Beyond COVID: New Thinking on the Future of Adult Social Care

A Summary of an SCIE Position Paper

COVID-19 has inflicted a heavy toll on the social care sector affecting both recipients of care and social care staff. Pre-existing issues relating to a fragile financial situation were amplified but the professionalism and commitment displayed by the workforce were one of the few positives seen during the pandemic.

Care organization’s capacity to innovate when delivering services was also notable and there is an opportunity to view the challenges presented by COVID-19 as a catalyst for reform.

Against this background, the Social Care Institute for Excellence launched a programme of engagement that aimed to determine what kind of future is needed for social care as we move beyond the pandemic. The position paper is aimed at commissioners and senior managers working in the health and social care sector.

Here the main findings of the programme are summarised.

Aims and conduct of the programme

The specific aims of this programme were

  1. To explore the impact of COVID-19 on the sector, both negative and positive, and draw out lessons and implications for social care reform
  2. To examine what is needed to improve social care in the future, once we emerge from the worst of the pandemic
  3. To produce recommendations that explore what kind of sector we want after the crisis, and what the priorities are for reform.

The programme included a series of essays by sector leaders, a roundtable discussion and an analysis of SCIE’s own work.

  • Articles and podcasts from over 25 stakeholders exploring the impact of COVID-19 and the future of social care
  • Roundtable discussion held on 22 July 2020 attended by Helen Whately MP, Minister for State
  • Contributions from members of the SCIE Board and the Co-production Steering Group, made up of people with lived experience
  • Insights from the DHSC-funded Social Care Innovation Network and DHSC-funded work to support the sector to recover from COVID-19, including extensive engagement with the sector.

Three strategic shifts

The position paper recommends three strategic shifts to enable the system to deliver better outcomes.

  • Shift 1. To shift the sector to sustainable and long-term funding (N.B. this has been addressed in the government’s recent changes to social care funding)
  • Shift 2. To shift investment and focus away from remedial and acute services, towards community-centred preventative models of care, support, housing and technology
  • Shift 3. To shift the workforce away from low pay, low recognition and poor conditions, towards higher pay, better conditions and parity of esteem with the NHS Recommendations.

In total, the position paper lists 21 recommendations for action by local authorities, national bodies and the Government. They are:

  1. Develop a positive, co-produced, vision for social care
  2. Facilitate a national conversation with people with lived experience including unpaid carers to shape the vision and detailed proposed reforms
  3. Urgently address the short-term funding pressures
  4. Government should publish proposals, along with a timetable, setting out how it will implement a fair and long-term funding settlement for social care
  5. Fund a new leadership programme on asset-based leadership and coproduction
  6. Conduct a review of ‘burnout’ and wider wellbeing across the social care workforce
  7. Permanently relax rules which govern how people using direct payments and personal budgets spend their budgets
  8. Fund, develop and roll out psycho-educational support for care home managers to help them and their staff manage trauma
  9. Local authorities develop plans for how they will continue to support mutual aid and other support networks
  10. Government should highlight a common goal to align health, housing and care systems around a shared objective of helping people to live independently in a home that is suited to their needs
  11. Government should introduce a prevention strategy
  12. Expand NHS England’s population health management programme
  13. Establish an innovation fund for adult social care
  14. Promote the new DHSC-funded Commissioning during COVID-19 and beyond guidance produced by SCIE and Social Care Future
  15. Introduce metrics that measure progress towards asset-based areas such as people’s independence, resilience, wellbeing and social connectivity
  16. Develop a new national learning and support network
  17. Restart the programme of local systems reviews
  18. Establish a fund to invest in scaling up proven, small-scale digital technology innovations
  19. Produce a cross-government strategy on health and social care inequalities
  20. As part of a long-term plan, set out a commitment and ambitious targets to tackle race, gender and other inequalities
  21. Publish, as part of the long-term adult social care plan, a national long-term workforce strategy.

