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Community Re-Emerges As Priority


In the midst of the biggest cuts to adult social care since the welfare state was created, an important new piece of research has highlighted the role of community organisations in enabling the 'transformation' (and 'integration') of local health and social care services.


The background, of course, is the global financial crisis and its aftermath. Last summer, the Associaltion of Directors of Adult Social Services highlighted that during the 5 years of the Coalition government there had been. "...funding reductions totalling £4.6 billion and representing 31% of real terms net budgets." The NHS budget has been preserved, but against a background of increasing needs. Those responsible with keeping the whole system working have been pinning their hopes on 'integration' of health and social carer services - particularly where this involves avoiding admission to hospital, or speeding up discharge where unavoidable. This is simply because acute hospital treatment is the only area of expenditure large enough to generate the kinds of savings needed. But what would this kind of transformation look like?


Since 2013, the Department of Health has been sponsoring a 'Pioneer Programme', and the important new peice of research is the 2nd phase of the evaluation. Many in health and social care have been looking to this to provide a blueprint of how to 'do' integration. The evaluation report contains a lot of important learning, but nothing approaching a blueprint that could be simply rolled out in other parts of the country.


Back on 2008, virtually the first services to be cut were community-based, typically in the voluntary sector, and typically not doing anything that looked very relevant to hospital admission rates. Things like information, advice, training, advocacy and helping people who used services to have more of a say in how they were run. In the narrow view of commissioners at the time, the limited resources available needed to be focussed on actual services. Since then the squeeze has extended to statutory social work servcies, to the point where assessing people and putting support in place had become virtyually the only thing people do. Now even that is not enough. Commissioners are turning back to the community. But is there enough of the community left to help?


The Early Evaluation of the Integrated Care and Support Pioneers Programme, to use its full title, is saying that in many areas the answer is 'no'.


"Many of the sites had service models based on developing communities and self-care; however, the services that these models relied on (such as befriending services, lunch clubs, peer support, social activities, etc) had often been subject to financial cuts. In other words, the budget reductions imposed by central government over the past few years have limited commissioners’ capacity to act in a number of areas that were considered to be fundamental to the objectives of some Pioneers."


As the evidence of the value of community services begins to emerge, far too late for many services, it is clearly time to act to save what's left.



Postscript: May the higher powers all bless Gerald Wistow, one of the authors of the report. No idea how old he must be now, but he's been generating important work like this since I've been workingin social care, and that's 30 years plus. Nice one, Gerald.


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