Key messages in the transformation of care and support

Creating the five year forward view for social care

• Adult social care has repeatedly demonstrated its capacity for transformation: pioneering de-institutionalisation, personal budgets and more recently, asset-based approaches.
• Health and care systems will not provide good services that meet rising demand without realigning around people and communities.
• There are five areas where transformation needs to take place
  1. Helping all people and families to stay well,connected to others and resilient when facing health or care needs.
  2. Supporting people and families who need help to carry on living well at home.
  3. Enabling people with support needs to do enjoyable and meaningful things during the day, or look for work.
  4. Developing new models of care for adults and older people who need support and a home in their community.
  5. Equipping people to regain independence following hospital or other forms of health care.
• If the sector scales up promising practice, economic modelling shows that outcomes can be improved and costs reduced.
• The sector needs to have difficult, challenging and creative local conversations involving people who use services and others, which create space to move forward together.
• Further research and economic modelling is needed on the promising practices to build a business case for proper and effective investment in social care.

Scaling up what works - summary

We looked at the available evidence around the costs and benefits associated with the implementation of a range of different schemes. The quality of the evidence was evaluated and six models were selected which could potentially be scaled up in Birmingham. The table below sets out a summary of the findings from this process, based on real data supplied by Birmingham City Council.

• Helping people to stay well, connected to others, and resilient when facing health or care needs
  Potential net saving (Birmingham): £900,000 ASCOpen

  Promising models:
  Community Agents

  Primary characteristic of target population
  Older people living alone

  Existing beneficiaries (Birmingham):
  No known existing scheme

  Potential beneficiaries (Birmingham):
  2,7000 users

  Potential barriers to expansion:
  Raising awareness, recruiting proactive community agents, mapping community services

  Key enablers for implementation:
  Developing positive relationships with key agencies to link users effectively to available services

• Supporting people and families who need help to carry on living at home
  Potential net saving (Birmingham): £1.0m ASC and £1.4m NHSOpen

  Promising models:
  Living Well home-based care

  Primary characteristic of target population
  Older people with multiple long-term conditions

  Existing beneficiaries (Birmingham):
  No known existing scheme

  Potential beneficiaries (Birmingham):
  1,000 users

  Potential barriers to expansion:
  Lack of available staff and volunteers

  Key enablers for implementation:
  Recruitment and training of coordinators and local volunteers

• Enabling people with support needs to do enjoyable and meaningful things during the day, or to look for work
  Potential net saving (Birmingham): £250,000 ASC Open

  Promising models:
  Kent Pathways Service

  Primary characteristic of target population:
  Adults with a learning disability

  Existing beneficiaries (Birmingham):
  No existing scheme

  Potential beneficiaries (Birmingham):
  146

  Potential barriers to expansion:
  Identifying those most likely to benefit

  Key enablers for implementation:
  Effective staff consultation and engagement

• Developing new models of care for adults and older people who need support and a home in their community
  Potential net saving (Birmingham): £1.3m ASC Open

  Promising models:
  Shared Lives

  Primary characteristic of target population:
  Learning disabilities and mental health needs

  Existing beneficiaries (Birmingham):
  78 people with learning disabilities with live-in arrangements. 10 people with mental health needs with live-in arrangements.

  Potential beneficiaries (Birmingham):
  52 additional users with live-in arrangements (one with mental health needs)

  Potential barriers to expansion:
  Lack of potential carers for live-in arrangements. Additional costs incurred when moving clients from existing care settings

  Key enablers for implementation:
  Investment of around £250,000 required for each new set of 75 arrangements. Time is required to see the full benefits. Once the coordinator has been recruited it will be two years until the break-even point for the scheme is reached

• Equipping people to regain independence following hospital or other forms of health care
  Potential net saving (Birmingham): £4.5m ASC Open

  Promising models:
  Kent County Council hospital discharge project (featured)

  Primary characteristic of target population:
  Mostly older people

  Existing beneficiaries (Birmingham):
  N/A

  Potential beneficiaries (Birmingham):
  N/A

  Potential barriers to expansion:
  Resistance to new processes.

  Key enablers for implementation:
  Additional intensive support from respected social workers who are prepared to challenge the status quo is required to embed new ways of working. Clear success measures and escalation routes are also required

• Equipping people to regain independence following hospital or other forms of health care
  Potential net saving (Birmingham): £167,000 ASC and £444,000 NHS Open

  Promising models:
  British Red Cross Support at Home (featured)

  Primary characteristic of target population:
  Older people whose day-today activities are very limited

  Existing beneficiaries (Birmingham):
  N/A

  Potential beneficiaries (Birmingham):
  1,357

  Potential barriers to expansion:
  Lack of available volunteers to run service at scale

  Key enablers for implementation:
  Sharing the costs with health organisations

• Total Financial benefit £7.5m ASC* and £1.8m NHS Open

  * The total financial benefit figure for adult social care (ASC) assumes that there is potential for double counting of benefits because of the small overlap between the target populations for the three schemes. The value of this duplicated benefit has been estimated as approximately £0.35m and deducted from the net total.