Focus on outcomes to achieve better social care results with less money

24 Apr 17

We need to change the way we think about social care, shifting away from need towards outcomes

As a civilised country, we will provide social care. We will care for old and infirm people, for those with significant disabilities, or with mental health problems. The challenge, while we focus on austerity and reducing costs, is how the state can continue to ensure this happens.

Earlier this month 100 commissioners and care providers gathered at a Local Government Association and Public Service Transformation Academy (PSTA) event. The Chatham House Rule enabled robust and productive exchange. We know we would be hard-pressed to create a more dysfunctional system for commissioning and providing social care than what we have now. But there’s hope. With grown-up conversations and a different way of thinking about social care, we could turn the situation around. It requires real change – dare I say it, transformation – and that’s a tall order.

The problems are many. Social care and health still barely work together, integration takes years, and even within local government, we aren’t joining up related budgets. Commissioners don’t know what it takes to run a care business, and the lack of insight goes both ways. Margins are often tiny, so providers want certainty and risk reduction – but commissioners want risk transfer and short-term contracts. ‘Savings’ come at the expense of a broken market. Each defends the status quo, because change is risky, at the greater risk of total system breakdown.

The way we think about social care is a major problem. We focus on ‘need’, defined by what we provide, but know little about self-funders, quality, or the local workforce. We provide care in fixed packages, and think ‘savings’ are based on reducing costs. We fund separate silos, but assume every pound spent on care services generates a pound of value. This is not true. As a recent IFS report demonstrated, the amount spent on social care in any area is not driven by population size, deprivation, or health. Quality is the same. It is how the system is structured that matters; a bad system costs more, with worse outcomes, even dealing with fewer, healthier people.

We need to shift the focus to outcomes. Often talked about, seldom defined, I mean our real effect on the lives of the people we are here to help. This also affects the system – when we aim for independence, we value empty hospital beds over full ones.

So better results can be achieved with less money – usually where we do real social work; asking people what they want and helping them to achieve it. The only way to improve certainty for providers and flexibility for commissioners is to work shoulder-to-shoulder together with citizens. It’s possible to commission services based on recovery, not dependency, to share financial information and seek savings together, to build trust. Providers want more real commissioning, not less – we all need to follow a maxim of the PSTA: to work ourselves out of a job!

It requires challenge, we must recognise that care is complex, and it takes time. It’s hard work, but it is our only option, because we have to provide social care, and that means we have to pay for it, too.

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