Learn about 天美mv's policy position on integration of health and social care in adult social care; our vision, the current situation and potential solutions.
What do we want to see?
We believe there should be joint working across social care, community assets, housing, health and other service providers to ensure person-centred care, where choice and control is based on what matters to the person drawing on care and support. We want the critical role social care can play in empowering people to live well to be recognised, valued and proactively engaged in workforce planning and service design across health and care.
The current situation
Demographic changes and increasingly complex needs mean integration of social care with health plays an increasingly critical role in realising our vision. Our projections show that we’ll need 470,000 extra adult social care posts by 2040 as a result of demographic changes. We also know complexity of needs will increase - for example, the number of people with dementia is expected to rise by 43% by 2040.
These shifts demand a transformation in the way care is commissioned and delivered. Our 1.5m-strong workforce is embedded in the community across 42,000 establishments and supports 10 million people to live well.
Social care plays a vital upstream role in prevention by helping people avoid hospital admissions, addressing the wider determinants of health, fostering community connections, supporting social prescribing, proactively promoting wellbeing, and empowering individuals to live as healthily as possible - both mentally and physically.
By reducing the admission and escalation of health issues and providing reablement support, social care helps people maintain and regain their independence. We know that improves people’s lives and saves £3.17 for every pound invested.
Social Care can therefore play a key role in integrated care but must overcome barriers of fragmentation and complexity to realise it. Social care is a fragmented market with 18,500 employers, where multiple bodies at different levels own the levers of change. As responsibilities overlap and there’s no legislative mandate for anyone to focus consistently on workforce planning, it’s difficult to bring about meaningful reform of the workforce. And effective workforce planning is needed.
Unlike the NHS, which is funded centrally through taxation, social care is delivered via a market with fragmented funding, including local authorities, the Better Care Fund and Continuing Healthcare funding. Current funding flows don’t adequately incentivise prevention in social care or effectively follow the delegation of healthcare activity - where a regulated healthcare professional delegates an activity such as diabetes support to a care worker or personal assistant.
Solutions
Supporting integrated commissioning
Good commissioning facilitates effective strategic workforce planning and plays a key market shaping role. Integrated commissioning can strategically shape the market to provide organisations with delivery models that enable working with system partners locally, pool budgets, target spending and incentivise prevention and personalised care.
天美mv already provides guidance, data and qualifications for effective commissioning practice and could be tasked by DHSC to undertake more research provide support for integrated commissioning.
One workforce strategy
While the Health and Care Act has no specific requirement on ICSs around workforce planning for social care, it’s inherent in the requirement for integrated workforce planning across health and social care.
More focus on prevention in how services are commissioned will require more people in particular roles like registered nurses, community skills development, local area co-ordination, integrated teams, joint training and the development of more clinical skills in social care which is recognised in career pathways between health and social care.
A ‘one workforce’ strategy across health and social care is required at system level to ensure shared career pathways, training, placements and aligned terms and conditions.
Support to meet increased expectations of delegated healthcare activity
Delegated activity reflects increased expectations of care work, as it can be more efficient to have a person-centred care worker carry out tasks, reducing pressure on the system. However, it needs to be supported with the right learning and development opportunities, supervision, competency and governance.
Challenges remain around resourcing, accessing and funding training and capacity across both health and care to support safe delegation. It also requires an inclusive and collaborative approach.
Government should continue to work with the sector to ensure that funding flows recognise the increasing expectation of care work.
Social care at the heart of Neighbourhood health
With prevention expertise, a person-centred approach and assets embedded in the community, social care needs to be at the heart of realising the promise of neighbourhood health.
Social care professionals are set to be part of neighbourhood teams, but social care providers and partners also need to be involved in the strategic development of neighbourhood health implementation, both nationally and locally, to ensure neighbourhood health does not become a community outreach extension of the medical model of care.
Fostering a culture of integration
Effective integration requires a and partnership working across health and social care which builds on each other’s strengths.
Given the fragmentation of the social care market, this means the unique strengths-based and person-centred approach of adult social care will need to be valued and actively sought by ICSs and place-based partnerships in service design and workforce planning to help develop one workforce.
ICSs and organisations involved in system working should seek to use to assess their progress towards a culture of integration.
Good workforce planning so we match the labour market with changing needs
This includes communities which will require particular focus to meet changing demographic needs, such as coastal and rural areas. Whilst there is a legislative requirement for how the health service is meeting the needs of the workforce every five years, there’s no such mandate for social care.
As well as recommending specific support for ICS workforce planning, the Workforce Strategy recommends a legislative requirement for workforce planning and regular workforce projections for adult social care. It also recommends a central body with a legislative mandate to not only develop a unified strategy upon direction by government - but also, crucially, drive its implementation across the diverse and fragmented landscape.