Adult Social Care Workshop
From Future of Local Services to the Public
As part of the greater LGA project four workshops were held with those working in the design and provision of local services to the public. This particular workshop met in London in July 2008 and was attended by experts in the provision of Adult Health and Social Care services. The workshop discussed the factors that had shaped services to this point in time, those that the participants are grappling with at the moment, and those that they are thinking about for the future.
Contents |
Reflecting on the current context
Participants agreed that although demand for adult health and social care services had increased in the last decade, fewer applicants are actually receiving treatment. The increase in demand has led to stricter prioritising and therefore a concentration on the most severe cases. Participants also felt that demand was being met in part by an increase in the number of citizens with carer responsibilities, who had not received enough political recognition or attention in recent years.
The supply of adult health and social care services was seen to be struggling in finding the right balance of quality vs culture; affluence vs happiness; and personalisation vs packages. Although the increase in the quality and affluence of services was widely welcomed, participants were concerned that the culture and the way that services are run had not sufficiently improved.
The 1990 NHS & Community Care Act is seen as an important milestone in current managerial attitudes. The introduction of assessments, gate keeping and rationing to prevent runaway expenditure has meant that managers are now good at identifying and meeting objectives. However, this in certain circumstances has lead to a ‘culture of star chasing’ and to a conclusion that “we are managing the wrong things much better”. Local Authorities are now seen to have mainly a commissioning role, acting as a commissioner between the private and voluntary sectors upon which it is reliant.
The current funding climate for adult health and social care was identified as grim and ‘not fit for purpose’. Apart from inadequate funding in services, it was felt that monopoly purchasers were often struggling for funds and that they therefore made savings that were not necessarily in the best interest of service users. A current funding gap of £6billion was identified.
Participants were worried about the opaque nature of the services and how the public perceive adult health and social care. They felt that citizens are often confused about its relationship with the NHS and that services are seen by many to be a ‘badge of infirmity’ and therefore undesirable. The baby boom generation appears concerned with services for their parents and children but often fail to take steps to look after themselves as they grow older.
Finally, participants identified a lack of innovation in the products for service users. This is in part a failure of the public sector who is seen to take too long to make decisions and have complicated purchasing processes. Where new technology has been introduced, participants felt that the successes were mixed and that in comparison to the private sector, public sector has not made the same of technological opportunities.
What is the relevance for the future of the provision of local services?
Within the context of service supply, there needs to be a more efficient future role for Local Authorities and a more direct line of communication between service users and voluntary and private suppliers. In that sense participants also felt that steps should be taken to make encourage volunteering and make it more accessible and desirable.
Bridging the gap in funding was seen to be crucial to the future of services. Future funding also needed to take account of changing demographics, ageing population, increased demand and the squeeze on personal finances through the credit crunch.
Future provision of adult health and social services has to ensure that there is sufficient flexibility to offer both personalised and packaged services, where users are able to feel confident in deciding what involvement they would like to have.
There is also a need to change public perceptions to create a more positive attitude where services are no longer seen as a ‘badge of infirmity’ for the few poor members of society, or as something that does not need to be considered until you reach old age at which point the NHS will ‘bail you out’.
Technology should be fully utilised. Innovations such as the ‘intelligent house’ which looks after owners, social networking reducing isolation, interaction with service suppliers through digital TV, and accessing technology outside of the home through WiFi, were seen to have massive potential.
Priorities for the future
Participants identified bridging the funding gap and changing public perception as priorities for the future.
Evidence led preventative social care, evidence poor at the moment
Joining-up of services / developing shared outcomes / agreement as to barriers
Headlines from the future?
What would we like to know about the state of adult and social care in 2018?
• What is the size of the budget (including total spend and spend by component)?
• What is the size/composition of the workforce?
• What are current levels of satisfaction/what are the appropriate measures of this?
• What are the employment rates of the current adult population?
• Individual budgets – what happened?
• How have budgets impacted on technology?
• Do people understand the social care system any better?
• Is it ‘Health and Social Care’, how is this service conceptualised?
Surprise or "shock" 2018 headlines:
Negative
‘All services five star’
‘State provides education, army and hospitals only’
‘Medication in old people’s homes: still an issue’
‘Euthanasia legalised in order to save money’
Positive
‘Only 1% go to hospital’
‘Massive shift in budget from hospitals to social care’
‘Last hospital closes for good’
‘Pill developed to cure dementia’
Issues mapping exercise
Innovations
Participants identified several service providers who they felt were innovators in the field of adult health and social care:
• Humana (USA) – work in preventative social care / healthcare innovations
• PCTs – giving out pedometers
• PruHealth – work carried out on prevention in South Africa
• inControls
• Oldham Council – operating individual budgets
• Demos
• Neil Reevely at Sunderland Council
• Steve Jones – Wigan Council CEO
• David Kelly – (West Lothian Council) joined up health and social care, new technologies
• Imelda Redmond from Carers UK
Communication Sources:
SCIE (Social Care Institute for Excellence) / CSCI (Commission for Social Care Inspection)
PSSRU (Personal Social Services Research Unit) at the LSE / Kent / York
