on most is best interests assessors (BIAs). This group of, mostly but not exclusively, experienced and specially-trained social workers, coordinate the Dols authorisations. They also carry out the key assessment, known as the best interests assessment, which determines whether a person is being, or will be, deprived of their liberty and, if so, whether this is in their best interests. A Dols assessment requires the BIA to visit the person, undertake a detailed analysis of care plans and records, speak to individuals involved in the case and complete detailed paperwork.

In 2012-13, around one in four councils said they didn’t have enough BIAs to meet demand. In the wake of the Supreme Court ruling, every local authority is short of BIAs and looking to boost numbers.

How councils are trying to boost BIA capacity

1. Turning to independent BIAs 

Many councils are now relying on independent BIAs and agency BIAs to boost their capacity. The data we obtained showed that £1.4m has been spent on indepdendent BIAs in the first five months of 2014-15, almost three times the £550,000 spent over the entire 12 month period in 2013-14.

There is, however, a shortage of even independent BIAs, certainly in some areas, and market pressures have seen bidding wars break out in some areas. Experts say councils are now offering up to £600 per assessment in some parts of the country. The price appears to depend highly on the competition. Our FOI research found that in Harrow – where the council pays an average of £360 per assessment – the council was finding it tough to recruit independents as another London authority was offering £500 per assessment. In contrast, the Isle of Wight said it had paid an independent BIA £200 for an assessment. 

2. Training more BIAs

Unsurprisingly, almost every local authority who responded to our FOI request is looking to boost BIA numbers. This is not, however, easy. Training a BIA is costly; as well as course fees and backfilling posts while staff are training, councils have to factor in the cost of meeting the 18 hours of refresher training each BIA is required to undertake each year.

Training also takes time; even condensed courses require someone being released from case work for 10 or 12 days. And the social workers who meet the required two years’ of practice experience to do the training are often highly skilled and much-needed members of their case carrying teams. One thing that came up in councils’ FOI responses is that courses are currently oversubscribed in some areas. In response, a number of training providers are putting on extra courses to meet demand, and the Department of Health is mulling over the idea of subsidising extra places.

Some councils are also looking to urgently arrange refresher training for social workers who have completed BIA training courses but, due to previous levels of demand for assessments being low, had not completed the required 18 hours of refresher training to allow them to practice.

3. Setting up dedicated Dols teams

Prior to Cheshire West, many councils were using a BIA rota system where assessors would combine one or two days of Dols work a month alongside their case carrying duties in adult social care and safeguarding teams. However, the surge in demand from the Supreme Court ruling means many councils are now setting up some kind of dedicated Dols team, with at least one full-time BIA.

The advantage is that a dedicated resource can focus purely on Dols. However, this move has led to concerns that, in pulling experienced social workers out of case carrying teams, safeguarding and other key services will be depleted.

One key statutory duty impacted is approved mental health professional work (AMHP). With many BIAs also practising as AMHPs, any shift in them doing more Dols work subsequently takes them out of AMHP duty availability.

Peterborough council’s action plan notes there is a “high level of conflicting priorities” between BIA work and AMHP duty. This is also an issue raised by a Stoke council report, which says: “The increased workload in their capacity as a BIA could potentially have an impact on their ability to fulfil their responsibilities to the AMHP rota. AMHP is also a statutory duty on the local authority and has serious potential implications should this not be met.”

4. Making BIAs do double the number of assessments per shift

Surrey County Council’s action plan shows that it plans to boost BIA availability by doubling the number of BIAs available on the weekly rota, increasing the frequency that BIAs are on the rota and ‘doubling the number of assessments each BIA is required to complete when on rota’. The council has also established two full-time BIAs and sponsored training for eight new BIAs in November and a further eight next March.

A council spokesperson said: “Quality is not compromised in any way [by asking BIAs to do more assessments per rota shift]. Prior to the Supreme Court judgement, BIAs on the rota would be advised in advance if they were going to be given an assessment and they would manage their diary around this priority task during their rota week.

“Post judgement, they know that they will be given two assessments and they clear their diaries for their rota week in advance. Completing two assessments in a week is comfortably within the Department of Health guideline (for their funding formula) of a BIA assesment taking on average seven hours (and is consistent with our own experience). Quality is checked by our Dols Team when the assessments are received from the BIA and again at the authorisation stage by the authoriser.”

Several other councils are also trying to increase the number of assessments their BIAs are doing, by offering to pay them overtime to work outside of their contracted hours.

5. Making the BIA role mandatory for social workers

A number of local authorities are considering making BIA training compulsory for senior social workers. Action plans we obtained from Cambridgeshire and Slough councils say that they are considering writing the BIA role into social worker job descriptions. Southampton council is developing a strategy to ‘train all new staff as BIAs’ and Wakefield council is considering whether or not to make all social workers and/or AMHPs train as BIAs.

“This will have implications on their own work in terms of being released to do the training and also undertaking assessments,” Wakefield’s plan states. “However, the more BIAs there are, the less risks there are and MCA is embedded into all practitioners’ work and their own caseload.”

6. Reciprocal arrangements for out-of-area assessments

A few local authorities, for example South Gloucestershire, have looked to set up reciprocal arrangements with other councils for out-of-area BIA assessments. However, the pressure in the system is so severe that other councils have struggled to implement any reciprocal arrangement despite wanting to. East Riding council’s action plan says that other councils were “unable to offer reciprocal resource plan due to [their] own Dols capacity issues”.

Other key workforce issues post-Cheshire West

Advocacy provision Independent mental capacity advocates (IMCAs) must be appointed by councils to represent people being assessed under the Deprivation of Liberty Safeguards (Dols), where the person has no-one else to consult, or to help family members represent their loved ones. With the exponential increase in Dols cases in the wake of the Supreme Court ruling, demand for IMCA services has also risen. As a result, several local authorities are having to review their IMCA contracts. For example, the Stoke council report shows a need to double the IMCA contract from £40,000 to £80,000 to meet the new demand. Cambridgeshire, Doncaster and Gloucestershire council’s plans also indentified the need to review their IMCA arrangements.

Mental health assessors Another key role in the Dols process is the mental health assessor, a doctor who has completed the necessary specialist Dols training, whose role is to assess whether the person has a mental disorder. A number of councils say that they are facing stiff regional competition for doctors at the moment, particularly as many will be independent and combine Dols work with Mental Health Act assessment work.

Strain on council legal teams The Supreme Court ruling also has significant implications for council legal teams. They expect an increase in the numbers of applications they have to submit to the Court of Protection to authorise deprivations of liberty in settings not covered by the Dols, such as supported living. An estimate prepared by Stoke council predicts that an additional two solicitors would be required.

More from Community Care

3 Responses to Six ways councils are trying to combat a shortage of best interests assessors

  1. Deb West October 8, 2014 at 2:04 pm #

    Please could you send me the reference or link to the Department of Health guideline funding formula for BIA assesments.
    many thanks