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Community Care’s survey into how funding panels are operating in adults’ services published yesterday asked social workers to tell us about the most recent case they presented to the panel in their council.
A freedom of information request was also sent to English councils asking for the terms of reference for any funding panels they operated and any relevant practice guidance for social workers. This revealed that some council policies are testing the limits of the Care Act 2014.
We also asked social workers to tell us about their experience of attending the panel meeting, highlighting what they felt was good or poor practice. Here’s what they told us:
- “It is disheartening that highly experienced social work managers who know nothing about the case insist that I undertake further work to prove to them that I have done my job properly.”
- “There is little attention paid to any qualified social workers’ suggestions, rather they are often bullied into reducing care packages and taking far greater risks than ever before.”
- “It increasingly makes little difference whether or not you attend, because decisions are not made on professional judgement and social work assessment, but more on whether there is a cheaper option or a reason why the council shouldn’t pay.”
- “I feel frustrated by this process – I feel the panel don’t believe my clinical judgements are often suggesting (cheaper) alternatives, which are totally inappropriate for this client group.”
- “I had already been in daily contact with the commissioner so he was very up-to-date with the information. I feel that he does listen and will agree [care] if all options have been tried.”
- “Members had clearly read the documentation prior to the meeting and had prepared questions. Questions were asked for clarity and not seen as a question of my professional judgement.”
- “I feel that I am unable to advocate fully for my service user, however [the panel process] does force me to produce a much more robust assessment.”
- “It is a ‘virtual’ panel but everything is submitted, even 30 minute calls are micro-managed. It is clearly a cost-focused exercise, and in this case, the panel was simply saying the person should pay for the care themselves. There is a limited focus on risk.”
- “The panel is supposed to be more of a discussion of options rather than trying to reduce the cost as such. While my last experience was very positive and there were no issues, I have often experienced frustration where it feels my professional judgement is not considered. You do sometimes feel like you’re begging for money.”
- “I felt positive about this experience. The panel listened to the advantages of the placement and focused on the impact of these on the service user, rather than the cost of the placements.”
- “The actual meeting is helpful. However, the process before is long winded. Assessments then care plan, then another form repeating the same details. Then waiting for brokerage to identify a service and cost so it can be detailed in the final form.”
- “I was more relaxed attending as our team psychiatrist was on the panel that day, which made it feel more personable. I felt I was given time to identify the needs, outline the proposed support and the possible positive outcomes.”
- “Panel has recently changed so that we only present the case to a handful of local social work and occupational therapy managers. Commissioners and accounts are no longer part of the process. This has been a positive step towards person-centred care planning and enables us to focus more on achieving outcomes and improving quality of life. Cost and best value is still part of the discussion, but it is balanced with the person’s needs.”
- “Panel do not take into account professional judgement and assessment. Decisions are made based on finances and do not take into account the best interests of the service user.”
- “Social workers are not invited to attend a meeting, but present a written proposal with the justification for why the care is requested. This is not always read in full by panellists and if they do not know the case in detail, the proposal is often likely to be rejected with additional questions asked. The answers for those questions are often found in the original written proposal, which adds to the frustration if the funding is not agreed.”
- “Panel is an anxiety-provoking environment where I feel I have to justify every penny spent on my adults. I don’t feel the panel members always listen to my recommendations as the professional who has been working with the service user. I fell they can become caught up with the words on paper, which will never be enough to fairly describe the complexity of a person.”
- “I did not personally attend the meeting – a senior presented on my behalf. I feel there is no faith in us as workers. Very little thought goes into the knock-on effect of agreeing short-term funding, particularly with a direct payment for personal assistants.”
- “Good practice – I was able to explain my rationale and the recent history of the case. Bad practice – a six-week limit was put on the plan. This often results in endless reviews and makes caseload management difficult. It sometimes feels like cases are being endlessly returned to the panel in the hope that savings will be found.”
- “The panel stated that they would not take into account the benefits of continuing the service – they said they would only authorise a less expensive service that the council already uses. When asked individually – and this is recorded in the panel minutes – each member stated that their remit is to reduce sots regardless of the effects on the service users. Each member also stated that they had no care experience in any capacity and were all financial advisors to the council.”
- “Panel is a forum to discuss different options and ideas. Decisions are often overridden by commissioning managers who have no background in social care and often a vague idea of the Care Act. The proposed actions are not in the spirit of the Care Act, which is bad.”
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My experience as both a current senior social worker and the parent of an adult service user with complex needs is that the social worker will always side with their employers and at best will not say anything to support you in care review meetings but more often than not they will support their managers even though they know the decisions are being made on budgetary grounds and not needs led. They will collude with the manipulation of assessments to try to whitewash them as based upon assessment of need!..I cannot understand how or why some of them ever went into the profession when being a social worker means challenging your employer or manager when necessary and not court popularity for an easy life or for career reasons.
Jim’s double credentials make him a compelling witness to how the system works. Its one where the ‘professional judgement’ of the social worker is commandeered by management to ensure delivery of a key corporate objective. That objective is two-pronged – to standardise and reduce ‘need’ to only what can be afforded, and to give the appearance of it being a social worker decision so the council can deny the decision was based on resources. This is a misappropriation of the ‘professional judgement’ that leaves something which should be a precious sort of support to the service user not undermined, but wholly corrupted. The question is why do managers behave like this? The answer is that they are only doing what the system requires of them. Until the system is changed so that assessments of need can be honest, and the decision about resource allocation can also be honest, and there can be an honest openness about the gap between needs and resources, Jim’s experience will continue in the same old same old.
These findings are very important. However, it is even more important to understand them in their proper context. These unhappy experiences are the inevitable consequence of a policy of addressing the gap between needs and resources by adjusting ‘need’ to fit the resource. Whether delivered by a panel, or a manager behind a desk, makes no difference. It is this policy that defines managerial behaviour. Changing the wording of panel remits, or changing social work practice, will make no difference. It would be treating the symptoms, not the sickness. The symptoms will re-emerge. Treatment of the sickness will require a change to management’s responsibility, which in turn will require a change in policy in relation to the way the gap between needs and resources is managed. It must allows honesty of assessment of need, and honesty of resource allocation decisions.
Should professionals need to clarify there professional opinion. Not really, it’s there opinion and should be based on evidence based practice and common thinking around strengths and assets. However, asking for money to quantify that opinion is a different matter.
Firstly, half of assessors aren’t qualified/ registered professionals. In times of such financial crisis, without a level of analysis/ questioning, how can budget holders be confident that public money is spent appropriately?
Do I believe that panels are necessary? NO… all that is needed is confidence in social work managers to question/ analyse the assessors recommendation. This should even include where no money is being spent to assure quality.
Panels monitoring spending are not right. Managers monitoring quality assurance is absolutely appropriate.
We just need to be clear on this within legislative framework. The Care could have done this, but didn’t. I wonder why???
It did Paragraph 10.85 of the statutory guidance! Unfortunately, it will only change with a legal challenge, at which point everything will collapse as restricting or delaying funding is the only way councils can manage to stay afloat…a bit like using a tea cup to bail out the water….