Reducing waste and improving efficiency

What this means

The basis for many of our discussions throughout the project – sometimes explicitly, sometimes implicitly – was that there simply is not enough money for social care. Regardless of which key change group they were part of, when asked about the one thing they would like to change about social care, most members of this project said ‘more money’ – and freedom to use it in different ways.

What does More Resources, Better Used mean to you?

In the videos below, Kadie Chapman, Martin Robertson, Susan Bruce and Katie Clarke explore how resources can be better used in social care:

In the More Resources, Better Used group, there were significant debates on this topic. Many discussions concluded that, while more resources alone would not necessarily solve the problems identified and experienced, it was necessary. Creative use of existing money could only go so far.

The group were also keen to highlight that people might often refer in shorthand to ’health‘ as one system, and ’social care‘ as another – but, in reality, both were fragmented, with a mix of centralised decision-making, local bodies, private sector interests and voluntary/charity sector involvement. This could cause significant fractures in the response people received from both health and social care.

Yet the group were also realistic about the current context, and one of the first things highlighted was how existing resources could be used in a more effective way. When citizens notice and experience waste and inefficiencies in the health and social care services they come into contact with, it is both frustrating and upsetting. Frustrating, because – in a world where we are told resources are limited – experiencing wasteful practice illustrates the fragmented way in which they are used. Upsetting, because – at times of difficulty – having to explain things over and over again, or to personally absorb the costs of inefficiency in time or money terms, can be especially hard to bear.

Observations of waste and inefficiency in the system

In the video below, Susan Bruce provides her observations about waste and inefficiency within the social care system:

In some cases, what people value may be simple and low-cost – so ask them! This has the potential to prevent high-cost yet ineffective interventions. More resources might be a financial issue, but better used is a cultural one. The group summed up what was needed in ‘Four Rs’:

• Recognition
  The value of social care, that it is equal in importance to health, and needs a highly skilled, empathetic workforce.
• Reward
  Fair pay and conditions.
• Representation
  The views of people who draw on social care, and of carers, should be central. People need to be represented on decision and policy-making bodies.
• Respect
  For people’s choices, needs, and preferences, and for the significant value of unpaid care.

Improving efficiency can be linked at virtually every stage with devolving power, co-production, and shared decision-making. Ask people what they want and improve communication.

The research

In 2021, the National Audit Office defined efficiency as being able to spend less to achieve the same or greater outputs (or to spend the same, but achieve more) (National Audit Office, 2021). This means cutting spending, without cutting services – or ‘getting more for your money’. This way of defining efficiency is different from how the word is sometimes used as a euphemism for cutting spending only, without the focus on maintaining or improving service: this is the language of ‘efficiency savings’ (Brien, 2022). Throughout More Resources, Better Used, when the word ‘efficiency’ is used, it relates to the National Audit Office definition.

Restrictive ‘needs testing’ is cited as a root cause of inefficiency in social care by the King’s Fund (2019). This is where people are prevented from accessing social care because their needs are deemed not serious enough; it is considered inefficient because lower-level support can help prevent people’s needs from deteriorating and causing more expensive interventions later on. This is explored in more depth in the section on connecting short-term and long-term. Avoiding inefficiencies is also discussed in the sections on transitions between services, and co-production.

Person-centred practice and personalisation have been cited as ways to increase the efficiency of resources in social care (SCIE, 2011); yet this is not a silver bullet for efficiency, particularly in light of budget cuts in adult social care. For example, personalisation needs to be carefully explained to people, with discussions regarding what it means, in practical terms, for people’s lives – as some studies have found there can be confusion in the way personalisation is explained and delivered (Kendall & Cameron, 2013). There is also concern that it can be inequitable for those on lower incomes (Carey et al., 2019), who are not able to access its full potential. Personalisation doesn’t mean wider work to address inequalities can be sidestepped. 

Personalisation and person-centred practice focus on a person’s outcomes - the impact that support or services have on a person’s life (Glendinning et al., 2006). Outcomes-focused services aim to achieve the aspirations, goals and priorities that people themselves set - in contrast to more regimented services whose content and/or forms of delivery are standardised, or are determined solely or mainly by professionals who deliver them (Lewis, 2017). Taking an outcomes approach in practice involves trust – because what the individual sees as ‘efficient’ may not be the same as what an organisation sees as efficient care (Lewis, 2017).

The principle of ‘subsidiarity’ devolves decision-making and finance to the most local level, and can be a way to address different ideas about efficiency (there is more information on subsidiarity in health and social care). With subsidiarity, the idea is that resources go further and decisions can be taken more quickly (integrated care systems in the UK have this as an underpinning principle). Evidence on integrated care systems is still in its infancy, but, already, nine out of ten leaders in integrated care systems say they work in this way (NHS Confederation, 2022a).

What you can do

If you are a senior leader: What do you understand by efficiency? Is it what is efficient for your organisation, or what is efficient for the people you serve? What do you do when there are different views on what is ‘efficient’?

The principle of 'systems leadership' is helpful when thinking about improving efficiency, and balancing different opinions of ‘efficiency’. It is a way of working that – rather than focusing on individual organisational reputation or performance – looks towards achieving goals for the collective good (Miller, 2020). A good place to start with systems leadership is considering your self-assessment – available at the end of this briefing. 

Further information

Engage

The Local Government Association has gathered together ten examples of innovative efficient practice in adult social care (via its Care and Health Improvement Programme). It includes contact details for those involved in the projects and encourages people to reach out and share practice.

Listen

Think Local Act Personal has a podcast on personalisation in Black, Asian and ethnic minoritised communities.