We see our role as district councils to convene our partners and the community to common goals, providing local solutions for local people. Our focus should turn to not just enabling people to survive, which has been the thrust of the Care Act to date, but to live and thrive.
The Care Act is about people. Supporting people, caring for people and enabling people to live their lives to the fullest. The Act placed certain duties around social care on ‘councils’ – of which county councils, London boroughs and metropolitan districts (upper tier authorities) are referenced. No mention of district councils I note.
The Act does, however, talk about co-operation with relevant partner authorities to deliver the key duties in the Act. Is co-operation enough, or should it be an equal duty to act?
A key element of the Act is the setting in stone of the requirement to arrange for the provision of preventative services, that is services which will reduce, prevent or delay the development of need for care and support. Across the sector, I think it could be argued that funding has been (quite rightly) particularly focussed upon the immediate need of people, rather than on prevention.
The often cited ‘Graph of Doom’, illustrating the growing funding gap between rising social care costs and decreasing budgets, candidly demonstrates the increasingly troubled financial waters in which councils are heading. With growing levels of need and demand and decreasing budgets, the public sector is fundamentally rethinking the way in which, and at what point, they deliver services.
Proactive intervention is needed, rather than waiting to react when people are in crisis. Often, it is down to the council to balance the funding requirement for responding to crisis, with prevention. It can be a difficult decision for councils to make to divert funding from immediate need into longer term prevention services.
For years, the public sector has discussed the benefits of prevention and how by focussing on this, we can prevent issues from spiralling, particularly around social care. But talk doesn't change lives.
Prevention is critical and building the stronger link between the NHS, social care and local services delivered to local people, should be built into the national consciousness. We have a key role as districts in the wider determinants of health with our strong community links and responsibilities around enabling good housing, healthier families and residents in employment. Achieving the goals in the Care Act needs to be focussed on providing wrap around services to people in need, blind to boundaries.
We see our role as district councils to convene our partners and the community to common goals, providing local solutions for local people. Our focus should turn to not just enabling people to survive, which has been the thrust of the Care Act to date, but to live and thrive.
In my district areas of Broadland and South Norfolk, we have taken a leading role in bringing together our partners to intervene at early stages and we see ourselves as a fundamental part of the integrated care system. We see this not just a statutory duty, but as the right thing to do. Often, we have gone above and beyond what the traditional role of a district council has been, in the environment of social care, to make a difference.
We lead on a unique initiative with the NHS, helping to support quicker hospital discharges, where the blockers to discharge are social factors rather than medical. Our ‘District Direct’ teams help people get home quicker, while supporting the wider care sector by opening up beds in hospitals for those who really need it. Last year, we dealt with 1,400 referrals, with an estimated 11,200 bed days being saved. This initiative recognises that there is a direct link between a person’s health and their social environment, and these need to be seen and dealt with hand in hand.
As an example, we are seeing an increase in where an admission has been made as poor home conditions have resulted in the package of care being withdrawn by the provider. Short term solutions are often put in place, which can create a cycle where people re-enter into hospital settings. Although a cost is attached, the re-introduction of ‘Home Help’ schemes would play a key role in ensuring outcomes are sustainable.
Alongside this, in Broadland and South Norfolk, we provide a social prescribing service delivered direct by us as the district council; building upon our role as a local operator, close to our communities at a neighbourhood level. This service places our officers in GP surgeries, with a focus on prevention, largely underpinned by the same principles as the Care Act around being person-centred and holistic. We see a greater opportunity, where adult social care does not have a role, to make onward referrals to preventative support services where individuals are given time to focus on what matters to them.
If we want prevention to succeed, as the Care Act intended, removing the silo-mentality between public sector organisations, and equalling up the playing field between single-tier and two-tier areas is central.
Symptomatic of the Care Act focussing upon upper tier authorities, is the failure to levy a social care precept for district councils in two-tier areas, which would significantly help to fund much of the preventative agenda.
Of course, shifting funding upstream to focus on prevention services is needed, that goes without saying, but also a cultural change around how things are done is crucial. There needs to be a mutual understanding of roles, responsibilities and capabilities of partners working together to provide preventative services. In Broadland and South Norfolk, this is something we will continue to advocate for, as we envisage the bigger picture.
Devolution also has a key role to play here by taking a focus on providing greater powers and freedoms to tackle issues like health inequalities which contribute to social care issues. This must be done at the right level to provide a holistic and co-design approach.
Only when we start to think more fluidly in terms of public sector spending and responsibilities, rather in terms of distinct organisational budgets and boundaries, will we start to deliver upon the Care Acts duty around prevention that can make a real difference to people’s lives.
