Guidance

Grant to Streamline Local Authority Adult Social Care Assessments - 2022 to 2023: guidance

Updated 4 April 2023

Applies to England

Overview

The Department of Health and Social Care (DHSC) released £27 million on 29 March to help adult social care teams in local authorities in England implement new ways of working to support more streamlined assessments to inform care planning. This grant supports wider efforts to reduce waiting times for people who may have care and support needs across the country and ensures people have choice, control, and support to live independent lives.

This funding is designed to support local authorities to continue the progress they have made in innovating their assessment approach and process, as part of preparations for charging reform, while also maintaining a strengths-based approach.

This grant is a one-off payment and can be used to fund work to date or to update and implement plans that may have been paused when the delay to charging reform was confirmed.

This funding can be used to help manage demand for assessments regardless of where people are requesting or accessing care from. Separate funding is being made available specifically to improve hospital discharge processes.

This fund has been paid as a non-ringfenced section 31 grant to all upper tier and unitary local authorities in England. The grant has been distributed using the adult social care relative needs formula with a minimum of £130,000 per local authority. The grant determination letter includes the full list of allocations.

Background

Local authorities made significant progress to streamline assessment processes as part of their preparations for charging reform. This included developing innovative digital solutions and transforming operating models to increase assessment capacity and optimise use of their workforce.

This work remains a priority as part of improving accessibility and choice of adult social care services for those who use them now. This funding has been allocated to support local authorities to continue developing these solutions. The Department of Health and Social Care will continue to work closely with the sector to develop this programme of work in future years to manage current and anticipated future demand.

This work will reflect the fact that assessments are more than the completion of a form to determine eligibility and funding but a process of ascertaining people’s circumstances and what is important to them.

Details of the grant

Local authorities are at different stages of transformation and digital maturity, and therefore there is flexibility to use this grant as appropriate for each local authority’s relative transformation journey. It may also be appropriate for local authorities to consider pooling resources with neighbouring authorities where beneficial for economies of scale or where it will enhance relevant local expertise.

The grant has been designed to ensure that each local authority can fund a post for a dedicated productivity lead for one year to review local systems and implement some or all the following approaches:

• procure and implement digital efficiency tools already available on the market, for example, through self-service tools or online portals that allow people who draw on care or carers to input or view their own information

• embed transformation or business process experts to improve operating models. For example, make use of virtual assessments where appropriate and consider implementing trusted assessment arrangements with care providers, intermediate care teams and other professionals, to reduce the number of times the same information is collected from the same person

• consider ways to supplement hard-to-fill social worker vacancies with higher ratios of assistant or trainee roles which can be easier to recruit to, for example, if there is a shortage of registered social workers. The social worker trainee case study below offers one potential route to achieving this

This is not an exhaustive list and local authorities are encouraged to tailor approaches to local priorities, where there are innovative ways to help simplify systems, reduce unnecessary processes and increase assessment capacity.

Some further examples of how the funding could be spent include those outlined below under the headings ‘Digital efficiencies’ and ‘Updating and improving operating models’.

Digital efficiencies

These could include:

• trialling automated and prepopulated care assessments to reduce manual input and data errors, capturing basic information that then prepopulates all subsequent forms

• encouraging local uptake of digital tools by identifying barriers to uptake and ensuring tools and systems are digitally inclusive. Provide training for social care staff to improve their digital capability and confidence

• improving data collection practices by recruiting and/or or buying in additional modelling and analytical expertise

• considering steps to integrate online assessment data with local and national systems to improve data consistency and reduce duplicated data entry

• building the evidence base for further innovation and scaling of technology products and/or digital solutions that improve day to day working

• piloting and rolling out automated validation of spend and other fraud and validation mitigations, ideally sharing these on an open source basis with other local authorities

Updating and improving operating models

This could include:

• improving local communications, for example, scaling up social care workforce recruitment campaigns; or securing additional communications expertise to disseminate bespoke information to varied local audiences and partners

• funding or part-funding a joint role with another local authority or several authorities, based on similar characteristics or regional footprint to identify economies of scale, develop creative solutions, and share good practice

• implementing and designing a standard way for current brokerage teams to manage care placements in a more effective way, or working with IT suppliers to develop, enhance or implement a care brokerage module

Maintaining assessment quality

It is important that efforts to improve productivity do not lead to a decline in the quality of engagement, holistic strengths-based assessments, and support for those seeking access to care.

