Social workers voice concerns over the influence of funding panels in adults’ services

Funding panels are being used routinely to make decisions about care for vulnerable adults, and in some cases override social workers’ professional recommendations, research by Community Care suggests.

A survey of 454 social workers and other care assessors in England found almost all (95%) had a funding panel operating in their council. Respondents voiced concerns over their use to amend care planning decisions, causing delays in service users receiving support, and too often prioritising costs over need.

The Community Care survey found of the 431 respondents working in a council with a panel that:

• More than three quarters (86%) had experienced a care package being refused or deferred by the panel in their council.
• More than half (54%) felt their professional judgement and recommendations were not always respected by the panel.
• Most (89%) said the panel process had caused a delay in a service user receiving the care and support they needed.
• Seven in ten said their council’s panel was not solely being used to sign off large or complex care and support packages.

The findings suggest that in many areas funding panels are being operated beyond their intended purpose, as set out in the Care Act statutory guidance.

Section 10.85 of the guidance states that ‘approval’ panels might be appropriate for signing off large or unique personal budget allocations or care plans, but councils should “refrain from creating or using panels that seek to amend planning decisions, micro-manage the planning process, or are in place purely for financial reasons”.

Under section 78 of the Care Act, councils must act under the general guidance of the government in relation to their Care Act functions, which means they may only depart from the statutory guidance with good reason.

‘The panel process’

The survey asked social workers about the panel they submit cases to most frequently. The majority (90%) said this panel considered both new and existing cases and 80% said the panel made decisions on all types of social care support.

The most common service user group panels applied to was older people, followed by people with learning disabilities and physical disabilities.

Respondents told us the paperwork they were required to prepare included assessments, the care plan, a panel application, and a resource allocation tool or costs breakdown. Four in ten respondents said they could both submit written recommendations and attend the panel in person, but a further third were only allowed to submit written recommendations.

Where social workers had experienced a care package being refused or deferred by the panel, the most common reason being given was that the recommended care package costed too much money. This was followed by the decision at panel that the person’s needs can be met by a different type of social care support and “insufficient evidence” being provided in support of the care plan.

One respondent told us: “The panel are at times far too stringent regarding what they feel to be ‘sufficient’ evidence. They frequently conclude that needs can be met a different way, when this has already been considered and ruled out by the social worker.”

Level of scrutiny

Alongside the survey, Community Care sent a freedom of information (FOI) request to England’s 152 local authorities, asking about the funding panels they operate within adults’ services. It received 113 responses, with 84 councils confirming they had at least one funding panel in place. Local authorities operated these panels under a range of different names, including scrutiny, quality assurance, weekly resource, care authorisation, and adult social care finance panels.

The FOI request found:
• Most (95%) panels looked at both new cases and reviews of existing care.
• More than half (58%) considered funding requests for all types of social care support, including residential, nursing and domiciliary care, and supported living.
• Panels either covered adult social care for all adults, a specific geographical or service area or service user group, including mental health, learning disability and older people.

The FOI request also asked councils if any of their panels had a financial threshold – a level of expenditure above which proposed care plan must be brought for approval – to try and determine the size and complexity of care packages being considered.

It found that, where a figure was quoted for at least one of a council’s panels, the median average financial threshold was for care packages costing £385 per week.

Almost a third of panels were operating with a threshold of £250 per week or less, while just over a third scrutinised care packages costing £500 per week or more.

However, 25 councils said there was no threshold in place and all requests for new or increased funding had to go to panel for approval.

A further five councils said they require any care plan that exceeds the indicative budget calculated by their resource allocation system (RAS) to go to panel. An indicative budget calculated by a RAS should act as a guide as to what level of resources will be available to meet particular support needs and outcomes, in order to provide a basis for care planning.

‘Concerns’

The research was carried out in response to concerns raised by legal experts and frontline practitioners about how funding panels were being used in adults’ services.

In February 2017, Luke Clements, a law professor at Leeds University, claimed funding panels were now rife in councils, but were not being used in line with the statutory guidance. He cited a decision by the Local Government and Social Care Ombudsman, which questioned whether Brighton and Hove council’s panel was “purely looking at Care Act compliance and cost effectiveness” when it rejected a social worker’s recommendations.

Two more recent ombudsman cases have raised concerns. In March 2017, Bromley council was criticised after its panel failed to give a decision for reducing a disabled teenager’s care, leaving the family without support for five months.

Meanwhile in September 2017, the ombudsman found Worcestershire council at fault for causing a delay in agreeing residential care for a man with severe learning disabilities, after its panel repeatedly refused a social worker’s request to fund his preferred placement.

The ombudsman’s report said: “We do not find it reasonable that the panel kept refusing the social worker’s recommendation given the absence of other realistic alternatives.”

Social workers responding to a previous survey by Community Care on care package cuts also highlighted the increasing use of funding panels to make decisions about care.

Sector response

Jamie Burton, barrister and head of the community care and health team at Doughty Street Chambers, said the survey findings suggest that “many councils across the country are routinely using funding panels, which is not what the statutory guidance contemplates”.

He added: “The role of panels should be to provide an overview in complex practice areas and ensure consistency in the context of commissioning large, resource-intensive care packages. They are not supposed to micro-manage the care planning process – that should be for social workers to do, in collaboration with the person with care and support needs.”

Margaret Willcox, president of the Association of Directors of Adult Social Services (ADASS), said the funding gap in adult social care meant teams across the county “experience the challenge of trying to improve lives with limited resources every day”.

She added: “Funding panels can help with us, supporting professional practice, while considering the costs of services. It’s an essential part of the challenge of providing adult social care for any community to be an effective steward of resources.

“Panels have to make the most effective use of time and make speedy decisions on behalf of people who depend on these services, but they must also be mindful of the number of options there are to meet the needs of adults who rely on social care.”

Joe Godden, professional officer at the British Association of Social Workers (BASW) said there was “widespread concern” that financial pressures are undermining the ability of local authorities to meet their Care Act duties.

“BASW urges social workers to clearly set out their professional judgement, informed by knowledge of the law and practice guidance about what funding is required for a personal budget to be sufficient to meet the needs of an individual.”

He added: “There is clearly a considerable variation in the use of panels and the parameters of what needs to be referred to panels. Panels are expensive and can be very bureaucratic processes, which add time and can be costly.

“BASW has come across examples of effective delegated decision making at the level of the social worker and team manager – decision making by people who know and understand the situation best, leading to better outcomes for service users and more money for services.”

A spokesperson for the Department of Health said: “Local authorities must involve individuals throughout the planning process for their care package. Our guidance is clear that panels may be appropriate to sign-off large or unique personal budget allocations or plans, but it is for local authorities to decide.”