“There’s generally a sense that the panel just want to know how much something is going to cost and why the person needs it – the nuances of someone’s care or needs seem too often not be considered,” says George*, an adults’ social worker.
“We’re working with people here – I think they forget that.”
George is one of three social workers interviewed by Community Care about their experiences of funding panels in adults’ services, following our survey over the summer.
We asked social workers to tell us about the most recent case they took to the panel in their council. We also sent a freedom of information request asking councils to supply us with the terms of reference documents for any panels operating in their adults’ services department and any guidance provided to social workers on presenting cases to panel.
One of George’s frustrations is the work that goes into preparing a panel submission, only for this to be given little consideration by members.
“The sense is they never read the paperwork and have little knowledge of the case – they ask you to represent it and argue why you need the money,” he says.
“You have to fight the corner both for your professional judgement and the client.”
George on Sally’s case: ‘A lack of realism’
The panel: In place for more than two years and made up of both social work and finance managers. All reviews and new care packages (costing more than £100 per week) to go to panel.
The service user: Aged between 18 and 65, with mental ill health.
Case summary: Sally* has been in hospital for several years. She is chronically unwell and needs a lot of support. An assessment by George concluded that she needed to be placed in a locked rehabilitation ward for her own health and safety.
Many providers were assessed for their suitability but only one offered Sally a bed. The care package is more than £1000 per week and the placement is out-of-area.
Panel decision: Agreed but with conditions.
Rationale: The panel agreed to fund the package, but on the condition that Sally’s care is reviewed by her social worker every three months and any improvement in her health is reported in subsequent panel meetings.
George says the panel seemed “reluctant” to fund the package because it was so expensive, and the conditions for reviewing were “unrealistic” because of the complexity of the case.
“The hope is Sally may improve in a year or two, but there is unlikely to be any immediate change. My view is she still needs to be reviewed regularly, but every six months would be more realistic.”
He adds: “It’s difficult with out-of-area placements because you must not forget about the person, but in this case it would also not be the best use of a social worker’s time to be reviewing so often.
“I just felt there was a lack of realism in terms of what the panel were expecting from me – this [realism] is regularly missing from panel because members often don’t have a social work background, or if they do they have not practised for a number of years
Follow-up: George put the six-month review timescale to the panel. He also suggested that telephone reviews could occur in the interim along with written feedback requested from the staff caring for Sally.
“The panel didn’t want to consider this – I didn’t feel that my suggestions were taken on board at all, which is a shame,” he says.
‘Strengths-based vs. savings’
Our survey asked social workers if they felt their professional recommendations had been respected by panel members when presenting the case.
Of the 93 respondents, almost half said their recommendations had been ‘overridden by other considerations’ while a fifth said they felt ‘not listened to or ignored’.
George says that in his local authority, management place emphasis on person-centred care and social workers taking a strengths-based approach to assessments and support planning, but in panel meetings the focus is often the opposite.
“It’s very much about ‘how much is this going to cost and why can we possibly justify spending this amount on this person’,” he says.
Social workers were also asked to tell us who sits on the panel in their council. Almost two thirds (62%) of respondents said the panel was made up of both social work and finance managers and 30% said their council’s panel included only managers with a social work background. The remainder (8%) said their council’s panel was made up of members with a financial background only.
“Who is on the panel makes a massive difference,” says George. “In my view, when there are commissioners on the panel it very much changes the whole tone of the meeting.”
“A panel made up of managers with a professional background [in health or social care], who still have some practice experience, will be very different,” he adds.
‘Expectation vs. reality’
Sue* tells us the recent spotlight on the use of panels has led to council managers sending emails to staff stating that panels are not there to make the final decision about a person’s care package.
“Clearly that is not the case at all,” she says. “The panel always makes the decision.”
Sue has been a social worker for more than 30 years and says she goes to panel with what she thinks is a “reasonable proposal”, based on her “thorough assessment work with the client and her understanding of how to cost placements and packages of care”.
“Of course, I expect to be questioned and challenged on what I’m spending, but sometimes it feels that it’s just about cost, not all the work I’ve done on assessing, negotiating, and working with an individual to fully understand their needs.”
‘Cost ceilings and complaints’
Sue says that when working with older people, her employer appears to be placing a “ceiling” on what a social worker should be looking to spend on a care package before the assessment and support planning process has started.
“We are told that if we can get a bed for £750 in residential care then the expectation is that we are not going to look to spend more on that on care at home.
“It’s not that I feel my professional judgement isn’t worth anything, but I do feel that I’m not going to be able to negotiate my best for people anyway because of that ceiling – it’s hard.”
In the case Sue shared with us, the ongoing negotiations over the cost of the placement have been “hugely stressful for the family”, leading them to make a complaint to the council.