The Department of Health and Social Care funded the Social Care Institute for Excellence (SCIE) to develop online Care Act training resources exploring the Care Act duties around 8 themes identified by the Social Care Committee. The training is available on the SCIE website and includes bite-size videos identifying the social care practitioner legal duties and the implications for individuals in the community seeking care. The resource will serve as a refresher for more experienced social care practitioners as well as during the induction of new social care practitioners.

Responding to COVID-19 has accelerated adoption of virtual assessment, which can have significant benefits for productivity. SCIE have developed a range of good practice resources to support effective adoption without compromising on the quality of service.

Evidence of impact

While there are no formal reporting requirements on this grant, DHSC is extremely interested in the progress of this work. Local authority responses to the adult social care charging reform retrospective survey in March will help the department understand how plans and ambitions have evolved in this space. The survey has now closed but we strongly encourage local authorities to share implementation learnings and good practice with other local authorities through sector representatives and DHSC especially where digital approaches are successful, by taking part in national webinars to showcase digital solutions.

Case studies

The following case studies from local authorities, including the former Trailblazer authorities, present examples of successful innovation. While some describe preparations carried out specifically for charging reform implementation, they are described below given the expected advantages for business as usual demand management.

Kirklees: online financial self-assessments

Background

Kirklees has a vision for adult social care that has working with people, partners, and places as its foundation.

Kirklees identified a digital journey that was critical for them to deliver against their vision as this would promote independence and empower people, enable them to build on other digital successes as well as improve the management of the demand for social care services.

There were clear expectations that self-accessed assessment would reduce the time pressures on services, link people to assessments more swiftly and ensure the voice of the person emerged more centrally.

Kirklees were careful to identify and overcome barriers relating to existing backlogs and digital exclusion, ensuring that all residents would be given a high-quality service. Working with residents they developed ‘Better Off Kirklees’, an online financial assessment service.

COVID-19 pressures necessitated and aided promotion of remote and digital services, and Kirklees recognized that many of their residents were more comfortable taking up an online option.

What went well

This new online financial assistance programme increased citizen access to digital, self-directed assessment. It led to a substantial uptake in online financial assessment, moving from 36 online financial assessments in 2017 to 4,002 in 2022. As it stands today, around 95% of financial assessments are now carried out through digital access.

Citizens can access assessments at a time and situation that is convenient to them and can be supported by their friends, family or own support network to assist if required, instead of being dependent on the local authority’s opening hours.

Building on this experience Kirklees are progressing an option to provide online access to assessments and reviews. Key to the success of this is developing the key enablers identified, which include:

• a commitment to deliver personalized outcomes

• development of a meaningful resource allocation system

• a system that gives a realistic indicative budget

• empowering people to take control of their planning

• an enhanced brokerage support service

• integrating their model alongside the Care Act 2014 assessment process

The Kirklees process meant that social care staff were positioned to support all citizens in validation and ensuring that a person-centred approach was maintained, ensuring checks and balances were in place.

Kirklees recognised that their digital improvement achieved a balance between technology and human resources, so their staff were enabled to use their time to best effect.

This system has increased readiness for reforms, readiness for Care Quality Commission assurance and sparked new initiatives.

Lessons learned

Further work is required to ensure that all digital systems can cooperate to produce a joined-up experience for all. Future work should also ensure that quality assurance, accessibility and co-production remain as central features as these have been pivotal to the success of this approach.

More information on this case study and learning from other local authorities is available on webinars on SCIE’s website.

Dorset: tackling waiting lists and the Care Act assessments backlog

Background

In September 2022, a team from the Department of Health and Social Care (DHSC) partnered with Dorset Council (DC) to conduct a 12-week experimental piece of work, using an informal partnership between central and local government. The aim was to find a different way to tackle waiting lists and the Care Act 2014 assessments backlog in Dorset.

Approach

The team carried out significant user research to understand the experiences of people who use the service, as well as those involved in its delivery. This included social workers, assessment support co-ordinators, unpaid carers and adults receiving care.

