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How will adult social care be delivered in 2018?

The Local Government Association (LGA) annual conference in Manchester in July heard from some of the biggest names in social care about the coming changes in the sector. The speakers were Jon Rouse, director general for social care, local government and care partnerships at the Department of Health; ADASS (Association of Directors of Adult Social Services) president Sandy Keene; and Theresa Grant, chief executive of Trafford Council.

Speaking at the LGA Conference 2013, Jon Rouse set out how the Department of Health saw the future of adult social care, and how local authorities could make this happen. 

He told delegates it was all about increasing personalisation, and shifting the focus towards prevention. Describing the announcement that health and social care would share a joint budget for integration, Rouse said: “We are as serious as you can imagine about the endeavour of driving integration on a whole system basis.” 

He said we are “past the tipping point” on integration, which should be an ends, not just a means. Payment by results will be used to bring about “real outcomes” on integration, despite its poor reputation so far getting people back into work. 

Personalisation, prevention, compassion, integration 

Rouse set out four key priorities for the next five years: increased personalisation, a greater emphasis on prevention, more compassion and integrated services. The Care Bill aims to make this a reality, he said, with law based on the “really core principle that we are organising the system around people’s wellbeing”. 

This also includes wellbeing of the carers, Rouse said, highlighting the importance of assessing and supporting their needs. 

The new national eligibility threshold will identify how people can be supported with their care, with current consultation and dialogue to “try to get it as close to what it needs to be as possible”. 

Moving to an “asset-based model” of care will require thinking about the individual’s needs more widely, considering what family and community can offer to meet these, as well what the state needs to provide.

Such an approach could avoid people having to prove their needs are at a certain level, with a “gradated set of interventions” essential to ensure the system doesn’t leave patients until they are desperate for care, although Rouse acknowledged this was a “medium-term” objective. 

The success of social care funding reforms will depend on each local authority “making this a reality within their locality”. A joint ADASS/LGA programme office will recognise the need for coordinated working on this. 

Beyond care

Providing a fully integrated service goes beyond health and social care, Rouse explained, highlighting how housing providers, social enterprise and the voluntary sector also have a part to play. 

He said: “It’s not just about health and care – one of the reason why we launched the specialist housing fund, £300m over five years, was to engage housing providers in the discussion about what can they do about the design of housing and the ways to manage that, which actually facilitates that preventative agenda that enables people to live at home for longer and have a higher quality of life. 

“Social finance has got a big role to play as well, and social enterprise. People, underpinned by statutory duty, will have to have access to better information on price, so they can understand the options available for them. 

“Providers now have a single portal at NHS Choices about your options, but that must be augmented by what happens at a local level.” 

5, 4, 3, 2, 1 

Rouse set out five characteristics he hoped to see in every locality by 2018, while recognising that this cannot be prescribed by Whitehall. 

“[First], proactive risk stratification and integrated care plans for most vulnerable groups, particularly the frail and elderly. Integration really needs to start there because they are the group who need most support and who are putting most pressure on acute services.

“Second, we need to see an integrated community service that supports people to remain in their homes, and prevent crisis. 

“That needs to wrap around GPs and they need to be supported in their clinical role as accountable for people’s continuity of care. 

“Third, we need a seamless transition between community and acute care. That means social care doing even more within the hospital settings, seven days a week, supporting admissions, stopping unnecessary admissions and helping plan discharge well in advance. 

“Finally, the digital journey, and our expectation that every area should have an integrated, electronic care record for all service users by 2018. 

“Fourth: integration between physical and mental health. Local authorities have a key role here in terms of commissioning responsibilities alongside the CCG.” 

“There are barriers to this – tell us about them. We will look to see how we can remove those barriers so you can move forwards on this journey to 2018.”

Still talking about it

Sandy Keene of ADASS warned that social care would not be able to get away from finance and improving quality, which she predicted would still be on the agenda in 2018. 

However, adult social care was starting from a “very strong baseline”, with a “good track record of change”, she said.

In the next five years, the key would be getting the basics right; the proportion of people receiving community-based solutions, and those in residential care, the cost of services and people’s access to services.

The Care Bill brought an “accelerated” policy drive, she said, highlighting a need to look at whole populations in a different way, with a wider remit, to improve care provision. 

She said: “We have an acceleration, increasing the scale and pace of change. One of the most obvious things is we can’t carry on doing more of the same; there isn’t enough money to do that. But equally, we will fail if we just do less of the same. The key thing is changing what we’re doing and how we’re doing it.” 

‘Services can and will be better’ 

She continued: “There is a need for creativity. It is perhaps a bit paradoxical. There’s a temptation at the moment to batten down the hatches, but actually it’s at times like this we need to keep finding ways of releasing the enterprise and creativity that is within services and across whole communities. And maybe to have the courage of a vision that services can and will be better at the end of this austerity period, than it was when we went into it.” 

“Integration must be the norm,” Keene said, and acknowledged that this will and should mean different things to different local areas. “At the heart of our offer together is coordinated services wrapped around individuals, with targeted services and multidisciplinary teams.” 

Health targets will be delivered in a much more direct way, and with the collaboration between the health service and local authorities, “should promote new conversations and new ways of doing things” as well as better approaches to communication, both internal and external. 

Taking the lead 

Technological innovation requires thinking about how it can be used to empower both the population and their services. This could include citizen connectivity, the development of apps, using immediate feedback and social media. 

Future technology could “often be limited by imagination”, but offers substantial potential for improvements, allowing data to be pulled together to plan more effectively. It also has implications for telecare, closer engagement with both staff and public and opportunities to work with the workforce in a different way. 

She said: “We have four important tasks as system leaders. Firstly to be role models, creating the right environment for joint working together. Secondly to create and develop a vision together; what we really want to achieve in a local area and how we might do it. 

“Thirdly to ensure the infrastructure that is needed to deliver those things is available so our front line services are more empowered to do the work they need to do. 

“Then fourthly, to look at how well we’re doing. If we begin to think about how leadership is exerted locally, then we can release the power of doing things differently.” 

Working differently 

Theresa Grant of Trafford Council concluded the session by showcasing some best practice for adult social care through a range of different changes. 

This included “moving away from a one-size-fits-all approach” with personal budgets, self-directed support and services purchased directly as required by the individual. 

Partnerships with health commissioners, pooled budget arrangements with CCGs help to support this, and Trafford has sought to stimulate the care market to deliver services in a very different way. 

This approach was achieved through collaboration with three neighbouring local authorities to allow micro providers and social enterprises with co-production values to run services. 

Some elements of this change process are politically difficult, with redesigned meal services, closing day centres for older people and outsourcing care services. But Grant said it was possible to “deliver a better service as a result”. Trafford has seen £23m savings over the last three years and is in the top 25% of adult social care services nationally.