Long since are the days that adult prevention and early intervention activities have been a budget priority for Local Authorities; whether this be in regard to Domestic Abuse, Community Safety, or Health and Care. The gradual but definite move away from prevention is the reality of 14 years of austerity, ever reducing public sector ringfenced budgets, post Brexit funding reductions (especially to the Third Sector), and unprecedented spending during Covid. Our new reality; prevention strategies and activities are a luxury many of us feel we can only dream of. With 5,000+ new requests into adult social care each day being made by carers, friends and family members thinking they can access care and support immediately, and all too often at a time of crisis, most local authorities are struggling to balance budgets that enable them to meet their statutory duties. However, continuing the delivery of Adult Social Care as is, trying to react to demand, is not financially sustainable, especially as demand will continue to increase in line with the national population.
Can we embed prevention?
It is widely accepted that prevention and early support is pivotal in supporting and helping people prevent, delay, or reduce their need for higher intensive services. The question is how we can do this with limited funds and resources. Additionally, we are told regularly by local authorities that they do not have the in-house capacity to research, implement and embed prevention and early support strategies whilst managing daily BAU of high demand into their council front door triage services. These strategies require change management to policy, processes, practice. So, can local authorities do anything to stem demand of high cost and intensive services and rebalance use of finite resources with prevention and early support services?
We believe yes. We know that each local authority context is different, but we have spent time listening and understanding many Councils and are confident we have identified several key areas that focus more on how we use existing resources, as well as how we communicate and work differently with the many partners that can help provide prevention and early support activities.
Moving towards a system of prevention
Best practice examples tell us that prevention is everyone’s business, with defined roles and responsibilities e.g. for public sector commissioners, voluntary and community sector providers, local authority, and NHS delivery partners, etc. This requires joint understanding that is translated into joint strategies and partnership working. We have learnt that for this to be effective it starts with leadership; for prevention to be understood, elocuted and welcomed by Elected Members; and absolutely led from the top of organisations by senior leaders. Frontline staff tell us often that they can see opportunities to work collaboratively with other organisations to enable early support, but they need direction from their senior leaders to adjust their workloads to make this possible. Just as importantly, effective delivery requires contribution at all layers; in joint commissioning, use of a common language that enables prevention, with joint goals, sharing of data, and agreed measures of success. Having an external resource convene partners can help bring partners together, identify joint mutual benefits and bring cohesion; crucial for many local government areas where there may be tensions between key stakeholders.
Core to re-establishing early support within local authority strategies and practice in our current financial reality is organisation’s knowing each other's service offers, capabilities, resources, and unique contributions. Frontline staff and managers in a Local Authority we are currently supporting to develop their prevention and early support offer have been clear that post-Covid they are unclear what partner offer services are. Part of a systems approach is knowing what differing partners offer and promoting these to our customers irrespective of who is providing it. Time and time again we are told within our customer engagement work that people do not care if a service is provided by the Council, NHS, or Third Sector; they just need to know what it is, how it will help, how much it costs and how to access it.
Community assets at the centre
Customer engagement is, and has always been, pivotal to understanding what is and is not working. Many local authorities tell us that they do not have the time or expertise to do this within their existing resources. Supporting councils to develop and execute participatory approaches is an area we have been well equipped to support. We have used our expertise to quickly engage diverse ranges of customers in understanding ‘As Is’ services in order to identify what needs to be different to support a range of customers earlier. Accessibility to information and services comes up repeatedly as a frustration to people needing prevention and early support. Local Authorities can often get stuck in a narrative that some people are ‘hard to reach;’ however, customers tell us that they too often find public sector organisations difficult to access. This is an area where working with our partners in the Third sector (including Faith groups and community organisations) can make a real difference. They are often experts at engaging people of difference, with tools and ways of doing things highly effective and much more cost effective. As much as they are community assets with subject matter expertise in prevention and early support, many of the same financial factors affecting local authorities are affecting too many Third Sector organisations. In inviting them to the table as valued partners to co-design prevention and early support services we can find better ways to support voluntary community and social enterprise organisations to do what they do. This is important as they are often the true pre-front door to a variety of adult services, and they hold so much of our community's infrastructure, social glue, and are agents for positive change.
Doing things differently
Frontline staff tell us that they support many people that simply did not know that services were available earlier that could have supported them and prevented or delayed their health and care needs from progressing as quickly as they did. We need to think about what would help people to start planning for their health and care before crisis point. Perhaps in the same way that many people think about schooling for their children when buying a house, or looking at which feeder school will get their children to the secondary school they feel confident will provide the best education, we need to create prompts that can give communities, family and friends, and carers to start thinking through, and preparing for, their health and care journeys earlier. There is growing evidence to support building and promoting care and support around life events e.g. retirement, at point of diagnosis; times when people are more open to thinking through their likely emerging needs before they reach these stages.
Once people are thinking about their needs earlier, they require better access to instant and accurate information, advice, and guidance (IAG). This is another area that use of participatory approaches to ensure service design, accessibility, and evaluation of effectiveness is shaped with and by users.
Embrace use of digital
Too often our fear of change leads to justifications to keep things the same; this can be said of digital IAG. We have heard many staff within organisations needing to move towards digital solutions raise concern re the increased use of digital and AI and what this means for those of our customers who are digitally excluded. However, just as our post-Covid epoch means more Deliveroo and Uber eats users for takeaways than flyers promoting restaurants through our letterboxes as effective ways to access information, so does public services needing to better embrace digital technology and AI options for promoting and accessing prevention and early support. Options that promote 24 hours 7 days a week access to IAG, options that can empower user to have accessibility options for ESOL and learning disabilities, and options that promote consistency and real time updates to information as it changes.
Tine for change
What is clear, the lack of prevention and early support options for too many local authorities means we cannot continue as we are…we do not have the finances, and our customers no longer have the bandwidth to be patient.
Sandjea-Marie Adassa is an Associate Consultant at Roretti.
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