Social care support is offered to adults whose independence or wellbeing is at risk. They may need support because of one or more long term health conditions, or because they have become frail in old age. Social care support helps to keep vulnerable people safe, while living as full a life as they can and so is essential to the health and wellbeing of the community. Most people who need support are supported in their own homes or communities, whilst some people are supported in residential or nursing care.
Traditional service-led approaches often meant that people were not able to shape the kind of support they need, or receive the right kind of help. Personalised approaches, such as self-directed support and personal budgets, however, enable people to have more choice and control about how they are supported to live their lives. Personalisation means recognising people as individuals who have strengths and preferences and putting them at the centre of their own care and support.
Unlike NHS care, social care support is means tested. Some people receiving social care have all of their services paid for by the local authority while others make a contribution from their own money and others pay for all of their services. This presents a challenge to providers of social care services as those who arrange their support services independently are largely unknown and therefore difficult to reach with preventative interventions.
While this chapter considers access to adult social care services more broadly, a specific aspect of access to services is that of access to social care from acute NHS inpatient services. This will be considered separately in the “transfer of care” chapter.
As our population continues to get older, so the burden of long term health conditions associated with ageing, such as dementia, in the population will rise. Even if we do not need care ourselves, most of us will know a family member or friend who does. More than eight out of 10 people aged 65 will need some care and support in their later years. (Ready for Ageing? Select Committee Report).
Improving access to social care has wide benefits for local authorities from protecting public health and preventing ill health and premature mortality to reducing health inequalities in the community. (Source: NICE ‘Improving access to health and social care services for people who do not routinely use them’).
There are many known barriers that prevent people from accessing social care services, from how the service is organised and physically located to personal factors such as language barriers, cultural beliefs or attitudes toward social care services.(Source: NICE Improving access to health and social care services).
With the already increasing demand for services as well as a recognition that adult social care services need to reach people in a more timely fashion to prevent crises, without significant change the pressure on the social care system will increase.
Although the population of Slough is younger than the population of England, there remain a significant number of people in Slough who rely on adult social care services including younger adults with care and support needs. Between April 2014 and March 2015 the adult social care team responded to 3,793 contacts resulting in 2,227 new cases.
(Source: Slough Adult Social Care Local Account 2014/15).
As well as significant absolute numbers, when considered as a rate per population, demands on social care in Slough are shown to be high. In Slough, a higher proportion of younger adults (under the age of 65) required support from adult social care services (1,330 per 100,000 of the population) than the national average (1,270 per 100,000). (Source: Public Health England Fingertips).
The type of care received by these residents varies. Over 2014-15 there were 528 clients supplied with pieces of equipment to help them remain independent in their home, while 74 residents aged over 65 moved into a care home. In 2014/15 64.4% of adults who received community based social care services did so through self-directed support, higher than the national average (57.4%) and that for the South East (58.9%).(Source: Slough Adult Social Care Local Account 2014/15 and National Adult Social Care Intelligence Service NASCIS).
As illustrated in Figure 1, the needs of social care users in Slough differ from the national picture, with lower rates of people with physical disabilities and mental health problems accessing social care support.
When asked whether they found it easy to find information about services, 72.5% of service users and carers in Slough agreed, this is slightly lower than the national average (Figure 2.). Overall satisfaction of people who use services with the care and support they receive has improved from 2011/12 to 2013/14 from 54% to 58%. This, however, remains below the England average of 65%.
Slough's Social Care related quality of life score from the 2013/14 Adult Social Care Survey was 18.4, slightly lower than the national average score of 19.0 (maximum score 24). This remains unchanged from the previous year. The score is calculated from 8 different quality of life questions that are included in the survey, which cover aspects like control, safety, dignity and social participation.
It is important to note, however, that the score will be influenced by a range of factors, and one of which is the services provided by the authority. In its current form this measure does not solely reflect the impact of social care services but captures people’s experience in all aspects of life relevant to social care.
(Source: Public Health England; Adult Social Care Profile)
The Care Act (2014) is a new law about care and support for adults in England. It modernises and simplifies the last 60 years of existing social care law, telling people what they should expect from adult social care services and giving local authorities a series of new duties. Some of these duties started on 1st April 2015 and others will be implemented in 2016. Changes include:
In response to increasing demand on services, changes to legislation, and funding of services the provision of adult social care services in Slough has been reviewed and a programme of reform design. The Slough Adult Social Care Reform Programme is centred around three innovations:
By moving away from an ‘assessment for services’ model and traditional defaults such as residential care, and instead moving towards a model that focuses on neighbourhood based support and care, maximising all the resources, assets and skills available to people and families where they live this programme aims to deliver meaningful and long term change across the following 6 domains:
||The development of a local system-wide strategy and action plan, spanning voluntary, health and social care services to maintain a healthy population in the community, working with the high consumers of services through targeted wellbeing and prevention plans.|
|Information & Advice
||This component will ensure that the right information is provided to the right people at the right trigger points in their lives. Proactive care and support planning will become the norm and independent advice and advocacy provided to people to help develop their support plans.|
||Through the development of the market place and safeguarding outcomes, people will have the choices of finding the right care and support at the right times in their lives.|
|Building Community Capacity
||Enabling people, voluntary organisations and the community to proactively manage their wellbeing and increase their resilience to succeed during periods of crisis.|
|Workforce Development and Quality
||Both internal and external workforces will be developed to deal with the changing and growing demands facing the health and social care economy in the next 5 years. This will require staff to adapt to flexible, multi-disciplinary ways of working.|
|Integration||The scale of the change required cannot be managed in isolation; people do not access care and support from just one single source. Slough services will continue to be commissioned from a whole systems perspective around the best outcomes for residents.|
There is a substantial challenge facing adult social care in Slough to meet the increasing needs of the population while making significant efficiency savings.
The adult social care transformation programme aims to meet this challenge by using community assets, being physically located within the community and assessing needs using a different approach to needs assessment focusing on people’s assets.
The adult social care reform programme blueprint highlights five key gaps in the current service that have driven the need for reform:
By definition, those in need of social care services are vulnerable and therefore at risk of experiencing poorer health outcomes than the general population.