LGC’s essential daily briefing.
County crisis: Surrey likely to struggle to meet £94m budget gap
Simon Jones: Annual reports can redress the transparency deficit
The failures of successive governments to act decisively on the developing crisis in adult social care is often attributed to a combination of a widespread public misunderstanding of what social care is and who provides it, alongside a lack of political bravery and vision in Westminster.
The ongoing perception that ‘health’ is solely the responsibility of the NHS ensures that outcry over diminishing quality and quantity of support for the vulnerable has historically, for those in power, been kept to a manageable minimum – and therefore not worthy of the difficult and decisive action required.
While calls for action have grown louder in recent years as the system approaches collapse, it is the absence of informed consensus on options for complex, sustainable financial solutions for social care and local government generally - as well as the the presence of a weak and distracted central government - that are undermining the chances of significant and lasting reform.
A report by charity Future Care Capital, published this week in conjunction with Cambridge Econometrics, adds another dynamic to this predicament by identifying what it sees as weaknesses in the national data used to monitor social care performance in local areas.
The report says this “flawed” data will inform future government proposals for placing social care on a long-term sustainable footing, raising further doubt about the possibility of viable change.
Among a series of conclusions is that national social care data is not developed enough to facilitate effective planning as narrow measures such as performance on delayed transfers of care are “out of step” with how local areas are seeking to integrate public services and deliver person-centred services.
The report said this data does not provide adequate understanding of when and how people interact with the wider health care system and beyond, with gaps in evidence relating to crucial factors such as the levels of unpaid, informal care and self-funders.
This, the report says, also makes it difficult to monitor accurately how a system is performing, with a risk there will be a focus on the effectiveness of isolated elements rather than the whole, which includes new prevention-based care models operating outside “late-stage” provision.
Moreover, the report argues that councils with limited resources are also currently “incentivised” to focus on simply monitoring local systems at the expense of establishing for themselves the scale of analysis required to devise future models to deal with looming demographic pressures.
The qualitative element of the research, which presents case studies from five councils, further compounds these concerns.
Leeds City Council told researchers headline “measures and averages” mask significant variations across the area, including “deep pockets” of deprivation.
Nottingham City Council highlighted relatively low average healthy life expectancy as a significant concern, with people needing support at a younger age than elsewhere potentially prolonging the support they need.
The report says the case studies provide further evidence that national data reflect an “outdated or old-fashioned” concept of social care provision, with the focus of national data “at odds” with local initiatives which view state-funded provision as just one part of a wider network of support.
With councils taking an “asset-based” approach to social care that aims to make the best use of personal and community resources, the report said there has been a shift away from “transactions and entitlements” to promoting wider wellbeing, as required in the Care Act 2014.
The report argues that new “integrated” datasets for care at an individual level, which could include information on benefits, housing, health and social care, would enable councils to work in a more systemic way in their areas by showing how people use different services over time and what the outcomes were.
This week the Social Metrics Commission proposed a new way of measuring poverty, which considers liquid assets such as savings as well as seeking to include people living on the streets and in overcrowded housing.
The proposals, experts said, would change our understanding of deprivation and help create policies and solutions that enable people to escape poverty.
Yesterday the Guardian reported on Brent LBC and Essex CC working with IBM on predictive software that assesses data on thousands of children, including their vulnerability to exploitation and risk of not being school-ready.
Health secretary Matt Hancock’s unabashed enthusiasm for technology plants a small seed of hope that he will not only advocate innovation on the social care frontline through assistive innovations but also begin to address the limits of the way the data is currently used to monitor, judge and (mis)shape the health and social care system.
The multiple practical, technical, financial and political barriers to progress remain worryingly prohibitive, but the long-term sustainability of social care, effective public services and the quality of life of citizens depends on work starting to begin to break them down.
Jon Bunn, senior reporter