Challenge 1: Supporting independence

In this section

What is the challenge?

To ensure that we are supporting a person’s independence at each stage of their life.

Prevention and early intervention

“Prevention … is about encouraging people to be more proactive about their health and wellbeing. It can increase independence and reduce or delay the need for care and support services.”[1]

The predicted increase in our population will have an impact on social care and NHS commissioned demand as our data tells is that the need for care increases with age. Simultaneously, workforce capacity in the adult social care market is reducing as the working age population is growing much more slowly and a significant proportion in the sector are nearing retirement.

We cannot alter demographic changes so if we want to reduce demand, we need to focus on how we can reduce the likelihood of people needing care services and the length of time for which they need them.

Supporting people to live longer in good health by preventing, delaying and reducing ill health and disability will be a cornerstone of our approach to support the market to respond to the increased demand. As such we will seek to make prevention a stronger element in models of care and care pathways.

Our approach will be to focus on people who are at risk of losing independence, self-reliance or resilience through illness, disability or disadvantages. We need to shift from the reactive treatment of acute health and social care needs to pro-active identification and early intervention to prevent, delay or reduce acute need. Prevention is and will not be a single service offer but does constitute a shift to a different model of care which will also benefit people’s quality of life, the care workforce and wider system resources.

Our analysis of the link between an individual’s first contact with Gloucestershire County Council and any subsequent package of care shows us that there are potential opportunities for early intervention that might prolong independence. Identifying those for whom a more pro-active approach would be beneficial will be the key to maximising our resources. This could involve the use of digital technology and artificial intelligence in the future.

Support for carers

“Millions of unpaid carers provide invaluable support to loved ones and our most vulnerable in society. We have shown how caring affects us all, in all walks and stages of life. Unpaid carers are also an integral part of the health and social care system: in 2015, unpaid carers provided care worth £132 billion a year, and in the first nine months of the Coronavirus pandemic, unpaid carers provided care worth £135 billion”.[2]

If the number of people requiring care is increasing, then the number of unpaid carers will be increasing too. Enabling unpaid carers to continue in their role, often alongside a working one, will be a key element of managing demand. Carer breakdown often leads to the introduction of statutory care services.

Despite the importance of unpaid carers in supporting our health and social care system, Carers UK found in their State of Caring Survey 2023 that “a widespread lack of support and recognition from health and care services is severely damaging unpaid carers’ mental health… people caring round the clock for older, disabled or seriously ill relatives do not have adequate support from statutory services that are in place to help them – leaving many steeped in thoughts of hopelessness, fear, and dread, and urgently in need of support”.[3]

Support for people who fund their own care

57% of older people living in residential care fund have made this decision themselves and are not funded by Gloucestershire County Council. These individuals are often not known to us and we are therefore unable to say whether they might have been able, or indeed chosen, to remain at home with the right support. It is likely that, without having had a statutory assessment, many of them will not have been aware of what help and support is available to them. With access to the right information about how to obtain care and support at home, a larger proportion of individuals who fund their own care could potentially live in their own homes for longer.

It the social care reforms proposed in 2021 are enacted, a large proportion of people who currently fund their own care will become eligible for local authority funding towards the costs. This would not only increase our financial liability but would reduce the potential customer base for providers whose business model is reliant on people that fund their own care.

How are we planning to address this challenge?

We will aim to strengthen our system-based approach with the closer alignment of services across adult social care, health and the voluntary sector. We need to better understand the needs of the whole individual and our population at large, to intervene appropriately and earlier to avoid an over-dependency on health and social care.

Several of the areas we need to address hinge on the development of a system wide approach to prevention of need for adult social care services and early intervention when people begin to require support, this includes:

Public Health led primary prevention:

Promoting health and wellbeing to support people entering older age in good health, and then staying in good health for as long as possible

Gloucestershire County Council Adult Social Care-led primary and secondary prevention:

Ensuring that all system partners information, advice, and guidance to allow residents to meet their needs appropriately whether from community, VCSE, or ASC/healthcare services
Planning to ensure accommodation is appropriate to need in public as well as private provision

Integrated Care System-led primary, secondary and tertiary prevention:

Thorough analysis of ASC and healthcare data, to support early identification of need and pro-active care to ensure early intervention and support
Intervention to maintain supported independence using equipment and technology enabled care
Intervention to help residents to plan for and be supported through crises to minimise their impacts

This work necessarily sits across the entire system, but strategic oversight will be led by our Adult Social Care transformation programme.

