Impact forecast : The big five changes in health and social care

In my recent blogpost I discussed the two possible futures for adult social care. The key question is, how do we seize the tactical opportunities that will move us towards a positive blueprint for social care, and prevent us being battered by conflicting demands?

Rather than waiting for clarity on policy coherence, we can forecast the impact of the reforms by identifying the five big changes.

1.  People at the Heart of Care reforms

This legislative change could bring the most significant systemic changes for a generation (deeper than Putting People First 2007, Health and Social Care Act 2008, Health and Social Care Act 2012, Care Act 2014, and the current Health and Care Bill). There are some potentially large changes lurking in small clauses, but the big three are:

• The Care Cap
• Councils arranging self-funders care (already known in code as 18(3), instigating a whole system change
• The new regulatory and assurance framework

2. A rapidly changing health and social care interface

Over the last two years, health and social care colleagues on the ground have worked more closely and intensely than ever before. With temporary funding and process arrangements finishing in March, it is uncertain to what extent this will continue. Whilst the Health and Care Act that formalises Integrated Care Systems is yet to be agreed, the new white paper includes a range of pointers and twenty specific actions about how local authorities, the NHS and the private sector can work together more efficiently. This includes reducing bureaucracy, and promoting joint decision making about the provision of services.

3. The coming of age of digital

Acceptance of technology, changing norms and national commitment will mean taking more advantage of the clear opportunities. This includes technology enabled care (TEC), analytics and data. The new white paper suggests that these tools “improve the ability to either prevent illness or prevent conditions deteriorating into acute illness.” In addition, a more accurate assessment of patient needs will improve the planning and delivery of care. In particular, the white paper highlights that identifying pressures on population groups will enable funding to be focused on those areas with the highest needs, creating a more stable service that does not abandon those that are vulnerable.

4. A reorientated workforce

It is clear that the pandemic has led to a resilience challenge. This can be described as an ‘energy crisis’ caused by deep fatigue. The workforce has diversified to meet increased need, and providers are under pressure to deliver (particularly in home care delivery). New roles and expectations are emerging, and re-energisation is needed.

5. A new social contract

Social care has had a rapid rise in public consciousness. This increased awareness has brought a greater ability for families and communities to work together. During such intense pressure on resources, we have glimpsed the deep power of true co-production. Furthermore, a renewed perspective has been witnessed on a number of key areas. Views on the risk of care homes have changed. A refreshed focus on younger adults, particularly with learning disabilities, has started to balance a pre-occupation with the frail elderly. Adult social care is now about to be the only specific public service for which there are two dedicated taxes (the Health and Care Levy and the Social Care Precept). These are just a few examples of the shifts taking place. Could this be the real driver for transformation?

Incorporating these changes will help us to shape the future blueprint for social care. The task for social care leaders is to find new ways of working with a balanced focus on each need and seize the opportunities these developments present. In doing so, we can use strategies that work within the current framework, allowing us to deliver greater outcomes.