What next for Adult Social Care?
Social Care has just faced its toughest ever test and while the months ahead will be different they look set to be equally challenging. As Councils consider their responses to our new world and its pressures, we offer some ideas and evidence we hope will help.
Right now: Keep the wheels turning
With some patients discharged early and a higher number than usual in short term care settings the top priority will be to ensure everyone stays safe and in the settings that best matches their circumstances.
This will also involve joint planning with local providers on the work remaining to ensure the safe and ongoing provision of care, including the contribution needed from the council to make that happen.
We must anticipate a different pattern of demand in the short term and this will differ by area. Requests for help from customers with autism, carers, those who have been discharged early from hospital, and those suffering from social isolation will continue to need an evolving response and we can expect a surge in demand from acute settings as elective surgery is reintroduced. Councils will need visibility of that front-door demand and the capacity to meet it. In the absence of armies of agency staff, practitioners will need to continue to avoid non-essential trips to the office and maximise their use of technology in interactions with customers.
This year: Helping to address acute in-year budget pressures
Nothing from central government suggests a change in the funding environment for the foreseeable future and every likelihood of acute financial stress over the next few months as councils reach deep into their reserves. Even so, there remain places where Adult Social Care can still look to achieve more for less and contribute to a wider council effort.
Focus on those recovering from Hospital Discharge. Even in more normal times it is typical for some patients to receive a higher package of care on discharge to meet short term needs that are then not always reviewed in the most timely fashion, given other urgent priorities which can lead to dependency and higher costs. Such cases over the last 12-16 weeks should be reviewed as a priority if this is a risk in your area.
If you are fortunate enough to be in an area where systems partners have made significant changes to Intermediate Care pathways in recent weeks, new arrangements should be reviewed and built on to ensure that they remain robust for a period where acute discharge pathways will have to catch up with months of pent up demand and will return customers to their own bed as quickly and safely as possible.
Look more broadly at your reablement outcomes, exclusion should be by exception and 80% of customers should leave fully Reabled if the service is operating well. The effectiveness of this service remains one of the biggest drivers of long term care costs.
Clarify and implement your local offer; building on strengths-based practice. It remains the case that even operating in a strengths-based model there remains a variance in support provided of between 6-8 times the package size in every Local Authority we have worked in, depending on the practitioner managing the case.
Build on the help offered by local volunteers and community support. Your community catalysts need to become the stars of the organisation. Engage with your VCS network in a more structured way to find alternatives to care and to address noo-1-2-1 support needs. The graphic below shows the results of a recent survey we undertook for a County Council of 30 VCS organisations on the level of local VCS support available (extensive) and the support that was accessed by the council (none). This is not atypical.
Medium term: Next year
There has been a steady shift in budgets from supporting those who are elderly and frail to those with Learning Disabilities which results from improved Reablement outcomes, and tighter eligibility criteria for the former leaving councils to support a smaller proportion of customer with higher needs. The majority of councils still have opportunities to do more to help customers with Learning Disabilities to live more independent lives and access employment. This will involve time and effort now but has demonstrable impacts on both outcomes and council finances in the medium term. The best councils will assess around 80% of referrals and are able to achieve improved outcomes for around 75% of those accepted to the service, delivering an average 4 hr per week reduction in 1-2-1 care over a 12-15 week period.
Dementia is associated with over 80% of customers in every council we have worked with and its prevalence is climbing. Councils’ response to this has yet to catch up in some areas and improvements may be available by looking at the newest tech to support customers and carers, dementia friendly design in different care settings and the approach taken to dementia in Reablement.
Mental health recovery and independence can impact outcomes and cost. The implementation of national best practice can result in a reduction in support of an average of 60% of package value for around 50% of participants.
We must acknowledge that even the best performing local health and care system is unlikely to deliver the efficiencies implied by funding shortfalls this year. Such changes may lend weight however to the argument that everything possible is being done.
If you would like any further detail on the topics discussed above, please drop us a line at: firstname.lastname@example.org
This article was written by Bill Guthrie