News and views
Achieving balance across the Adult Social Care system
In his article titled ‘Striking the right balance’, MV’s Emmet Regan emphasises the need for local authorities to reframe complex problems and seek out connected solutions, if they are to successfully balance competing priorities. In this follow up article, MV’s Mark Bandalli takes a closer look at adult social care and the particular challenges this essential service faces.
Since then the results of the 16th annual ADASS Budget Survey have been published. These provide a fascinating insight into the minds of the Directors of Adult Social Care operating up and down the country, and how they view the challenges that they and their workforce face. These challenges can broadly be categorised into four groups: increasing demand for services; rising complexity; pressures created elsewhere in the system; and decreasing resources.
While each of the key messages from the survey deserves our attention, the complexity and impact of two, in particular, are worth considering through the lens of a ‘balance’ approach.
The first relates to wider system pressures and their impact on people who require health and social care to work together to meet their needs. Given the 5% real terms funding reduction experienced by Adult Social Care services since 2010/11, and the reduced capacity across primary and community health care, the situation increases the risk of people falling through the cracks created by organisational boundaries, and arriving at hospital as a last resort. To their credit, health and social care services try their best to not let this happen. However, the results from the survey are telling: 87% of councils are experiencing pressures associated with increased demand for social care by patients on discharge, with 71% reporting that these pressures have been further exacerbated by insufficient capacity in primary care, community health care or mental health services.
Changes elsewhere in the system are having a direct impact on demand for social care. No one service or organisation can solve this challenge by themselves – a system-wide balancing act is required to jointly manage competing priorities and make the most of limited resources. The case for balance strengthens, requiring system leaders to commit to shared outcomes and an integrated approach to delivery.
The second message relates to the challenges associated with moving towards a model that places greater focus on prevention and early intervention. This shift, and the anticipated savings that would be realised, are once again identified as a priority by Directors. The challenge is an obvious one – how to reallocate resources to enable a focus on prevention, at a time when councils and health services are struggling to meet higher end need?
Council and health commissioners are increasingly focussed on promoting solutions designed to develop the resilience and capabilities of individuals, such as social prescribing and increasing access to a range of community services that have a huge role to play in promoting health and wellbeing (i.e. library, arts and culture organisations etc.). Here lies another challenge – the services that individuals are often being signposted to, are themselves often struggling to remain viable after years of funding reductions.
A system-wide approach to promoting health and wellbeing is required; one where council and health commissioners jointly invest in community services. Despite funding pressures, interesting pockets of innovation across culture services are emerging, with these services benefiting from a placed-based commissioning strategy and the investment that allows pilots to test innovative community led approaches.
The shift from direct delivery to enablement has started, and the early signs are promising.