Additional £5.4bn will not shift the dial on social care

We very much welcome the PM’s announcement this week, but there are still many challenges facing the social care sector. Only 15% of the £36bn agreed additional funding is destined for social care – and not until 2023. Most authorities are facing increasing demand for domiciliary care and capacity shortfalls – both leading to significant increases for both assessments and care.

The recent ‘Snap Survey’ produced by the Association of Directors of Adult Social Services (ADASS) revealed that nearly 300,000 people are awaiting social care assessments, care and support, or reviews. This figure has increased by 26% over the last three months. But, why is this?

• Rightly, there is a focus on Home First, but this increases demand for domiciliary care. An insufficient focus on avoidance – underpinned by prediction and prevention – has increased the need for community-driven care and post-discharge support.
• Covid has led to record-breaking hospital waiting lists. D2A arrangements now see patients being discharged sooner – when they are ‘clinically optimised’ rather than ‘socially’ or even ‘physically’ ready.
• There is an enhanced reluctance to go into residential care – leaving more complex cases to be supported at home.
• The data and insights about people’s wellbeing are not optimised or fully available – resulting in more post-hoc care and less prevention.
• Fewer family members are working from home – and that will reduce further as people return to work, leaving vulnerable people in need of more domiciliary care support.
• More could be done to help carers – supporting informal carers and signposting them appropriately is critical.

Exacerbated by increasing demand, capacity and supply is proving increasingly challenging. Authorities are finding it more and more difficult to both employ and commission support due to insufficient public workforce and market capacity. Authorities are exploring ways to overcome this – often focused on attracting more employees and commissioned providers. But, based on 2020 data published by Skills for Care, vacancies in social care have been rising for years.

All of this means that fewer people are able to be Home First, be at home independently, receive sufficient support and reablement – and the risk for discharged and/or vulnerable people is even greater.

So, what would help shift the dial?

Local authorities have made strides in their social care provision, increasingly adopting strengths-based approaches rather than universal service delivery. There has been a migration towards more predicted and preventative care, and a recognition that multi-disciplinary interventions are required to help people be at home and independent. Genuine collaboration between health, social care, the voluntary and community sector and other sectors is vital.

Our strong view however – drawing upon extensive work with local authorities’ social care departments – is that simply doing more of the same (or similar) will not address the challenges that ADASS has flagged. We believe there are four key areas to consider:

• Managing demand – it is increasing – how can that be avoided?
• ‘Valuing Home’ – evidently, Home First is key, but how can we ensure people remain and get home soon and safely?
• Using TEC not simply to augment things, but to provide stronger insights; including better prediction, prioritisation and tailoring of support, releasing capacity to address current and future challenges.
• Different approaches to commissioning external support/provision – a greater focus on outcomes, more co-production and consumer involvement, and improved integration across the public and private sector.

IMPOWER has supported local authorities for years in the social care space. We have a passion for delivering sustainable impact that matters – especially for vulnerable people. Our EDGEWORK approach, embedded within our Valuing Home programme, has enabled us to deliver significant impact in the Home First space. We recognise that change management is not a simple thing – but we embrace that complexity to secure better outcomes that cost less.