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Adult social care - adopting a whole-system approach

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The changing demographic profile of the UK means more elderly people will become dependent on support, pushing up the total cost of care. Meanwhile the financial pressure adult social care services are under is no less intense than in every other part of the public sector – with widespread scepticism that the promised, but un-ring fenced, ‘extra money’ for the service will materialise. If Local Authorities (LAs) continue planning to do ‘more of the same’ the economics will rapidly become unworkable. We consider a more whole-system approach to Adult social care.

LAs know they need to address increasing adult care costs but are concerned about the risks within this sensitive area. They are in a four-way squeeze. They face rising demand; downward pressure on budgets; legal obligations to care for vulnerable adults, and a reputational risk if they are seen to let their citizens down.

Simply raising the eligibility criteria so that fewer elderly people receive services, or squeezing suppliers prices are not sustainable options. Something different is needed. Instead of asking ‘which single solution will get me back on track?’ authorities need to apply a whole system approach to Adult social care, implementing a carefully calibrated mix of demand and supply actions and use this to deliver benefits across the whole.

Too much to choose from?

Self-directed support? Community help? Fair pricing models? Externalisation of in-house teams? Telecare? Re-ablement? So many possibilities, each focused on a part of the problem on a different timescale. Some options delay the need for LA intervention (reducing demand) and some improve the cost effectiveness of services on offer (improving supply). For some options there are unresolved questions about their effectiveness, others take adult service departments into uncharted waters, so present unknown risks.

Different teams with different priorities

Some LAs are putting all their energy into a single cost reduction idea, while in others multiple teams are working independently on unconnected initiatives to save money. Partners in the NHS and the third sector are driven by their own objectives. As an example, a hospital will discharge an elderly patient as soon as medically possible to keep their costs down, but the LA must be ready to pick up the baton, or risk incurring greater costs with long term ramifications across the whole system.

Generate financial sustainability

By bringing all the elements together with a programme approach. Look at both demand and supply, consider every option and see what each can contribute. Allocate effort based on an evaluation of the predicted benefits. Join up the service providers under the programme umbrella to build an end-to-end view of service-user care. This portfolio of activity can tip the balance in the Authority's favour.

Now is the right time to do this. With other far-reaching changes in services (such as GP Commissioning) the care landscape is being redrawn on a large scale.
Everyone is thinking in different ways and is open to new ideas. This is an opportunity to bring together the multiple parts of Adult social care and forge better links with healthcare providers to achieve a financially sustainable future and create the ‘Gestalt’ whole that is truly greater.

To learn more about how PA can help you create your Adult social care programme, please contact us now.

Contact the government and public sector team

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