Public Health led primary prevention:

Promoting health and wellbeing to support people entering older age in good health, and then staying in good health for as long as possible

Gloucestershire County Council Adult Social Care-led primary and secondary prevention:

Ensuring that all system partners information, advice, and guidance to allow residents to meet their needs appropriately whether from community, VCSE, or ASC/healthcare services
Planning to ensure accommodation is appropriate to need in public as well as private provision

Integrated Care System-led primary, secondary and tertiary prevention:

Thorough analysis of ASC and healthcare data, to support early identification of need and pro-active care to ensure early intervention and support
Intervention to maintain supported independence using equipment and technology enabled care
Intervention to help residents to plan for and be supported through crises to minimise their impacts

This work necessarily sits across the entire system, but strategic oversight will be led by our Adult Social Care transformation programme.

We have a proud history of supporting unpaid carers in Gloucestershire and we work with providers to support carers from all communities in the county. The Gloucestershire Carers Hub have increased the number of unpaid carers they support from 2,000 when they took over the contract five years ago to over 12,000 now. We understand that a generic offer might not suit everybody so we also commission smaller voluntary organisations to support specific groups.

To further recognise the importance of unpaid carers and the impact that the Covid-19 pandemic had, we plan to work with them and other representative groups to build on our existing Carer’s Action Plan by developing a new Carer’s Strategy to co-ordinate a system wide approach. It is anticipated that this will include an in-depth study of crisis / emergency response for unpaid carers and the development of a new approach to services in this area.

We will also extend the carer's action plan to include:

Timely support for carers
Support during crises (emergency response and out of hours care)
Support through transitions
Training for unpaid carers
Day opportunities, short-breaks and respite

This work will be led by Integrated Commissioning and will involve the Carers Partnership Board, the Gloucestershire Carer’s Hub, as well as other groups to ensure a co-produced strategy is developed which we will aim to publish in spring 2025.

We will also extend the carer's action plan to include:

Timely support for carers
Support during crises (emergency response and out of hours care)
Support through transitions
Training for unpaid carers
Day opportunities, short-breaks and respite

The delivery of adult social care services across the county is entirely reliant on the care workforce and the pressures in this area are well known. For this reason, we are developing a ‘working well’ integrated workforce strategy which will include analysis of:

Recruitment and retention across the sector
Training and development needs (including healthcare and digital skills)
International recruitment and how providers and overseas recruits are supported

Our engagement with providers has identified four key areas for development:

Recruitment

We will need to ensure that providers are offering the best terms and conditions to their staff in terms of pay, career progression and job security. We propose to work with providers and the care workforce to find ways to achieve this.

We recognise that as the older population is growing faster than the working age population, staff are increasingly going to be drawn from a younger age group. This may require a shift in culture to ensure that they are attracted to roles in adult social care. We propose to work with staff and young people to understand what is important to them and what might have the most impact.

Retention

We will work with providers to develop ways that will make a difference to retaining our care workforce. These might include:

Efficient recruitment processes to onboard staff quickly
Training opportunities
Recognition of transferable skills
Access to career pathways
Job satisfaction
Development opportunities (for example, delivery of delegated healthcare activities)
Staff wellbeing support in the preferred style or format

We will work on developing a culture shift to recognise providers and the care workforce as an important part of the integrated care system.

Training and development

We recognise that there are skills gaps in the market as people being supported have increasingly complex health and social care needs. Training and development for staff is key to providers being able to meet these needs.

We will work with providers to further develop the training offer in Gloucestershire and to find ways to make it more accessible for staff. This will include dementia care, delegated healthcare activities, complex behaviours, and digital skills.

We are currently reviewing proposals for the delegation of healthcare activities and seeking sustainable ways to enable this to happen.

We will continue to work with providers to enhance their digital capability and increase their use of digital solutions. Support is currently available to take up the “Digital Security Protection Toolkit” (DSPT) and use of digital social care records (DSCR). More work is proposed to explore how digital developments can further increase the efficiency and productivity of care provision.

International recruitment

We are working with local authorities across the South-west region to support international recruitment practice and there is a focus in Gloucestershire on providing pastoral care to international recruits.

We are also considering what the additional or bespoke training needs are for this group to ensure that they are as effective in their new roles as possible.

We recognise that international recruitment is not and cannot be the single solution for our workforce crisis but are keen to ensure that if used it is used effectively and

forms part of a strategic approach to workforce recruitment and deployment.

The work is being led by our Integrated Commissioning and will involve providers and their representative body. We will aim to publish in autumn 2024.

Recruitment and retention across the sector
Training and development needs (including healthcare and digital skills)
International recruitment and how providers and overseas recruits are supported