8.2 One of the main findings of this research, although it is neither new nor surprising, is that authorities reported a very diverse range of policies surrounding care management. There seem to be three reasons for this apparent diversity:
• inconsistent use of terminology between, and possibly within, authorities
• differences in policy and practice between authorities
• confusion and lack of clarity about certain aspects of care management.
These are separate points but they impact on each other. The terminology surrounding care management is used very differently across Scotland (and beyond – see Manthorpe, 1999). It is very important to be aware that terminology can mask differentiation in policy: conversely, polices and practice which are much the same may be presented quite differently. Perhaps the most critical of these is the term ‘care management’ itself.
8.3 Some authorities say they only ‘care manage’ people with complex needs; others ‘care manage’ all their community care clients. However, there was some evidence of different policy and practice among those who claim to only care manage people with complex needs. For example, a service manager from one such authority also commented that the decision about whom to care manage was not always a ‘pure’ one and could depend on current availability of resources and staff skills. Again, authorities which ‘care manage’ all their clients still differentiate, to varying degrees, between those with different levels of need, the policy being to adapt the process accordingly, for example, by doing simpler assessments, less intense monitoring, less frequent reviews. However, that policy may not always be translated into practice consistently: for example, as identified in previous chapters, professionals may carry out full assessments of all clients in the expectation that the information may come in useful later, or monitor some cases
managers commented that the level of assessment or review expected by their authority was not always appropriate to the complexity (or otherwise) of the case.
8.4 There was also evidence of confusion and lack of clarity about certain aspects of care management. This can be illustrated by the responses of some service managers, when asked if their authority was using single shared assessment tools. Many reported that they were, but this included arrangements whereby different disciplines in local authority community care teams used the same form, or where care managers asked health colleagues to fill in a medical section on a local authority assessment form, or they informed health colleagues about the results of completed assessments. Some service managers commented that care management policies within their authority required some clarification, while several care managers reported that their role had not been clearly defined.
8.5 These findings all suggest that a clearer differentiation between complex and more straightforward cases would be helpful, matched by a clearly differentiated process for each, with different terminology used to describe these processes (as discussed below).
8.6 Only one authority was using the “role” model of care management; in 21, it was a “task”, while ten authorities reported a mixture of “role” and “task”. A number of arguments were made for and against each approach. Fears have been expressed elsewhere that the “role” model robs social workers of their traditional listening and counselling activities. These are an important part of assessment in complex cases which, this research shows, are not incompatible with the role model.
8.7 Most authorities encouraged some degree of specialism by user group, often using the role model in specialist or multi-disciplinary teams. People with learning disabilities and users of mental health services were the groups most often served by such teams. Although it could be argued that care management skills are transferable between user groups, many care managers believed that knowledge of particular user groups was important.
8.8 All authorities had, or were developing polices for joint working: there was a mixed picture here with some authorities much further advanced than others. Six per cent of care managers were employed by NHS Trusts, 5 per cent were based in GP practices, although many more were linked to GPs, and 11 per cent were located in hospitals. About nine per cent of care managers were OT trained and a slightly smaller proportion, nurse- trained. It was reported that 310, or 16 per cent, of care management posts were located in multi-disciplinary teams, although this is almost certainly an under-estimate. Only five authorities did not have any such attachments. Twelve authorities accepted health colleagues’ assessments, although this was often confined to simple cases or particular projects. Fifteen authorities were piloting or developing single shared assessment tools, or using them within particular teams. One was about to launch a single shared tool for all user groups across the authority. Overall then there was evidence that considerable progress had been made towards closer collaboration with health colleagues.
8.9 In contrast, the involvement of housing colleagues in assessment and care management was generally very weak. However there were exceptions, as mentioned below.
8.10 There was widespread agreement that multidisciplinary work is key to success in care management. Where it was working well, this was identified as a major strength and where it was more problematic, this was a considerable barrier.
8.11 The findings underline the importance of a sound infrastructure for care management, in terms of IT, financial information, accounting systems and budgetary arrangements. A few authorities had plans to develop IT systems which would be compatible with those used by health colleagues. The ability to share and exchange information in this way would obviously be a huge step forward in joint working and the delivery of a seamless service to users.
8.12 Most care managers and service managers identified lack of resources and funding as the most problematic aspects of care management. This was cited as the main reason why authorities were not able to support more people with complex needs at home.
2. To identify how care management operates in practice in each local authority