The Changing Futures programme is a £91.8 million joint funded initiative between Government and The National Lottery Community Fund, the largest community funder in the UK. The programme funds local organisations working in partnership in 15 local areas across England to better support those who experience multiple disadvantage.
Over the last two years, MEAM has brought the local programme leads together for regular discussions about key aspects of the work. In this second of six blog posts in our latest series, we reflect on some of the topics covered, drawing on their insight and input from others in the Changing Futures programme and the wider MEAM Approach network.
At a recent conversation with representatives across the Changing Futures programme, we discussed how adult social care functions and responsibilities are interacting with Changing Futures work in local areas, and more broadly with the concept of multiple disadvantage.
What’s the relationship between adult social care functions and multiple disadvantage?
The relationship between adult social care and people experiencing multiple disadvantage is inextricable. Local authorities have statutory responsibilities for supporting adults with care and support needs, and the alignment between this function and the needs of those experiencing multiple disadvantage ought to be strong. To meet the needs of people experiencing multiple disadvantage, local areas require an adult social care function that is embedded in, connected to, and interacting with many parts of the local system.
However, it’s no secret that adult social care teams are under a lot of pressure and have been for a long period of time. With a growing population of both older people and people with specific support needs, many teams in local authorities feel inundated with requests for assessment and under-resourced to provide support. There is intense political pressure for social care to both prevent demand and to tackle the backlog of delayed discharge within hospitals, and it can feel that there is little space to tackle anything else. This means that people facing multiple disadvantage often don’t get the assessment or support that they should from adult social care.
Where adult social care teams in Changing Futures areas have a good understanding of multiple disadvantage and a connection to local partnerships, we’ve seen the development of co-located multidisciplinary teams, better access to assessment and care packages, shared co-ordination mechanisms and joint commissioning arrangements. Where this hasn’t yet been achieved, unsurprisingly, we see fragmented or inconsistent support which leads to missed opportunities to provide coordinated support for people experiencing multiple disadvantage who have care and support needs.
The relationship between adult social care functions and the rest of the local system are complex. At times, where integration is weak, relationships can feel adversarial. For example, adult social care teams can be seen to be acting as gatekeepers due to resource constraints, while others in the system try to access social care support for people without really understanding what’s available or possible. The knock-on impact is that individuals are prevented or delayed from accessing the support they need, often resulting in escalating need and a greater long-term demand for adult social care services.
Addressing culture and the relationship with the rest of the system
Cultural and systemic barriers between adult social care teams and other parts of the system can complicate local relationships and partnership work. Many people working outside adult social care may not fully understand the challenges and responsibilities of social workers. Conversely, in some adult social care teams there may be scepticism towards multiple disadvantage workers particularly when work is delivered outside adult social care structures. This is sometimes driven by anxieties around legal liability, risk management, and working beyond traditional professional boundaries. Addressing these barriers on both sides requires strong local leadership and the creation of shared spaces for learning, innovation, and trust-building across sectors, many examples of which we see regularly in Changing Futures areas. Understanding each other’s needs, challenges, practices and values quickly helps build shared understanding.
Re-thinking eligibility and consistency of approach
There is a growing consensus that assessment of eligibility for adult social care support needs to evolve to meet and understand the increasing needs of individuals experiencing multiple disadvantage. Currently, where this is not yet a flexible and responsive process, many people who would likely qualify for support under the Care Act 2014 are falling through the gaps in service provision. There is growing recognition that outreach-based and incremental approaches to assessment could better reflect individuals’ lived experiences and needs, unlocking access to support. There is a need to engage people effectively, particularly to adapt assessments to account for fluctuating capacity, substance use, or deep-seated mistrust of statutory services. Work originating in Stoke, both now and as part of the Fulfilling Lives programme, engages with these challenges to provide practical tools to manage these dynamics.
Similarly, formal safeguarding processes are an area where engagement and approach are inconsistent across the country for people experiencing multiple disadvantage. People experiencing multiple disadvantage often fall outside statutory safeguarding thresholds, and formal safeguarding processes may become performative – focused more on demonstrating compliance than delivering meaningful intervention. There is a need for more collaborative, learning-oriented approaches that place the person at the centre and embrace complexity.
The provision that is available is not always suitable
We also discussed the risk of placing individuals experiencing multiple disadvantage with care needs in traditional care delivery settings (e,g., residential homes for older people) that are not equipped to manage other complex needs not traditionally associated with aging or frailty. We heard stories about how this often leads to placement breakdowns (e.g., due to “poor” or “unmanageable” behaviour) and perpetuates the cycle of mistrust, service failure and exclusion.
How might we address this?
Practically this begs the question, “so how do we change this?” There is a shift in thinking required to create a coordinated response. Workers who sit outside of adult social care structures need to be asking how they can best support the local adult social care function and vice versa. What neutral spaces can be created to support joint learning? There are also practical challenges here in navigating the interface between specialist support services and adult social care. Questions also remain about whether external workers should aim to facilitate adult social care assessments, advocate for care packages, or take on joint responsibility without formal handover.
Ultimately, effective working between adult social care teams and others will require shared goals and strong leadership which gives people across sectors permission to work innovatively to create responsive and coordinated services. This requires a cultural change, to engender trust both with individuals who require support and the local system.
If systems can continue to evolve in this way, we are optimistic about the potential for a future that better supports adult social care teams, alleviates service pressure, and ultimately improves outcomes for people experiencing multiple disadvantage.