by Catherine Cross and Becca Tildesley

“It’s down to us to take a whole new approach to care, with our communities playing a much bigger role.”

 

Introduction

It’s become clear in recent weeks that, as a sector, we can’t rely on national leadership, policy changes or major reform to make social care either a transformational or financial priority anytime soon. Prior to the budget, we met and had uncompromisingly open, honest and energising conversations with leaders across Adult Social Care, Health, Community sector and those making truly transformational change happen.

The outcome was a broad consensus that the categorisation of cohort, condition and care settings, system wide financial and performance measures and regulatory oversight (along with some market, capacity and workforce challenges) are all actively working against the achievement of good outcomes for those who need care, and their carers. While it was sobering, there was a determination to find solutions from within communities and Social Care as, we all now know, no one else is coming to save social care.

There are a few challenges to overcome. The capacity to really think about the change that is needed and move it to action is hard to find while doing the day job. There may be a need for some micro-investment, funded through operational and spend rigour in existing services, or by being more creative around how social value is quantified and realised in procurement. A business case approach could be adopted, mainly to drive the identification of benefits and ensure that any new approaches have the funding to support their embedding and sustainment.

Four major themes were explored in our conversation.

Shifting away from Traditional Models

There is a clear need to move away from a top-down, bureaucratic solution approach towards more community-led approaches.

In recent years, communities have retaken their place in social care, providing a level of care locally between families, neighbours and friends. What we need to do now is to provide options for these individuals and groups to continue to do what they’re doing through better and easier access to lower-level support.

The focus now needs to be on empowering individuals, communities, and local councils to take ownership of the full spectrum of social care – from local authority-funded, eligible care at one end to informal, grassroots support at the other. Framing social care as a spectrum rather than a set of isolated services helps in understanding and addressing the end-to-end needs of individuals. This is hugely important in providing real, quality care.

Many models of community-driven social care already exist and many of them have worked very effectively in the past. This strong base of learning and support is available, so we need to draw on those foundations.

People Power at the centre, and a new Social Contract

Shifting power to individuals and allowing them to make informed decisions about either their own care or how they access and arrange care for others could transform what we know as social care now and help to ease workforce and financial challenges. Benefits would be especially prevalent in informal or lower-level care and self-funded care packages, though would require a level of understanding between local authorities and their communities.

The role of councils and health services would need to change from authoritative bodies to supportive partners supporting people to navigate their own care journeys and helping other vulnerable people to navigate theirs. Through this approach, a new ‘social contract’ between councils and citizens is formed, which could outline clear mutual responsibilities and expectations, with councils playing a supportive rather than a directive or authoritative role.

The evidence for repositioning traditional responsibilities like this exists and we know it works, but there are likely to be challenges, particularly around the perception of risk, when shifting power to the people.

Some questions to consider as we explore a move towards people-power risk: As a sector, are we too risk averse? Are we ready to start viewing risk differently to create opportunity?

Rethinking Prevention and Self-Funding 

As we continue this exploration, we also need to reassess our relationship with self-funded and preventative healthcare, and our trust (or lack of) in the community and our neighbourhood teams. Drawing on these resources to help and enable individuals to prepare for their own care before they need it will start a shift towards enablement ahead of the time when the need is for reablement.

Community support, much of it in the form of neighbourhood teams, exists despite statutory bodies, not because of them. [Remember the Pandemic.] This support plays a huge role in tackling some of the key drivers of poor health, such as loneliness. To really utilise the support of these teams, statutory bodies must work better with their communities to ensure that the fundamentals basics are in place.

The idea of a consumer portal were floated in our discussions, highlighting the need, from both professional and personal experience, for a one-stop-shop for self-funders and community or family-based care givers. Smoother, easier access to guidance and information could be the underlying enabler to this kind of care.

There is lots to be learned from the established neighbourhood teams, their successes and their challenges. It can help us to understand how much can be achieved, at little or no cost, within local neighbourhoods. Recognising this, that a more stable and fulfilling life can flourish, from a seemingly readily available resource for a relatively small investment, will help inject our drive to make this a thing.

Focus on outcomes, not money

Care models and the delivery of those models are driven by regulation, policy, finances, procurement and system efficiency,  with services divided into specific episodes or ‘boxes’. This approach doesn’t allow for the flexibility needed across the spectrum of care and support.

If we return to the primary focus being on tangible improvements in people’s quality of life across the entire spectrum of how care and support is defined should lead to demand reduction and better use of resources across the system. There is an inherent inefficiency in multiple handoffs across teams.

A complex and important part of a change of approach will be the measurement of the investment, not just in cost or demand reduction, but in wealth creation, productivity improvement and quality of life. At the moment, we do not have all the answers to measuring these (sometimes) intangible or longer-term outcomes. The combined brains in our 4OC – Rethink team have jump-started working out ways to do it.

Testing this approach, without breaking statutory social care, is eminently doable. A better use of data is one possibility, where the focus shifts from reporting on finances and performance to providing insights across population and communities. The technology to do this is available, is inexpensive and is easy to implement.

What the research says…

The workshops and the conversations that ensued were informed by research that clearly support these arguments. The participants also offered up examples that have worked, and we have provided some links below:

• Building on Covid-19’s community-centred approaches
• Lessons from the Wigan Deal
• Prescription for Prevention: a new model for primary care
• Options for Restoring the Public Health Grant
• A GP’s Analysis for what’s next for Primary Care
• How Local Authorities Are Thinking Differently Under Unprecedented Financial Pressures
• CIPFA’s podcast on managing demand in social care

If you want to get involved

… the (r)evolution starts here and there’s lots more where that came from. We’d love to chat about any of the things we’ve discussed, and more. We’ll be at the National Children and Adult Services Conference from 28-29 November in Liverpool to continue the conversation. Or you can give us a shout at hello@the4oc.com.