I’ve been in social care long enough to remember ‘investment decisions’ – here’s how it changed

Adult care director Iain MacBeath speaks about his experience of running services under financial pressures and his council's strategy to improve care with less money

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By Iain MacBeath

I’ve worked in adult care services for Hertfordshire County Council for more than 11 years now – long enough to remember ‘investment’ decisions when I started as assistant director.

Also long enough to remember then making some far more difficult decisions during the austerity years that have followed since 2010.

Since 2013, I have been director of adult care services, and my colleagues and I recently looked back at those years to analyse how we had made savings – and then discussed our plans for the future and where we’ll go next.

Hertfordshire’s story is not untypical of other areas. For the first half of austerity years, councils made savings in the following ways. Firstly, we introduced short-term interventions like enablement home care and short-stay beds to help people get back to independence after a stay in hospital or an accident at home. This took people out of the long-term community care population – both home care and residential care.

We also promoted direct payments and personal budgets as a way of offering choice and control without the overheads that commissioned services attract.

In addition, councils also looked to take cost out of the care services they commissioned by not providing the inflationary increases they had before austerity and by negotiating with care providers to reduce care package prices where the price didn’t appear to match the cost of delivery.

Change of direction

Halfway through austerity, there was a shift in the way councils made their savings. This appears to have been driven by the introduction of the national living wage for over 25s in 2016 and the government’s policy to, rightly, increase that wage by more than inflation.

But that additional financial pressure was not funded by central government, so councils had to look for ever more innovative ways of reducing the amount of care they commissioned because the price of care had closed in on the cost of delivery.

Councils looked to improve accommodation for people – more community equipment, home adaptations and different housing models. They looked at ‘asset-based community development’ to see if people’s eligible care needs could be met in ways other than through traditional care services.

We all looked to improve our targeted prevention offer, while funding streams like the Better Care Fund and winter grants have led to councils working more closely with their NHS colleagues to spend their respective monies to the mutual benefit of the person and the system.

The Care Act helped us to refocus our efforts on carers and personalisation.

Effects of budget cuts

Taking such a large amount of cash out of a system that was never generously funded in the first place has left the care sector under huge strain.

Social care frontline staff turnover in 2017-18 was over 30% (Skills for Care, 2018), care providers failing or handing back contracts to councils and the ‘big finance’ issues, where investment funds now own large care conglomerates are hugely worrying.

They also have a real human cost that our staff see every day.

During the Allied Healthcare failure and subsequent sale last autumn, Hertfordshire had to find alternative care providers for nearly 500 people, some with very complex care needs.

A new local authority trading company to take on domiciliary care was part of the answer – as was turning to our excellent trusted care provider partners.

In areas like Hertfordshire, close to London and with eye-watering housing costs for staff and a shortage of housing for everyone, these problems are compounded.

To stabilise the system, we need to pay our care staff more and offer better terms and conditions. Having the same person for their care and support is always people’s top priority when we ask – it’s what I would want too.

Six ‘big ideas’ to improve care

For the future, Hertfordshire has come up with six ‘big ideas’ to increase care quality, improve people’s lives and cope with less money:

  1. We will continue to invest and grow our prevention offer with our health partners – we believe anything else is a false economy.
  2. We will continue to invest in learning and development for our professional staff within the council and our dedicated care staff in our communities (our new Care Professional Standards Academy, through our unique Hertfordshire Care Providers Association, went live last month) – we need their innovation and compassion more than ever.
  3. We are commissioning our short-term interventions collaboratively with local NHS partners to make people’s experience of the health and care system as satisfactory as possible when they need it; people will get therapy at home alongside their enablement home care.
  4. Over the autumn, the council will make decisions on a huge investment in improving and extending its built estate to assist older or disabled people through hundreds of Flexicare Housing units, supported living, modern day opportunities and move-on accommodation for people who are mentally unwell.
  5. We have also worked on pathways to employment for disabled people and those with autism, Asperger’s and mental ill-health.
  6. All of this is underpinned by our Connected Lives model – a call to action to all 31,000 people who work in adult social care in Hertfordshire to think of the most innovative and appropriate way to meet people’s needs, to make them as independent and happy as they can be.

Iain MacBeath is director of adult social care at Hertfordshire County Council

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One Response to I’ve been in social care long enough to remember ‘investment decisions’ – here’s how it changed

  1. Colin Slasberg June 29, 2019 at 11:02 pm #

    None of these ideas will be worth a fig, Iain, all the time you continue to acquiesce with a system of resource allocation that incentivises personal deficit. The eligibility system seeks out and lives on crises. Your ideas will be swimming against an impossible tide. The eligibility system serves to keep spending to budget while denying there is any gap between needs and resources. It’s the political leaders dream. It’s time for sector leaders to rethink where their priorities lie and decide if they are to be true to their stated objectives. It’s a system that can be changed if sector leaders find the professionalism and the courage.

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