Looking through the right end of the telescope: How we can approach efficiency and productivity in adult social care from the right starting place 

ADASS Vice President Phil Holmes gives his personal take on efficiency and productivity in adult social care and how a wrong-headed approach risks increasing costs and missing opportunities. 

People working in councils wrack their collective brains about finding financial efficiencies every year. This has happened for the last decade and a half, and probably longer. To paraphrase the quote about the definition of history, the search for ever-greater efficiency in local government has been one damn thing after another. There’s plenty of information available about the fundamental changes in councils over that time, as they’ve tried to balance increased societal pressures with ever-escalating calls for savings. 

Since May, for some councils, there’s been a new sheriff in town. This has led to more publicity about the need for efficiency and productivity in local government, connected with the Trumpian idea of DOGE. But whether there’s been a local election or not, whether there’s been a change in administration or not, all local authorities are already starting to plan ahead for 2026-27 (and beyond) in light of their legal requirement to set a balanced budget across all their functions and services. And in doing that they’ll all be grappling with the problem articulated by the London Borough of Barnet in 2011 via the infamous “graph of doom”: an ever-increasing proportion of funding going into social care for both children and for adults, and an ever-decreasing proportion going into other council services that are sometimes described as “core”, “universal” or “where the votes are”. 

This blog is a personal take on efficiency and productivity in adult social care and how a wrong-headed approach (we’ve been here before) will potentially increase costs and miss opportunities. 

When I say we’ve been here before, lots of adult social care colleagues will have experienced the “I want to go through your budgets line-by-line” position of a succession of elected councillors since at least 2010 as they’ve sought to respond to austerity in any given year or electoral term. It’s important not to be arrogant about this: a fresh pair of eyes from somebody with a broad life experience can yield insights that others might miss. But in light of fifteen or so years of councillors with a range of health, care and business backgrounds supporting and exhorting us about productivity and efficiency in adult social care we probably can be arrogant enough to dismiss the myth that there is “low hanging fruit” in any sort of sufficiency to address the challenges we face. 

There’s definitely truth to the old adage of looking after the pennies so the pounds look after themselves but there are going to be diminishing returns from this sort of micro-management in light of all the fruit that has already been harvested. There’s also a significant opportunity cost from council staff having to administrate and provide professional advice on line-by-line accounts (or to respond to one-size-fits-all diktats like demands for a fixed percentage of procurement efficiencies or back-office cuts that are similarly based on low hanging fruit assumptions as if nobody has had these ideas before).  

But regardless of diminishing returns and wasted effort, the above approaches all feel like looking through the wrong end of the telescope. They risk generating a lot of heat but very little light, coming as they do from a place of distance and of inherited assumptions. These inherited assumptions can often bake-in inefficiency because they look to frame adult social care as a one-size-fits-all set of processes akin to a factory. Treating everybody the same means that everyone experiences the same level of inefficiency. 

There’s a great adage that says “projects don’t go wrong – they start wrong”. So how can we approach efficiency and productivity from the right starting place? It’s unsurprising that some new councillors and administrations might start from a place of distance and it’s essential for council officers to make connections so their energy and their many skills and experiences aren’t wasted. Thankfully there are a number of opportunities to turn the telescope around and work together on establishing great local relationships that drive to the heart of what’s possible. 

1. Moving away from seeing adult social care as a safety net there to “protect the most vulnerable” helps us see people who draw on care and support as individuals who have strengths, human rights and who are seeking the same sorts of opportunities that the rest of us take for granted. Adult social care at its best treats people who draw on care and support as active contributors to their families, their communities and their workplaces. It builds on potential (rather than crushing it by stereotyping people as vulnerable). It’s not about some of us being dependent and others of us being independent, it’s about all of us being interdependent. 

2. Moving towards co-production is the best way to develop local insights into the living experience of people who draw on care and support in each council area – and then to understand the degree of human potential that might be currently being wasted (often driven by wrong-end-of-the-telescope thinking) by not getting alongside people to help them live the gloriously ordinary lives that we all take for granted. Co-production is just jargon meaning “making together” and councillors, as elected representatives of local communities, are in a great position to help officers form equal partnerships with people drawing on care and support so we make best use of resources in “doing with” not “doing to”. Councils that aren’t hollowing out funding to their local voluntary, faith and community organisations might have a head start here. 

3. Seeing the whole council, not just part of it, as key to effective adult social care. What are the opportunities to make so-called mainstream council services (from our pavements to our parks, from our customer services to our culture and leisure) more accessible to the older and disabled people who live locally? How might this help arrest declines in wellbeing that most often start with people losing connection with the people and the assets around them? The councils that use adult social care resources most effectively are likely to frame this in a shared responsibility for wellbeing. And they are likely to see inclusion as cost-effective and exclusion as a false economy. 

4. Helping our adult social care funding circulate within our local economy rather than leak outside. The number of people supported by adult social care often at very high costs in residential settings outside our local boundaries is a good place to start here. Where these moves (separating people from families, communities and what makes them feel strong) have occurred because of perceptions that there isn’t sufficiency of local provision, what are the local partnerships (often with council children’s and housing colleagues but also with the NHS and local care and support providers) that can correct this over time? And how much of the out-of-area provision is driven by the “protect the most vulnerable” impulse that bypasses individual strengths and warehouses people in distant, gilded cages with supposed economies of scale? But this isn’t just about high cost out of area “placements” it’s also about generally getting alongside the local small and medium sized enterprises fully committed to our places and neighbourhoods and who will provide efficiencies through great support based on thinking locally and acting personally. 

5. Getting alongside our workforce too. We’re obsessed with economic growth, right? And our adult social care workforce is likely to be among our largest employment sectors. So what does creating and sustaining good adult social care jobs (in local organisations but also amongst self-employed Personal Assistants) do to help regenerate local economies? It’s another way as framing adult social care as a strength rather than a burden. 

6. And not forgetting the NHS. The national narrative is entirely one way, that adult social care is there to “protect our NHS”. That’s partially true – well deployed adult social care can of course reduce pressures on hospitals and other parts of the NHS too – mental health trusts supporting people in crisis, GP services facing significant demand driven by social isolation and loneliness. But it also cuts both ways: NHS services can and do drive large financial pressures into adult social care for a variety of avoidable reasons in the way people are supported before they come to our attention. In a time where NHS England and its Integrated Care Boards are hugely retracting, any council focused on the efficiency and productivity of adult social care has no choice but to step into the space that is being vacated and think very hard about what good quality integrated neighbourhood care should be achieving, as well as what the end-to-end experience of people with care and support needs admitted to hospitals and mental health trust wards should be like. We literally can’t afford not to. 

Nobody said it would be easy but there are still opportunities for councils to increase efficiency and productivity in adult social care if we look through the right end of the telescope and start with the human not the factory. As a starting point councils can avoid doubling down on wrong-headed approaches driven by an assembly line mentality that is likely to add to financial costs (and seriously compound human costs). As an alternative to that, elected councillors with their powerful democratic mandate can definitely help councils shift the dial by rolling up their sleeves and getting alongside people who draw on care and support, people in the adult social care workforce, our local care and support organisations and discussions with NHS partners. 

Councils can’t do it all by themselves of course. National government still has a very strong role to play. ADASS needs decision-makers in Whitehall to look through the right end of the telescope too so that adult social care is sustainably funded. This is why we say Care Can’t Wait – another message that people are increasingly united on, whatever their political persuasion.