Recommendations for the future of adult social care reform

Below we set out three strategic shifts which are needed to overcome the immense challenges we face in the social care sector, along with 21 recommendations that will help facilitate rapid progress towards these goals. We call on the Government to consider these proposals as it develops its thinking on the long-term plan for social care.

Three strategic shifts for the future of adult social care: What SCIE says

Faced with unprecedented challenges, we need three strategic shifts to take place in social care, which together will enable the sector to move onto more sustainable ground and deliver much better outcomes for people.

Shift 1: To shift the sector from surviving hand-to-mouth, to the point where it has long-term and sustainable funding

How care is paid for and funded for those who are eligible for state-funded care is deeply unfair. Whereas the NHS is free to everyone who wants to use it, everyone with assets of more than £23,250 must pay for themselves, rely on family, or go without.

The level of funding for those entitled to care has been squeezed for many years, which has led many local authorities to cut services. Age UK estimates that over 1.4 million people who need care now don’t receive any. Finally, as the ADASS survey reported in spring, COVID-19 has only made the finances of local government and providers even more precarious.

Several comprehensive reviews have explored what funding options are available, and there is no need to cover this same ground again. What is now needed is a decision on how social care will be funded, and a timetable for implementing this.

What SCIE says

We simply can’t go on like this, and call on the Government to bring forward and publish proposals this autumn, along with a timetable, setting out how it will implement a fair and long-term funding settlement for social care.

We support ADASS and the LGA's call for the Government to make additional immediate funding available, above and beyond that already committed, to support the adult social care response to the pandemic and recovery over the next year.

Shift 2: To shift investment and focus away from remedial and acute services, towards community-centred preventative models of care, support, housing and technology

As a sector, we are not yet investing a sufficient proportion of expenditure on prevention. In the context of fiscal austerity – as highlighted by Shift 1 - and rising demand, the capacity of local authorities to focus on the strategies that support people to stay independent and well for longer have been eroded, leaving little choice but to fund services that support people who have priority needs. However, even if more money materialises for social care, we need a clear and overriding strategy that once and for all makes prevention a priority; reducing demand over time for acute and remedial services, whilst dramatically improving the quality of lives of many more people.

Although we will always need forms of care (such as care homes) which support people who require intensive forms of care or support people experiencing a crisis, we do not currently invest enough in models of care that are proven to maintain people’s resilience, wellbeing and independence.

Through this programme of engagement with the sector, we have identified a large number of innovations in the housing sector, the field of technology and in community-centred approaches to care (see Think Local Act Personal’s Innovations in community-centred support directory for examples). These are helping to bolster community resilience and enable people to live well at home, but they are starved of investment. We need a national commitment, supported locally through co-produced and outcome-focused forms of commissioning, that facilitates a shift in funding and focus towards preventative approaches to care.

What SCIE says

We call for the long-term plan for social care to restate the Government’s commitment to prevention, and introduce innovation funds which enable the sector to rapidly scale up the most effective preventative models of care, housing and technology.

Shift 3: To shift the workforce away from low pay, low recognition and poor conditions, towards higher pay, better conditions and parity of esteem with the NHS

The social care workforce is in a dire need of investment and reform. Skills for Care estimates that there is a 30.8 per cent turnover rate, equivalent to approximately 440,000 leavers over the year, and that around a quarter of the workforce (24 per cent) are on a zero-hours contract (370,000 jobs). Whilst some efforts have been made during the pandemic to increase the recognition of people working in social care, care work lags well behind the NHS in terms of pay, conditions, career opportunities and access to training and development.

We agree with ADASS:

For too long the skilled and compassionate adult social care workforce has been undervalued by the rest of society.

Moreover, as we move steadily towards a more integrated health and social care system, we need to start planning now for how we build a workforce which is better placed to work closer together, and provide more multi-disciplinary and coordinated care to people.

What SCIE says

We call for the Government to produce a workforce strategy for social care which sets out proposals for better pay, conditions, progression and development. We ask that the Government works closely with Skills for Care, who lead the sector on workforce development, and ask it to take a lead role on co-producing this strategy with the sector.

Recommendations by theme

We have identified 21 recommendations for the Government, other national bodies and local authorities to consider under a number of themes.

Theme: Vision for adult social care

  1. Develop a positive, co-produced, vision for social care – like the one produced by Social Care Future, which permeates all aspects of proposals for sector reform: 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.

