The stitch-in-time approach to early intervention outlined in the Care Act is hardly a radical departure for health and social services. Local authorities are already spending around 7% of their adult social care budget – over £900m in each of the past two years – on services designed to prevent low-level needs escalating into health or social care emergencies.
What the Care Act does do, however, is make prevention a statutory duty. “The Care Act is rubber-stamping current practice,” says Brighton social worker Kate Metcalf, until recently practice advisor at the College of Social Work. “We are moving away from doing things because people think it’s the right thing to do, to putting it on a statutory footing. The Care Act will make it easier to bring a case against a local authority that is failing in its duty.”
It may also end the postcode lottery familiar to anyone who has sought early help from social services. “Preventive services have been up to the interpretation of local authorities, so every council is different,” says Metcalf. “The expectation will be for that level of support to be a whole lot better.”
A diverse array of preventive and early intervention initiatives exist – from high-tech telecare systems using motion sensors and personal alarms, to simple befriending schemes to combat loneliness. All are based on the principle that nipping problems in the bud reduces the risk of distressing and expensive consequences later on.
Surprisingly, there isn’t much evidence to prove this is so. The most commonly cited data comes from a government-commissioned study in 2010 of 470 pilot projects involving over 250,000 older people. This found that early intervention improved people’s quality of life, reduced their dependence on acute hospital services and saved £1.20 for every £1 spent. Unfortunately, when the Nuffield Trust re-evaluated the pilots in 2011, they came to the opposite conclusion. There was no reduction in hospital admissions at all.
“It’s always difficult to prove you’ve had an effect by preventing something,” points out Steve Goldensmith, lead commissioner on housing and prevention at Buckinghamshire council (see case study). “So by putting a focus on prevention, the Care Act does offer us a commitment for the future.”
In North East Lincolnshire, Joe Warner has his own data to show the positive effect of early intervention. Managing director of Focus Independent Adult Social Work, which delivers the council’s adult social services, Warner points to a number of projects that “divert people away from expensive services like acute care”.
“For instance we’ve identified the top 200 people attending A&E each month and are trying to help them address their needs in different ways.” So far the scheme has reduced attendances from 500 in December to 60 in February, while care costs for the 200 most prolific users of A&E have dropped from £46,000 to £5,500 each month.
“The Care Act fits in very closely with what Focus has been trying to do in terms of promoting independence and using community resources,” says Warner. “The downside of it will be if it results in extra assessments and extra reviews without any extra resources.”
This is a widespread concern. According to Izzi Seccombe, leader of Warwickshire council and chair of the Local Government Association’s Community Wellbeing Board, the act has been underfunded by “as much as £50m in the first year alone”.
These funding worries are thrown into stark relief by the fact that the duty to provide early intervention extends not only to service users but also to carers. According to Emily Holzhausen, director of policy and public affairs at Carers UK, this is an important advance. “If a carer’s health breaks down, it is emotionally devastating for all concerned and the costs can be catastrophic,” she says. “There are situations where both the carer and the person they are caring for have been hospitalised. So it’s really important that these preventive services are put in.”
Richard Cross from Cambridgeshire acts as a carer for his wife who suffers both mental and physical illness.
“Carers have always struggled for recognition,” he says. “So I’m pleased that the Care Act puts it into law that support for carers is as important as the care for those they look after. It took me 12 years of caring to realise there was support out there.”
