Assessing Need Under Austerity
Author: Virginia Moffatt
The search for greater efficiency, in the face of austerity, is never easy. However some times real improvements can be achieved by taking a fresh look at things. None of this justifies an inhuman approach to reassessment of need or the management of staff. Virginia Moffatt reflects on her own time working in local government.
After the banking crisis in 2008, the Labour Chancellor took a number of steps to save the economy which included cutting public sector spending. As a result, those of us who worked in the local authorities were asked to find ways to make our services more cost effective.
I’ve never known a time when the public sector hasn’t had to consider the value of every penny it spends, but this new environment proved more challenging than previous. It required creative thinking to ensure that we managed our budgets effectively without impacting on the quality of care. Fortunately, I worked in a very thoughtful and committed learning disabilities team who had already been used to thinking in this way. My boss remembered that a few years previously our largest provider had worked with us to look at the costs of individual services. They found that people’s needs had changed over time, and some needed less support, which enabled savings to be made. She suggested we repeat the exercise.
I was tasked with recruiting a team of care managers to do this. The work of the team was based on three principles. Reviews were to be person centred, focussing on what each individual needed and wanted in their life, involving families, friends and advocates wherever possible, and maximising the use of informal supports and community networks. They were to identify support needs using our new resource allocation system, so that we could ensure each individual had a personal budget that was sufficient and equitable with others who had similar needs. Finally, they were to ensure the quality of outcome for each person was not reduced by any proposed changes.
The care managers we recruited were passionate and creative. They built up positive relationships with people, their families and support workers. In some instances they were able to increase informal supports for people by increasing the opportunities for family members to be involved in the service or connecting them with a club or activity they were interested in. There were many instances where people had developed more skills for independence and needed less support than they had when they started. Whilst careful mapping of how support was provided helped clarify when assistance was needed on a 1:1 basis (e.g. for personal care) and when it could be shared with others (e.g. during a meal time). Additionally, they came across instances where support had increased through aging or ill health, and so for some, the cost of the service went up.
It was a challenging process. Some were fearful of the team before we started, some disliked the process of review and some disagreed with the final assessment. However, we found that by being open about our reasons for doing the work and the principles that underpinned it, by investigating complaints as they arose, and adjusting any errors, we were able to reach agreement with the majority of people affected. I believe we did so without affecting the quality of support and in some cases, we were told that the outcome gave them more control over their lives. An example of this was a group of people sharing a house who had developed skills for independent living to such an extent that they found they had too many support staff around. Their service was redesigned so that staff offered a more focussed service at specific times that suited them, giving them more freedom. And using a combination of review and tendering we made over £1 million savings on the contract we held with our largest provider, and a further £500,000 on our internal supported living services.
I was comfortable with this approach because we were able to make the best use of the resources available to us, without compromising quality or our person centred approach. However, after the coalition government came into power in 2010, the increased pressure on services gradually eroded our ability to do this, which is one of the reasons I left in 2014.
This week, I read an article on the Secret Social Worker website relaying how their local authority had bought in a private sector company to do a similar review process. Whilst I can understand the pressure the local authority was under, I was horrified by what I read. Instead of focussing on the individual, the company makes it savings by setting targets that have to be achieved. The starting point is not what someone needs but what can be delivered for free first. Social workers’ time is tracked by bosses and administrators; they don’t even have control of their diaries, appointments are made for them. As for the work required to actually complete an assessment, travel time, liaising with fellow professional, writing up notes, this is all deemed irrelevant.
I’m fully aware that there have always been limitations in social care systems, but they were generally managed by staff who wanted to do their best to serve those who needed support. Every year austerity has gone on, and councils are driven to further cuts, I watch the systems becoming increasingly inhumane. We’ve seen the horrors of a cruel assessment system in welfare benefits, it seems as if social services are going the same way.
The Conservative Government seems to think the extra 3% council tax this year will resolve the problem of social care. It won’t. What we need is reinvestment, and we need it now. Otherwise, things are just going to get worse, and as usual it is sick and disabled people who are going to suffer.
The publisher is the Centre for Welfare Reform.
Assessing Need Under Austerity © Virginia Moffatt 2017.
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