UK. Intermediate and social care

Citation

(2003), "UK. Intermediate and social care", International Journal of Health Care Quality Assurance, Vol. 16 No. 1. https://doi.org/10.1108/ijhcqa.2003.06216aab.004

UK. Intermediate and social care

UK

Intermediate and social care

Keywords: Social services, Social care

In the autumn, three reports on intermediate and social care were published, presenting a range of views about how this is and should be provided. These are outlined below:

1. 1.

   The King's Fund guide to developing intermediate care. A new guide published by the King's Fund, Developing Intermediate Care, by Jan Stevenson and Linda Spencer, shows that intermediate care requires a transformation in the whole system of services provided to older people in a locality. Intermediate care can be defined as a short-term intervention to preserve the independence of a person who might otherwise be forced to go into hospital or a nursing home. It is an active and intensive way of helping those who have suffered from illness or injury to get their lives back. It includes a wide range of activities, such as physiotherapy, speech and language therapy and practical support for everyday living. The guide has been produced following the three-year King's Fund Rehabilitation Programme, which worked with pilot sites across England to develop intermediate care for older people. It gives guidance to those responsible for developing inter-mediate care in their localities. The authors say that intermediate care is not built through one-off schemes but through a radical change to the way health and social services operate; intermediate care should fit as an integral part of a wide range of health, social care and housing services, and not simply seen as more beds in a hospital or care home. Janice Robinson, King's Fund senior adviser on social care, said: "When intermediate care is done well, it can help the NHS and social services to stop wasting money on unnecessary hospital and nursing home admissions. It can give people more confidence in themselves and a better chance of living healthily for longer into old age. "But intermediate care can be challenging to develop. It requires a high level of partnership working between local agencies as well as a commitment to involve users and their carers in designing new kinds of service. Our new guide should help those responsible for developing intermediate care to find ways of getting the job done effectively." Further information: Developing Intermediate Care: A Guide for Health and Social Care Professionals, by Jan Stevenson and Linda Spencer, is available from the King's Fund bookshop, Tel: 020 7307 2591 or at www.kingsfundbookshop.org.uk

2. 2.

   Joint reviews report a mixed picture in England's social services in 2001/2002. Tracking the Changes, the social services joint review team's sixth annual report, published by the Audit Commission and Social Services Inspectorate, says that of the 30 councils reviewed in 2001/2002, several councils were performing well and most had good quality services for some groups of users. However the report also found that a number of joint reviews had disappointing outcomes. The biggest challenge facing councils is to ensure that they assess potential new customers in a timely and consistent manner and sort out how they are going to help them quickly. In the year since October 2001, just less than half of all English councils reviewed were rated as having promising or excellent prospects for improvement, but 16 of the 30 reviewed were judged as having uncertain or poor prospects The report highlights the increasingly tough environment that councils delivering social care are operating in:

3. 3.
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     the demand for services is increasing;

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     there is an ongoing need to modernise;

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     the expectations of users and the general public are rising;

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     many authorities are experiencing shortages of qualified staff;

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     instability in the independent sector market is threatening the supply of services such as nursing home beds in some parts of the country;

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     significant changes within the NHS have sometimes interrupted relationships at local level;

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     councils, together with their partners (for example those in health) are being asked to meet challenging targets;

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     many councils face budget pressures in relation to social services, with a reported overspend of around £1 billion in 2001/2002.

   According to the report, a feature of successful councils is their acceptance of the need to make basic changes to the services they provide and how they deliver them. For example, older people in future are unlikely to follow the same pathways as in the past, with few people wishing to move into residential or nursing home care if other choices are available. Whilst the range of new options for vulnerable people is exciting, there are marked differences between those councils which are modernising their services and those which are not. It says that too many of those reviewed in 2001/2002 are clinging to some outdated building-based services, and failing to improve their community care. The report highlights the key role played by councillors in steering change and urges them to be prepared to make some hard decisions. Overall, the aim must be for the basic shape of services to continue to shift so that both children and adults are helped to remain at home, crises are prevented, and people are supported and empowered to make choices for themselves. It also highlights a number of councils reviewed in the past which have successfully tackled the challenges raised by their joint reviews. The report presents good practice from these councils and "tracks the changes" they have achieved. The sample group of improving councils include several who were previously judged to be failing, but have made significant improvements in a relatively short space of time. Controller of the Audit Commission, Sir Andrew Foster said: "The good news is that councils have a growing awareness of the need to embrace change. Many have responded positively to their joint reviews. Overall, social services are still not where they should be, but steps are being made in the right direction. As in previous years, much remains to be done to improve the quality of social services across England. The tendency of some councils to avoid making tough decisions is hindering progress and leading to further problems such as spiralling costs. This is a crucial issue that needs to be tackled sooner rather than later." Chief Inspector of Social Services Denise Platt said: "Councils need to ensure that their social services are flexible enough to respond to the many different needs of the people who seek their help. And they need to ensure they can offer choice in the way that those services are delivered. There is excellence in many services, but it is spread too thinly. Councils are developing new services for older people and children – these services need to move to the mainstream if reform is to make a difference to all that seek their help. Councils should not be afraid to challenge and make radical change to the way they have delivered their services in the past if they are to meet the public's expectations."

4. 4.

   IPPR says that a radical rethink of social care is needed. A new report from the Institute for Public Policy Research (IPPR), From Welfare to Well-being, edited by Liz Kendall and Lisa Harker, says that the social care system must be transformed to combat the perception that it provides poor services for the poor. The report sets out a vision of social care for 2020 in which it proposes that by 2020 social work and social services departments would cease to exist. New professions would replace them and age-related organisations and local government would be responsible for commissioning health and social care. The report, based on a project funded by the Association of Directors of Social Services and Community Care magazine, calls for local government to be given more freedom to shape and fund services. It argues that central government needs to pull back from micro managing services and instead focus on strategic goals and building public support. It also calls on the government to consider setting up a separate dedicated child protection service to improve multi-agency working, emphasise specialist skills and clarify staff roles. It also recommends a greater focus on prevention: social care must shift its focus away from last minute crisis point interventions. This will require more investment in prevention, an enhanced role for the voluntary sector, concerted action by other public services like education and health to help intervene at an earlier stage, and a more appropriate balance between the policy priorities of children and adults. There should be a strengthening of local accountability. Responsibility for social care should remain within local government but the re-invigoration of public engagement in democracy is critical. Local government should have more freedoms to shape services according to local need, including the power to raise additional resources through local taxation Staff roles should be transformed. The existence of separate professions working closely together presents a major barrier to delivering user-focused services. The authors say that by 2020, social work as we currently know it will cease to exist, being replaced by new professions focusing on key age groups. This will require the current training emphasis on generic skills and practice to be replaced by a more specialised focus. Lisa Harker, co-editor of the report and IPPR deputy director, said: "Social care services have the potential to transform communities but they will not be able to do so unless there are fundamental changes in the way these services are perceived and delivered. Incremental change to one part of the social care system is not an option – wholesale reform is needed. Government must be willing to allow local government to have greater freedom to shape and fund social care services and the relationship with the NHS must be rethought. But the focus of social care will also need to become more preventative and less crisis-driven." Further information: From Welfare to Well-being: the Future of Social Care, edited by Liz Kendall and Lisa Harker is available by e-mail from Central Books, Tel: 0845 458 9911.