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September 5, 2018
New models required
Attend any debate on the future of social care and apart from the growing sense of desperation that becomes ever more evident as the affordability precipice approaches, there’s usually a bit of a spat between the sectors – public/private/not for profit – as to who provides the best quality or best value service. What rarely seems to get any air time is the feasibility of shifting the whole paradigm of social care provision. Understandable, given the vested interests involved, but at some point soon this needs to change. New Economics Foundation is knocking at the door.
New Economics Foundation. Sustainable Social Care – Full report here
EXECUTIVE SUMMARY
The current debate about adult social care is centred on funding reform, which is urgently needed. But we will struggle to evaluate funding options in a meaningful way until we have determined how to improve the system. Our approach to social care is unsustainable, not least because we wait until care needs are acute before we address them.
Shifting towards sustainability requires innovation from creative people and organisations. Community businesses are beginning to step up to the plate. These are organisations, usually small in scale, that emerge when communities come together to address challenges they face. They are locally rooted, and trade for the benefit of, are accountable to, and have a positive impact on the local community. A small but growing number are using their knowledge of people and place to develop social care models.
This report seeks to meet the need among community businesses and other communityled care models to communicate the role they can play in sustainable social care. It also aims to shed light on the perspectives of commissioners, who shape care markets alongside providers and citizens, and therefore play a part in determining that role.
FINDINGS
Community businesses are:
• preventing harm – keeping people well through an active focus on health and wellbeing;
• building community power – enabling people to take collective control at a local level;
• spreading eco-systems of care – connecting local social infrastructure to create social, economic and environmental value; and
• creating good jobs – providing sustainable employment and acting as a driver of local economic development. Commissioners see potential in community-led care models, above all to prevent harm. But these models remain on the margins of commissioning, because:
• years of austerity have reduced local government capacity, with the result
that commissioners are contracting to fewer, large-scale providers;
• a culture of ‘quick wins’ is acting as a disincentive from investing in prevention, which is long-term, complex and hard to measure;
• a perception that small is risky persists among commissioners; and
• the number of community-led care providers varies geographically, being more abundant in some places than others.
RECOMMENDATIONS
This report outlines three routes to a more sustainable, community-led social care system for local and national government to consider:
• spread community-led care models – fund catalysts and incubators to scale out care models such as those developed by community businesses;
• commission for outcomes and co-production – focus on the ‘triple bottom line’ of social, economic and environmental value and on co-production to get real value for money, achieve wellbeing and prevent harm; and
• grow the core economy – ensure people have the time to care for others and to be active in their communities, by strengthening social security. The shift is beginning now at a local level. But to be transformative, it requires much more support and investment.