By Bruno Ornelas, Service Manager, VOICES and Dr Michelle Cornes, Senior Research fellow, Kings College London

How we developed a toolkit to bridge the gap between individuals and the social care system.

The aim of the Care Act 2014 is to ‘make the law fair and consistent’ and to remove ‘anomalies, which treat particular groups of people differently’ regardless of the provision they need or when they need it (DH 2013). The Care Act 2014 was introduced in England on 1st April 2015. It rescinds former legislation, including the NHS and Community Act 1990, with the aim of creating a single consistent route to establishing entitlement to publically funded care and support. This may mean that people who were frequently passed over by adult social care on the grounds that they did not come within a certain user group defined in legislation, such as homeless people, will no longer be excluded (Mandelstam 2013).

For the VOICES coordination team, issues quickly came to light in relation to access to adult social care. Coordinators found it difficult to negotiate the initial customer services screening processes and to secure an assessment for their customers.

A key lesson to emerge from VOICES early work, centred on the importance of communicating with adult social care in their own language. We recognised that our referrals to adult social care often provided a narrative account of our customers’ circumstances, which were rarely acted upon by social workers. What worked from an advocacy perspective, was ensuring that referrals clearly specified how presenting needs mapped onto the ‘eligibility regulations’ contained in the Care Act 2014. Eligibility is important because it triggers a legal duty for the local authority to meet a person’s needs.

A powerful advocacy aid

To assist the coordinators in their advocacy work, we designed the Care Act Multiple Needs Toolkit (Ornelas and Meakin 2016). This provides a step-by-step guide to working through the Care Act 2014 eligibility regulations. The toolkit is a powerful advocacy aid, as it works to reduce the scope for professional social work discretion in several subtle ways. First, by presenting the eligibility regulations in an accessible format, support workers, customers and other professionals no longer have to rely on social workers’ interpretations of the legislation. Second, a key design feature of the toolkit is that it records different viewpoints side by side: that of the person being assessed, that of the support worker (or advocate) and that of the social work assessor. One outcome of presenting information in this way is that it renders any discretionary professional judgement explicit and therefore open to much greater scrutiny and challenge.

For example, the social work assessor might support the VOICES customer’s perspective that they are managing their personal hygiene well, while the view of the support worker may be that the customer is unkempt and self-neglecting. Here, the social worker might argue the VOICES coordinator is being paternalistic, while the support worker might see the social worker as saving resources by not questioning why the customer is declining care and support. The customer meanwhile can potentially find themselves stuck between both these professional judgements, which might then be played out in terms of an assessment of his or her capacity. Homeless Link has published guidance on the Mental Capacity Act here.

Initially, social workers and their managers did not welcome the toolkit, as there were concerns that it duplicated a self-assessment tool, being developed by the local authority. However, VOICES addressed these concerns by making the aims of the toolkit clearer in the introductory section, providing reassurance that it was not intended to replace the formal assessments of professional social workers.

The toolkit’s stated aims are:

• To ensure that people with ‘multiple needs’ can record and communicate their needs as effectively as possible
• To increase confidence among VOICES and other voluntary sector workers in working with the Care Act 2014
• To support social workers (who may be unfamiliar with this ‘client group’) to explore how ‘multiple needs’ impacts on the need for care and support
• To enable relationships and information exchange between these two groups of workers who may not have worked together previously.

For VOICES Coordinators, its main value was in promoting greater knowledge and understanding of how to work with the complexity inherent in the Care Act 2014 eligibility regulations. For social workers who had little previous experience of working with people with multiple needs, it was acknowledged as being helpful in enabling them to ascertain a better understanding of the seriousness and gravity of risks associated with issues such as sleeping rough.

VOICES and Adult Social Care continue to work together to develop new narratives in relation to adults with multiple needs. Through this, we’ve recognised that supporting people with multiple needs often brings unresolved ethical tensions within the system back into the forefront. The toolkit, alongside positive working relationships with Social Workers, has given us a base with the potential to understand and overcome systemic challenges that people with multiple needs face when accessing social care.

The toolkit is available for download and printing on the publications page

Blog written jointly by Bruno Ornelas &  Dr Michelle Cornes