*Some names have been changed
Social workers feel under pressure to reduce care packages for vulnerable adults, with some fearing the reductions are unfair and unsafe, a Community Care survey has revealed.
More than two-thirds (68%) of the 469 social workers and other care assessors in England who responded to the survey said they were expected to cut people’s care because of budget pressures within their council.
More than a quarter of respondents (28%) also said they did not feel confident that the reductions they have made to care packages were fair or safe.
The survey was carried out by Community Care and the Care and Support Alliance, a coalition of over 80 charities representing older and disabled people and their carers.
It also found:
- Less than half of respondents (43%) felt decisions about a person’s care and support were being left to their professional judgements.
- More than a third (37%) said they felt unable to get people the care they need.
- Less than half (38%) felt supported to have difficult conversations with service users and their families about meeting needs and changes to their care.
BASW said the findings highlighted the complexity of adults’ social work and the “increasing pressures of budget and target driven demands”.
UNISON said the impact of council cuts had been “devastating” and social workers’ professional judgements should not be “restricted by dwindling budgets”.
The Association of Directors of Adult Social Services said social care remained at a tipping point and the survey laid bare the “invidious decisions” social workers are making every day.
The findings are set in the context of six successive years of cuts to council budgets. Since 2010, directors have made £5.5.bn worth of savings from adult social care, and estimate that another £1bn needs to be found this year. Efficiencies and back office savings options have been exhausted, which means care packages have come under increasing scrutiny.
Last year, ADASS said 24% of planned savings for 2016-17 were due to come from reducing people’s personal budgets, or cutting back services. This fell to 19% for 2017-18.
In November 2016, the Local Government and Social Care Ombudsman reported that in 2015-16, it received 600 complaints about assessments and care planning; more than any other area of adult social care. It upheld 59% of the 300 complaints it investigated in detail.
The ombudsman’s report also warned that while the pressures on council budgets were well understood, local authority care provision should be determined by an individual assessment of need and take into account a person’s preferences.
Community Care also found eight examples of cases investigated by the ombudsman in the past 12 months, where councils were criticised for reducing care packages without a proper assessment of need, without explanation, or without considering the impact on individuals.
The majority of respondents to the survey (83%) had cut at least one care package in the past 12 months. Most (54%) said they had cut between one and 10, while 13% said they had reduced more than 20. The three types of support being cut most frequently were social and leisure activities, domestic tasks, and support to help people access their local community.
‘Losing a lifeline’
“Transport seems to be a major cutback. It used to be a local authority-run service but is now commissioned out. We’re encouraged to use the ‘door-to-door’ service because it’s cheaper and something that the service user can pay for.
“However, it doesn’t turn up at the times the day centre opens and so service users miss several hours a day of the centre experience. This is a big deal to people who use those centres as their lifeline.”
Source: a respondent to the survey
‘Change in need’
Respondents were also asked to list, in a free-text box, the reasons why they had reduced care packages. While a change in needs was listed as the most common reason, many also cited budget pressures and restrictions around the types of support their council will fund.
Some social workers said they were facing pressure from managers to reduce people’s care and support, or that the ‘strengths-based’ approach, a model of assessment which focuses on people’s strengths, rather than what they can’t do, was being used as a guise for cuts.
A number of respondents also pointed to a rise in the creation of funding panels, which are usually made up of service managers, to make decisions about care packages.
Earlier this year, a legal expert warned panels were now “rife in local authorities”, but were not being used in line with the Care Act. The guidance says panels might be appropriate for signing off large or unique care packages, but should not be used to “amend planning decisions, micro-manage the planning process, or be used purely for financial reasons”.
One social worker responding to the survey said:
The council has decided they will no longer fund medication or lunchtime calls. These reductions are being agreed at a panel without social work recommendations.
‘No choice and control’
More than three quarters of respondents (83%) to the survey did not think there was enough varied and quality provision in their local area to ensure service users had genuine choice and control over the care they receive.
Under the Care Act, local authorities are expected to shape local care provision to ensure it meets the needs of all people who require care and support, regardless of who funds it. The guidance states that councils should encourage a “diverse range of appropriate, high quality services” and ensure “the market as a whole remains vibrant and sustainable”.
More than half of respondents (51%) also said their council was placing exclusions on what people could spend their personal budget on to meet their eligible needs. Transport, social activities, shopping and other domestic tasks were again frequently mentioned.
One social worker responding to the survey said:
It has become so much more stringent lately. Everything has to be itemised and decided upon in advance. It removes the spontaneity of choice – and that, in itself, is restrictive
In-depth interviews with social workers who responded to the survey further highlighted the difficult decisions they are having to make in the current financial climate.
Sarah*, a social worker in the West Midlands, told Community Care that the atmosphere on the frontline in adults’ services now felt “very restrictive and frustrating”.
