‘Don’t stop me now’ – a mantra for DASSs

You can always rely on Freddie Mercury to inject some energy into proceedings, so we are shamelessly using his 1979 hit ‘Don’t stop me now’ as a call to arms today. If Freddie can’t convince you of the need to be ‘like a tiger defying the laws of gravity’, no one can!

This wonderfully optimistic song probably came to mind as the days are getting warmer and longer, the Covid numbers are improving, and there is a general feeling that the crisis period of the pandemic is beginning to subside. In the adult social care sector, we have noticed that for some people this air of positivity is contributing to an idea that the coming year will be a smoother ride. Local financial pressures have eased in certain areas (nationally, councils have experienced a 9% reduction in demand for residential and nursing care), and some DASSs also reason that staff exhaustion will also require everyone to slow down the pace of activity and change.

While we are reluctant to rain on this rather sunny parade (particularly as the weather is so good this week), the reality is unfortunately rather different.  In a blogpost published last summer titled 10 DASSs on ‘what next for adult social care?’, we highlighted that ‘there will be a significant surge in post Covid-19 demand that the sector needs to understand and manage.’ We have recently completed some demand analysis which lays bare the challenges that now lie ahead.

The crux of this is that Directors of Adult Social Care must resist the temptation to return to a passive response to demand. In fact, if they move quickly, there is an opportunity to understand this demand and react to it – and therefore to get ahead of the demand curve. (Cue Freddie singing ‘And the world I’ll turn it inside out, yeah‘).

The changing picture of demand

Understanding demand in all its forms can be complicated and confusing. We use an approach which categorises and defines five different types of demand so that we can have a clear and systematic response to each.

New demand is demand that has been created that didn’t exist before (e.g. providing support for people who are shielding)

Additional demand has two elements: increase in volume (e.g. carer breakdown) or increase in complexity (e.g. decline in conditions as prevention opportunities missed through delayed assessments) of existing demand

Deferred demand is demand that is not being dealt with now that is expected to be dealt with in the future (e.g. increase in safeguarding referrals as care homes re-open to visits from family members)

Displaced demand is demand that is being dealt with somewhere else in the system (e.g. people who would have normally requested support from adult social care who instead are being supported by voluntary and community sector)

Avoided demand is demand that will not re-enter the system as lockdown eases (e.g. people who arranged their own support during the pandemic and are now happy being more independent)

Insights on the demand categories

New demand 

• Demand expected from the introduction of Liberty Protection Safeguards (LPS) in April 2022.

Additional demand:

• One of our clients has seen a 10% increase in people receiving homecare in the past two months as a result of unmet demand. Several others are seeing the number of homecare hours increasing at a greater rate than the number of people, indicating an increase in complexity.
• The risk of carer breakdown has risen as 81% of unpaid carers are currently providing more care than before the pandemic and 64% have not been able to take a break. The wellbeing of carers requires immediate action from the sector if it wants to minimise levels of breakdown.

Deferred demand:

• Research by Mencap found that 69% of people with a learning disability had their social care cut during the pandemic, and a survey by Sense revealed 34% of disabled people did not have their support reinstated after the first lockdown
• A survey of people discharged from hospital indicates that 15% left hospital with unmet needs.
• Community support with no personal budget for those aged 65+ has increased nationally by 23% and these are likely to need to be revisited for full support plans and financial arrangements
• Nationally the number of safeguarding concerns rose by 4% during the first 6 months of the pandemic. One of our clients is already starting to experience further increases since visiting restrictions have begun to be lifted and families have started see loved ones again.
• Fewer Deprivation of Liberty Safeguards (DoLS) applications are being completed, at 77% compared to pre-covid figures of 89%, leaving 24,000 outstanding
• As hospitals come under significant pressure to reduce the number of outstanding elective admissions (currently estimated at 8.9 million when taking into account the reduction in completed pathways and the reduction in new pathways starting) we will see increased pressure on adult social care and the community solution to support more people at home.

Displaced demand

• A positive for the sector is that the pandemic has reduced demand and occupancy levels by 9% in residential and nursing homes. However, provider failure is now a real risk, especially as councils covering the costs of voids is no longer financially sustainable, and funds are running low for homes with mainly self-funders.

Given this stark reality, it is critical that Directors of Adult Social Care respond proactively to grip this challenge and stay ahead of the demand curve. We are actively helping our clients do that by supporting them in relation to:

1. Insight: investing in understanding how their local demand picture is changing, by leveraging performance information and resetting their demand and cost baseline for a post covid world.
2. Wellbeing: undertaking remedial activity to address staff exhaustion and regain positive energy at the frontline.
3. Transformation plans: revamping and reprioritising plans to focus on the risks and opportunities that emerge from their new demand and cost baseline.
4. Leadership: resisting the temptation to respond passively to the perceived easing of the crisis, and instead investing in support for frontline teams to bring additional pace and energy to the next phase of your improvement journey.

Whether you are interested in being a ‘shooting star leaping through the sky’, or understanding more about our latest demand insights and the opportunity they present, don’t hesitate to get in touch!