The beginning of the year heralds transformative resolutions and fresh starts, but for the social care sector, there is no new deal. Social care professionals need to remain steadfast in their resolve to deliver high quality care amid straitened circumstances.
The outlook for an already stretched, and financially challenged, social care sector is getting worse. Managing the funding gap is a key source of tension between commissioners and providers of social care which could lead to short-term retrenched positions. The overall shrinkage in the sector is seeing less of the same services commissioned - for example cutting hours contained within care packages. But there are only so many cuts that can be made before services are withdrawn from those in need, or become financially unviable to run.
The concern is so great that commissioners, providers and charities recently joined forces to make a renewed case to government for sustainable funding for the sector. Funding is urgently required to mitigate risks affecting access to and quality of social care.
What are the challenges?
There are numerous challenges:
- Increasing demand for services with growing numbers of older and disabled people, including carers, with unmet needs. With need barely met now through existing structures and practices, services need to be transformed to meet future demand.
- Maximising outcomes with new and different arrangements and ways of working cannot be levered and incentivised through commissioning that is driven by price rather than quality and outcomes.
- Risk aversion and reluctance to share risks and rewards between commissioners and providers - the crisis in social care is leaving few services able to seize the benefits afforded by technology.
- Market fragility, especially for services that support people who rely on state funded care is leading to an overall reduction in the numbers of providers and overall capacity.
- Pressures in the NHS will only intensify as more people are admitted to hospital because of the erosion of community services.
- Some services that are simply out dated may need to be decommissioned and have care re-provided.
As expectations shift and priorities, policies and practice evolve, what was once fit for purpose will not necessarily remain fit for addressing future need. It feels as if the only constant element in social care is its rapid pace of change. History illustrates the on-going shift from institutional to community care and more personalised approaches to support. So we must also consider new skills and capabilities to build sustainable and long-term workforce capacity.
What can help?
Change requires investment in social care. Nothing happens without investment and social care will go backwards without sustainable funding to ensure high quality care and support for all who need it.
The notion of investing to save is well understood, and largely accepted in principle, but finding upfront investment funds has become ever more challenging. The government's spending review measures have been described as a short term 'hotpotch' which is doing little to tackle the growing care crisis. Important questions continue to be asked of Government, including what has happened to £6bn originally allocated for the full implementation of the Care Act 2014.
The Care Act seeks to support constructive relationships between commissioners and providers. Local councils are required to understand the business environments of providers, and to signal services that are both required, as well as those that need to decrease or stop altogether. The measures contained within the Care Act need to be implemented, but there are signs that some parts of the legislation will not be introduced thereby undermining the foundations. The cap on funding care costs has been shelved, and few people are able to access legal entitlements to advocacy and more needs to be done to strengthen safeguarding provisions.
Commissioning of social care is another key area. The current practice of commissioning individual packages of care, crudely based on a fixed price for hours of care, does little to incentivise providers to innovate. Creating confidence and trust through a shared vision are key building blocks that will enable new and different ways of commissioning and provision to be delivered. To deliver what people who use service need in the future, will require providers to collaborate in certain areas, and compete in others. Commissioners have pooled budgets for many years, and opportunities exist for providers to draw together resources, including the workforce, to deliver in a sector that will become increasingly financially challenged.
No single organisation can address the multitude of system risks facing the sector, and collaboration and partnerships will be the key. The worst of times can enable inspiration and innovation, and the future must be founded on positivity and solutions.