Working with people to avoid a crisis
Over the past two decades, the role of adult social care has evolved. While it was acceptable to focus on people with the highest level of needs, this is no longer the case.
Among your statutory remits is promoting social inclusion and wellbeing, with a view to developing sustainable services that promote independence and minimise the need for more intensive services. The Care Act 2014 helped to broaden the role of adult social care with respect to wellbeing, bringing considerations of early intervention and prevention (EI&P) into sharp focus.
The unrelenting pressure of people seeking and requiring support, and the associated costs of meeting these needs through the delivery of traditional services, was increasingly seen as unsustainable.
It is recognised that to deliver excellent adult social care, EI&P needs to be at the heart of the organisation’s approach. There are several reasons for this.
A focus on EI&P achieves better outcomes for the individuals concerned, their carers and their families. The vast majority of people want to continue living at home – they want to be independent, make decisions, be in close touch with family, friends and communities. By intervening early, we work with individuals to prevent them from experiencing a crisis and needing long-term care.
There are many options as part of a wide network of support to achieve this. For example, small aids to daily living, larger-scale interventions such as walk-in showers, technology-enabled care (TEC), linking people to community groups, improved housing, healthcare advice and support. These all support the resilience of the individuals, their family and community.
If we achieve resilience, it reduces pressure on our front door and moves staff away from responding to crisis-driven work and allows more time for them to speak to people in need of our support and their families about how they can maintain the lives they want to lead. Not only is this better for the individuals concerned, but also for staff, who report higher levels of job satisfaction.
Critically for local government, this approach also reduces financial pressures. Long-term placements and large packages of care are expensive, so delaying or removing these eases pressure on the budget.
This enables the creation of a virtuous circle, enabling money to be released from crisis intervention and long-term placements and instead be invested in EI&P activities delivered by local groups and third sector organisations in the community. This leads to a sustainable care system and not one that is constantly making cuts to avoid overspending.
To achieve most success, the culture and practice of EI&P should run through all areas of adult social care. This approach should be as much at the heart of the work discharging people from hospitals (Home First) as it is in community-based teams. Commissioning teams play a significant role in ensuring there is a focus on EI&P delivery and that community groups can be supported to provide local and effective services.
EI&P culture and practice should be adopted as the operating model for the council as a whole. When we consider what people want in their lives, money (often through employment), housing and feeling safe are always reflected.
While you are not responsible for all of these areas, they are part of what you should be influencing as a senior member of your council’s corporate team. In return, this approach should lead to less demand for long-term adult social care services.
This focus on EI&P in every aspect of people’s lives is vital to achieving better outcomes for everyone. It is better to prevent people from becoming homeless or falling into debt, not just for the individuals concerned, but also for their communities and for the public purse.
EI&P should be part of the wider engagement that the council and the broader public sector have with the community. So much activity in this area is undertaken voluntarily, which means it requires continuous nurturing to maximise the potential for creating networks of support. This again should be part of a strategic approach involving the council and its partners – particularly the NHS.
One of the challenges lies in working with the NHS to help it adopt this approach. The introduction of Integrated Care Systems (ICSs) gives you opportunities to work at ‘place’ level, with a focus on integrated working and co-production.
This approach is highlighted as part of the mandated purpose of ICSs, which also includes ‘help the NHS support broader social and economic development’. For example, there are opportunities to join up GP prescribing with investment from the council in neighbourhood working and EI&P.
For more on working with partners, see the chapter Partnership with the NHS: working together for the public good.
If EI&P is to succeed, it must be adopted by all staff. Is there a culture change programme in your organisation that sets out a vision for achieving better outcomes for individuals who use services and a clear programme for delivering it? Does it have at its heart a staff programme that demonstrates the benefits for people and staff? This needs to be reinforced through training and effective communications.
It can be challenging to shift funding from acute and crisis intervention to EI&P and there is no single solution. Each system will have to find its own way, but opportunities could include using resources made available through national funding opportunities such as the Better Care Fund (BCF), or local funding drawn from the ICS, corporate invest-to-save initiatives, use of commissioning funding and so on.
It is crucial to have the vision and clear plans for delivery, but this has to work alongside managing expectations against a realistic timescale for demonstrating the impact of planned changes. Monitoring performance against those plans is critical to demonstrate achievements such as improved outcomes for people, staff satisfaction and reduction in spending. Success breeds success.