There is a commonly-held illusion that the social care system can be controlled and that it can best be improved by taking a linear approach to each element of the system, thereby driving out efficiencies. While over the past decade, in the face of growing demand and smaller budgets, many councils have made significant savings, this is not sustainable and doesn’t always deliver better outcomes.
At IMPOWER, we believe adult social care should be reframed around creating value citizens’ lives, and in particular maximising their independence. In practice, this means taking every opportunity at every point in the system to promote independence and positive outcomes. It also means ruthlessly seeking out opportunities where any action, intervention or lack of intervention does not maximise value in people’s lives. We call this eradicating unnecessary demand.
In every social care system we have examined, local practitioners have analysed that in at least 20% of cases, we do not maximise value and independence. The closer we can get this figure to zero, the better.
Giving up current models of control, even if they are illusory, is scary. It should only be done if there is a better alternative. We call the alternative building a Target Demand System. This combines building a new detailed analytical view of demand so trajectories can be understood and reacted to in real time. It also means focusing in on specific behaviours and decisions right across the system, which requires behavioural science and new performance management systems. This adds up to both an overall culture change, and a new operating model.
Through this approach we have already helped improve thousands of lives and save over £30 million across 10 councils. Building on this track record, we want to reach a further 100,000 people.
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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