Integrated Adult Social Care

People tell us that what matters to them is to stay living safely at home in their community, surrounded by their family and friends, where they can retain as much of their independence as possible for as long as possible, living the life they want to lead by doing what matters to them.

Our key policy and approach is Promoting Independence and this is the starting point for how Integrated Adult Social Care in Devon delivers its statutory duties including those set out in the Care Act 2014.

This approach will become increasingly more important given projected demographic change: by 2043 the number of people aged 85 and over is likely to increase by 80% to over 55,000. We’re already ahead of most areas in terms of the age of our population, but this growth will bring unprecedented challenges that we must be ready for.

People living longer is to be celebrated, but it brings different challenges. One of those challenges is dementia, and by 2040 dementia prevalence in Devon may increase by over 51% to over 24,000 people.

We’re seeing changes within the younger adults population too. Life-saving and life giving medical advances mean more children and young people are living much longer into adulthood, outliving their parent carers, and into old age with complex needs requiring complex and intense care and support from more people. And with a positive focus on mental health, more people are seeking the help and support they need.

Our wider duties include wellbeing, safeguarding and the sufficiency of local care market, all delivered in partnership, across the Council, and with other organisations including district councils, NHS organisations, independent health and care service providers, and the voluntary and community sector.

We have long standing relationships with our partners including joint arrangements, and agreements such as jointly managed and co-located community health and social care teams aligned around primary care networks. Mental health services are delivered via a S75 agreement with the local mental health trust (DPT), and services to carers delivered by a commissioning arrangement with Devon Carers. We have worked hard recently to maintain these relationships during times of broad leadership change and financial and resource pressures across the system.

This includes the work around hospital discharge and ensuring those ready to leave hospital can do so quickly, with the support they need to remain in their own home and community safely.

This year we have continued our preparations for our future inclusion in the CQC inspection of adult social care duties, build on learning and feedback from our recent LGA Peer Challenge, and drawing on the experience of local authorities regionally and nationally who have already been or are being inspected.

We have updated and published our self-assessment and have been proactive in engaging across the Council and with our partners.

This year we have seen the long-delayed charging reforms cancelled. These reforms would have protected people from catastrophic care costs, but placed increasing financial and staffing pressures on local authorities exacerbated by a lack of clarify on how the reforms would have been funded.

Future national developments that will impact adult social care include proposals for National Care Service, and establishing a fair pay agreement for the adult social care sector through an Employment Rights Bill.

What we can be proud of

In 2022/23 Devon had 16/26 indicators from the Adult Social Care Outcomes Framework ranked in the top two quartiles, up from 13/26 in 2020/21, with improvements on most measures over the last two years and recent data indicating this performance will be sustained.
Our overall satisfaction ratings for service users and their quality-of-life indicator based on survey questions about their lived experience were among the best in the country, ranking 11/152 and 27/152 respectively, with recent data indicating this performance will also be sustained.
Our provider quality ratings in Devon judged by the Care Quality Commission exceed the national, regional and comparator authority averages with a greater proportion of community-based services and care homes in Devon rated Good or Outstanding by the Care Quality Commission.
Our staff and providers being nominated for and winning many national and regional awards in the last two years, including gold and silver awards in the National Social Worker of the Year in 2023, building on our strong showing in recent years.
Improvements in the sufficiency of regulated personal care with significant contributions from overseas workers.
Our partnership approach to working with providers, our collaborative approach to managing the pandemic (with high vaccination rates, nationally acclaimed support arrangements, and comparatively low numbers of outbreaks and fatalities) demonstrating the benefits of a more collaborative approach.
Our open and honest approach to involving stakeholders in the production of an annual self-assessment which we have consistently published in the public domain, with governance through an Assurance Board that invites external challenge and support.

What we are concerned about

Financial sustainability, with the cost-of-living crisis impacting on people who use our services and their carers; people who might become vulnerable; the viability of our providers; and county council budgets.
Maintaining the morale of our staff, with our recent leadership surveys indicating colleagues are becoming concerned about the pace of change and the potential for demands to be increasing as capacity decreases.
Hospital discharge and system flow, with delays sometimes due to lack of capacity in community-based health and care services, which can mean people don’t get the right care at the right place at the right time to optimise their recovery.
Working across the council and its partners to address the social isolation of carers, with its impact on their wellbeing highlighted in recent surveys as being of particular concern, especially in rural areas, despite higher than average access to carers’ breaks. .
Demand pressures from those aged 18-64, with activity levels higher in Devon than elsewhere, and market costs rising more rapidly than is typical, especially for services to older people, both residential and community based.
Consistency and responsiveness of safeguarding practice, ensuring that decision-making and thresholds are comparable across localities, and that learning from Safeguarding Adults Reviews and other Serious Incidents is embedded in learning and development and impacts on practice.
Operational waiting lists for assessments and reviews, for financial assessment, and for DoLS assessments with our own capacity constrained, demand increasing, and people’s circumstances changing more frequently.

The challenges ahead

Delivering on our ‘Promoting Independence’ vision and ‘Living Well’, ‘Ageing Well’, and ‘Caring Well’ strategies including maintaining people at home and not in hospital or a care home wherever possible.
Living up to the vision that people should be supported to live their best possible life in the place they call home, with the people and things they love, in communities where people look out for each other, doing what matters to them and be independent, informed, secure, and connected.
Managing within a budget that while increasing is under pressure from rising demand and complexity, increasing costs, sufficiency challenges, cost of living pressures, and falling council income.
Maintaining flow through the health and care system, especially during winter when we are facing outbreaks of infectious diseases, and pent-up demand for NHS services.
Recruiting, retaining, and developing sufficient staff to deliver on our statutory duties and maintain sufficient, diverse, and high-quality services including working with providers to innovate new services.
Strengthening our governance in line with a corporate review and building on the changes we have made to the governance of assurance and change in adult social care, reinvigorating practice quality assurance.
Improving our productivity, including through implementing a new care management system, and reviewing and redesigning our operating model deploy our capacity and capability most effectively and reduce waiting lists and waiting times.