How do we make care personalisation cost-efficient?

As local authorities grapple with the challenges of the Care Act, it is becoming clear that significant change is required in the way that adult social care is managed and delivered. The UK needs a successful modern care system that addresses both personalisation and value for money.

While the personalisation agenda aims to allow choice and flexibility in care provision and how people manage their money, the feedback from the local authorities I spoke to at this year’s Local Government Strategy Forum is that this agenda cannot be easily fulfilled using the methods in practice today.

Some local authorities had already begun or completed strategic reviews of their social care systems with the aim of finding a better way. Many had found that personalisation created challenges – particularly in care management and financial reconciliation processes, but also in the development of diversity in care provision.

There were also widespread complaints about increasingly siloed care information – for example, between those using direct payments and authority-managed care, and between council and self-funded recipients. These silos mean there is a lack of understanding about what types of care will be needed tomorrow and by whom – and crucially whether money is being well spent. Many concluded that the only answer to these problems is radical change.

Conflicting responsibilities

Local authorities’ main challenge in adult social care is delivering the demands of the Care Act. It is their responsibility to support anyone needing care in their area, to offer alternatives that are more cost effective, to give the customer precisely the amount of financial freedom they want and ultimately to personalise care. Some of these responsibilities can conflict. For instance:

• How do we keep track of what individuals are spending their money on through their personal budgets, and ensuring maximum benefit, while giving them control?
• How can you offer a broader range of (possibly cheaper) care alternatives and suppliers when your supply strategy has previously been founded on the bulk-buying of care from fewer providers?
• How do you accurately anticipate and plan when you have little information on what care-related services people are searching for and buying?
• How do you know what alternative services are required when you have no knowledge of emerging demand?
• With personalisation creating more work for frontline social care teams, how can social workers focus on giving support to those who need it most?

My calculations, based on sector data, produce interesting results. We at Younifi looked at three areas of change that could impact how much councils save on adult social care budgets. Our recommendations include:

• Diversification of the supply base to offer more, lower cost care alternatives.
• Technology integration, bringing disparate initiatives together – such as purchasing and financial control, case management, and information and advice.
• Culture change inside the authority, focusing effort where it really matters while automating resource-intensive processes.

‘Quick-win’ savings

Our estimations are that “quick win” savings of at least £186m per annum are easily possible. Over £71m could be taken off council administration costs through automated financial transaction management. Over £73m could be saved on better use of direct payments, proactively diverting people towards more cost-effective care alternatives and through retention of unspent money. Councils could then use the unspent money to support more people or invest in more preventative services.

Finally, over £40m could be saved on staffing by simplifying administrative processes in the management of care services. These savings could be made on reviews and assessments, supplier contract monitoring and arranging care for people.

The market, cultural and technological changes needed to make this happen would also provide the groundwork for a more cost-efficient and personalised care system in the future.

More than anything else, councils need to rethink their position in the care system. Instead of being care providers, they need to consider their responsibilities to themselves, their suppliers and those using care services. It was encouraging to see how many local authorities are making bold decisions, beginning to focus on enabling care, rather than seeing themselves as being the sole care owner.