Facing the inevitable: Sharing risk for adult social care
The announcement of extra cash via the precept and a new fund has caused a welcome debate in the sector. Whatever you think about the sufficiency of the new money, we can all agree that adult social care requires fundamental change in its offer and services to achieve longer term sustainability.
The Nuffield Trust estimates the cumulative gap between the need for adult social care, and the funding available, will reach £6 billion over the next three years, with a typical local authority facing a £50 million budget gap over the same period. I think we can be objectively clear that new funding might help a typical council deal with a fraction of their problem, for a small amount of time. The sector needs a long-term plan.
The underlying deficit in adult social care is structural and long term. What is really needed is investment in fundamental reform, without which even the best councils can’t move to a lower cost, sustainable model. So if the ongoing funding level is to remain behind cost and demand pressure, councils realistically have two choices – either to reduce the level of service below what consensus agrees is safe and morally appropriate – or to try to share the responsibility for social care more widely. For some councils, sharing accountability and responsibility for adult social care might not be palatable, but the hard truth is that the Town Hall will no longer be able to match statutory responsibility with the cash to commission services. Councils can either shrink their service, imperilling vulnerable people in the process - or find ways to get others involved.
My view is that no potential partner will want to prop up an unchanged model. So some of the key to councils finding ways to share risk sit in the change agenda for the service, and there is now a measure of agreement between councils about this. Most are developing new models of practice, seeking integration opportunities, digitising pathways, innovating in managing demand, experimenting with delivery models and intervening in the market. Inevitably, some are doing this at a bigger and better scale than others. It is here – in this change agenda – that the opportunities can be surfaced.
So who can help? Well, there are four different kinds of candidates that could be a source of help: the NHS; the community and voluntary sector; the private sector and even service users/families.
Some risk of course is already shared with all four. And each poses a different opportunity, and a different set of challenges. But it is possible to see how a deliberate agenda can provide for the cash, capability and solutions to lift adult social care into something approaching a sustainable future.
- Local NHS organisations are not simply going to take untrammelled financial risk – but there are a range of practical integration opportunities that offer benefits in the longer term. We would have all hoped for more local deals by now, to create genuinely integrated delivery teams taking proper account of council’s ability to fund change in the shorter term.
- The community and voluntary sector should not be seen as a sponge that can soak up unmet need in adult social care, but the distance between social work and local communities is too great. Social work needs to be intimately connected to local communities; only in that way can councils take advantage of latent social capital. That potentially means creating new organisations that can deliver social work which are not the council, and all the association with money and services that currently implies.
- A more certain (and contractual) way of sharing risk is with the private sector. At one extreme, there are traditional outsourcing options; but my guess is most councils would want a less pervasive set of arrangements that allow them to keep control into the long term. Whatever the council’s appetite, there is no doubt that deals large and small can help jump start transformation with investment – and support delivery of benefits.
- Possibly the surest way of transferring risk is to people. Personalisation still has a huge distance to travel; arguably we have not created choice and control in the way we envisaged a decade ago. Digital marketplaces, smarter funding of peer to peer support and more innovative assessment processes are some of the ways we can put power in the hands of the consumer. Sharing risk with customers is not the crude offloading of financial responsibility, but a cultural change in the network of responsibilities that sit around a vulnerable adult.
For those people most in need, councils can’t simply reduce adult social care to an ever smaller imitation of the service they used to have. That way leads to an awful place. Although it can be tough to be positive when conditions are so austere, one way of lifting the gloom is to see the steps we can take together towards a more sustainable future for care.
This article was first published in the Local Government Chronicle.