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Towards excellence in adult social care Progress with adult social care priorities England 2011/12

In relation to key national objectives for council funded adult social care, the evidence is limited, but suggests the following:

Is prevention developing and working? The lack of standardised evidence on the effectiveness of prevention, and the relatively recent introduction of new practices and services means that it is not possible to say how many people are now helped more effectively to maintain independent living.

Typically, the focus of prevention work by health and social care commissioners aims to reduce or avoid demand for ongoing support. Resources are being focused more intensively on fewer people for shorter periods: but the prevalence of long term conditions and complex health care needs is still rising rapidly, especially amongst older people. Intelligence from social care leaders in the regions suggests that enablement policies and practices now help many more people to maintain independent living, avoiding or delaying the escalation of care and support needs. Terminology and understanding of the range of preventative approaches still needs to be developed, alongside related measures, to achieve a better understanding.

There are many local examples of improved practice and innovation leading to better outcomes. For the moment, the only available Adult Social Care Outcome Framework (ASCOF) indicator gives a proxy measure of effectiveness.

How far have personal budgets been implemented to improve control?
There has been a further rapid increase in the roll out of personal budgets in all regions. Just over half of all eligible people (52 per cent) now have a personal budget. The number of people using self directed support during 2011/12 was 605,7392, an increase of 38 per cent since 2010/11. Of these, 192,3443 people had a direct payment, an increase of 9.5 per cent since 2010/11.

Direct Payments are still an increasingly popular choice, but there is work still to do to develop alternative options for people to use their personal budget independently. Councils have made progress towards the Government’s 2013 objective that all people eligible for care should be provided with a personal budget, preferably as a direct payment: they will need to maintain and extend this to reach the objective for April 2013.

Many councils are pilotting innovative schemes such as managed accounts and individual service funds, but evidence of these schemes and their effectiveness is not yet captured. The number of people whose services were “arranged”  within personal budgets grew by 57 per cent from 262,597 to 413,395, suggesting that “arranged” budgets are the main approach in use to increase the rate of implementation.

There were wide variations in the levels of achievement and rates of growth for self directed support across groups with different types of need.

Are carers getting the support they need?
The proportion of support for carers that is delivered through direct payments has increased significantly. But overall levels of support for carers appear to have declined: around 7 per cent6 fewer people are reported to have received support in the last year. This may partly reflect the reduction in the number of primary users of the services. Changes in the way services are recorded may also partly explain the apparent reduction7. Young carers have been prioritised, and services for this group increased slightly.

Is there a better range of community based provision?
The evidence is too limited to be clear. Data show that more traditional services such as home care, day care, respite care, equipment, and meals on wheels reduced in 2011/12 overall, but at varying rates. As yet, there are no measures in place to assess the growth of personal assistants, whose support is one of the major alternatives to home care. Lack of evidence does not necessarily reflect realities of local change on the ground: it does reflect the limited range of standardised information available, as well as the difficulties inherent in assessing the wellbeing outcomes achieved by social care. As some current programmes to monitor innovation such as Think Local Act Personal gather pace, there are better prospects for learning more about the ways that people who use services and carers are achieving desired outcomes through the use of personal
budgets.

Other findings
Access to council support has reduced significantly, in response to budget presssures, but perhaps also reflecting better preventative work and early intervention. Some traditional services appear to be in decline, but it is not clear if this is driven by the choices of people who use services and carers: and if so, what kinds of support and services, if any, are developing. The number of people who were delayed in leaving hopital for reasons attributable to social care reduced significantly.