    Recommended for: Government

  2. Facilitate a national conversation with people with lived experience including unpaid carers to shape the vision and detailed proposed reforms, so that they reflect the needs, aspirations and views of people who use services.

    Recommended for: Government with support from the LGA, ADASS, SCIE and Care Provider Alliance

Theme: Funding and resources

  1. Urgently address the short-term funding pressures, which have worsened as a result of COVID-19 to prevent further deterioration in access to care, and ensure adequate supplies of PPE, equipment and funds to recruit workers during the next year.

    Recommended for: Government

  2. This autumn, the Government should publish proposals, along with a timetable, setting out how it will implement a fair and long-term funding settlement for social care.

    Recommended for: Government

Theme: Leadership and culture

  1. Fund a new leadership programme on asset-based leadership and co-production, for directors and aspiring directors from local government, voluntary and community and social enterprises, NHS and people with lived experience in asset-based forms of working.

    Recommended for:
    NHS England and NHS Improvement and
    Leadership Academy

Theme: Supporting the sector to recover from COVID-19

  1. Conduct a review of ‘burnout’ and wider wellbeing across the social care workforce.

    Recommended for: Government

  2. Permanently relax rules which govern how people using direct payments and personal budgets spend their budgets so that they have much more freedom to spend money as they see fit.

    Recommended for: Local authorities

  3. Fund, develop and roll out psycho-educational support for care home managers to help them and their staff manage trauma. This support would be freely available and accessible online for managers to access when they most need them.

    Recommended for: Government

  4. Local authorities develop plans for how they will continue to support mutual aid and other support networks to flourish beyond the end of the immediate COVID-19 crisis.

    Recommended for: Local authorities

Theme: Housing with care

  1. As part of the long-term plan for adult social care, the Government should highlight a common goal to align health, housing and care systems around a shared objective of helping people to live independently in a home that is suited to their needs. This should include plans to invest in extra care housing, supported living accommodation and intergenerational housing solutions to enable family members to support each other more effectively – either as full-time or part-time residents.

    Recommended for: Government

Theme: Prevention

  1. As part of its long-term plan, the Government should introduce a prevention strategy which clearly sets out how it will support the sector to create more person-centred care and support that help prevent, delay or reduce the need for more formal care services

    Recommended for: Government

  2. Expand NHS England and Improvement’s population health management programme , to give local authorities access and capabilities to utilise predictive analytics so that they can better target services at those at most risk.

    Recommended for: NHS England and NHS Improvement

Theme: Creating asset-based areas

  1. Establish an innovation fund for adult social care, which would fund a number of local-area ‘exemplars’ to implement asset-based, preventative, approaches to care and support at scale, from which the wider sector would learn.

    Recommended for: Government

  2. Promote the new DHSC-funded Commissioning during COVID-19 and beyond guidance produced by SCIE and Social Care Future, which promotes asset-based commissioning, through a programme of webinars, peer support and learning events.

    Recommended for: Government with support from LGA, SCIE and ADASS

  3. Introduce metrics which measure progress towards asset-based areas such as people’s independence, resilience, wellbeing and social connectivity into the refreshed Adult Social Care Outcomes Framework (ASCOF).

    Recommended for: Government

Theme: Place-based integration of health and care

  1. Develop a new national learning and support network – involve the LGA, NHS Confederation, NHS England and support place-based working between the NHS, local government and other partners.

    Recommended for: LGA,
    NHS Confederation,
    NHS England and NHS Improvement

  2. Restart the programme of local systems reviews which are led by the Care Quality Commission, as a way to identify better ways in which health and care can be integrated within local places.

    Recommended for: Government and
    Care Quality Commission

Theme: Innovation and technology

  1. Establish a fund to invest in scaling up proven, small-scale digital technology innovations which have flourished during the pandemic, but need funding and support to grow to their potential.

    Recommended for: Government

Theme: Equalities

  1. Produce a cross-government strategy on health and social care inequalities committing the Government to ambitious targets for meeting these.

    Recommended for: Government

  2. As part of a long-term plan, set out a commitment and ambitious targets to tackle race, gender and other inequalities experienced by protected groups in terms of access, workforce and quality in social care.

    Recommended for: Government

Theme: Workforce and skills

  1. Publish, as part of the long-term adult social care plan, a national long-term workforce strategy which sets out proposals on training, pay, leadership development, career progression pathways and recognition.

    Recommended for: Government

New thinking on the future of adult social care
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