As the Government nears publication of its proposals for reform, and as the country works to cope with the ongoing impact of the pandemic, now is the time to have this important discussion.
The County Councils Network, Association of County Chief Executives and Newton have collaborated on a programme of work to form a perspective on the future of adult social care and, in particular, what it takes to optimise delivery in a reformed system.
Following engagement with over 150 stakeholders, the report presents an optimised model for how adult social care can be delivered effectively (in terms of achieving good outcomes at a sustainable cost).
During the financial year 2019/20 there were 1.9 million requests for adult social care support from 1.4 million new clients, equivalent to 5,289 per day.
In 2020/21, adult social care is projected to represent 33% of authorities’ total service costs.
In 2019/20, 838,530 adults received publicly funded long-term adult social care.
To achieve an optimised model for adult social care, there are a set of foundations that need to be in place at a national and local level. The key foundations summarised here are explained in more detail in the full report.
The COVID-19 pandemic has increased the visibility of adult social care, but there remains a general lack of understanding of what adult social care is and how it is delivered.
As a result, there can be a negative societal perception of social care, where individuals seek to avoid engaging with the sector. The profile of adult social care therefore needs to be raised so that people feel there is no stigma attached to approaching these services, and for the whole workforce to feel proud to work in the sector, and see a clear route to career development and progression.
This profile should be underpinned by a shared vision for adult social care, deeply understood both locally and nationally, that supports and enables individuals to live as independently as possible.
So much of social care is about prevention and enhancing long-term wellbeing. The majority is provided informally through families, informal carers and voluntary and community groups and assets. Local government is uniquely placed to effectively coordinate and manage this overall ecosystem, with deep roots in informal care networks that exist in a community. To centralise this responsibility, as has previously been suggested, would risk disrupting these crucial local links, which are the foundation of an optimised model, and would lead to a much greater need for state-funded care.
Alongside this, a shared understanding of both local and national performance could begin to create the conditions for parity and help each party to understand how they best play their role in improvement and innovation. An outcomes-based performance framework would serve to highlight local areas of innovation or best practice that could be shared, tailored, or adopted as appropriate.
There is no doubt that any reformed system should be based on stable finances and a funding model that promotes the right behaviours by those who commission care services.
Adult social care is delivered locally, and while most of the funding for care services is raised through local taxation, central government funding is, and will remain, critical. Decisions made centrally have a significant impact on both the quantum of funding local authorities have access to, as well as, to a certain extent, what they need and are able to spend it on. This creates a tension that makes adult social care both a local responsibility and a national responsibility.
A funding model which gives longer-term certainty would promote local accountability and support local leaders to make decisions in the best interests of the local population. This will enable local authorities to tailor services to their unique demographic, delivering good outcomes at a sustainable cost through the optimised delivery model described in this report.
The NHS long-term plan sets out the vision for Integrated Care Systems (ICSs), built off the foundational building blocks of Primary Care Networks (PCNs). The plan to implement ICSs relies on governance changes and improved wider system relationships. It is not (currently) strengthened with strict legislation, policy or more profound changes to organisational form or function.
Social care leadership in PCNs and as an ICS requires building strong local relationships with health partners; investing the time and effort into ensuring there is a common purpose, mandate and accountability for joint teams; and building, coordinating and navigating community assets to fundamentally reduce the presenting need of the future population.
Alongside this, delivering adult social care is not only the responsibility of the adult social care directorate within a local authority. The far-reaching nature of the system and its intersection with other services makes partnership working across different agencies not just desirable, but completely essential.
From this core, service ‘layers’ can then be built out, with each layer supporting, enabling and reinforcing the values and beliefs. These three layers are broken down further into nine ‘themes’.
The three layers are:
The values and beliefs which underpin the optimised model of adult social care focus on promoting people’s independence. This approach states that the best outcome that can be achieved for an individual is one which enables them to live as independently as possible, whilst remaining safe from harm.
These values and beliefs recognise the importance of personalisation and choice. This is achieved by taking a strengths-based, or asset-based approach. Promoting wellbeing, promoting independence, and supporting independence is not only best for individuals – it is also a cost-effective way of meeting the needs of the population, as more independent individuals typically require less care.
Given the breadth of scope of the adult social care system, the complexity and nuance of the communities within which it is delivered, and the evolving national context, this is a complex task. However, the report seeks to provide a basis for an optimised service, and points to the key enablers that need to be prioritised in order to make this a reality.
The central overarching conclusions, covered in detail in the report, are:
To find out more about our conclusions, download the report.