Social Care Services

Further integration of social care and health services at the local level is a significant policy objective, as is evident from the models for Integrated Care Systems, Primary Care Networks and from the Better Care Fund programme.  There is also an expectation the funding model will undergo (potentially major) reform and, to that end, further Government announcements are expected.  However, a notable feature of social care provision is that it involves a wide array of large and small providers (regulated by the Care Quality Commission) that offer both privately and publicly funded care provision.  Added to which, much care is given outside any formal system by families, neighbours and friends.

Social care services support children and adults of all ages.  The highest volume of demand is that from older age groups, though a major financial pressure for the public sector is provision for profoundly disabled working age adults.  Older people form a relatively high proportion of the rural population, especially in coastal areas, and that proportion is expected to increase further.  Other specific challenges for providers may be associated with providing domiciliary care to clients in outlying areas and ensuring that rural users have fair access to services, so they can continue living independently at home wherever possible.

The following questions are intended to help improve rural service planning and design:

  1. What scope is there, when conducting service planning, to access information about the population age profile (and other relevant metrics) at a locality level, so that any spatial patterns which might impact on demand can be identified?
  2. What scope is there, when planning service needs and designing commissioning processes, to involve some rural based service providers or rural interest groups, as a means to ensure that learning from rural experience is incorporated?
  3. How well embedded are social care staff within any locality-based structures or multi-disciplinary teams?  Does such a team approach offer opportunities to improve support to rural clients?  Could further partnership working with other frontline service organisations also prove beneficial e.g. to information sharing?
  4. Where domiciliary care providers visit clients living independently in outlying areas, what is known about their travel costs and downtime?  How do contracts awarded for provision to local authority funded clients ensure that all locations are served and clients living in remoter areas receive an equitable service?
  5. How robust and effective is the lone worker policy for those social care and NHS staff whose jobs involve them making home visits in or regularly travelling through rural areas, where mobile phone signal connectivity may be unreliable?
  6. How readily can the rural housing stock, including older and more isolated dwellings, be adapted to meet the needs of residents, whether or working age or retired, who develop disabilities?  Do local policies to support independent living address the needs of rural residents?
  7. What is the geographic distribution of residential and nursing home settings across the area being served?  Does that distribution provide users (or potential users) from rural areas with the option to remain close to the locality and community they have lived in?
  8. How adequately supported by health professional are those that live in rural-located residential care homes (including nursing homes)?  Do those residents and their care homes have arranged access to a visiting team of health professions and to a named GP?  Do they also have good access to health professionals who can provide end of life care?
  9. What is the geographic distribution of day care centres and the activities that they offer across the area being served?  Does that distribution provide users (or potential users) from rural areas with fair access to day care centres?
  10. To what extent do rural communities in the area benefit from befriending schemes or good neighbour schemes that help combat loneliness and isolation?  Are there gaps in provision and, if so, what local organisation(s) could support their development?
  11. What support services are in place, which are accessible to rural residents, to help those that need advice with financial planning to help them manage their future care costs or to access allowances they are eligible for?
  12. What initiatives or projects are in place to support and to provide respite for those who care informally for a partner, a parent or a child with special care needs?  Are those initiatives or projects sufficiently accessible to informal carers in rural areas?
  13. What opportunities exist to introduce digital or online solutions, to assist with the delivery of social care support?  Could care at-a-distance prove especially useful as a means to enhance support to clients in outlying areas?
  14. Do rural geographies create any additional challenge for social care teams and multi-agency networks seeking to deliver prompt and effective safeguarding and other support to vulnerable children and young people, including those requiring intensive intervention?  What options exist to mitigate such rural challenges?

Case studies [not yet available]:

  • Commissioning local micro-providers of care in Somerset
  • South West Care Collaborative in Devon

Other solutions to rural service delivery challenges could include:

  • Plugging gaps in service provision by developing (or repurposing existing buildings to become) social care hubs located in rural towns, thus addressing rural needs whilst still achieving some economies of scale.
  • Partnering with local voluntary sector organisations to ensure that befriending or good neighbour schemes are widely available across the area for vulnerable and older people in its communities.
  • Supporting care sector providers to adapt to changing needs in their local area in a more coordinated and sustainable way, through a representative body which can offer them advice and development opportunities (as LinCA does in Lincolnshire).  
  • Exploring the potential of digital innovation to complement domiciliary care provision in rural areas and to enhance support for those living independently at home.
  • Utilising social farms or gardens to provide opportunities for older people with care needs (not least those in care homes) who have worked outdoors for much of their life and who may benefit from the stimulation that such facilities offer.