According to BASW and ADASS, more than 40% of annual care reviews are overdue in some parts of the country. And we shouldn’t be surprised. Demand for care is going up at the same time as resources are shrinking. The £3bn savings needed in England over the spending review period are on top of £2bn already achieved by adult social care in the past four years. That’s about 25% of the total budget in just eight years. We can do little about how macroeconomics affect social care, but there are different ways to resolve specific issues of assessment volumes backing up. There is no perfect solution; but amongst the options on offer are some good strategic choices and perhaps some bad ones. We’re going to set out just a few of the main options here, accepting there will be many more.
Whilst councils have manifold legal duties to adult social care users, the rationing approach suggests that only the barest compliance with regulation is affordable. Moreover, the timeliness of assessment will also be subject to available resources. No one wants to employ rationing as their primary strategy, but most councils, at some level, have to. A rationing strategy doesn’t clear the backlog; it accepts it will always be there, like the queues for bread after WW2.
The Skylakes verdict: We live in the 21st Century and not the 1950s. We can do better than this.
Hiring agency staff is a logical reflex to a bulge in demand, but it can sometimes feel like throwing mud at the wall. When leaders want an outcome delivered, getting agency staff is only half the solution – you then have to focus a large number of individual contractors on a common outcome. It’s hard to do it well.
The Skylakes verdict: Agency staff can be a critical part of the solution, but they need to be managed well and should be used alongside other strategies.
A managed service attempts to address peak capacity issues but deliver to common targets and outcomes, which is in some respects an ideal way to bring down a backlog. The trick is to get your managed service to help you resolve peak issues in a sustainable way.
The Skylakes verdict: It’s what we do, so of course we like it! But we know it works best as part of a wider workforce strategy and not just as an ‘emergency’ service. Beware though of agency models masquerading as a ‘managed’ service.
Increasing the number of permanent staff ultimately depends on how well the in-house model is performing and whether the permanent staffing level is set at the right point, below the ‘troughs’ at low demand levels. Otherwise the council is paying for capacity it doesn’t always need, and possibly cultivating an environment that encourages low productivity.
The Skylakes verdict: A strong base of permanent staff is necessary, but the level needs to be right and set within a high performance culture. There is little point attracting permanent staff to a model that isn’t working.
It is right to look for higher assessment productivity (at Skylakes we do that in a range of ways), but the unit cost of an assessment is dwarfed by the cost of consequential care packages. High quality assessments should be optimising user assets and maximising independence.
The Skylakes verdict: There is a ‘right’ cost for each assessment, councils must be careful assessment economies don’t end up costing far more than they save.
There can be big differences in the extent and nature of any service redesign, from modest pathway re-engineering to wholesale outsourcing. But an assessment backlog will often have its roots in organisational problems as well as a demand surge.
The Skylakes verdict: Too often, the extra cash to manage demand only solves the problem for a short amount of time; we should always ask the question about whether the underlying model is fit for purpose.
In reprising these options, we think a few things become clear. Of course, it hugely depends on the circumstances of individual councils (in terms of what strategies they deploy). The ‘answer’ is probably to have multiple options working together in pursuit of the right price, quality and risk transfer. There is another factor at work though; if we accept that prices go up the more demand is unforeseen, then councils that can forecast and plan well are those that will achieve better prices for any excess demand.
Avoiding the ration book or queue for social care is tough and getting tougher. Getting smarter and more strategic about backlog management is a more positive alternative.
As always with Skylakes’ blogs, we would love to hear your views, so please contact us.