Even before the global COVID-19 pandemic emerged, the Government was under pressure to set out its long-awaited plans for adult social care reform.
As the challenges of the first wave of coronavirus began to subside, and for a brief few weeks thoughts returned to the domestic policy agenda, the County Councils’ Network, Association of County Chief Executives and operational improvement agency Newton started an ambitious programme of work to influence the future direction of reform.
Rather than examining the well-trodden arguments on funding reform, this project started with the premise of how excellent, people-based services could, and should, look under a reformed system.
Make no mistake, a resolution to the long-term funding of care services is critical, and our programme of work has taken place at a time when the financial fragility of the system has never been more exposed.
But a decision on the quantum of funding required can only follow once a decision is taken on how best to deliver services going forward, and the roles that need to be played by both local and central Government.
The local government sector needs to articulate the type of care system it wants to develop, and crucially, who is best to deliver this. This requires establishing a common set of values to underpin a reformed system and optimising the delivery of adult social care to achieve these values, ensuring the service delivers good outcomes for people cost-effectively.
In developing our perspective on an optimised model of delivery, we have spoken to over 150 people who are experts in the field; not just chief executives, directors of social care, and health leaders, but also private sector providers on the frontline and carers and those with lived experience. The report is a product of these conversations, overlaid with in-depth insight and analysis.
With this body of evidence, the report sets out the key ingredients that would make for a better social care system, through an optimised local delivery model.
This emphasis on local is important. Much of the national conversation has sought to explore the idea of taking more central control of social care, including the potential for handing major parts of the service to the NHS. The opposite argument is based on modernising and improving the current model of localised delivery.
But a one-size-fits-all centralisation would be simplistic, ineffective, and expensive. It plays on the notion that social care is solely about transfers of care from hospitals.
Across the nine key components of our optimised model, our report shows it is only councils who can fully grasp and nurture a vast ecosystem of care and support well beyond this narrow view.
With their in-depth knowledge of their local population and care providers; commissioning capacity; understanding of the informal carer network; strong links with their voluntary and community assets; and close links to other services such as housing, education and the NHS, local authorities are in a unique place to be able to commission the right wrap-around care and support tailored to each individual to enable them to live their best lives.
This role needs to be supported by a core set of values. Those that have underpinned this model focus on promoting independence, recognising the importance of personalisation and choice. This results in a service where individuals are supported to set their own ambitious goals, build on their strengths, make a positive contribution to their local community, and live as independently as possible.
Our report shows that delivering this model of optimised care could achieve significant benefits. As part of a wider transformation that would improve services for all those with care needs, tens of thousands of individuals could live more independent lives each and every year, while delivering £1.6bn of annual financial benefits if fully implemented across all councils.
However, delivering the optimised model and the invest-to-save activity we outline is extremely complex and requires of a set of key local and national enablers to be in place. Chief among these is a funding solution which gives long-term financial security to the sector.
Parity with the NHS is also called for, with social care getting a more prominent voice in local decision-making, and a campaign to raise the positive profile of the sector with the public.
As part of this, the vital role of local authorities in the wider place, including as part of Integrated Care Systems (ICSs), will be essential for organisations to truly work in partnership within the ICS model.
We also recognise that with more funding and greater local decision-making, our optimised model should be underpinned by a new, outcomes-based performance framework for social care – to make clear the impact of funding decisions, highlight areas of good and poor practice, and give central Government sufficient oversight and a mechanism to support improvement.
The impact of COVID-19 has raised the public profile of adult social care and acted to give renewed emphasis on the need to reform care services in England. Now is the time for the local government sector to grasp the opportunity to co-design an optimised model of social care fit for the future.
- Visit www.futureasc.com to download the report and find out more about the model.
James Maker is head of policy and communications at the County Councils Network and Daniel Sperrin is director at Newton