Warrington Borough Council

Using Demand Management to Maximise Independence in Adult Social Care

November 2016 – February 2017

The Challenge

In common with most adult social care departments across the country, Warrington is facing a further round of spending cuts. IMPOWER were invited to undertake a review, in order to understand what was driving demand for the most costly adult social care services. The task was then to identify ways to manage this demand, in order to achieve better outcomes for citizens needing social care and to lower costs for the Council.

“We think we have come out of the process with a compelling evidence base, a greater insight into how we are doing things and a detailed plan for the next three years. It’s often hard to feel you are still ‘doing the right thing’ whilst designing a way of working at a lower cost base. But I think staff at all levels of the service believe that’s what we have been doing, because we have focused on different ways of doing things that empower and inform people with care and support needs.”

Steve Peddie, Operational Director Social Care (and Deputy DASS),Warrington Council

What we did

We began by gathering data and establishing the facts around where demand lies and what drives it. This was then used to develop an evidence-based case for change, and to build support for a specific model of demand that would work for Warrington. We invested time in staff engagement, to ensure that the case for change resonated with the people who would be key in implementing it.

What we discovered

The project discovered that demand management interventions could help the service become financially sustainable over the medium term. Through identifying where the demand pressures were in the system – and most importantly where there were opportunities to prevent, reduce or delay demand – the joint team co-designed a new target demand scenario for Adult Services. Evidence for the viability of the new scenario was gathered (and cross-checked) from a range of sources, including practitioner reviews of current cases, staff observations, a staff survey, benchmarking and current demand analysis.

Key insights included:

In 52% of cases that were reviewed, more could have been done to prevent, reduce or delay the needs of clients
Learning disabilities accounted for 46% of net spend (as opposed to only 36% of gross spend)
Only 7% of reviews were resulting in a reduction in the level of support
Only 31% of contacts were being signposted away from Adult Social Care within the contact centre

The analysis we undertook helped us to quantify the potential for demand reduction, and to identify specific focus areas for improvement such as services for adults with learning disabilities and older adults.

This gave the department a very tangible target to aim for. Moving from a conceptual picture of demand, to metrics that individuals can actually relate to in their jobs, is an important step in translating theory into reality.

Results and impact

The main result is an evidence-based case for change, built on a positive future. This includes a clear model to aim for, and a clear plan of how to get there. The model is backed up with practical inputs, including:

Clear feedback on how messaging to the public and partners can be improved
Identified examples of demand that could be avoided
Ideas to change culture and improve social care practice (in line with strengths and independence based approaches)
A tool to help model and monitor how demand converts to cost

Another key outcome is an evidence base and strategy for achieving the approximately £6m of savings that are required, whilst still meeting needs. This means a reduction in demand of 11%, both from a reduced number of people being directly supported and a reduction in the average package size.

Consequently, despite ongoing funding cuts, there is a more optimistic picture of the future. While this future will certainly involve hard work, tough decisions and tough conversations, the ultimate focus will remain on keeping adults with additional needs as independent as possible.

The hardest work begins now, with the true benefits of that work only being felt further down the line. However, Warrington have already done much to improve the independence of its citizens and meet the funding challenges given to them. Within the management team, there is also now a clarity of vision coupled with an understanding of practical next steps. With IMPOWER’s support, this vision has also been cascaded to the wider workforce. It is this focus on clarity that will help Warrington to bolster its ability to provide the support that citizens need, maximise their independence and meet its funding challenges.