The Care and Support Alliance: ‘How ‘personal’ are personal budgets in 2017?’
“As a social worker you come into the profession because you want to help people improve their quality of life, but it feels like you are becoming increasingly limited in your ability to do that and there is an ever-growing number of hoops to jump through,” she said.
Sarah said the toughest conversations were with service users who had received support for 20 years and this was now being questioned, despite there being no change in their needs.
“I find that very difficult and I’m not sure how comfortable I feel with that legally,” she said.
“We’re not supposed to do reviews just to cut care packages and you’re not supposed to necessarily cut things unless there has been a change in need.”
‘Expectation to reduce’
Lucy*, an agency social worker who has worked in Greater London and the North of England, said she has seen an increasing use of funding panels, with one council she worked for using a panel to agree “every financial decision or review”.
The social workers would often decide what would best meet the needs of a person, only to be told to try something else, she said.
“Things were taken out of our hands. At that point the panel were almost making casework decisions and telling you what you needed to do,” she said.
“I really hated that and so did all the other social workers I came across.”
She added that there was “no doubt” decisions about care were being financially driven, and sometimes “your professional opinion is overridden because of the need to reduce costs”.
“At each review there is an expectation [to reduce] – it’s dressed up in terms of value for money, because that doesn’t sound quite so bad as reducing people’s care,” she said.
“But that’s what service managers do, they sit in their office and work out how to reduce these expensive care packages because that is what the council is expecting them to do.”
Maris Stratulis, manager at BASW, said: “The survey results highlight the complexity of social work with adults and the increasing pressures of budget and target driven demands. Social workers are experts in their own profession and need to be afforded the respect, value and support to do their job effectively, remaining person-centred at all times.
“BASW, ADASS, the Local Government Association, and other user and carer groups have an important role to play in highlighting the impact of budget restraints and finite resources to MPs and ministers. We must constantly strive to ensure high standards of professional practice and keep users of services and their carers at the heart of what we do.”
Matthew Egan, social care officer at Unison, added: “Social workers and other staff should be able to make care assessments based on their professional judgement and not be restricted by dwindling budgets. The huge cuts ministers have made to council budgets have had devastating consequences for the provision of care to those people in need.
“We see people effectively being abandoned and let down. It is not fair on social workers and it’s certainly not fair on care users.”
Caroline Abrahams, co-chair of the Care and Support Alliance, said it was impossible not to be “angered and saddened” by the social workers’ descriptions of what the cuts mean for older and disabled people, and those with mental health problems.
She added: “It is though important to remember that while social care is a service administered by councils, the buck stops with ministers, and the suffering that vulnerable people are experiencing today is the direct result of the decisions successive governments have made to underfund social care.
“The extra £2bn this government has pledged will certainly help but the funding gap is far larger, so the situation is certain to worsen without further action.”
Margaret Willcox, president of ADASS, said: “This telling and poignant report lays bare the invidious decisions that are having to be made by social workers and managers every day.
“Working within finite budgets is challenging and staff have to consider how best to meet assessed needs within those financial parameters. Adult social care remains at a tipping point and this survey is further evidence of why the issue needs to be treated as a national priority. We look forward to contributing to debates about funding a long-term sustainable solution to adult social care funding and delivery.”
A spokesperson for the Department of Health said: “We know social workers do incredible work and we want to make sure that everyone, especially older and vulnerable people, receive compassionate care. That is why we have enshrined in law in the Care Act that local authorities must assess and meet the needs of people in their area.
“We have provided an additional £2 billion for social care and have committed to consult on the future of social care to ensure sustainability in the long term.”
‘We are not a load of tins in a supermarket, we are human beings’Rachel, 30, is visually impaired, has dyspraxia and autism.She received 17 hours of support a week for eight years, to help with cleaning and cooking, managing her medication and personal care. Two years ago her care was reduced at a review to just five hours a week.
Rachel was left with no one to help manage her medication and this meant she missed doses and had a seizure. To make things worse, while recovering she mistook her dog’s flea medication for her own and ended up in hospital. Rachel says these two incidents knocked her confidence and she became demotivated. She also stopped taking her anti-depressants
“Being in hospital left me feeling anxious and upset and I worried if something else might happen once I got home,” she says. “It had a massive impact on me.”
“I kept forgetting my tablets and I was struggling to keep a lid on my depression. I wasn’t interested in doing anything, I would only go out to take my dog out.”
Rachel’s care was reinstated and she now receives 20 hours of support a week. She says things are much better now because she’s “not being left alone for days at a time” and is on top of her medication.
She also receives some social support to help her get out and about.
She adds: “I don’t want this to happen to someone else. I was lucky that I had support from other people [when my care was cut], but there are people who don’t and that’s dangerous.
“We are not talking about a supermarket and a load of tins here, we’re talking about people, human beings, and I think sometimes that gets forgotten.”