Following a 3-day workshop, the team came up with a proposal to redesign part of Dorset’s service with the aim of reducing the time between someone requesting care and having care in place. The team have used a persona called Alex to represent care users for whom more complex assessments are leading to significant or excessive waiting times. The key aspects were:

• to improve Alex’s experience, we would need to reduce the instances of asking Alex to repeat their story from many to one

• to empower staff at Dorset Council, we would need to provide them with faster and better access to higher quality information about Alex’s history and needs

• to remove waiting lists for people like Alex, we would need to find a way of shortening their journey from several months to several weeks

Outcome

The combined team came up with the idea of a Social Care Passport for a person like Alex. The digital component of the proposed redesign, when implemented would:

• enable Alex to record and share their own story

• securely hold records of interventions and encounters that Alex may have had with the health service or local community or voluntary organisations and make them accessible through explicit consent

• allow the local authority and other trusted organisations and individuals to access a rich summary of the most pertinent facts about Alex’s needs, thus making it possible to shorten the time from requesting care to getting it for Alex

• introduce transparency in the process

• consideration has also been given to how the passport could be used to record and check how much money had been spent towards the spending cap, when the spending cap has been introduced

• the work has been of huge value to Dorset and helped it to identify the right foundations have to be in place to adopt the proposed approach. However, it shouldn’t be viewed as being ‘oven-ready’ for implementation. In the first instance, exploring and then further enhancing capability of Dorset Care Record (DCR) would be a logical step towards the vision of a better service for people who are like Alex in terms of their needs.

Gateshead: social work trainee model

Background

On 26 January 2023 Gateshead Council presented in a SCIE webinar showcasing the social work trainee model that they had developed in partnership with the University of Sunderland.

Gateshead was facing challenges, some of which are experienced nationally. They had recognized difficulties in recruiting qualified social workers, and loss of workforce capacity. There was also a reduction in the numbers of currently employed workers either eligible for or seeking to undertake degree apprenticeships.

By developing a social work trainee model in partnership with the University of Sunderland, they were aiming to bring in high calibre social work trainees at a lower cost, widen the accessibility of, and participation in the training and build a solid foundation for the future workforce with clearly defined career pathways.

A Social Worker Apprenticeship model was co-developed between Gateshead Council and the University of Sunderland and was funded through repurposing other (difficult to fill) posts within the department.

A pod model was developed to ensure that the apprentices developed a comprehensive assessment experience, in a supportive environment with training and leadership development opportunities for the existing social workers.

The pod model also allowed Gateshead to direct the roles according to their strategic objectives and build capacity for reforms and policy changes. The partnership work is maintained throughout, including both professional and academic support.

What went well

Over 100 apprentices have attended the broader programme since it began in 2018. The first cohort has graduated from the 3-year programme, achieving BA (Hons) and professional social work qualifications, satisfying the Social Work England registration requirements.

Apprentices benefit from dedicated university time, ‘day release’ and work placements in years 2 and 3. All trainees found the support, induction, shadowing and opportunities extremely beneficial.

During the apprenticeships the local authority will benefit from having extra people working with them during the duration of the 3-year apprenticeship. The local authority further benefits from growing their own experienced, qualified and committed social workers from within their own community who will be able to take on social worker roles as they qualify.

Support for learners is sustainable as graduates can offer peer support and mentoring for future groups.

Academic standards have been maintained whilst accessibility has improved for those who would have been unable to access the traditional qualification routes.

Resources

The approach was co-developed over 8 months by University of Sunderland and Gateshead.

The cost of the approach was £27,000 over 3 years drawn down from the apprenticeship levy.

There were 18 people involved in recruitment and selection.

There was full oversight and delivery by the adult social care director, service manager, HR advisor, workforce development advisor, accountants, local authority apprenticeship team, lead practitioners, course leader, senior lecturer, university apprenticeship team and graduate management team.

Lessons learned

Greater lead-in time would have been beneficial, developing the internal and external recruitment processes and using the university networks to power recruitment.

Budget was anticipated to be a barrier, but creative repurposing of budget allowed the scheme to be funded from within existing budgets. For example, the salary for 2 social work posts can be re-purposed to fund the salaries of 3 trainees, plus the uplift in salary for the lead practitioner.

More information on this case study and learning from other local authorities is available on SCIE’s website.

