Guest blogpost on Ealing's adult social care transformation programme and their incredible 'spend per day' reduction.
Waking up the day after England’s exit last week, my first thought was that the concept of winning the World Cup would remain just that, and my second was that it was the day of the South West ADASS (Association Directors of Adult Social Services) annual conference, supported by RiPfA (Research in Practice for Adults). Keep reading, and you’ll find out why my mind made that connection.
Demand management was the theme of the day. We were delighted to be asked to give one of the main presentations at the event, drawing on our seven years of experience with demand-led change.
During that time we’ve witnessed a huge increase in the embeddedness of the approach. When we surveyed Directors of Adult Social Services back in 2011, just 8% said they were putting a heavy focus on demand-side interventions. But according to the 2018 ADASS budget survey, 82% now say that managing demand (‘developing asset-based and self-help approaches so as to reduce the numbers of people receiving long-term care’) is very important for their savings. The biggest question is now not ‘what should we do’, but ‘can we (collectively) deliver?’
Richard Humphries of the King’s Fund kicked off the day by summarising the national context and background. Twelve papers (of various colours) in 20 years, 5 independent reviews and commissions, 13 ministers for care services, and now a delayed green paper. Expectations are high but the reality will likely leave us wanting much more (my mind wanders to Raheem Sterling).
Despite this, the resilience of those working in local government shone through – as it did with the rejuvenated England team during most of the recent matches. If it has to, the sector will just get on with delivering sustainable services and improved outcomes from the bottom up.
In support of this, our presentation set out five key elements needed to successfully deliver demand management programmes. These are drawn from EDGEWORK, IMPOWER’s unique approach to solving complex problems in public services:
- Reframing ambition: problems need to be reframed with a wider lens, including by capturing avoidable demand and identifying opportunities to reduce it.
- Delivering at the front line: most change in complex systems is delivered at the front line, so it is necessary to work with colleagues from across the service to build ownership and understanding of their own contributions.
- Applied behavioural science: influencing behaviours is key to reorientating organisational culture towards a demand management approach.
- Managing interfaces: We believe that most of the opportunity for change exists at the interfaces between teams, services or organisations.
- Managing trajectory: This is my favourite – the ‘glue’ that holds everything else together. The impacts of demand management are often far removed from the interventions, so evidencing impacts and savings requires new data (which we call primed metrics). The approach helps us shift from a financial narrative to one which resonates well with the frontline, connecting staff to outcomes in real time, and helping to secure financial benefits in parallel.
We shared local examples of impact from managing demand at the interface of health and social care. We also discussed insights into IMPOWER’s work with Gloucestershire County Council (£4.1 million net savings in 17/18) and Bristol City Council (9% reduction in nursing placements and a 6% reduction in residential placements for older people in the last 6 months). The region can be confident that the transition from concept to delivery is firmly underway.
This brings me back to my opening paragraph – the parallels between demand-led change and the England football team. There have already been some really positive results, although there is also a recognition that there is still much to do. But if I were a betting man I would still be more likely to back the likelihood of significant positive impacts from demand management by the time of Qatar 2022, than I would the possibility of England doing better than fourth place.