What social care really needs from politicians is not a Brexit response, but that they tear themselves away from Brexit long enough to tackle the bigger questions
iMPOWER was one of the pioneers of demand management in local government. Our work with more than 140 councils, health bodies and other local organisations since 2000 has consistently proven that demand-led change results in better outcomes and reduced costs. These days, demand management is widely considered a mainstream approach – one that is essential to delivering better public services. The Local Government Association website features a host of case studies from around the country, which showcase local authorities who have successfully implemented demand management interventions.
Nevertheless, when you look through the case studies it is noticeable that these initiatives are frequently confined to the traditional borders and structures of local government services (for example, targeted early help in children’s services, or the use of equipment and technology to support older people).
At iMPOWER, we believe there is an opportunity to take the approach further by widening the lens that public services problems are viewed through. Rather than focusing on how to reduce demand in a particular service area (or for a particular cohort) in order to meet a specific budget pressure, more should be done to understand the root causes of demand across all services. This would encourage services to work in a coordinated way with individuals and families, which in turn would ease the pressure on multiple services and to deliver a much better experience and outcomes to individuals and families in the community. The root causes of demand and the reasons people need support do not perfectly map onto the way public services and teams are structured, or match with the high thresholds many services now have. This means that those individuals or families with multiple needs may get stuck in a circle of referrals, without always getting adequate support for the issues they are facing.
Recent iMPOWER analysis of cases of looked after children, working aged adults and older adults receiving long term support, and homeless households living in temporary accommodation reveals that there are three cross-cutting drivers of demand for local authorities:
· Poor mental health and wellbeing featured in 36% of all cases
· Domestic abuse featured in 28% of all cases
· Physical and learning disability – physical disability featured in 25% of cases and learning disability in 18% of cases.
Our analysis also showed that 41% of the cases we examined were known to more than one service area, highlighting the opportunity for professionals from different teams and areas of expertise to work together. Too often thresholds, budgets and structures prevent effective joint working from taking place.
For example, a mother or father with a mental health need may have their own care and support plan, and a child and family support plan developed with the local authority. But the same local authority might also impose punitive measures on the individual if their mental health issues result in any housing or anti-social behaviour issues. The treatment of individuals like this is a complete contradiction; at worst it is cruel and at best it is sloppy.
If local authorities can reframe the problem and focus on the root causes of demand, rather on than presenting needs, they can create the opportunity to redesign pathways, teams and prevention services differently and more innovatively. Linking professionals together through multidisciplinary working so they focus on the root causes of demand, rather than their traditional service areas, is key. Problems are better understood – and families and individuals better supported – by mixed teams of professionals who bring a variety of knowledge, skills and tools to the table.
In a time of growing demand and diminishing resources, it is time to widen the lens in order to better understand and manage demand.