A complaint was made in 29 other cases detailed in our survey. The most common route for making a complaint was via a council’s complaints procedure, followed by ‘with the assistance of an advocacy group’ and ‘to the Local Government and Social Care Ombudsman’.
Sue on Tom’s case: ‘None of us want to move someone who is settled’
The panel: In place for more than two years and made up of both social work and business managers.
The service user: Aged between 18 and 65, with a learning disability.
Case summary: Tom’s* case was a review of an existing care package costing more than £850 per week. Tom was moved to an out-of-area placement a few years ago and his family relocated to be close to him. At the time, this was the only suitable accommodation available to meet Tom’s needs.
Sue was asked to review the placement because the provider was requesting a significant fee increase. This was higher than the council would normally pay for this type of care.
Sue carried out an assessment and used a care funding calculator to determine the level of care Tom was receiving in his current placement and how much this should cost.
Panel decision: Initially refused on cost grounds.
Rationale: The panel concluded Tom’s needs could be met more cheaply in a local placement.
“The panel said the cost was exceptionally high and I was told to go back and renegotiate with the provider if I felt that Tom should remain in the current placement,” Sue says.
Follow-up: Sue came back to the panel with a second proposal, but the cost was more than the council would be willing to pay. Negotiations are ongoing. Sue was also told to look at other placements close to where Tom currently lives, to see if there is a cheaper alternative.
The family has made a complaint to the council, she says. “They are tired of worrying that any day their loved one might be moved somewhere else that doesn’t meet their needs so well – it has been hugely stressful for them.”
Sue’s view is that it is in Tom’s best interests to remain where he is because he’s settled in the placement, it maintains contact with his family, and there’s evidence his needs are being well met.
“But I understand why the council would question such a huge fee increase – I think it would be much easier to agree a figure if there wasn’t so much pressure on budgets,” she adds.
“It’s very difficult, because none of us want to move someone from where they are settled.”
Some social workers told us they were not always able to attend panel meetings, and in some cases weren’t allowed to go as a matter of policy.
Tim, whose case was about support under section 117 of the Mental Health Act, feels if he had been able to attend “then the case might have had a different outcome”.
Instead, he was expected to discuss with his manager whether it was reasonable for the local authority to fund the care package before the case went to panel.
“Well it’s not about reasonableness is it – it’s about whether the person is eligible,” he says.
Tim on Lizzie’s case: ‘The panel interpreted the law incorrectly’
The panel: A joint health and social care panel for section 117 aftercare applications under the Mental Health Act (MHA). In place for over two years and made up of health, social care and finance managers.
The service user: Aged between 18 and 65. Detained in hospital under section 3 of the MHA.
Case summary: A mental health tribunal agreed Lizzie* was ready to be discharged from hospital and could be placed on a less restrictive section in the community. Under section 117 of the MHA, Lizzie was eligible for aftercare support, which would be joint-funded by the council and the NHS.
Tim proposed a bespoke care package costing between £351 and £450 per week. This included a suitable supported housing placement, as well as a personal assistant to facilitate the discharge and support Lizzie to readjust to life in the community.
Panel decision: The panel initially refused to fund the package. It said it was not the council’s responsibility to pay for the care as the original section 3 application to detain Lizzie was made by a local authority in a different part of the country. Tim says the panel misinterpreted the legislation.
“I am an approved mental health professional – I knew the panel were interpreting the section 117 provision incorrectly, they had made massive oversights,” he adds.
Follow up: Tim recorded where there were errors made in understanding the legislation and was able to argue the case, and the package was eventually funded. But the process caused a significant delay, leaving Lizzie “devastated” and the housing provider threatening to pull out.
“She had been in hospital for two and a half years and for someone with her challenges on a daily basis, I don’t think that was fair.” Tim says.
“It was also very difficult keeping the provider interested – they had been commissioned, Lizzie had spent time there overnight and they couldn’t understand what the issue was.”
“What I was most cross about was that this was such a cheap package of care compared to some mental health cases we see – it was minuscule really.”
Tim tells us he was given no support in dealing with the outcome of the meeting, and his employers do not provide guidance on reporting decisions back to service users.
Our FOI request asked councils if they provided guidance to social workers on reporting panel decisions to service users and their families, specifically in cases where the process resulted in a change to the indicative budget determined by an assessment.
Of 107 respondent councils, just 14 said they provided any guidance, with five saying this was ‘verbal’ and given in social work training or supervision.
“The case was discussed in supervision with my manager before it went to panel, but it doesn’t work both ways – the outcome is for me to deal with,” says Tim.
“In this case that was difficult – but they don’t see that on funding panels because they are there to question applications, not to look at the repercussions of their decisions.
*All names have been changed