Councils to consider outsourcing assessments to manage impact of cap on care costs

Story updated 20 March

Councils could consider outsourcing Care Act needs assessments to external organistions in order to manage the workforce demands of implementing the cap on care costs, the goverment has said.

With the policy expected to result in hundreds of thousands more assessments and reviews a year, the Department of Health and Social Care (DHSC) has already said that councils will need to recruit more social workers, which it plans to support by increasing the number of qualifying routes into the profession.

However, in draft guidance for councils on preparing for implementation, the DHSC said authorities should consider how they could manage the increased demands through increasing efficiency and reducing demands on their own workforces.

This could involve greater use of supported self-assessments – where people assess their own needs, with support – entering into arrangements for the NHS or care providers to play more of a role in needs assessments or delegating the assessment function to external organisations, such as charities.

Such organisations “may be open to being trained to carry out certain types of assessments or assessments for certain population groups on the authority’s behalf”, the department said.

Under section 79 of the Care Act 2014, councils can authorise external bodies to carry out most of their adult social care functions – including conducting needs assessments – on their behalf, though liability remains with the authority.

Such assessments would be subject to the requirements of the Care and Support (Assessment) Regulations 2014, including that the local authority must ensure that the person carrying out the assessment has the skills, knowledge and competence to do so, and is appropriately trained.

The DHSC draft guidance, which is open to consultation until 1 April, said “there should be clear protocols in place for professional oversight, quality assurance and ongoing monitoring”, and that councils should ensure that staff in external organisations are “trained to the same standard and have access to supervision and advice from social workers and occupational therapists”.

Hundreds of thousands more assessments and reviews

The government’s adult social care funding reforms will increase demand for assessments, reviews and the case management of people needing care and support by bringing more existing self-funders into the system. This arises from:

• The need to assess and determine eligibility for anyone wanting to benefit from the £86,000 cap on personal care costs, in order to quantify the cost to them of meeting their needs. For self-funders, this would need to be set out in an “independent personal budget”, which would have to be reviewed each year, while a “care account” would also be maintained to track a person’s progress towards the cap.
• The increase in the upper capital limit for the social care means test, from £23,250 to £100,000, making more people eligible for council-funded care.
• The full implementation of section 18(3) of the Care Act 2014, meaning self-funders can request their local authority meets their needs in a care home, necessitating assessment, planning and review for them.

The reforms will be fully implemented in October 2023, but the government expects councils to carry out early assessments of self-funders who want to take advantage of the reforms from April next year. The draft guidance said councils needed to bear in mind that, if a person’s needs changed, they would need to be assessed again. It suggested that people funding their own residential care may be worth assessing early because their needs were less likely to change.

In addition, a “trailblazer” group of authorities will be given legal authority to implement the reforms later this year.

Additional assessments carried out in 2023-24 will be met from £168m that will be allocated to councils to help implement the reforms, according to an impact assessment published in January. Thereafter, the DHSC estimated, additional assessments, reviews and case management will cost between £160m and £180m a year, with the vast majority of the cost concerning people aged over 65.

Worsening workforce situation

Councils are preparing for implementation amid a worsening workforce situation, with latest official figures showing the number of social workers employed by councils fell from September 2020 to September 2021, while vacancies and turnover increased.

At the same time, councils are facing increased backlogs for assessments and the arrangement of care packages, according to successive surveys of directors.

In response to the latest consultation, the British Association of Social Workers (BASW) England said the government needed to invest in recruiting and retaining social workers within local authorities, rather than delegating their roles.

“It is incredibly frustrating that this latest draft guidance contains only one reference to social workers,” said Liz Howard, professional officer for BASW England’s adults’ group. “Through thorough assessments, social work is crucial to help people to plan to meet their social care needs.

“The suggestion that this function could be delegated rather than investing in the existing and future social work workforce is deeply concerning and appears to be at odds with other proposals for social care reform which emphasise the importance of a skilled workforce in the social care sector.

“BASW England believes that local authorities need a full funding solution now to provide sufficient, high-quality social work and social care services, to stabilise supply and develop the workforce at a time of crisis in recruitment and retention across social care. We call on the government to address this as a matter of urgency.”

Case management system upgrade

The draft guidance said councils would need to upgrade their case management systems to include the functionality required for care accounts, and this should be in place before October 2023.

The DHSC said it would work with councils and IT suppliers to produce “a detailed technical specification” for what was required, but said councils should also engage with suppliers on the issue.

The draft guidance said the DHSC would also work with councils to explore how technology could support other aspects of the reforms, including in improving the efficiency of financial and needs assessments and supporting portability of assessments between authorities.

Councils ‘need to understand demand’

The draft guidance said councils needed to take steps to understand the likely additional demand they would face from people as a result of the funding reforms, for example, by gathering data information from providers, GPs or information and advice services about existing self-funders.

The DHSC also said councils should raise awareness of the funding reforms – in line with their duty under section 4 of the Care Act 2014 to provide information and advice – targeted at self-funders, particularly those who lack, or may be at risk of losing, relevant capacity.

Communications should encourage people to plan for their future care needs, both in terms of financial planning and accessing services to delay or prevent needs, which would in turn help councils manage demand over the longer-term.

The draft guidance on preparing for implementation has been released alongside draft statutory guidance on implementing the cap on care costs, which would be added to, and would amend, the existing statutory guidance under the Care Act.

The DHSC has also released a consultation paper seeking views on both. People can respond by completing an online survey or emailing comments to the department.