Opportunities for the future of adult social care
This section pulls together the themes from the essays, roundtable and SCIE’s wider improvement work with the social care sector on the key opportunities facing adult social care.
Shifting investment towards prevention
Despite widespread recognition that more preventative investment in social care could reap great benefits to society and the public purse, it remains a small proportion of social care expenditure.
There is a huge potential for social care to help more people stay healthy, happy and independent for as long as possible through prevention, but as an overall proportion of what we spend, too little is allocated to preventive approaches to care. Our own research has shown that if we invest in scaling up preventative, person-centred approaches to care such as asset-based approaches to reducing social isolation, shared lives and community agents, outcomes can be improved and costs reduced.
As a country, we are not very good at prevention. We need to see far more money spent on prevention – on skills, mental health, preventative social care – which reduce demand for acute services.Rob Whiteman, Chief Executive, Cipfa
To enable this shift to happen, we need to commission differently, shifting resources towards organisations which demonstrate that they can support people to live independent and fulfilled lives, and help people recover independence quickly after hospitalisation or a crisis. As part of this solution, we need to invest in technology, which has a huge potential to support more people to live independently.
As we argue later in this report, we also need to invest in innovation, establishing a national fund which will support local areas to grow innovative models of preventative care.
The reforms of social care need to be framed in positive language
Reviewing all of the insights that have informed this report, it is clear that the sector has reached a dead end in its use of the language of ‘crisis’ as a way of compelling the public to sit up and take notice, and for the Treasury to realise the merit of investing in social care. Those who shared their concerns about the negative language we use for social care insisted that a better, more compelling way forward is to talk up the role of social care, and to accentuate the contribution it makes to society.
In SCIE’s work on the Social Care Innovation Network, and more widely, we have adopted the ‘re-framing social care language', put forward by the Social Care Future movement, in a way which has led to high levels of engagement with, and commitment to, the aims of the network:
We all want to live in the place we call home with the people and things that we love, in communities where we look out for one another, doing the things that matter to us.
And in a new statement about social care from the LGA:
Social care is an essential part of the fabric of our society. Social care at its best enables and transforms lives. It enables millions of us to live the lives we want to lead, where we want to live them. Whether we need support with our mental health, because of physical disabilities, learning disabilities, or because we are older and need additional support. It supports us to work; to socialise; to care and support family members; and to play an active role in our communities.
A thriving and sustainable voluntary, community and social enterprise sector
There was broad support from everyone we spoke to and who contributed essays to expanding the role of the voluntary, community and social enterprise sector in supporting adult social care, building on the many impressive ways this sector supported people through the pandemic. However, this would require a conscious commitment to investing more in the sector, and would require commissioners to bring the voluntary, community and social enterprise (VCSE) much more into discussion to shape local commissioning plans, through a ‘co-commissioning’ approach.
Many of our voluntary providers came up with amazing ideas over night on how we could support those who were shielded, bringing different organisations together for a collective effort.Commissioner involved in SCIE’s DHSC-funded COVID-19 meetup
The solutions are already out there and this crisis has helped reveal the value of micro-enterprises, the wide range of communities’ different assets, mutual aid, and innovative housing arrangements in supporting people, to name a few examples. These solutions feel infinitely more ‘human’ and are infinitely preferable to some of the more traditional services on offer.Cllr Ian Hudspeth, Chair, Local Government Association’s Community Wellbeing Board
Digital at scale
It has become received wisdom that the social care sector struggles to adopt new approaches to digital technology, with many local authorities and care providers seen to be falling behind developments in other sectors, such as the NHS. Yet during the COVID-19 pandemic, many social care organisations have moved services online – such as assessments, care planning, reviews and outreach – at astonishing pace. Many contributors felt that we are at a tipping point on digital technology, which would lead to much faster spread and uptake of new technology and online working.
If we truly want to see a future vision for social care, and put the person at the heart and centre of delivery we need to think about a preventative and proactive approach. Data, workforce and true partnerships are critical in delivering the right care at the right time that deliver real differences for people. Technology-enabled care should be considered as part of an overall package of care tailored to the individual.Alyson Scurfield, Chief Executive, TSA
Within the space of a week, huge parts of the social care workforce were operating online. We heard about examples like the Isle of Wight, which managed to move its Personal Assistant Hub online within a few weeks, so that people could still be matched to personal assistants (PAs) when they left hospital or a PA fell sick. We heard about how the London Borough of Hammersmith and Fulham was able to use an artificial intelligence (AI) platform to make regular direct contact with more than 9,000 shielded individuals during the lockdown. This deployment meant that the Council's staff were able to identify the unmet needs of residents, many of whom are suffering from social isolation and loneliness. In local communities, we heard about how community navigators and local area coordinators, used to working door to door, were suddenly able to recreate their unique forms of communal support through online networks and WhatsApp.
If we want to keep people in their homes, technology is a key part of this … in terms of systems and actual hardware. There's loads of it out there but none of it is being adopted at scale due to the fact that most innovation sits in small and medium-sized enterprises and they find it difficult to sell at scale into the public sector.Mary McKenna, Technology entrepreneur
My hunch is we will continue to see moves towards looking after people in their own homes. But, if that is to work, we will move people into homes which work better; new homes purpose built, or adapted for it. I think we will see more new and exciting ways of looking after people in their own homes. More reliance on technology, monitoring people’s conditions.Sir Andrew Dilnot, University of Oxford
Developing new forms of housing with care
There are fundamental connections between housing, health and care. However, despite their obvious interdependencies, these connections are not fully recognised or reflected in policy, institutional incentives or practice. In our engagement with commissioners and care workers through our COVID-19 work for the DHSC, we heard lots of calls for investment in a broader range of housing with care options, including extra care, supported living and home share options.
At the roundtable, questions were raised about the long-term sustainability of residential care, with several commenting that we need to reduce our reliance on this. If we could rebalance investment into a broader range of well-designed housing options, which support healthy ageing and adults with learning disabilities, care outcomes could be transformed.
People at the heart of decision-making
The future of social care was one that needed to be more co-produced – that is a way of working that involves people who use health and care services, carers and communities in equal partnership, and which engages groups of people at the earliest stages of service design, development and evaluation.
However, we were told of too many cases where key decisions at the level of the system, and at the level of the individual, that people who receive services and carers were not involved in decisions. This is a missed opportunity, given true co-production can reduce waste and enhance services, and undermines the aims of the Care Act which foresaw co-production as a critical part of achieving greater wellbeing for people.
On a more positive note, we were given examples of co-production beginning to be developed to positively shape local services.
In Kirklees, for example, the Council has set out a vision for ‘people as active and equal partners in how we work together to co-produce, co-design, co-deliver and co-evaluate care services,’ whilst Oxfordshire County Council has demonstrated a long-term commitment to co-production by establishing a co-production board and recruiting a cohort of co-production champions.
For these reasons, it was argued, the forthcoming social care reforms need to place co-production at their heart.
Co-production and shared endeavour with our citizens go to the heart of what we’re doing in Camden; we have a citizens’ assembly about the future of children’s and adult social care; and co-production is embedded deeply in how we deliver services.Cllr Georgia Gould, Leader, London Borough of Camden
We achieve better outcomes when people are sat alongside professionals when we are making decisions – working with professionals to decide how services are designed, paid for and delivered. Everyone wins when we do co-production in a meaningful way.Kate Terroni, Chief Inspector Adult Social Care, Care Quality Commission