When the Chancellor recently announced he had signed up four government departments for 30% cuts as part of the next spending round, I was convinced local government would not be one of them. It was.
So what do we do now?
Councils are on their knees, their eyes understandably more firmly fixed on dwindling budgets, not on how to deliver dynamic social care responses to people and families in their communities. These people need some kind of support to get on with their lives. And they need it now.
The King’s Fund tells us that social care spending is at its lowest for 20 years despite hugely increasing need.
It tells us that social care spend as a proportion of GDP will have halved by the end of this parliament if there is no change.
Maybe the mooted council tax rise will help – if it happens and if cash strapped councils manage to get it to its intended social care target without siphoning off significant proportions in the process. But even if it happens, it will only be a temporary fix.
Some councils have decided they will have to take matters into their own hands. They can no longer be lemmings running towards a cliff, eyes tight shut hoping that people with needs will disappear. They have decided they can no longer be ‘assessment for services’ factories that by definition pull people into the world of ongoing paid formal care. They know they have very little to lose in trying something radically different. They also know ‘their offer’ cannot be a binary yes/no decision about eligibility, and that if it is a ‘yes’ the prescription will be paid for home care, residential care or respite.
The result is that they are on a programme that aims to change the conversation radically. No longer is it allowed to ‘assess people for services’ as the first or core offer. It has almost become a banned concept, or a sign of failure.
Instead they are supporting and coaching their workforce to have new conversations based on listening to and learning about people, what makes them tick and what kind of community connections would help them get on with their lives. As one council put it, “we no longer focus on connecting people to services, we focus on connecting people to people”. Another one said, “instead of having conversations based on what we want to ask, we have conversations based on what people want to tell us”.
But what about those people who don’t need a conversation about their assets and strengths? What if they need something to happen urgently otherwise something horrible like hospital or residential care admission will happen?
Those people do exist – probably far too many as a result of our blind faith that if we ignore people or just make it hard for them to contact us they will go away. Councils are learning another new conversation that is nothing like ‘6 weeks of reablement’ and everything about an immediate response (today, not tomorrow or next week), understanding what the crisis is about through good instant listening skills, and committing to help the changes come about that will mean the crisis recedes or goes away.
Councils working like this talk about ‘sticking to people like glue’ for a short period – the complete antithesis to the rushed assessment and the plugging in of short-term services in the hope that something good will happen. People need to be listened to:
- maybe the most pressing thing a carer needs is a decent night’s sleep
- maybe the second most pressing thing they need is a working washing machine
- maybe the third most pressing thing is to get some immediate medical advice and medication review about the person they are caring for.
Working through these key elements of change (we could use some horrible jargon here and call them ‘outcomes’) becomes the focus of the work. There is nothing more important for the social care (or health) professional to do than to stay close to this person to ensure that the plan has the maximum chance of success.
In terms of economics, success in this approach is the holy grail for both health and social care budgets. Some councils are integrating this approach with their community health and GP colleagues to create a joined up experience, working with people on GP ‘at risk’ lists.
The beauty of the approach is that so long as you collect data as you go, you can create compelling evidence of what happens when you work differently. It doesn’t require the chancellor to change his mind, or older people to stop getting older. It just requires us to rethink what we do in social care.
Councils following this approach are now compiling evidence that you can halve the number of people coming to you who actually end up with ongoing support packages. It busts our assumptions about the numbers of people for whom this is actually a necessary or desirable end point.
If we can halve the number of people in social care organisations who have ongoing recurring packages of support, doesn’t austerity go away?