The current care management process resulted from the Griffith Report and the Community Care Act 1990. It is the practitioners guide for carrying out assessments. The Government initially wanted to save money and reduce costs by keeping disabled service users within there home and gearing services to their needs rather than institutionalising these individuals. Also a change from service led provisions. In 1996 direct payments were introduced for service users to be able to select and control their own services. The idea is merely about keeping people in the community and it’s cheaper than institutions. Disabled service users feel with direct payments they have the power to decide who cares for them which gives them independence as stated by (camichael 2004) support and reliability of this service is, positive. People have choice and rights.
The care management process has seven tasks which are used, and it begins with publishing information, informing potential users and carers of the services available, and of the arrangements and range of services currently available for meeting them. It states if carers and service users are to be empowered they need to have more control over gaining access to relevant services. Therefore social workers need to make sure information is readily available to them about their entitlement to services of how and where to obtain this help and also about the complaints procedures. Information needs to be provided in different languages for those whose language is not English, and for those who have sensory impairments or learning disabilities.
The DOH (2006), 'Our Health, Our Care, Our Say', identified the need for more information on services for people so more choices can be made about staying healthy and well. This also identified how it will give quality of support and protection to those with highest level of need, it promotes a social model of care for adults. This is led by the person and what they want. Vulnerable adults are also additionally defined by certain groups, which are, elderly, learning disabled, physically disabled, sensory impaired and mentally ill, Ruston et al (2000). More recently the introduction of the DOH No Secrets (2000) guidance was developed which promotes empowerment and well being of vulnerable adults and states the importance of raising awareness. Second stage is Determining the level of assessment needed, this involves an initial identification of the service users need in order to find out the complexity of assessment required, it is about gathering information to identify the level of need and urgency of the needs. The local authority is required to offer a comprehensive assessment to people ‘disabled,’ in terms of Disabled Persons (SCR) Act 1986.
Assessing need which is gaining an understanding of the individuals needs assessments in line with agencies policies. Assessment process should be simple, informal and speedy as possible. Comprehensive assessment should be reserved for those with complex needs or those that are disabled which may require participation of other agencies. This assessment enables service users to be considered as a whole. Whereby strengths and weaknesses are identified and the services users should be actively involved in the process. There can be differences in the perception of needs between the users, their carers, and other agencies. It is the practitioner’s task to try to reconcile these, although user’s views should be foremost. The guideline state it is the practitioner who defines the user’s needs, although participation should be shared by all. Once the needs are identified they have to be related to the eligibility criteria defined in the policy of the agency, needs have to be prioritised, and meeting them defined. Care Planning considers the resources available to best meet the individual requirement. Care planning should use the individual’s strengths and resources of the carers within the resource constraints to look at how needs can be met. Services users should be offered a choice of services appropriate to ethnic and cultural backgrounds, enabling them to have control over their lives. Practitioners have to be satisfied the option chosen is the most suited to the needs otherwise full explanation should be given. Practitioners who are for defining needs and allocating resources may find it hard to balance accountability.
Implementing the care plan, securing the necessary services or resources. Both users and cares should play an active part in implementing the care plan. The plan should enhance the care arrangements. Service providers should deliver flexible services and they should be delivered, quality service in a cost effective as possible.
Monitoring is making adjustments, supporting those involved it is seen as the facilitation of objectives stated in the care plan. Users, carers, and managers should all be involved in the monitoring.
The practitioner has to make sure the care plan is delivered taking into account the budget which has to also be monitored. The information is shared to ensure the care meets the standards expected. The monitoring records all the information, and finally Reviewing ensuring that the services remain relevant to needs and evaluating their quality.
Review starts with the views of the service user and carers on the progress that has been achieved in reaching the objectives stated in the care plan. Cost and quality of services is examined. The assessment of new needs may be necessary. At this stage reduction or withdrawal of services can be made. The objectives of the care plan, service provision, and services are revised and any deficiencies are identified (D.O.H 2005.)
Service users feel inadequate with regards to the how the system actually works gaining access to information, the eligibility criteria and assessment process is lengthy. Both practitioners and service users acknowledge that this system can often be oppressive and discriminatory. Structural oppression is embedded in the organisation. This indeed seems to be a problem for statutory organisations. The number of referrals and the intensity of work initiated have altered with more time now required for bureaucracy. Furthermore, the system is often perceived as being too procedural in nature. Research commissioned by WSUN and funded by Joseph Rowntree Foundation demonstrated service users abilities to carry out best value reviews of services (Carmichael 2002)
Another criticism of assessments is that clients are not actively empowered by the process stated by Mencap in a survey done in 2001. Discrimination still exists within social work practice and the care planning stage may only seek to reinforce the powerlessness of service users and carers. The Assessment Framework is ‘delivered’ by practitioners in a variety of ways. There can be a good professional relationship or hostility can overshadow the process, cause of isolation and stigmatisation and make positive working difficult. Local authorities suffer from being large, intimidating and often oppressive organisations. With endless guidelines and practice circulars can do little to improve the process of assessment.
It is concluded In order to develop and maintain a positive relationship with a disabled service user Competence in assessment and care planning must be based on solution and client-focussed approach that combines holistic assessment with quality preparation and planning. They must identify strengths and weaknesses but seek to enable the client to take responsibility and control over their lives.
In addition, authority can play a significant role in the assessment process. If there are not clear expectations for the family and stated responsibilities of the practitioner confusion can emphasise the difference. The abuse of power in especially difficult situations can alienate and thus reduce co-operative working.
The role of the care management is central to the community care and the assessment process. Care management and assessment were identified by the 1989 White Paper, Caring for people, as being the cornerstone of high quality care (CMD 2006 p849 para 111.) This is primarily seen as empowering the service users and carers.
References
Clare, L. and Cox, S. (2003) ‘Improving Service Approaches and Outcomes for People with Complex Needs through Consultation and Involvement’. Disability and Society 18(7) pp.935-953.
Department of Health (2000) No Secrets; The Protection of Vulnerable Adults – Guidance on the Development and Implementation of Multi-Agency Policies and Procedures. London: Department of Health
Department of Health (2005) Independence well being and choice: our vision for the future of social care for adults in England. London: HMSO.
Department of Health (2006) Our Health Our Care Our Say London: HMSO
General Social Care Council (2002) Codes of Practice General Social Care Council.
Carmichael A and Brown L (2000) Exploring the accommodation and support needs of disabled people Leonard Cheshire organisation.
French S (1994) On Equal Terms Working With Disabled People Butterworth Henman Ltd
Department of Health (2005) Independence, Well-being and Choice. Our vision for the future of social care for adults in England, London: Department of Health.
