Prevention in adult social care – invest or cut?
In this year’s excellent ADASS annual budget survey, there is a short, yet revealing, section on prevention.
To summarise, spending on prevention (as defined in the survey) is going down, but increased spending on prevention and early intervention is regarded by directors as the most important savings strategy, by some margin.
So it would seem there is clear disparity here – surely if funding is reducing, and prevention is so important, councils should be investing? Indeed, in my last blog I called for just that, major investment in the reform of adult social care and an end to the current Transformation Salami. But on the specific issue of prevention I think there are a couple of reasons why directors are wary.
- Councils have very little room for budgetary manoeuvre. Most will quite rightly be fearful of ever-building cost and demand pressures for statutory services. So, there is a difference between recognising something as positive, and being able to act on that understanding. That is one of the reasons we suggested, with Localis, that capitalisation is a possible route to funding a prevention business case.
- In the context of austerity, directors must be certain that one pound they take away from statutory priorities like funding long term care, will deliver a savings multiple of which can be approximately traced to the original investment. Prevention can be made to sound seductive and compelling, but often, directors are wise to be cautious. Simply spending on initiatives that look and feel preventive is a poor judgement when the causal relationships between action and result are so complicated.
Yet for all the understandable context and caution, departing from prevention would be precisely the wrong approach. Adult social care needs to grasp prevention – working well it could represent a basis for financial sustainability for the sector and deliver better outcomes for the people we serve. But the risk remains – every director of adult social care (DASC) should be asking how they can invest in prevention that reliably works, not whether they should invest at all.
This is a challenge not easily summarised, but I believe there are six foundations for a successful local prevention strategy for adults:
- A coherent prevention model: DASCs need a way to distinguish between types of prevention at different stages of the user journey, and clarity about what prevention outcomes they are seeking. This is the key to using scarce prevention cash wisely.
- Focus on excellence in the big, controllable opportunities: Optimal reablement, better transitions, and effective front door/s are delivered with very variable effectiveness. These are statutory services, but ones which all contribute to preventing expensive long-term care.
- A social work practice model, practised well: Most councils could do much more to ensure that social work delivers on prevention, starting with a published practice model. There is little point investing in community prevention if the pathway still leads to a reflex to services.
- A triple lock of academic evidence, good data and ROI: Without stifling innovation, all prevention spend has to stack up against a proportionate use of data and evidence.
- A data insight and monitoring system: that allows a (better) understanding of user journeys, demand levels, and social determinants.
- An experimentation pipeline: Using sound research approaches, a way of conducting small-scale testing of novel approaches, often now with a digital component. Often the evidence needs creating in context, rather than waiting for proof from elsewhere.
Adults prevention is a huge and undeveloped opportunity for the sector. Because it often looks woolly and speculative it becomes easy to cut. We need a way of injecting rigour, structure and clarity into preventions that councils have confidence to invest.