Since the adult social care system was established 70 years ago, expectations, cultures, processes and systems that drive dependency on services have inadvertently been created. Local citizens expect to receive services, and practitioners expect to provide them – but rising demand and declining budgets have made these expectations unsustainable. A dependency culture also reduces the independence of service users and increases costs. Some £3 billion of the £14 billion spent on adult social care each year goes on unnecessary care. That’s more than one pound in every five.
Cost savings have already been pushed to the limit. The way to create a sustainable adult social care system and improve outcomes is therefore for councils to push demand-led change. Demand-led change is an approach that focuses on maximising the independence of service users, and on addressing citizens’ needs early to prevent them from escalating. By empowering people to do more for themselves, and by building self-sufficient and resilient communities, individuals experience greater independence and better outcomes with less state intervention. Our analysis shows that 70% of demand in adult social care is influenceable, and 20% of it is avoidable.
We work with councils to build a Target Demand System – a tool which helps them to:
- Understand the current demand in the system
- Understand what level of demand is avoidable
- Establish what level of demand is realistically affordable and realistic for the service to be sustainable
- Using the Target Demand Model, design and implement a programme to deliver a reduction in demand.
Since 2013, we have worked on demand-led change projects with more than 20 Departments of Adult Social Services. We have learned that:
- Benefits realisation and their trajectories must be set up as early as possible so that there is a robust and shared understanding of the benefits of the new systems, and of how operational practice and systematic approaches drive results.
- Working closely with council staff to understand the current system and then co-designing a new operating model together is key to getting that new model right. It is essential that the team feel genuine ownership so that they can fully and authentically transition to new ways of working.
- An iterative approach produces a culture of continuous improvement, helps to embed the change, and allows specific interventions, cohorts or teams to be focused on.
- To ensure that maximising independence can become the central focus for adult social care and that savings are achieved, it is essential that human behaviour change and culture change are given the same priority as process and structure change.
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