Shaping neighbourhood care: The role of adult social services in transforming health and wellbeing

The government’s drive to move care into communities will be a cornerstone of next year’s NHS ten-year plan. In this blog, Richard Humphries, ADASS Associate Trustee, explores why adult social care is vital to making this vision a reality.

Shifting care from hospitals to communities is emerging as a strong policy thrust of the new government. It will feature strongly in next year’s ten-year plan for the NHS. In the words of the Prime Minister it marks  “the moment we begin to turn our National Health Service  into a Neighbourhood Health Service” in which “we’ve got to make good on the integration of health and social care”.  Who could object to more care and support delivered in people’s own homes and communities, offering joined-up help that brings together primary, community and social care services with diagnostics and other specialist input? 

These are not new aspirations and Labour has been here before. The 2006 White Paper Our Health Our Care Our Say set out a major shift towards prevention and care closer to home, enabling “a wide range of health and social care services to work together to provide integrated services to the local community.” Yet the Darzi Review pointed out that between 2006 and 2022 the share of the NHS budget spent on hospitals increased from 47 per cent to 58 per cent. Policy rhetoric and the money have been travelling in opposite directions. More recently the 2022 the Fuller Stocktake report  proposed integrated neighbourhood teams, driven by primary care with professionals from all disciplines and parts of the system working together to prevent and improve health and tackle health inequalities.

So how can neighbourhood care be delivered in practice and why is the contribution of adult social care so crucial to its success? Here are six key design principles to guide the development of a fresh approach:

1. The vision for neighbourhood care must avoid simply shifting a medical model of care from hospitals into the community. A limited ambition of re-locating activities and their costs from one part of the system to another is unlikely on its own to improve people’s experience and outcomes.  Prevention and promoting better health and wellbeing, alongside offering joined-up support and treatment for individuals, should be central aims.
2. Bottom-up ideas and experimentation with different models of neighbourhood care will be more effective – though on paper less tidy – than top-down, one-size- fits-all prescriptions. Front-line practitioners have a wealth of experience and ideas that could be drawn upon, as do people who use health and care services. The NHS Confederation’s recent report on the case for neighbourhood health and care offers plenty of examples. Social care and primary care have a good track record of working together.
3. It follows that structural reorganisation is likely to be distracting and unnecessarily costly. A better approach is to nurture cultures of trust and collaboration through multidisciplinary and inter-professional teamwork – an outward focus on patients, citizens and communities instead of preoccupation with internal organisational arrangements.
4. Imaginative thinking will be needed to develop financial and policy levers to re-balance investment towards non-acute services and resist the intense gravitational pull of building-based services.  Some way of protecting funding for non-acute services will be essential, drawing on the experience of the deinstitutionalisation of mental health services. Another important lesson from the past is about the unintended consequences of other policies; the introduction of payment by results for acute but not community services and the creation of foundation trusts reinforced the financial power of hospitals.
5. Developing care closer to home will need to balance ambition with realism about the state of the current workforce, including shortages in the number if GPs and district nurses and insufficient investment in social care support. This will demand a pragmatic and long-term approach, not unrealistic short-term targets.  
6. Making progress on neighbourhood care depends on assembling a coalition of willing across all key partners whose engagement and contribution is vital to making neighbourhood care a reality – adult social care, public health, primary care, community health services as well as hospitals. Community capacity represented by the third sector will also be crucial, as will other council services that contribute to wellbeing.  In Making care closer to home a reality The King’s Fund has warned that “if the focus remains on hospital performance, e.g., waiting times and elective care targets, until performance recovers, this will reinforce the status quo and mean that the wholesale changes required will not be delivered”. Neighbourhood care is a system issue.

Adult social care is well-placed to play a pivotal role in the development of neighbourhood care. Managerially, Directors of Adult Social Care, alongside Directors of Public Health, are an important gateway into a range of local government functions that are key to improving the health of communities. Together with their involvement in Integrated Care Systems, they offer a strong and distinctive system leadership role. Professionally, the three regulated professions of social care – social work, nursing and occupational therapy – will be indispensable members of local multidisciplinary teams. Without social care, there can be no neighbourhood care.