Winter is coming
Winter is traditionally a time in which the NHS struggles. This is due to the arrival of the flu and increased pressures on the system. In 2020 these pressures will be increased with the tag team of Covid-19 and the flu. More money can be added to the system to prop up layers of support but as the discussion at ADASS directed, this is not enough.
If the money does not also reach social care and if it is not invested in the system beyond simply buying more PPE then it will cause more problems than it solves. What is really apparent is that partnership working is key, now more than ever. We can no longer work in isolation. The biggest example of this is with the NHS and social care. We have said for years that they are two sides of the same coin. There needs to be additional focus on joined-up working. This is key to the response to Covid-19.
The current pandemic has challenged everyone. Health and social care suppliers have been required to rapidly change plans and re-prioritise in the light of Covid-19. We are now over the initial outbreak and have time to analyse the data that we have and prepare for the Winter. The key question through all of this is the continuity of care and how this can be ensured.
Adjusting to Covid-19
During a conference session entitled, care markets, attendees were treated to a detailed discussion on the current state of the market. Presenters looked at how it has responded to the current pandemic. This session was delivered from multiple perspectives, the Chief Inspector of adult social care, a former ADASS president and a mother, whose daughter is in receipt of care. The top-level themes that emerged were:
- Home care has seen a decline in the number of hours delivered with care workers not being asked in
- There has been a reduction in bed occupancy
- Care is rigid and not flexible around the individual needs of the service user
- Testing and PPE are two big areas that need to be prioritised before the Winter
- Provider instability is a real concern at present, with worries of the system collapsing.
All of these considerations are not surprising. With the infectious nature of the virus and the high-risk factor of those that are being cared for, it is no surprise that fewer hours of care have been called for. This has then shifted over to an increase in prominence of care in the family. If this has been possible, then it is has taken place to reduce costs and also reduce risks. This is positive in the sense that those being cared for see their loved ones more, but it adds worries to the system that is already concerned about increasing costs.
Care in the Community
Increase in care from family. There was a real sense from the conference that people have bound together to help those that are vulnerable. More can be done, and some have fallen through the system but broadly speaking, it has been great to see the public response. It is those who are unseen who are the concern.
If Covid-19 has proved anything to us, it is that there is a desire for community deep down in society. When the need is there, people bind together to support each other. The problem is the visibility of exactly what is out there. When time is of the essence, people are still being prescribed care, which in the broad sense is insufficient and causes more damage.
Access the right care at the right time. This is a statement that we have all heard before and was echoed by the CQC Chief Inspector of Adult Social Care, Kate Teroni. Let people tell their story once and have this made available to those providers who will be involved with the care of the individual in question. This was important before Covid-19 and is still important today.
Working together to enable change
Regardless of the session, everyone agreed that we need to work together to enable change. Resources are stretched and people are falling through the system. The more that we all band together and continue to join up care is how we can reduce the fragmentation of health and social care.
‘We made progress when we stopped asking for permission’
Sally Warren, King’s Fund
Health and social care are amazing sectors. They help thousands every year but with this focus on care, there has been an equal hesitation in embracing new ideas, in particular technology. It is not new news to say that in the NHS it was not unsurprising to see fax machines being used as recently as 2019. The Covid-19 pandemic has removed a lot of the bureaucracy behind these decisions and enabled the sectors to be braver.
Through the pandemic, the shackles have been removed and both sectors have been free to use their judgement. We all know that the system needs change and if there is one good thing that can come from the pandemic it is that technology will be seen as a key partner.
The continuing importance of technology
We maintain that technology is a key enabler of change. It is freeing health and social workers from the constraints of the past, which, when we are working from home is essential. This was a key theme that was discussed across the conference and something that delegates hope will continue being perceived as important. If we want effective joined-up care then we need to work together, through the means of effective and purpose-built technology.
Technology makes key changes and providers need to be brave to invest. There is a delayed benefit with technology that needs to be acknowledged, alongside the cultural shift. Change is always hard-fought, and people can be nervous. This is something that needs to be considered when embracing new sources of technology. The delayed impact on savings, alongside the need to work with team members for them to understand the benefits.
At the Spring Conference, the benefits of technology were embraced every bit as much as changing the perception of social care. Ensuring that workers in the sector need a fair wage was heralded alongside the need for mobile care. It is a balancing act in terms of continuing to deliver the best care when tempering this against the need for a fair wage and working closely together with partner agencies.
Technology has proved that it is an essential ally in troubled times. It is a key component in the battle to work closer together and enable person-centred care.
Social care in 2030
The final session of the conference looked at the future. It highlighted a variety of perspectives from those within different areas of care, all of whom agreed that the future looked murky. Funding will only become more of an issue as the years go by. In the first instance, there will be more than half a million additional jobs that need to be filled within adult social care over the next ten years. On top of this costs will continue to increase by more than 3% each year, which will not be offset in any increases in GDP.
All of these facts are known. We know that there is a huge funding gap in social care. There are currently more than 120,000 vacancies within adult social care, and this will only increase with the arrival of Brexit. It is a situation that keeps us up at night and needs to be acknowledged.
“We should not go back to the way that things were.”
Jenefer Rees, Principal Social Worker, The London Borough of Islington
Covid-19 has brought along with it opportunities for change. Many of the changes that have been temporarily installed would have taken years to arrive but now they are here, we need to keep them. The most evident of this is working from home. The freedoms that Covid-19 has brought need to be maintained, as they have empowered workers. Technology is here to help, not hinder us.
“We don’t fear technology, we embrace it and make the most of it”
Jenefer Rees, Principal Social Worker, The London Borough of Islington
Through working together and maintaining the independence and confidence that Covid has brought, we can change the picture of the future. We need a joint funding agreement between health and social care that can be used across both sectors. With a long-term plan, dedicated technology solutions that enable person-centred care and a shared desire to work together, we can change that picture of the future.
Through discussion emerges change. The latest ADASS Spring Conference took place online over the last two days. It brought together industry leaders to discuss the future of adult social care, and how Covid-19 has shifted its direction.
Lessons have been learned, that was agreed, alongside the need for technological trust and investment across health and social care. Many times, we scream for the government to see the two sectors as one entity, but still to this day, they are hesitant. We are unsure as to why but through continued discussions such as those presented at ADASS, we can enable change.
The service users and those in receipt of care need clarity. They don’t want to hear that their funding has been cut in order to place more money in the NHS. This could then ultimately lead to them being admitted to hospital and this is the type of future that no-one wishes to see. We want to continue supporting organisations such as ADASS in their vision to create a better, shared version of it.
We can enable lasting change but only through working together and embracing the benefits that technology can bring, can we do that. James Bullion, the President of ADASS set out nine statements to help shape adult social care reform. We embrace these and endorse them as we can all agree that we need to fundamentally change the way in which care is delivered and experienced. We need to create a system for ourselves and our families, both now and in the future.