27 January 2025
By Gerard Crofton-Martin, Director of Transformation and Improvement, SCIE
We have established a ‘manifesto’ of five critical success factors that we think need to be ‘front of mind’ for decision-makers when considering future arrangements for adult social care (ASC) and the transformation of the service.
Strategic co-production and enhanced resident engagement
We think it is fair to say that this remains a huge opportunity across the sector. While many local authorities are making huge progress there is still much more to do to put the ‘voice’ of individuals and their experience of care and support right at the heart of service design and service decision-making.
There are significant opportunities to do this through co-production arrangements that are closely aligned with (and part of) all key strategic decisions and service planning arrangements.
There is also potential for the use of better (and continuous engagement channels) at each step of the care pathway that mirror the best day-to-day experience of residents consuming services in other sectors (such as retail). The fact that large numbers of contacts into ASC ‘front door’ teams simply want an update on ‘progress’ on the next steps shows just how big this challenge, and opportunity, remains in most places.
Reappraisal of geography
Local government reform (LGR) brings the real opportunity to join up services around ‘places’ and across the local system that are difficult to achieve in some geographies. There is near unanimity on the power of delivering services through localities and the consequent clearer focus on the goal of keeping people independent, at home and closely aligned with their local communities and getting great support from local ‘community assets’.
However, there remains a challenge in many two-tier areas that these localities often seem to reflect a professional and efficient division of geography rather than those geographies necessarily recognised by other services, partners and residents and communities themselves.
SCIE believe there are often greater synergies that could be achieved through a more coterminous locality delivery model which maximises the ability to collocate and work together cross-service and cross-organisation more effectively.
Needs analysis and risk stratification
One of the biggest shifts we have seen across the sector is a shift in the way data is being analysed to improve intelligence about care needs, vulnerability and risk.
This new wave of data analytics and risk stratification work, partly buoyed by the developments in population heath management techniques in local systems, provides greater opportunities to focus prevention efforts and manage key risks that bring people into the care system much earlier (such as falls, UTIs etc.).
Sophisticated data and performance management approaches can also help to manage the escalation of care needs and are becoming an increasingly important way of maintaining independence for longer periods in their own homes.
This opportunity should be placed ‘front and centre’ of new care and support strategies. In many ways, evidence-based care and support are fast becoming a real, deliverable organisational driver for decision-making and the design of care and support delivery.
Transforming practice models
Most local authorities, if not all, are pursuing strengths-based practice models as a key philosophical foundation in their approach to care and support. Most local authorities are in the midst of implementing and embedding this model and the benefits that this will bring. This good work should continue to be prioritised and supported and, SCIE believe, is one of the keys to the sustainability of the service in the future.
Strengths-based thinking takes time to embed. We often find that while there are clear commitments to strengths-based working, key supporting processes and systems are often in conflict with these principles which can lead to the persistence of deficit-based thinking and working.
There is a significant opportunity to properly incubate strengths-based working through more aligned processes and systems, workforce empowerment, valuing creativity and encouraging reflective practice and peer learning.
We are also seeing the increasing use of technology at scale in the approach to practice. Digital tools, assistive technology and artificial intelligence (AI) are becoming increasingly used elements of triage, evidence-based decision-making, monitoring, engagement, knowledge management and risk identification. Technology, particularly AI, will continue to build on fundamentals, as in AI transcribing, with further opportunities to significantly enhance ways of working and productivity.
In many ways, we are entering an era where the expectation is that care professionals will need to work hand-in-hand with technology to deliver their work effectively. We believe that transformation of practice should lie at the heart of all ASC structural thinking and new delivery models. This is another cultural change that ASC must embrace.
Rethinking commissioning strategy and market relationships
The final critical success factor of our five success factors is the transformation of commissioning and the role that service providers and the local ‘market’ can play in the delivery of new ASC strategies.
Too often we see commissioning models that aren’t aligned sufficiently with practice models and service strategic ambitions and create a critical ‘disconnect’ in the way care and support services are delivered.
There are some great examples of co-produced, outcome-based services that are delivering quality results and joining up responsibilities for delivering new strengths-based care models.
However, there is still a long journey to deliver commissioned services that provide continuity and deliver on key strategic intentions. There is often too big a gap between social care practitioners and commissioners and not the confidence, ethos and partnership arrangements in service providers to deliver effectively.
Partnership working and building market capacity will be key to delivery in the future, particularly as care estate needs to evolve and place increasingly less emphasis on long-term residential care as a solution to meet individual care needs. How local authorities work closely and flexibly with the local care markets is likely to see increasing emphasis over the next few years.
Close working with housing services and planners will be critical to setting out needs and building infrastructure to meet the needs of the next generation of individuals receiving care and support. It will be a key element in meeting the tsunami of need and demand that is coming.
While we have identified just five critical success factors in the transformation of ASC (we could easily add to this list and I am sure readers could too!), if local authorities embrace these challenges and LGR delivers marked change in these areas it would be a process that has delivered real value.
SCIE is working with councils across all tiers to support them in assessing and understanding preferred options around the future provision of ASC. We would love to talk to you to explore your thinking and your priorities in your areas.
Our team have been actively involved in the development of LGR business cases (and subsequent change programmes) in the previous four rounds of LGR – so we have some insight – and understand the difficulties – from all of this learning and previous processes.
Here at SCIE, we’re all about collaborating and innovating to improve lives, so we are keen to share and support you.
Contact our team for more information, or to find out how SCIE can support you.