In his latest blog for Social Care News, Ewan King, SCIE’s Director of Business Development and Delivery makes the case for placing prevention at the heart of the new Green Paper. Investing now to relieve the pressure on social care is important, he says, but not at the expense of longer term solutions to delivering sustainable, high quality services…
Dealing with what is right in front of you - the here and the now - is a natural human response. As for longer term thinking - well perhaps that comes later.
And right now, faced with real pressure, there is a strong case for social care leaders to focus on the most immediate issues: too many people stuck in hospitals, and a collapsing care market.
That means investing in immediate solutions to alleviate the pressures on hospitals, including if necessary propping up struggling care providers. There is a danger here, however, that whilst we sort out immediate problems we might neglect to think about the potential long-term future of care.
Given more time, and additional investment, there is broad consensus that a different approach is needed. Alex Fox of Shared Lives Plus and a SCIE trustee argues that we need to invest in innovative, preventative, new models of care, not just safeguard struggling existing models.
He maintains that: “A narrow focus on what forms of social care will immediately alleviate the current pressures in the NHS will not ultimately achieve its goals. The models which work are those which are... built around goals like wellbeing, independence and resilience.”
The trouble is that as money has tightened - and despite all the good practice out there - we have sometimes struggled to invest in preventative services. There is agreement that increasing the focus on prevention can release savings in the future, increasing independence and limiting the need for more expensive ongoing care. Yet, according to ADASS, spending on prevention has greatly reduced in recent years.
Thankfully, templates already exist for how preventative models can work. These include models like village agents, community circles, local area coordination and social prescriptions, all of which have shown that community-based preventative models can save money whilst helping more people maintain their independence.
One such model - care navigation - developed as part of a new model of care on the Isle of Wight - involves care coordinators assessing the holistic needs of people and supporting them to access a range of support services which boost their confidence and independence. Independent evaluation estimates that cost savings of £553k (ROI 53%) per annum (through reductions to the use of services) have been achieved whilst increasing people's well-being.
Time to scale up
Even though the Care Act 2014 sets out a vision for more preventative approaches that build on people's strengths, these models are yet to be scaled up. They need to be now. The alternative is a future that includes quick fixes and work-arounds that will probably lead to poorer quality outcomes.
Prevention needs to be at the heart of the proposed social care green paper. New money will be part of the solution, as the very best preventative models need investment in order to grow. Budgets are too stretched right now to pump prime new innovations.
But we also need to fundamentally change how we measure and incentivise the health and care system, for instance by finding better ways to reward areas that demonstrate significant increased investment in preventative models of care.
Social care, to be fair, has got better at responding to these challenges. It has had to. But with the right kind of policy framework and underpinning funding, the sector can also become even more adept at developing preventative models of care that deliver for the longer term.