While the benefits of prevention are largely understood, with recent evidence showing a return on investment of £3.17 for every £1 invested in Early Action and Support Interventions¹, preventative services continue to make up a disproportionately small amount of local authority and NHS spend. –
Short-term care only makes up 4% of Council’s current Adult Social Care spend2
Council spending on early intervention services has fallen by more than £2 billion since 2010/11 – an overall drop of 42%3
£68.1 billion spent on acute care in NHS trusts – a real-term increase of 4.4% in 2022-23 from 2016/17 with public health and community services seeing real terms cuts of -3.9%4
And as demand and pressure on budgets grow, prioritising prevention remains a challenge for many local authorities.
Earlier in the year, 31ten were lucky enough to work with Cambridgeshire County Council, looking at how their Care Together programme could be sustained and scaled into a place-based commissioning and operational model for Adult Social Care services. The Care Together programme places prevention at its core, involving place-based commissioners who work across different localities in the county to:
- build connections with local people and partners to co-design future services
- support the creation and growth of voluntary, community and social enterprises (VCSEs) to help older residents remain living independently for longer
Through this work, I personally learnt a lot about what effective co-designed, preventative support looks like and how it was possible to demonstrate impact and secure ongoing commitment – no easy feat!
I caught up with Jo Melvin, Strategic Lead from Adult Social Care Commissioning in Cambridgeshire to find out a bit more about why prevention is so important in the county and how they have managed to implement and sustain something that many areas find so hard to do.
So, why is Cambridgeshire so committed to prevention?
In Cambridgeshire, the Council aims to ensure everyone is able to live healthy, safe and independent lives and is central to how we work. Prevention and early intervention sit at the heart of our approach, and we recognise the crucial role local community assets play in supporting us to improve outcomes for people and manage demand for services both now and in the future. However, this is also balanced against the importance of evidencing impact.
Care Together has sought to support the growth of community assets to help more people stay independent for longer. Our investment in community assets was underpinned by a public health evidence base, and we used a test and learn approach through a short commissioning cycle. This helped us understand which services are having an impact, how support can be self-sustained and ensure priorities and resources shift to meet evolving needs. This approach has helped to create a more diverse, localised offer rooted in the community and reach more people and unpaid carers with our prevention offer. This is critical to ensuring we can maintain support in the future to assist us in managing increasing demand.
In relation to Care Together – what do you think was key to its success?
It has demonstrated the value of place-based coproduction and collaborative commissioning alongside the added value of community assets. We’ve been able to develop an innovative prevention and early help offer through coproduction and commissioning services from within and in partnership with local communities. Additional investment hasn’t always been needed (but does help!) and being willing to commission differently has been key.
We now have a varied and broad offer which reaches far more people than ever before. We’ve also built a local evidence base which we can point to, to demonstrate impact.
Care Together has also led to development of a locally owned model which is understood and provides a gold standard for coproduction. We are working to embed this in commissioning practice across our Adults, Health and Commissioning department.
Another key element which is fundamental to the success of the programme is seed funding. This aims to be a starting point for innovative, local solutions to address gaps, coproduced with local communities and partners which ultimately have the ability to self-sustain beyond the short funding period. Our strong connection with local communities, mean we have good communication loops so get anecdotal intelligence around this which is really helpful.
Our work to develop the Community Micro-Enterprises (CMEs) market continues to have impact. These enterprises offer hyper-local support and give more choice to local people as well as providing value for money. The uptake has been really strong from self-funders and there has been a mix of people using this more informal support because it’s accessible and can meet those non-statutory needs and statutory needs.
What challenges have you experienced in relation to the model and keeping it going?
Being able to evidence the impact of our new prevention offer on demand for Adult Social Care continues to be a challenge. We have plenty of proxy measures but that hard evidence which is often desired is much more difficult to get to. This makes it far more challenging for councils to maintain investment in prevention. Fortunately, Cambridgeshire is embedding place-based approaches and innovation through our target operating model and new Adults, Health & Commissioning Strategy. This has really helped to embed the approach as it means people across the organisation value the model.
And finally, how will it work going forward?
Plans are in place to continue with seed funding across Adult Social Care and Public Health as this is recognised as a key element to the model. As part of this, we’re also exploring how we can better evidence the impact of future seed funding.
We are also working to embed place-based, collaborative commissioning as part of our usual operating approach. This will be reflected in the future shape of our commissioning service and is already underpinning several of our large recommissioning projects in the department, including homecare and Public Health’s Behaviour Change Service.
31ten had the pleasure of supporting CCC to review and strengthen the Care Together programme, ensuring that place-based commissioning and delivery were optimised for improved outcomes and financial sustainability. Our work focused on:
- Developing a place-based commissioning model
- Strengthening prevention to reduce demand
- Enhancing co-production and engagement
- Aligning ASC commissioning and operations with public health, and community teams
- Delivering efficiencies and value for money
Please contact Laura on laura.power-wharton@31tenconsulting.co.uk if you want to hear more about the Care Together programme or how 31ten could support you to start to turn the dial from reactionary, high-cost interventions to preventative support, striking the right balance for your community.