Move to community services held up by risk-averse culture

Efforts to shift health and social care out of institutions and into the community are being hampered by risk-averse commissioning and a lack of government policy direction.

That was the conclusion of a report published today, commissioned by the Association of Directors of Adult Social Services and the Department of Health and based on fieldwork in seven English council areas.

The study examined how the goal to shift care “closer to home” from hospitals and care homes, articulated in the 2006 Our Care, Our Say White Paper, was being implemented.

The report pointed to evidence of improved outcomes and value from community-based services, including the preventive schemes funded through the DH’s Partnerships for Older People Projects (Popp).

However, it found that, despite this, NHS and council commissioners were sometimes judging community services by “unrealistically high standards of evidence” and not shifting resources out of traditional services.

Co-author Gerald Wistow, visiting professor of social policy at the London School of Economics, said: “It’s understandable that managers become risk averse. Even if some services that they are currently funding may not be as effective as alternatives, they don’t know that.

“They are taking a risk to fund a service that could reduce their control while they have to hit targets.”

The report also concluded that, since the White Paper, there had been a lack of government focus on implementing care closer to home with no defined programme to do so and no specification about how far and fast commissioners should shift care out of acute settings.

It called for a firmer direction from the DH and said there needed to be “realistic expectations” about the evidence needed to shift services into the community.

It said targets for councils and the NHS ought to look at the whole system, rather than part of it, while financial systems needed to be able to move money easily between and within local government and the NHS.

The report was based on fieldwork in Blackpool, Islington, Sandwell, Hampshire, Knowsley, Leeds and Oxfordshire.

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