Social workers feel funding panels are being used to dismiss their professional judgment and prioritise cutting costs over the needs of vulnerable adults, a Community Care survey has revealed.
Last year Community Care and the Care and Support Alliance carried out a survey on care package cuts and discovered concerns that panels were being used to override social work recommendations about people’s care.
Our latest survey and research, published today, sought to explore this further. The findings suggest that in many areas funding panels are being operated beyond their intended purpose as outlined in the Care Act statutory guidance. A more detailed account of the experiences social workers shared with us is set out below.
Finance versus service user need
Social workers had mixed experiences of panel meetings.
One survey respondent said they “enjoyed the opportunity to provide a directly detailed account of information gathered, identified needs, suggested support plan and rationale”, adding that the experience was “very informative”. Another said their panel was “open-minded to find the right solutions for the people I referred and were not just motivated by cost-minimisation”.
However, others painted a more tainted picture, with a common concern being that panels saw the finance involved as the priority rather than the needs of the service user. One said they attended a panel meeting every week, with this often resulting in tears on their part and that “money rather than need is the focus”.
The experience was described as “a battle” by another, who added that “the start points appears to be how can we refuse or reduce this package”.
A third said: “The panel does not want to listen to my recommendations. It is a horrible experience for someone with 30 years’ experience in adult social care – there is absolutely no application of the Care Act wellbeing principle or personalisation.”
What was also highlighted was that panels are in some areas comprised of individuals with little or no adult social care background.
One survey respondent told us of their “shock” in finding the panel was made up more of staff “from the finance world”, adding “my support plan wasn’t really discussed, it was more the numbers that were on the resource allocation system”.
Another said their experience was intimidating with “numerous questions fired at you by people who have never worked in the environment as a practising social worker, and who have little understanding of service users’ needs and the impact not receiving the requested funding would have on them.”
We asked respondents whether the panel in their local authority ever made casework decisions, for example, recommending a different type of social care support for a person. They told us:
- “Panel will regularly decline a support package, with a decision for the worker to look at alternative options. Recommendations and justification are overlooked and as a worker you feel there is no point completing an assessment because professional autonomy and decision-making are no longer in our remit. It’s soul destroying.”
- “[They make casework decisions] all the time. Recently the panel suggested that a person have care that actually increased the risks of infection because the council did not wish to fund the care at night.”
- “These decisions are purely based on finance and often to the detriment of the client – for example wanting a lady with severe dementia to move from home where she has finally settled with skilled carers because her family will not make a contribution.”
- “It can be helpful because sometimes the senior managers have knowledge of new services that are being developed.”
- “Sometimes this can be helpful because the panel is suggesting things I may not have thought of. However, often there are not services out there to meet the suggestions.”
Social workers left to be the bearers of bad news
The survey also asked social workers about the impact of the panel process on service users and their families. Most respondents (89%) said this had caused a delay in a service user receiving the care and support package they need.
Almost half (48%) said the delay lasted more than one month, 25% said between two and four weeks, 19% said between one and two weeks, and 7% said up to one week.
Social workers shared some causes for the delays. These included further information or clarification being requested by the panel, funding not being agreed, practitioners unable to attend panel on a set date, and ongoing discussions between health and social care services about whose responsibility it was to fund the care package.
More than two thirds of social workers (72%) also said their council’s panel did not have an appeals process to allow service users and families to challenge decisions.
Another experience cited by our respondents was that of how to support families after a decision had been made by the panel.
The majority (97%) said it was their responsibility to inform the service user or their family if the care and support plan was refused by the panel.
When asked to tell us their experience in doing so, the common theme was social workers felt their professional recommendations had been ignored but were left to be “the bearer of bad news” with little support.
One respondent said the experience was “heartbreaking” and it felt like their “professional opinion counted for nothing”.
This was echoed by another participant, who said it was “a painful experience”, adding that “it feels like the panel members get to hide behind their desks, leaving the worker exposed to abuse and anger from service users. The worker is blamed even though they have recommended approval of the support”.
Another said: “It is very difficult to be the person to deliver the news to people who are often very anxious or at crisis point – more so when you really feel your recommendation was the most appropriate way to meet the person’s needs.“
But one respondent told us they appealed a decision after informing the family by writing “a detailed letter citing the Care Act statutory guidance and Human Rights Act”, after which their application for the care plan was accepted.
Case study: ‘Most of the panel members have never actually practised social work – I find that alarming’
Emma*, a social worker in the North of England, shared her experience of having a care and support plan refused by the funding panel in her local authority. The case involved a woman with Parkinson’s disease and her young daughter, who provided most of the care. The woman needed respite care but she wanted this at home for cultural reasons. Her daughter also needed time out regularly to go to college.
“The panel said we didn’t have the resources to meet those needs and it would be more cost-effective for this service user to be in a nursing home,” Emma says.
“My argument was we do have the resources but the reality is it is going to be a more expensive care package to maintain this person’s safety and wellbeing at home and to allow the carer to carry on with their role and with an education.”
‘Upsetting and unnecessary’
The council wasn’t willing to fund the package based on the woman’s “social needs“, Emma says, and the panel deferred the case, requesting more information about the woman’s health. This delay caused significant distress for her daughter.
“She broke down and said she was feeling suicidal and didn’t think she could carry on… ‘if she wasn’t around the council would have to provide the care’,” she recalls.
Emma decided to go and see the daughter and explained they needed to make sure the funding arrangements were robust and necessary.
“She did understand, but it was upsetting and unnecessary – if the panel had accepted the recommendation in the first place she wouldn’t have been at that point, feeling so low.”
Emma adds that, as a newly qualified social worker, she felt unequipped to diffuse the situation and did not confide in colleagues, fearing it was her fault. She thought that the panel had turned down her case because she “hadn’t done a good enough job”.
Emma had to create a “very health-orientated” assessment to get the funding approved, which she felt “dehumanised” the woman involved.
“You wouldn’t think she had been assessed by a social worker. It wasn’t my piece of work – it was a basically a bid to get some money to get her the care she needed.”
The case had a positive outcome and the care package was funded. However, Emma says she remains alarmed that most panel members, in her experience, don’t have a social work qualification and haven’t practised as social workers.
“They don’t actually know how hard it is to get the information, do the assessment or work with the service users,” she says.
*Names have been changed