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Wales Audit Office - Postcode lottery for new ‘front door’ to adult social care services

Councils are doing a good job in preventing social care demand, but information, advice and assistance is not consistently effective across Wales. That’s the conclusion of a report, published today, by the Auditor General for Wales.

The number of people aged 65 and over who are unable to manage at least one domestic task on their own will rise by 46% by 2035 and the proportion of the population predicted to have a limiting long-term illness will rise by 19.4%. These predictions highlight that demand for adult social care services in Wales, which is set to rise significantly in the next 30 years.

The Social Services and Well-being (Wales) Act (2014) places a duty on local authorities to focus on prevention and early intervention and deliver a wider range of community-based services through partnerships and multi-agency working. To do this, authorities need to create a comprehensive ‘front door’ to social care - focussed on a wider and more detailed range of information, advice and assistance services – known as the ‘IAA’ service. This service directs people to preventive and community-based services and identifies when someone needs an assessment or more specialist help.

Today’s report found that authorities are becoming more person-centred in their approach, but there is much work still to be done to promote access to the front door to ensure that all those who may benefit from IAA services receive it.

The wide variation in the availability, visibility, accessibility and quality of information provided by local authorities is resulting in inconsistent take up across Wales. Often, authorities do not know where gaps in provision lie. Without identifying and addressing these gaps, some authorities are still promoting traditional care packages and social services, encouraging dependency rather than promoting independence and self-reliance. 

While councils have effective referral systems for people who may need social services, carers are still not getting equal access. Many carers interviewed continue to experience difficulties finding out what they are entitled to.

One carer we spoke to commented:

“I felt there was a lack of care for me. When being assessed for home adaptions I was offered a shower upstairs rather than a stairlift, which would have been far more suited to my late husband’s needs. In the end I had to pay £5000 of my own money to have a stairlift installed”.

Although the ‘front door’ is helping to reduce demand, local authority services are in transition and local authorities find it difficult to demonstrate if their approach is helping people whilst supporting the financial sustainability of social services. Social care assessments reduced by 17% since the Act came into force; but gross expenditure in real terms for adult personal social services has risen by 11% from £1,360 million in 2008-09 to £1,506 million in 2017-18.

The report makes a number of recommendations, including:

  • Councils need to map the availability of preventative services in their area to better understand current levels of provision and identify gaps and duplication.
  • Councils should involve third sector partners in co-producing preventative solutions to meet people’s needs and ensure people have equitable access to these services.
  • Councils should review their current approaches, consider their audience, and ensure that good quality information is made available in a timely manner to avoid needs deteriorating and people presenting for assistance in ‘crisis’.
  • The Welsh Government needs to improve carers’ awareness and understanding of their rights to be assessed for their own care and support needs.

The Auditor General for Wales, Adrian Crompton said today:

“With an ageing population, it’s good to see that social care is focusing much more on early intervention, preventative services and community-based support. But there’s still too much variation in the access and quality of services available across Wales. In particular, local authorities need to take stock on how they are implementing the legislation and to refocus their efforts on ensuing carers get equal access to the help they need and are entitled to.”  

This report also contains an interactive data tool, which shows carers’ views from our carers’ survey and the results of our website review. Where appropriate, the tool allows users to explore trends by local authority, as well as at a national level.

Notes to Editors:

  • This report focuses on whether councils in Wales are preventing social care demand since the Social Services and Well-being (Wales) Act (2014).
  • Case studies in relation to carers comments can be found on pages 28-29 (English) and 31-32 (Welsh).
  • Our recommendations are on pages 8-9 (English) and 9-10 (Welsh).
  • English and Welsh language spokespeople are available.
  • The Auditor General is the independent statutory external auditor of the devolved Welsh public sector. He is responsible for the annual audit of the majority of the public money spent in Wales, including the £15 billion of funds that are voted on annually by the National Assembly. Elements of this funding are passed by the Welsh Government to the NHS in Wales (over £7 billion) and to local government (over £4 billion).
  • The audit independence of the Auditor General is of paramount importance. He is appointed by the Queen, and his audit work is not subject to direction or control by the National Assembly or government. 
  • The Wales Audit Office (WAO) is a corporate body consisting of a nine member statutory Board which employs staff and provides other resources to the Auditor General, who is also the Board’s Chief Executive and Accounting Officer. The Board monitors and advises the Auditor General, regarding the exercise of his functions.

The ‘front door’ to adult social care

Original article link: http://www.audit.wales/news/front-door-adult-social-care-services

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