Improving outcomes for service users in adult placement - Commissioning and care management

Summary - Key findings

Adult placement services are well placed to help social services (now adult social care) offer more control, choice and community-based support to people who use care services, including those with learning disabilities, mental health needs, physical disabilities and complex conditions. The project fieldwork, however, suggests that adult placement needs to become better known and understood by strategic commissioners and care managers, and schemes need to become more active partners in developing local commissioning strategies. Awareness of adult placement is often limited to just a few social workers in a locality, and purchasing of placements is rarely related to a local strategic commissioning policy. Many practitioners do not understand or embrace new policies, new regulatory requirements and new ways of working such as person-centred approaches, individual budgets and self-directed services.

While agreeing that assessment is key to making a good placement, discussion group participants reported a wide variation in assessment practice, and in the quality of information received at referral. Only people recently referred for adult placement are likely to have a care management care plan, and the quality and relevance of care plans was queried. Concerns were raised about responsibility for and quality of risk assessment, and about static and inflexible risk plans preventing adult placement service users from moving on in their lives. Participants confirmed the low profile of care management/social work in adult placements, and a trend among social work departments to appoint separate reviewing offers. Adult placement carers reported minimal and often unsatisfactory social work involvement in the placement. Many believe reviews are paper exercises, and that social workers do not listen to them or take them seriously.

Discussions confirmed a continuing lack of understanding of person-centred approaches and formal person-centred planning in social services departments. Service user aspirations set out in person-centred plans are disheartening if not achieved in reality. Independent advocacy is a rarity. Adult placement service users and adult placement carers are frustrated by (but also resigned to) the lack of independent advocacy, and sometimes disappointed with the advocacy service they do receive.