This month we have had a stark reminder that we have not seen the back of COVID-19 yet. The prospect of a second wave anywhere near as bad as the first, makes those working in social care shudder.
In its report, Beyond COVID-19: new thinking on the future of adult social care, the Social Care Institute for Excellence (SCIE) describes in some detail how we were all unprepared for the unparalleled challenges posed by the first wave; arguing that: ‘Not only was the sector ill-prepared for the crisis but the response needed more to be done and faster.'
Like colleagues in the Local Government Association and the Association of Directors of Adult Social Services (ADASS), SCIE now calls for a clear plan of action to support the sector to manage the second wave.
Using data differently
We can't keep doing the same thing in social care and expect it to have a different result; we need to adopt a different approach. One of our strategies must be about using data differently, and more intelligently, to understand the impact of COVID-19 and consequently prepare different plans. Bromley LBC has been using data to do just that.
Responding to the first wave of COVID-19 reinforced the importance of good data and intelligence. How quickly and how well they understood and responded to the demand pressures faced determined a local story of success or failure.
The strong partnership between the council and NHS in Bromley enabled them to quickly establish the single point of access (SPA) to hospital discharges. This worked well. Discharges were timely and supported with good packages of home care and timely placements in care homes where required.
Working closely with local care homes Bromley already had a good baseline understanding of the provider capacity, allowing them to ensure that all short-term need was successfully met. They have performed well on all measures; in the short-term the sustainability and transformation partnership achieved a core objective with no delays to discharge and very few re-admissions to hospital.
Data from the agencies
While this is a great example of joint working, Bromley also wanted to understand the sustainability of the SPA model in the medium and long-term, specifically regarding the use of resources in adult social care.
At the ‘end' of the first wave they brought together data from across all agencies. There are barriers to doing this, but it is not as hard as you may think.
Whole systems thinking can only be well informed with the wealth of data held across the agencies. Such a rounded view allowed the council to understand the demand pressures on the whole adult social care market, including demand for both publicly and self-funded need.
Bromley took the demand analysis further to quantify the cost of COVID-19 across the ‘Bromley pound' as a direct result of decisions made in the SPA. The analysis led to more understanding of the medium to long-term impact of these decisions. This, in turn, led them to act and remodel the makeup of ‘trusted assessors' working in the SPA.
Bromley understood the effectiveness of the initial short-term home care reablement offer. It identified a longer-term home care need for 56% of residents who have not regained their independence.
Some 92% of these service users are new, never previously known to social care. The longer-term financial impact on the local authority's adult social care budget is clear to see.
The analysis also led to interesting findings about the length of support required post COVID-19, the severity of need and the long-term impact on care home capacity.
Multi-agency response
Social workers often refer to a ‘team around a child or adult' – a need for collaboration and a multi-agency response to casework. It is just as important that we all respond to this crisis and the broader crisis in adult social care, with a multi-agency response to the collection and use of data and intelligence.
A clear understanding of what the whole system is doing is needed. The push and pull of policy decisions across agencies can be driven by a focus on protecting the NHS, without modelling the impact on social care.
The intended and unintended consequences of any system design can be clearly understood with good data analysis. Key decision-makers must demand this level of detailed intelligence from us.
Strategists and analysts must be practice led, exploring the issues and brokering the evidence of a shared narrative, ‘one version of the truth' across the agencies that balances the impact on the whole system; rather than just one element. This leads to better decisions and better outcomes for residents.
Bromley is using its shared understanding of the first wave of COVID-19 to anticipate a second. This strengthened approach to data use is also informing a long-term transformation plan, and particularly a commitment to create a more preventative system, something which SCIE argues for in the Beyond COVID-19 report.
As we write this article, the sun is shining, and it seems implausible that we are once again thinking about how we survive the winter. But if we use data more extensively and differently as part of our planning, we can get ahead of the curve, and better equip our teams for whatever dangers lie ahead as the sky darkens.
Naheed Chaudhry is assistant director strategy, performance and transformation at Bromley LBC and Ewan King is deputy chief executive at the Social Care Institute for Excellence (SCIE)
