Adult social care was facing severe challenges long before COVID-19 came along and made the pressures even worse. Age UK estimated in 2018 that 1.4 million people—nearly 1 in 7 of the population over 65—are living with unmet care needs. Now, local authorities find themselves at risk of service disruption. There are serious workforce issues and the domiciliary and care home market in the UK is affected by the largest formal care providers reporting losses or withdrawing from the publicly-funded market.
The growing gap between the need for social care for older people and the provision of support arises not only from a crisis of funding, but also from a failure to learn from what is already being done well. Closing the gap does not necessarily require some heroic leap of imagination. Rather, it might be achieved by carefully interrogating and learning from creative approaches already being tried—and then implementing them.
Policymakers could go even further by not only identifying and then spreading exemplary models of social care, but also establishing and propagating a set of principles to stimulate and support local innovation in care provision.
RAND Europe came together with the Power to Change charitable trust to explore the question: “Can innovative approaches not only support more and better care, but also make better use of community and individual resources to contribute to that care?” The kind of care we had in mind was a full-spectrum approach that would adapt as people age and their needs change. Organisations, communities, and sectors could link together to provide consistent support while making the best use of resources.
We concentrated on ideas to stimulate and sustain innovation in social care and ideas for research to bring closer a system of sustainable social care innovation. Following desk research and a briefing paper, these ideas were generated and discussed in a roundtable workshop funded by, and organised with, Power to Change.
The workshop identified important ways innovation in social care for older people might be supported:
- Promote the adoption of principles rather than advocate the use of specific models. Principles can be spread more easily, and be more flexibly adapted to local circumstances, than models of care.
- Regulation can support innovation in care. 'Smart' regulation can be a supporter of innovation and a means to spread learning and good practice
- Recognise and harness the value of building reciprocity. Modestly scaled and locally tailored approaches can nourish and support reciprocity between volunteers and carers/service recipients; these could be delivered by or working in partnership with community organisations to build connections between people in need of support and their local communities.
- See social care as part of the local economy. Social care could be a part of an innovating local economy deploying the opportunities for training, enhanced labour market flexibility (with more women entering the labour market), and civic engagement.
- Deepen understanding of the potential for technology. In comparison with debates over the role of technology in health care, its potential role in social care has been too little discussed.
The discussion arrived at four significant opportunities for stimulating innovation in social care in the following areas:
- using the interface between the experiences and preferences of those receiving care and the wisdom of care providers to drive innovation
- exploiting the opportunities that technology makes available to provide quicker and more relevant information so that resources might be better targeted and used
- rather than only focusing on improving care provision, to also focus on reducing the burdens of isolation and inaccessible services that push people, often prematurely, into formal care
- encouraging and socially rewarding participation beyond 'traditional' (often female) informal care to encourage wider kinship and friendship groups to engage.
Our targeted discussions on this topic took place in February 2020, predating the onset of COVID-19 in the UK. But recent events have made the conclusions presented here even more relevant. Our ideas are not focused on how to get ever more out of existing arrangements but, rather, on how to innovate. The demand for adult social care in the UK already exceeds the supply; and that demand is rising and will continue to rise. The result is that increasing numbers of people are being left without support they need.
The answer to matching supply to demand for social care could require significant increases in public funding. But another big part of the answer could be innovation in social care and creating an environment that stimulates and nurtures that innovation.
Tom Ling is a senior research leader and head of evaluation at RAND Europe. Jon Sussex is chief economist at RAND Europe and codirector of the Cambridge Centre for Health Services Research. Susie Finlayson is development manager at Power to Change and leads on their health and social care work. Workshop participants and contributors to their thinking include Fiona Flowers, Juliette Malley, Raphael Wittenberg, Terry Yarnall, Sian Lockwood and Jo Chataway.
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