Access to social care and personalisation

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.

What do we know?

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.

Facts, figures, trends

Demand for Services

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.

Figure 1. Adults aged under 65 supported by Adult Social Care per 100,000 population (2013/14)

Figure 1

Quality of life and experience of services

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%.

Figure 2. Proportion of Adult Social Care users and their carers who find it easy to access iformation about services

Figure2

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)

National and local strategies (current best practices)

National policies and guidance

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:

  • New responsibilities to prevent people’s care needs from becoming serious or delay the impact and support and to provide information and advice.
  • New national eligibility criteria for social care
  • Changes to safeguarding legal framework
  • Responsibility to provide information and advice (including financial advice) on care and support services to all, regardless of care needs– a significant change requiring such services to be available to self-funders
  • Changes to how councils can charge for care and support, including offering deferred payment or loan agreements (known as DPAs) to more people.
  • Responsibility to assess and meet the needs of carers, regardless of how much care they provide.
This builds on vision of the 2007 report Putting People First: A shared vision and commitment to the transformation of Adult Social Care, to focus on “enabling people to live their own lives as the wish” and to “promote individual needs for independence, wellbeing and dignity”.

Local strategy

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:

  1. Asset based conversations – 3 tier system
    • Tier 1 conversations – how can we connect people to information and information support systems that help them get on with their lives?
    • Tier 2 conversations – when someone is in crisis or their independence is at risk how can we offer immediate support and leave people more resilient?
    • Tier 3 conversations – only after exploring the first two tiers will longer-term support arrangements be explored
  2. Community Hubs
    • Some of our work may be undertaken from hubs within the community. These community hubs will involve closer working across the council frontline and with the voluntary sector.
  3. Local Links
    • Local links are people who can act like a walking community noticeboard, signposting people to resources and support.

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:

Prevention
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.
Personalised Outcomes
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.

What is this telling us?

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.

What are the gaps and unmet needs?

The adult social care reform programme blueprint highlights five key gaps in the current service that have driven the need for reform:

  • the system is slow, it reacts to crisis not before
  • society is not making the most of the skills and talents that communities have to offer
  • though they make a vital contribution to many thousands of people. carers are not treated equitably during the current assessment and support planning processes, hampering their access to support services and reducing their ability to continue in their caring roles
  • people do not have access to good information and advice and are consequently not empower to take control of their lives
  • people often feel ‘bounced around’ and have to fight the system to have the joined-up health, care and support they need.

What are the key inequalities?

By definition, those in need of social care services are vulnerable and therefore at risk of experiencing poorer health outcomes than the general population.

  • Self-funders

    As previously highlighted, those able to afford to finance their care privately (‘self funders’) are required to arrange their support services independently. This means that this group remains largely unknown to the local authority and so supporting prevention of deterioration in health or independence is difficult.
    In addition to this there are a group of self-funders whose private income only marginally exceeds the threshold of funding who are financially vulnerable. (Source: Just Ageing? AgeConcern and Help The Aged).
  • Black and minority ethnic (BME) groups

    Older people from black and minority ethnic groups are known to be under-represented in their use of health and social care. Barriers to accessing services include lack of information, language difficulties and differing expectations of services. (Source: Race Equality Foundation).

Recommendations for consideration for key organisations

  • To continue working towards integration of health and social care.
  • To continue to explore joint health and social care personal budgets.
  • To continue to develop models to enable people to take more responsibility for their own care and support with the assistance of council, voluntary sector and NHS partners.
  • To make more effective use of local assets and to develop community resilience.
  • To support people through the pathway by providing clear and concise information and advice in a seamless manner.

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