By David Grigsby, Liquidlogic
In an open letter to social care workers this month, health and social care secretary Sajid Javid promised to put social care on a sustainable footing for the future, “building on the spirit of integrated working” because “we know we’re at our best when we work as one”. While the details are still being hashed out, at a slower pace than many of us would like, one thing is clear – social care reform and funding is back on the agenda.
It’s no wonder that frustration is rippling through the sector. In May, the End Child Poverty Coalition revealed that in 2019-20, before the pandemic, 4.3 million children were living in poverty, up 200,000 from the previous year – and 500,000 higher than five years previously. At the other end of the age scale, Age UK estimated that 1.6 million older people in England were going without all the help they needed with day-to-day life, before Covid-19 struck.
Interestingly, some councils are turning to targeted early support programmes, using actionable insights from across the country. Collaboration and shared learnings are central to this approach.
What can be done with existing funding?
The big issue has always been funding and that isn’t likely to change anytime soon. Pressures on public money are greater than ever before. However, there are actions that can be taken within the existing constraints.
First, break down the barriers between social care and health services, so they can co-ordinate and plan in a way that best meets the needs of their local populations. Secondly, use data and insights to pinpoint the citizens that are in the greatest need of support, and provide assistance before issues spiral out of control.
Early support is a familiar concept in social care settings and the supporting arguments are well made. Whether you are providing early help for adults with complex health issues, or children and younger people, the same principles apply:
- The outcomes or aims of the support should be clear so that they can be tracked and measured.
- Acting in anticipation – based on joined up data from different agencies and aspects of the individuals’ life – can provide vital signs before situations escalate.
- The interaction of health (mental and physical) with living conditions, education, family support, employment and other social factors create the potential for increased risk and a ‘chain reaction’ of personal or family crisis.
How and where to target services
A way forward could be for proven local initiatives to be scaled up to regional services, backed by data-driven targeting of the support programmes. This would go a long way towards helping integrated care systems (ICSs) meet their responsibilities. Each one has been tasked to develop an ICS partnership body, with the NHS and local government as equal partners, and they must develop an integrated care strategy for their whole population. To achieve this, they have been asked to use the best available evidence and data to address the wider determinants of health and wellbeing and to improve outcomes.
With this new focus, local authorities could leverage data to understand where and how to target services and with early support as a tool.
Many of the data-driven support initiatives are health-focused, with pioneering work such as the CIPHA (combined intelligence for population health action) programme, which originated across the Cheshire and Merseyside ICS, using combined health and care data to deal with the immediate Covid pandemic. Use cases from a growing number of contributing ICSs have been rapidly developed, and virtual hubs and services created to optimise the management of long-term conditions, such as blood pressure monitoring in hypertensive patients. Work to support people with cancer, along with suicide prevention and complex care (multi-morbidity), is all in the pipeline. The data platforms and supporting applications delivered through the CIPHA programme can be rapidly adapted to target social care challenges too.
On the social care side, Supporting Families (formerly, Troubled Families) may well have divided opinions. However, it has prompted councils to consider whether data has a place in making care decisions, including helping social care leaders to plan and predict future needs for services or support.
Similarly to the health programmes, it is heavily dependent on data analysis, relying on data from multiple sources where intensive multi-agency support could reduce the incidence of negative consequences for individuals and families. Since 2015, the initiative has reported that over 400,000 families have seen improvements in their lives – ranging from better school attendance, to supporting parents to overcome their substance misuse – as a result of direct support funded through the programme.
Striving for long-lasting change
Targeting services at those with health deficits is complex but it is already proven with programmes like CIPHA and on other data platforms – while schemes like Supporting Families are providing a glimpse of what could be possible within social care. Applying this approach more broadly will demand even greater integration of health and lifestyle data, and insights from other agencies, to identify individuals of all ages who may benefit from assistance. The data and insights used in existing health and social care support programmes can be easily transferred to other areas, with the combined will to deliver change supported by robust information governance.
It’s clear that the benefits could extend far beyond the good work that has been done during the pandemic. Our population is ageing, and England is home to 15 million people dealing with long-term conditions, such as mental health problems, heart disease, obesity and diabetes. That’s on top of the raft of challenges besetting our younger generations.
With social care and health working collaboratively – sharing data, developing use cases, ‘blue printing’ and spreading best practice – there is the prospect of real and long-lasting change.