Buckinghamshire: provider quality oversight

Background

On 13 March 2023 Buckinghamshire shared their experience of improving their commissioning approach through an SCIE showcase.

Buckinghamshire was seeking to ensure high quality and value for money services from care providers by working in partnership to achieve the best outcomes for residents. Buckinghamshire was keen to address the challenges of staffing and workforce issues; remote quality assurance; increased need for communication and support; and market pressures.

They set themselves targets of excellence, which were:

• clarity of monitoring expectations

• clarity of support

• quality of intelligence and data sharing

• quality of governance, audit and review

All these targets were infused with a commitment to partnership working, using feedback and achieving good practice.

What went well

Buckinghamshire used the challenge of COVID-19 to launch a more dynamic approach to understanding provider risk and developed a proportionate model of monitoring. This has proved so successful that this has been adopted as the standard response.

Buckinghamshire developed a suite of approaches, tools and methods to implement this approach consistently, including:

• a concerns procedure

• a handbook and guidance

• a Provider Assessment and Market Management Solution (PAMMS) framework linked to the Care Quality Commission’s (CQC) quality standards

• internal checks and balances

• digital, interactive data dashboards

Buckinghamshire provided materials to support providers including a handbook and detailed guides to assist them in understanding the quality requirements and developing in accordance with them.

Buckinghamshire were able to include quality assurance of both in and out of county provision, ensuring remote services were as well monitored as closer ones.

The focus on improving governance arrangements has resulted in a better service for those people who use the provision and home closures have been avoided.

Good practice has been shared and a system wide improvement in learning has been generated.

Commissioners in Buckinghamshire report feeling more confident managing provider concerns. They experienced practical benefit from these quality assurance measures in reversing poor quality outcomes. One example included working together with the provider of older people’s housing services to turn around quality concerns relating to quality, safeguarding and finances.

Recent feedback from the CQC echoes the feedback from local providers that these measures are being used to support quality improvement.

This work has led to improved quality at a better value rate, so the savings did not come at the expense of resident experience or outcomes.

The changes have been delivered in-house, and delivery has been supported by generating an inclusive culture. This has meant that significant investment was not required. The improved relationships have been welcomed by all parties and have boosted impact.

There has been a ‘snowball effect’ with this new approach inspiring more innovation and having prompted a greater ambition and creativity.

The approach has ensured that remedial actions can be used to maintain service supply and rectify difficulties.

This approach has been well received and the handbook is being provided as an exemplar by the Institute of Public Care at Oxford Brooks University to inform training.

More information on this case study and learning from other local authorities is available on SCIE’s website.

Cheshire East: adapting operating models to accommodate increased future demand

Cheshire East demand modelling had projected significant future demand for assessments resulting from planned charging reforms, where more self-funders would become eligible for means tested care and metering towards a lifetime cap on care costs.

They were anticipating the need for a significant increase of assessors to undertake assessments under the Care Act 2014 – estimating that around 50 additional assessors would be needed. As part of plans to manage this extra demand, they worked with their digital service provider to develop a full online self-assessment form, including a full financial assessment, which would be transferred straight into their wider systems.

Eligibility determination and financial assessment information is not visible to the person completing the form to reduce the risks of multiple attempts ‘until they got the right answer’.

This system allowed allocation of assessor time in a more targeted way:

It allowed them to redirect people directly to adult contact teams where there were indications of risk under safeguarding policy, or if people needed social work involvement.

It allowed diversion of people who did not appear to have eligible needs for care and support to other support through their ‘Live Well’ website, which includes universal and third-sector support.

It allowed completion of financial assessments at the earliest opportunity to determine contributions to care costs.

It informed triage of received online adult needs assessments to indicate whether the information submitted was appropriate to the level of care being procured or whether follow-up work would be required by a social care assessor, who would then review the adult needs assessment with the person.

The reduced number of people coming through to the social care assessor teams would then follow a workflow and new assessors were recruited and fully trained to carry out adult needs assessments.

With a greater emphasis on online self-assessment or third-party assisted self-assessment, the numbers of staff required to support this workstream was reduced significantly and based on an estimated average of 6.

With 2 hours for each triage or follow-up, it was estimated that the additional staff required would reduce from 50 to between 10 and 14.