‘Front door’ approach to adult social care creating postcode lottery in Wales

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 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.

The new 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.

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: “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.”

Download ‘The ‘front door’ to adult social care’ report here.