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A guide for the new generation of social care decision-makers

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The May elections may not bring a great shift in control, but they will create new cabinet members who will have to grapple with the continuing challenge of social care

The May elections for London and metropolitan boroughs, along with some unitaries, mean the political leadership of adult social care will be tested in over half the councils in England.

While, in relative terms, no great shift in the national political landscape is predicted, we can still expect around a third of lead members to change when cabinet roles are settled. How will they judge the state of the social care services they inherit?

A good starting place is to consider the risk assessments most directors will have completed this autumn. This is part of the Local Government Association/Association of Directors of Adult Social Services initiative that is central to sector-led support.

They assess progress across six domains: leadership and governance; performance; commissioning; partnerships; resource management and culture. Together with surveys of user and carer satisfaction and statistics collated by NHS Digital, they provide a chance to benchmark progress and challenges.

I have read over a quarter of them and a picture emerges of fundamental, structural challenges spread consistently across most councils. There are also sub-regional challenges, all tempered by examples of successful local reform and innovation.

The top risks identified are environmental as opposed to being within the direct control of councils. Most directors are bothered by the sustainability and capacity of their local care market, and the linked issue of workforce availability.

Brexit is a factor where the local economy draws on EU workers. This risk has been mitigated by greater support to providers, addressing business continuity in new contracts, and – on occasions – by taking services back in-house on a short or medium-term basis.

Directors also report the challenge of managing rising demand within reducing resources. This is often linked to overheating the local NHS. In a worst-case scenario, this can find expression in high numbers of delayed discharges.

The Care Act 2014 assumed a shift to prevention as the key way of managing demand. It also envisaged the adoption of personalisation as the default operating model for those with enduring social care needs and their carers.

Progress towards this is very patchy. Some report increased numbers in residential and nursing home care, and a real term decline in the use of direct payments. At the other extreme, more people are requiring lower levels of support after successful care planning and reablement.

Faced with this, councils are asking fundamental questions about the transactional costs of assessment and rationing to gate-keep adult social care. There is strong interest in the wider determinants of need for care and in how the whole family, caring and community context can be better supported.

From this platform new lead members can begin to develop their local political strategy, perhaps feeling less hamstrung by the unresolved national funding dilemmas.

Andrew Cozens, independent social care and health specialist

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