Priorities for the Comprehensive Spending Review
24 November 2020
Social Care – A new vision
Social care reform must be underpinned by a vision. There is an opportunity to transform social care so that it is sustainable, a contributor to national economic recovery and plays a key role in ensuring that all people with care & support needs are fully included in their communities.
As Social Care Future put it:
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.
This vision cannot be achieved by social care or even wider public services alone. Public service resources need to be targeted to support and supplement the efforts and activities of citizens, community groups, voluntary organisations and local businesses. Social care leaders and local support providers, working alongside other council services and the NHS, can shift their practices to enable a much-increased level of preventative activity, freeing up resources for personalised support to local people requiring long term care.
Policy on social care, including funding reform, should be guided by and tested against this vision - with a single shared ambition across health and social care which puts people's expectations for their lives at the centre. This can be measured using Think Local Act Personal's Making It Real Framework.
Areas of priority
The Strategic Partners have agreed three key areas of priority for social care that the Comprehensive Spending Review should support:
- Urgently bringing forward investment and reform proposals needed to ensure the sustainable long-term future of social care
- Funding for short-term stabilisation
- Investment in the short term to speed the process of change.
1. Funding reform
The government should bring forward proposals for longer-term investment and reform as an immediate priority to create a simpler, fairer system. However, any additional funding that is made available to social care, should not simply be used for ‘more of the same’ and the pre-COVID-19 status quo. It should be targeted on action to shift towards the above vision with clear expectations and levers that drive system transformation in care and support towards a more asset-based and preventative model of care.
As a first step, the Government must urgently address short-term funding challenges, which have been worsened by Covid-19, to prevent further deterioration in the access to and quality of care. An immediate injection of funding is needed to enable short term stability and avoid serious risks to support during the next phase of the pandemic. Work by our organisations and others has identified the most serious challenges to support which will require funding during the pandemic.
3. Early investment in change
We have identified the following key priorities for short term investment which can speed the shift towards the vision of a social care that is both sustainable and fit for the modern age.
A targeted fund enabling councils and their partners to make a rapid shift towards prevention that current financial constraints will not allow to happen without further investment funding. It is important that councils have the resources to support the prevention assumptions of the NHS Plan otherwise that ambition will not succeed and healthcare needs will also grow faster than necessary. In advance of the bedding in of long-term reform this fund would allow all councils to make progress towards use of the best, evidence-based approaches to start to reduce demand for and unwanted dependency upon formal services. This includes short term interventions when people first look for support and broader demand reduction in long term care.
New deal for the care workforce
The Government should commit to and fund a new deal for the care workforce, including personal assistants and other non-traditional workforce roles. This would develop clear career progression, better recognise and value staff, invest in their training and support, professionalisation and registration where this is appropriate. This would mean that we were able to recruit and keep high quality, skilled social care staff with the right values. Early investment is also required for the expansion of the workforce in roles which enable prevention, support the growth of innovative models of support and to develop and recruit a workforce that reflects and understand the needs of communities being served. This is particularly important in the context of the inequalities and discrimination experienced by black, Asian and minority ethnic people and their communities (see below).
Action on inequalities
Funding support for action on inequalities. The disproportionate impact of Covid-19 on some communities has exposed long endured patterns of inequality and discrimination. The need to address and help tackle ingrained inequalities and challenge discrimination is a given for all concerned with responsibility for adult social care services. The principles of social justice have always underpinned both social work and social care and it is vital that targeted and specific action is funded to address inequalities and poor outcomes for those people at greater risk. This funding would be linked to and support necessary DHSC and MHCLG action to support and ensure compliance with Section 1 of the Equality Act by public authorities. Funding along with specific advice and guidance could support local authorities to take action in line with the public sector equality duty of the Equalities Act 2010 to evidence and address the inequality of outcomes. Some funding would be directed to identifying exemplars that are improving equality of outcomes for people requiring care and support from BAME communities, so that the spread of effective approaches is accelerated. This should be taken forward within council’s existing formal responsibilities. This action should align with NHS action, and minimum expectations for action.
Whilst innovation and technology are making inroads into the way care is delivered, it is generally accepted that social care has been slow to capitalise on the potential of digital technology. We have the opportunity to invest in the rapid adoption of proven technologies which can enhance outcomes, such as artificial intelligence, assistive technology, predictive analytics and apps. An innovation fund would support councils and support providers to make best use of technology. It would also support bringing evidence based but currently marginalised positive models of care and support into more mainstream use. This fund could also be used to develop and rapidly test solutions to particularly challenging care problems.
Transformation and improvement support
Transformation and improvement support to councils and support providers: Change happens locally but local partners need technical and practical support to learn about best practice, innovate and embed better approaches. Resources are required to ensure a new funded transformation and improvement framework for adult social care can be delivered, linked to strong independent means of assessing how well local systems work together and metrics which incentivise this. Improvement should include a complete review of how care markets work, with a much stronger emphasis on the contribution providers make to the lives of the people they support and their contribution to the communities in which they operate and to wider society. Practice change needs to be thoroughly evaluated to provide evidence of what works to incentivise change.
- Anna Severwright – Social Care Future
- Caroline Speirs – TLAP
- Clenton Farquharson – TLAP
- James Bullion – ADASS
- Kathy Roberts – AMHP for the Care Providers Alliance
- Kathryn Smith – Social Care Institute for Excellence
- Martin Green – Care England for the Care Providers Alliance
- Martin Routledge – Social Care Future
- Councillor Ian Hudspeth – Local Government Association