Social workers reveal the extent of social care meltdown

Devastating impact of service cuts on vulnerable people laid bare

The findings of a new survey of social workers by Community Care Magazine, supported by the Care and Support Alliance, provide shocking evidence of just how threadbare the social care safety net in England has become.

The survey (1) gives a unique insight into how many social workers feel about the frustrations of their day to day work as they ‘tell it how it is'.

There were 469 responses from social workers to the online survey, from every region of England, and their comments reveal the incredibly difficult position they are often in as they strive to support people in desperate need without enough cash in the system. For example,

'[There is] strong pressure from my line manager and commissioners to reduce costs as a main priority.'

'Colleagues constantly battle to keep packages at an adequate level to support clients/assist to keep them safe.'

'Care packages are not getting agreed by the funding panel. I am having to submit reduced care packages to the panel in the hope that some support will get funded, as opposed to none.'

'I cannot get new packages of care agreed or increases agreed when needs have increased.'

These comments need to be seen against a context in which nearly 7 in 10 68%(1) respondents to the survey said they felt expected to reduce care packages because of cost pressures in their local authority; more than 1 in 3 (37%) said they believed they couldn't get people the care they needed; and, chillingly, more than 1 in 4 (28%) were not confident that the reduced care packages they had to administer were ‘fair and safe'. In addition, 4 in 5 respondents (81%) said family and friends are being expected to provide more support to ‘fill in' where care has been reduced.

In the survey the reason given most often by social workers for having reduced a person's care package was because their needs had changed. However, far more worryingly this was followed by budget pressures and because local authority support is now more restricted. The examples some respondents gave describing the plight of older people and disabled and mentally ill adults whose social care and support is being restricted or removed because of lack of resources were profoundly concerning:

'I worked with a woman who could strip wash but who couldn't reach her back and intimate parts of her body so had paid carers for years as part of her personal budget to help her....however it was cut as she was physically able enough to strip wash. This was devastating for her.'

'A person with hoarding issues and a tendency to eat rotten food had their shopping and housework call cut, resulting in an admission to hospital with food poisoning.'

'After one service user was told her care package was being reduced she seriously self-harmed and had to be detained in hospital.'

'I had to reduce the care package for three brothers who live together. Each has either a mental health problem, physical or learning disability. They had a substantial care package for 15 years. It kept them safe from financial abuse and enabled them to live in the community. After reducing the care package two of them went into residential care and died. The other was admitted to hospital with dehydration and hypothermia.'

'In my local authority I work for managers who will not approve time for a care worker to visit an older person and prepare a hot meal. I am told to record telling the individual about hot meal deliveries as a reasonable way to meet this need. Meals on wheels are self-funded within the authority and can cost a minimum of £42 per week. Lots of my service users worry about spending money and so go without a hot meal.'

'(Reducing care packages) has led to individuals becoming more isolated, engaging in risky behaviour and being exploited.'

'The person requires support with walking to the bathroom but due to the cost he is now required to contribute towards it so he has decided he would rather have the risk of falling than an evening call.'

'There has been pressure on an elderly husband due to a reduction in assistance to his wife, causing the breakdown of the relationship. He ended up in hospital and she was placed in residential care.'

'Lunch calls and toileting calls are being reduced from 30 minutes to 15 minutes to save costs……'

'[We have] removed lunch calls for service users with dementia.'

The survey also found that support to get out and take part in social and leisure activities was the type of help which was most commonly being reduced (72%), followed by help with domestic tasks such as food shopping and cleaning (67%).

In addition, more than 4 in 5 respondents (83%) did not think there was enough variety and quality of social care provision in their area for people to exercise genuine choice and control over the care they received.

Caroline Abrahams, Charity Director at Age UK and co-Chair of the Care and Support Alliance said:

'This is the first time that England's social workers have spoken out in such numbers, blowing the whistle on just what a drastic state of decline social care is now in.'

'The social workers' descriptions of what the cuts mean in practice for disabled people, those with mental health problems and older people make for tough reading and it is impossible not to be angered and saddened by them.'

'It is though important to remember that while social care is a service administered by local authorities, ‘the buck stops with Ministers' and the suffering that vulnerable people are experiencing today is the direct result of the decisions successive governments have made to underfund social care. The extra £2 billion this Government has pledged will certainly help but the funding gap is far larger, so the situation is certain to worsen without further action.'

