A long-term approach to social care: Local Government Chronicle

Strategies that improve the quality of life can also help to cut costs.

Social care costs local government in England more than £5bn a year, with a total cost to public funds of nearly £14bn in 2008-09, according to a recent report from the Local Government Association .

Those costs have risen substantially in recent years and are projected to treble by 2041 because of the ageing population, the report, entitled Facing Facts and Tomorrow’s Reality Today: the cost of care , reveals.

Given these figures, there is arguably no other local government responsibility where efficiency improvements are as essential.

Much effort has been made in recent years to collate best practice and encourage councils to learn more effectively from each other about what works and what does not.

One of the focal points of those studies has been to understand why practice shows so much divergence between local authorities and what the impacts have been of such different approaches.

The Department of Health’s Care Services Efficiency Delivery (CSED) unit was established in 2004 as a result of Sir Peter Gershon’s effi ciency review.

It is now headed by John Bolton (formerly director of community services at Coventry City Council ), the department’s strategic director of finance with responsibility for social care.

Under his leadership, the unit has been conducting extensive research into best practice and common practice in local government.

The priorities for CSED and the Improvement & Development Agency (IDeA) are to improve preventative work and to help patients recover more quickly and more completely after periods of ill-health.

One part of this task is to train carers to work more effectively with those they support.

One word that increasingly pops up in social care is ‘reablement’ or ‘enablement’.

Reablement support is initially intensive for patients who have just been discharged from hospital following, for instance, a stroke or a hip replacement.

By visiting a patient several times a week after discharge, a care worker can support patients to do more things for themselves, be more independent and greatly reduce the likelihood of hospital readmission, or referral to residential or nursing care.

It can also signifi cantly reduce the incidence of falls within the home — a common problem for recently discharged patients.

The LGA report estimates that patients are one third less likely to need to go into residential care if they have reablement support after hospital discharge.

In addition, better training of carers who are helping relatives with dementia can delay admission to a nursing home by 20 months.

Approaches such as these offer substantial savings to both local and central government.

But Sarah Pickup, co-chair of the Association of Directors of Adult Social Services ‘ resources network and director of adult care services at Hertfordshire County Council , warns that it is not sensible to extrapolate from this that all councils could make these substantial savings.

Most authorities, such as her own, are already a long way down the road of implementing more effi cient practices that mop up the easy effi ciency gains.

“There are a lot of things that can be done,” says Ms Pickup. “But it is wrong to assume there are pots and pots of savings still to be achieved all over the place. A whole load of budgets are tied up in the independent sector and there are limited opportunities in making savings on this.”

Andrew Cozens , strategic adviser for children, adults and health services at the IDeA, adds his own note of caution. “It needs a lot of time to steer towards different provision,” he warns.

For example, he says, the programme adopted by Coventry to replace residential care with ‘extra-care’ accommodation took a long time to be rolled out and generate savings.

Reducing the use of nursing care requires a gradual and substantial investment in extra-care accommodation, he suggests.

Investment is also needed to use more ‘telecare’ monitoring devices — one of the major opportunities for improving efficiency, according to the LGA’s Facing Facts report.

“Tunstall [one of the largest providers of equipment] says it is like pushing a stone uphill trying to get local authorities interested,” says Mr Cozens.

He warns that councils also need to think further about their use of residential care. Despite the intention for several years to reduce its use, savings have still been small, he says.

Mr Cozens believes that further opportunities for efficiency improvements lie in addressing councils’ wellbeing powers and place-shaping agendas more seriously.

If authorities can raise the quality and availability of a range of services for the wider population — such as transport and leisure — this can prevent much of the need for social care support, he argues.

Another potential problem is the sheer number of efficiency programmes being promoted. There are so many — and generally with signifi cant capital investment requirements, or front-loading of extra revenue costs — that prioritisation is a problem.

But the good news is that there are real opportunities for initiatives that both improve the quality of care and reduce costs.

Other services should be so lucky.

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