Negative impacts of COVID-19

The negative impact of COVID-19 on the care sector can be categorized into five areas.
Poor preparation for the pandemic
The sector was ill-prepared for the crisis in terms of advance planning and resources such as space to isolate infected individuals and PPE. Guidance, financial aid and resources arrived too late to prevent huge morbidity and many deaths.
Inequalities
Some sectors of the community have been more affected by the pandemic exposing pre-existing inequalities. Black, Asian and minority ethnic communities together with those on low incomes need to be involved in producing plans for reform. In particular, adults with learning disabilities have been disproportionately affected.
Fragmentation and disconnection
There are around 18,500 social care organisations operating in 39,000 locations in England alone leading to a fragmented sector that ‘wasn’t joined up’. The logistical challenges that this posed got in the way of the response to the pandemic.
Delayed local response
Some local authorities were criticised for being slow and inflexible when it came to passing on funding to providers. This led to feelings of fear and isolation.
Low worker morale
There are major concerns about low morale and burnout in the sector. Many feel isolated and access to high-quality support will be required to help them recover.

Positive impacts of COVID-19

Despite the enormity of loss experienced during the COVID-19 pandemic, there are some positives that were identified.
Community involvement
Communities were extraordinarily willing to help out during the pandemic. The challenge is to maintain that enthusiasm so that it does not wither away.
Improved relationships between local government and providers
This was not a universal experience but some local authorities and providers found that their relationship improved. For example, some improved communications with weekly call arounds and some created online forums.
Digital innovation
The rapid and successful ‘move online’ was seen as a positive during the pandemic with many examples of local authorities and providers rolling out new technology in a matter of weeks where this would normally take years to complete.
Reduction in rules
Several local authorities decided to reduce rules and streamline processes relating to the allocation of funds. This introduced flexibility to adapt to changing needs.

Key challenges and opportunities facing adult social care

The position paper identified a set of key challenges facing the adult social care sector but also identified several opportunities.

The key challenges (things that need to be changed) were:

  • Commissioning being focused on outputs rather than outcomes
  • A lack of support for innovation
  • Variability in access to and quality of care
  • Lack of a clear plan for the workforce

The key opportunities were identified as:

  • A shift in investment to prevention
  • Reframing the language used to describe social care
  • Supporting the voluntary, community and social enterprise sector
  • Faster roll out of technology
  • Use of broader housing options
  • Involvement of care receivers in decisions

What should the future social care sector look like?

Finally, the paper identified the features that a post-COVID social care sector should have. These were listed as:

  1. Locally based and community-centered as opposed to distant, national organizations
  2. Based on people’s strengths and assets, rather than their problems or deficits
  3. Focussing on community strengths and assets, collaboration with providers and community, and seeking whole-person outcomes
  4. Allowing innovation to thrive
  5. Improved social care workers’ pay and conditions
  6. Tackles deep-rooted social inequalities and social injustices in society
  7. Utilizes a broad range of housing with care options
  8. Devolves budgets locally
  9. Measures the true impact of care and support
  10. Supports the voluntary and community sector.

Summing up the report

The report draws on a broad range of sources including essays, roundtable discussions, podcasts, articles and engagement with the sector as well as SCIE’s own work on innovation. It concludes that three strategic shifts are needed and makes 21 detailed recommendations for both short-term and medium-term action.

The report clearly recommends that now is the time for bold action. A simple, fairer funding system together with action to tackle inequalities are urgently needed. The universal opinion was that ‘tinkering around the edges’ simply will not do.
In addition, the future plan needs to incorporate the lessons learnt during the COVID-19 pandemic.
Since publication of the report, the Government has announced changes to the funding of social care. Nevertheless, there are still many recommendations that are yet to be put into practice.

Sources

Beyond COVID: New thinking on the future of adult social care
Social Care Institute for Excellence

New tax will fund health and social care reform
BBC News

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