Preventing the Adult Social Care financial ‘Whack a Mole’
In January this year I wrote about adult social care facing the inevitable and finding ways to transfer some of the responsibility for vulnerable adults away from the Town Hall. Not simply because the money isn’t there anymore, but because outcomes for people can be better realised with a lighter, more system- and person-oriented approach.
My central argument hasn’t really changed, but the £2bn allocated in the Budget was a welcome surprise, giving temporary respite from the Adult Social Care ‘Whack a Mole’ where success is achieved in one area, only for cost and demand pressure to pop up in another. The money radically changes the risks and opportunities, and there are broadly two types of response from councils that we can anticipate.
There is no doubt overspends in Adults are serious, so the immediate response for many will be the shoring up of budgets for 17/18. ‘Phew’ is a legitimate – but wholly insufficient – reaction, so there may well be a group of councils who find themselves in the same unsustainable position in 18 months’ time. It is by no means a lazy strategy, as the short-term pressure for Adults is immense but, for this group, the money will have achieved only the deferral of the tough choices. Choices that should be made now, when there is respite, and not later, when there is no time to think with a clear head.
The second response, which I hope will be from the majority, will be from those who have gazed into the abyss sufficiently briefly not to be swallowed by it. They will recognise that Adult Social Care support is provided to a tiny percentage of the population and, as such, will never possess the public saliency of the NHS. Nor will councils be able to tax for it in such a way as to restore the levels of funding enjoyed in the last decade. They know the additional money helps them transition to a different model, one that both costs less, but also involves the council differently.
In my January article, I discussed some broad concepts and models, some of which involved putting statutory social work into arms-length vehicles to enable rapid transformation of practice. Several people came back to me and asked what the specific money saving initiatives would be that underpin this or other delivery models. Let me put my toe in the water and suggest there are seven big things any council should be doing at this tactical level. As with almost any list like this, there will be different takes or opinions, and I welcome challenge and dialogue. But here are the seven business case areas my own organisation focuses on – the qualification for each being there must be significant financial benefit to the council paired with real improvement of user outcomes:
- Learning Disabilities Independence: a concerted, funded approach to placement change
- Rebalancing Older Adults Care: reducing/delaying expensive and limiting institutional care
- Digital Transformation: a range of interventions which raise workforce productivity and put power in the hands of the user
- Prevention and Demand Management: focusing on the actionable (and evidence-able) drivers of demand like social isolation and reablement effectiveness, utilising digital capability far more ambitiously
- Workforce Transformation: making a much faster reality of asset/strengths based practice, increasing permanency and morale
- Hospital Pathway: using the ‘crisis’ in discharge as an opportunity to integrate with the NHS and manage down bad and untimely decisions
- Procurement and Property: using the care market to deliver better value and intervening better in an era of cheap capital.
‘Integration’ per se doesn’t make my list – it is obviously important, but also often poorly framed in the context of Adult Social Care reform. In general I think the integration agenda needs to focus on simpler, easier ‘win-wins’ between social care and health, instead of boiling the proverbial ocean. This more direct, pragmatic approach is the subject of a current Capita/Localis project.
Most councils can already say something about all seven cases for change, but in general I am seeing transformation or change plans which lack bold vision, investment and implementation effectiveness. Many DASCs I talk to are ostensibly focusing on the right things, but are frustrated the initiatives aren’t gripping sufficiently. This is simply because the scale and/or potency of action required has been undercooked. So, if the £2bn is not simply ‘Whack a Mole deferred’, then it is time to truly commit to the reform the sector badly needs.