In the second and concluding part of his articles on the direction of services, Andrew Cozens examines how the adult care agenda is shifting at an accelerating pace
A dult social care is in transition. This state of flux has sector-wide ramifications, which will affect service users and providers. The challenges faced by adult care commissioners and providers are varied and will only increase as the government exerts more pressure on the field to reform and as greater demands are created by changes. Because of the variety of service need and a subsequent lack of clarity of the central vision, adult social care service providers have their work cut out in the years ahead.
Adult social care is changing as a result of several factors. Since the reorganisation of social services following the Children Act 2004, social care managers have struggled to define the parameters of their responsibilities. Additionally, government is encouraging the blending of adult social services with the public health and well-being agenda, which potentially blurs the lines of what adult social care practitioners are responsible for and who their customers are.
In addition to these challenges, adult social care needs are diverse in scope and level. All these issues contribute to the current debate about what adult social care services should look like. Unlike the children’s services agenda, there is still an outcomes framework for adult social care. This clouded vision of the future of adult services is, however, constructive for the time being. Adult social care is unique in its need to be flexible. Due to the diverse scope and level of adult need, adult service providers need to have the luxury of being flexible enough to provide services when and how they are needed, which varies enormously between service users. In addition, with the blending of public health and well-being into the adult social care mix, service providers will need the room provided by this transitional phase to negotiate and work out the new set of roles and responsibilities with their partner organisations.
Beyond the choice and control that those opting for direct payments can gain, all service users are being encouraged to take a stronger role in determining the kinds and levels of service they require. Adult social care providers will need to regularly consult with users and carers to ensure that the right services are being provided.
This is of growing importance given councils’ new responsibilities for planning for the whole population, including self-funders. Directors of adults’ services will face challenges from the need for increased inter-departmental working within their council and greater reliance on partnerships with outside organisations.
Council departments will have to find ways to communicate and work together to provide the joined-up services that the new adult agenda is aiming to provide. As the well-being agenda grows to include housing, planning, leisure and transport, local authority officers in these areas will have to work together with adult social care managers to ensure that their services promote social inclusion.
The promise of an older population is a challenge to providers of adults’ services. Currently in the UK there are 20 million people (42 per cent of the population) older than 50. This figure is expected to increase steadily and it is estimated that, by 2020, 48 per cent of the population will be older than 50, 19 per cent will be over 65 and there will be more people older than 85 than under five. The life expectancy of women is now 81 years and 76 for men.
These statistics have wide-reaching implications for local and national infrastructure and services. For example:
● What kind of support will be available to the growing number of people over the age of 50 with school-aged children?
● What kind of support will be available to those aged over 65 who do not lead healthy and active lifestyles? Healthcare spending for them is already three times more than the spending on those aged under 65.
● What will be done to help those aged over 85 who live in homes that do not meet the decent homes standard?
● What will be done to address the employment, transport and leisure needs of healthy and active people over the age of 65?
The main question being asked is where will the funding come from for this increase in demand? Also, who will provide the services and care these people will need?
Funding and recruitment will need to be addressed by central and local government. Both the Wanless report on the care of older people, and the forthcoming Options for Excellence review on the future social care workforce requirements make the case for investment and reform. Will this be taken account of in the forthcoming comprehensive spending review announcements?
The IDeA is already participating in work which addresses this issue. The round five (2004) Improving Services for Older People beacon winners have produced a best practice guide called Assisting Ageing. This provides advice and guidance on what local authorities can do to prepare for the changing needs of an aging community.
The guide outlines different strategy models used by authorities recognised for their best practice. It also includes case studies showing how real improvements have been made to residents’ lives. Advice is provided on:
● Planning a strategy.
● Improving multi-agency working.
● Engaging with older people.
● Using the skills of the older population.
The problem needs to be addressed through lateral thinking. The government cannot just conjure up some more money and citizens do not want to have to impoverish themselves to pay for care. The public health agenda, which aims to increase public well-being and health in order to reduce the demand on the NHS for acute services, is one example of a means to change the patterns of need of an aging population.
More exercise, better diet, reduced falls and better general health will help an ageing population to be more independent and reduce their need for traditional public adult care services. Local government will also need to look into partnering with voluntary and community groups to find new, innovative ways to provide services.
Local government will also need to find ways to consult their service users to collect regular feedback to ensure that they are providing the services that users want and need. Also adults’ services need new benchmarks to denote excellence and provide guidance for councils to measure their own services and policies against.
ANDREW COZENS is strategic adviser for children’s, adults’ and health services at the Improvement and Development Agency. Before that he was corporate director of social care and health for Leicester Council. He was president of the Association of Directors of Social Services in 2004-5. He is an adviser to the Local Government Association and to the Joseph Rowntree Foundation on social care and health matters.
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A look at the state of adults’ social services reveals that the parameters are cloudy and that practitioners have their work cut out for them. The reorganisation of social
services and government pressure to blend adults’ services with the public health and well-being agenda are creating challenges for practitioners to redefine
their work. An ageing population will add to the challenge. Agencies need to be prepared to work in partnership and find nontraditional solutions.
The Improvement and Development Agency provides support and advice for councils on adults’ services, public health, housing, communities, leisure and cultural services,
leadership and partnership development. Peer reviews, stock takes, bespoke consultancy work and leadership academy modules are all popular IDeA products and services which local authorities can use for help in improving their services. See IDeA Knowledge.
This article appeared in the 19-25 October issue, on page 38 & 39, under the headline Use your imagination