Mark Lever, Chief Executive of the National Autistic Society and co-Chair of the Care and Support Alliance said:

'Social care became an important topic during the recent General Election campaign and in the Queen's Speech, when the Government committed to consulting on proposals to place social care on a sustainable financial footing for the future. Since then, however, it has all gone ominously quiet.'

'This survey of social workers demonstrates why it is so crucial that this Government tackles the social care crisis as an urgent priority. Some of the suffering described is sickening and I think decent people in this country will be appalled at how little support is now available for people in need. People should be rightly anxious about what this might mean for themselves and their loved ones if they should they need help.'

Social care budgets have been cut by more than £6bn in real terms over the past seven years (2). As a result, half a million fewer older and disabled people receive care now than did five years ago (3), and research has estimated that more than one million people are not getting the care they need (4).

Jane*, a locum social worker, said: 'As a locum member of staff - I've seen social workers again and again and again being expected to make cuts and if you don't your contract's cut. It's brutal. Obviously, we're not told to make cuts - but we are! It seems to me to be that those who are well informed about their rights are able to get the care they need but if they're old or unwell and need someone to advocate for them - they go without.'

Social care user Rachel Looby, 30, from Harrogate, needed medical help after the amount of social care she received was cut (further details below). She said: 'When my hours were cut it was a stressful time for me. I took the wrong medication and ended up in hospital, and this made me feel like my health had not been considered at all. Being in hospital left me feeling anxious and upset and I worried if something else might happen once I got home.'

Margaret Willcox, President of the Association of Directors of Adult Social Services (ADASS), said:

'This telling and poignant report lays bare the invidious decisions that are having to be made by social workers and managers every day. Working within finite budgets is challenging and staff have to consider how best to meet assessed needs within those financial parameters.

'We welcomed the additional £1 billion in extra funding this year, but we need a sustainable funding solution for social care.

'Adult social care remains at a tipping point and this survey is further evidence of why the issue needs to be treated as a national priority. We look forward to contributing to debates about finding a long-term sustainable solution to adult social care funding and delivery.'

Ends

Case example:

Rachel's Story

Rachel, 30, from Harrogate is visually impaired, has dyspraxia and autism.

For a long time, Rachel received 17 hours of social care a week. This involved help with basic tasks such as cleaning and cooking, as well as support with managing her money, medication and personal care.

However, although her needs had not become any less pronounced her support was reduced to just five hours per week. This meant she only had help with basic tasks. With no one to help her manage her medication Rachel missed doses and had a seizure. To make things worse, while recovering Rachel mistook her dog's medication for her own and became very ill and had to be hospitalised.

These two incidents understandably knocked her confidence and she became demotivated and stopped taking her anti-depressant medication. This led to her becoming depressed and socially isolated, threatening to compound the difficulties she was facing.

*Named changed

Notes on the survey

(1) 469 social workers and other professionals who undertake care assessments and reviews responded to the survey which ran online on Community Care's website between 12 April and Friday 9 June 2017. We asked a series of questions relating to instances where they had reduced service users' care packages over the last 12 months.

In one question respondents were asked ‘what is the most common reason you have had to reduce people's care packages?' and invited to complete a free-form box. Where respondents mentioned multiple reasons, they have been counted separately.

(2) ADASS, Budget survey 2017

Total cumulative savings in adult social care since 2010 will amount to over £6.3bn by the end of March 2018.

(3) Comparing NHS Digital, Community Care Statistics, Social Services Activity, England for 2010/11 and 2015/16.

(4) Age UK, Health and Care of Older People in England 2017, February 2017

End notes

The Care and Support Alliance (CSA) - a coalition of more than 80 of the country's leading charities - who are calling for a properly funded care system.

Community Care is an online magazine for social workers and social care professionals

About social care

Social care is an essential life support system that people rely on for everyday tasks like washing, dressing, eating and managing in the home. It helps people get out and about and is meant to support people not just to live but to have a life. Without social care, many people would be lonely and isolated, as well as at risk of crisis.

A social worker's role is to assess what support someone needs to keep them safe and able to live independently. They are required by law to follow a set criteria and guidance on the level of care people are entitled to. The main legislation that governs social care today is the Care Act 2014.

For media enquires contact Will Staynes or Liz Fairweather on Tel: 020 3033 1264 / 020 3033 1718 or Liz.Fairweather@ageuk.org.uk / William.Staynes@ageuk.org.uk