The government must introduce a national mechanism to monitor social care needs assessments and the staff who conduct them to ensure consistency and equality, a report published this week argues.
Lack of oversight has created an environment in which finance-driven social care assessments can deprive people of support packages, leaving Care Act 2014 and human rights obligations unfulfilled, the study found.
Some older people interviewed for the study, by the international organisation Human Rights Watch, said they were told before an assessment was carried out that services to them would be cut.
One, ‘Peter’, said a social worker told him that an extra hour of care would be “more than her job was worth” and that instead his support would be cut.
Lack of understanding
Other interviewees raised concerns that assessors appeared not to understand their disabilities or social care needs, the study said.
Too often, it found, people trying to appeal decisions had their original packages suspended in the meantime.
The study raised questions over the lack of systematic auditing of decisions, and quoted one local authority administrator who said she had been asked to submit fraudulent data to the Department of Health and Social Care.
As well as introducing national monitoring, the report called for further review of the impact of austerity policies on adult social care provision, and for the government to facilitate sustainable long-term funding.
‘Decisions based on finances, not needs’
The Human Rights Watch study was carried out during 2017 and 2018 and was based on 104 interviews, including with 27 older people aged between 58 and 94 and 20 family carers.
Researchers also interviewed 51 professionals, including charity staff, lawyers, academics and health practitioners – though, the report said, they were unable to interview any social workers, who have frequently raised concerns about the assessment system.
The report quoted one day care worker who complained that demand had risen – because people were losing home-based support – to the point where he and colleagues could no longer answer the phone.
“Now, decisions are based on finances, not needs,” he said. “About five years ago, we started seeing people with higher and higher levels of need.”
Service users quoted in the study complained that decisions about their care appeared pre-planned, based on cost-cutting agendas.
While many appealed, a key area of concern identified by the study was that most lost services while their case was being reviewed.
Two councils – North Yorkshire and Dorset – told researchers they had the discretion to maintain or issue services pending an appeal, but did not clarify how frequently they did so or what criteria they used.
Some interviewees also told researchers their assessments were inaccurate or inconsistent, with one saying that her assessor did not appear to “know anything about dementia”.
The study noted recent comments from the Local Government and Social Care Ombudsman, Michael King. King said last year that he was increasingly seeing bad decisions within adult social care being made as a result of problems with “systems, policies and the way procedures are being applied” rather than individual errors.
The new findings come in the wake of a Community Care investigation into local authorities’ use of funding panels, which were found to be “testing the limits” of the Care Act.
Legal expert Yogi Amin, a partner in public law at Irwin Mitchell, warned last year that councils who use funding panels to scrutinise all adult social care packages were breaching statutory guidance under the Care Act.
The guidance stipulates that local authorities may take their budgetary position “into reasonable consideration” when determining how to meet needs. But, under the Care Act, when a duty to meet needs is triggered, councils have no discretion as to whether to meet need.
‘Utterly unfair’ system
Responding to the study findings, Garrod said ongoing and significant reductions in funding, alongside increasing demand, had inevitably affected the scope of care packages and size of direct payments.
“Across the country social care staff are working hard to find ways, with families, friends and communities to meet people’s care needs in the most personal and best way that they can,” Garrod said. “Inevitably some invidious decisions are having to be made. These stories are very regrettable and we most certainly would not support any fraud in data returns (nor are we aware of any).”
Sally Copley, director of policy campaigns and partnerships at the Alzheimer’s Society, said the report showed how “utterly unfair” the social care assessment process could be, and how often people living with dementia have their rights breached.
“We’ve seen a steep rise in people contacting us over the last year, and heard shocking reports about assessors not even having a basic knowledge of dementia,” she said. “We’ve also heard of people whose lives have been put on hold, while they go through courts to reverse wrong decisions – an unimaginable strain on top of living with dementia.”
‘Not what the Care Act intended’
Caroline Abrahams, charity director at Age UK said: “Older people and their families have often fought hard to get their care package and then some find it is reduced or in the worst cases taken away entirely.”
She added: “Support is routinely being reduced to the essentials, rather than focusing on what the Care Act intended – improving people’s wellbeing, dignity and independence.”
A Department of Health and Social Care spokesperson said: “Older people should receive the support they need to live healthy and independent lives. Councils have a legal duty to assess people’s needs and, subject to their financial circumstances, provide support.
“We have provided local authorities with access to up to £3.6 billion this year for adult social care,” the spokesperson said, adding that the government would soon set out, via its much-delayed green paper, plans for a sustainable future.
You can read the full report here: Unmet Needs – Improper Social Care Assessments for Older People in England