Social care integral to the success of STPs

Source: PSE Oct/Nov 16

David Pearson, honorary treasurer and former president at the Association of Directors of Adult Social Services (ADASS), discusses the development of NHS-led sustainability and transformation plans (STPs) and the importance of embedding social care within them.

Social care provides care, support and safeguards for those people in our communities with the highest need, as well as their carers. A YouGov poll recently found that 1 in 3 people either receive or are in touch with social care services. The same poll indicated that adult social care was the top public choice for additional government investment, apart from the NHS. 

But funding for adult social care has fallen by nearly a third over the past five years; fewer people are receiving services, and further cuts will affect the quality of care. The decline has only been slowed by the adult social care precept – which doesn’t cover even two-thirds of the cost of the National Living Wage, let alone the cost of providing growing numbers of older and disabled people and their carers with the care and support they need – and the increase in safeguarding referrals. The next two years in particular are going to be incredibly tough. 

The task is enormous and is taking place at a time when the viability of the social care market is in question. Providers are going out of business and handing back contracts, and quality is a key concern. ADASS members are committed to ensuring that social care, social work and social models are articulated strongly in integration and in STPs alongside good health and medical approaches. Without this, and without addressing the funding challenge of social care, the ambitions of NHS England’s Five Year Forward View will not be realised. 

Fundamental change needed 

Health and social care are two sides of the same coin, though the NHS is often far more prominent in the public’s consciousness until social care is needed – usually in a crisis. The NHS has its own challenges, however, not least dealing with the reductions in social, primary, community and mental health care which have contributed to significant increases in acute hospital activity. 

The NHS needs to fundamentally change the way it plans, commissions and delivers services to address gaps in health and wellbeing, care and quality, and funding and efficiency. 

Integration isn’t an end in itself, and there’s no evidence it will save money, but it’s a potential enabler of better outcomes and experiences for people. STPs should put the NHS and social care in a better place to integrate services, and come at a time when extremely challenging austerity for the sector means we have to find even more ways of doing things differently. The move away from annual plans for individual NHS organisations towards a long-term place-based strategy is welcome. The NHS and social care must work together with their local populations, and recognise the contribution of wider services in effective prevention. 

Social care must be integral to STPs 

Within the next few weeks, each area will be expected to submit revised STPs, including plans for better integration of health and social care commissioning and services, and proposals for further meaningful engagement with all stakeholders, including patients, staff and service users.

Each STP must also identify finance and quality gaps, and the revised plans need to recognise the interdependence of NHS and adult social care services. STPs provide an important opportunity to empower people to help develop new services aimed at keeping them well, independent and better able to manage their own health. Investing in prevention needs to be a key priority, but it is difficult to see how this will be resourced. Robust governance arrangements also need to be in place to ensure transparency and accountability of decisions taken, and how STPs will be directed and controlled. 

STPs should recognise the need to make decisions as close as possible to the people who receive the services. The closer that local commissioners can work with leaders in councils and Health and Wellbeing Boards, the more effectively this can happen. 

Social care needs to be integral to each planning process or it won’t work. Good care enhances health and wellbeing, and makes an enormous contribution to the support of treatment and people’s care in the 21st century, helping to promote independence, choice and control. At its best, it is distinctive, valued and personal, and it helps people to live the very best lives that they can.

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