In a 2002 US Department of Defense briefing, Donald Rumsfeld famously announced to the world that US knowledge relating to whether or not Saddam Hussein’s was suppling of weapons of mass destruction to terrorist groups was incomplete, because..
“…as we know, there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns—the ones we don’t know we don’t know…”
It was perhaps not the most elegant phrasing and it was certainly much mocked at the time, but there’s a fundamental truth in there, which applies currently, not only with the Covid crisis in general but with its impact on Social Care in the UK in particular.
Affinity Works has spent the last few years developing analytics solutions for Social Care, including its predictive Demand Model. Those tools exist to help Local Authorities Social Care departments best understand the state of the domain in which they operate and where possible provide forward projections based on long and short term past data.
Those tools are drawn together in our Social Care Landscape product. These are continually evolving to add new data sets and offer new insights, but the big question for Affinity Works right now is how we extend Landscape to help Local Authorities Social Care managers to:
- Assess the scale of the short term and immediate ongoing impacts of the Covid crisis
- Project how the care market will behave as we move into the medium and longer term, hopefully putting Covid behind us, enabling Social care to re-plan
- Monitor the ongoing behaviour of the sector, so that where planning assumptions prove to be flawed, the Local Authority team can react quickly and adjust their plans accordingly
The short term impacts of Covid on the sector are perhaps closest to being the ‘known knowns‘. We are not there yet though, we need to turn the anecdotal evidence into hard data, but the indications so far are:
- big falls in demand for Residential care, triggered by headlines about excess deaths in care homes, which, along with deaths of residents (from both the usual causes and Covid related additions), is seeding a potential revenue crisis for Providers
- similar falls in demand for Homecare, perhaps as furloughed workers became more available to provide care within their family units and again driven by concerns about allowing external carers into the family environment
- unit cost increases (driven for example by PPE needs), plus staffing pressures driven by absence and illness for Providers
- a significant drop in Local Authority revenues as some traditional sources of non-grant funded income is curtailed by closed car parks and closed businesses.
The throughput data in Local Authority systems and in national data sets will quickly catch up with the received wisdom, indeed we have already developed our first wave of additional Landscape tools to crystallise that data.
Then we will be into the more vital territory of thinking about Mr Rumsfelds ‘known unknowns’.
We have no idea right now how the sector will reshape itself after the crisis abates. Will the relatively static shape of the care market re-exert itself with a drift back, or even bounce back, towards the pre-virus mix of Homecare, Residential Care and Direct Payments? Or has the shock of the virus changed the pattern for ever, creating the conditions for a ‘new normal’. If we are looking at a structural change, then what will the new mix of supply look like and how can the care market adjust to accommodate it?
We have seen barriers between Health and Social Care, which seemed to be insurmountable over many years of joined up working initiatives, blown away almost overnight as many health and social care services co-located and joined up (for good or ill) to move people from health to social care environments at astonishing speed.
How many of these changes are here to stay and how much will it melt away as the direct crisis recedes?
It is hard to imagine that the return of furloughed workers and the diminishing spectre of the virus won’t release some pent up demand back into the care market, but how should Local Authorities work with the Provider Market to make sure that the right kind of provision is available to align with the potentially changed shape of demand for services? In fact, how do they make sure those Providers have survived the current situation at all!
A substantial re-plan is going to be critical, but right now we can’t expect to rely heavily on what we knew before to build those plans.
Within Affinity Works we are focussed on finding ways of improving tools like Landscape to inform that planning process, but also to facilitate a ‘check and plan again’ approach that surely needs to become the mantra as LA’s engage with the current ‘known unknowns’ and the future shape of the market begins to be properly understood.
So that’s our other agenda for Landscape – not only to provide the best possible view of what has happened during the crisis, but also to deliver the right instrumentation to quickly identify and flag up to planners where and how their assumptions about current unknowns are not playing out as expected, and to help them iterate around their planning process.
The software world has moved everyone into the language of agile and always beta – for now at least it feels as though those concepts need to be applied to Social Care planning. Now – this needs to become a much more active, iterative and fluid process and we need to work out how Landscape can help make that happen.
Ah – and what of the ‘unknown unknowns‘? – Well, like the erstwhile US Secretary of State for Defense, we haven’t worked out how to do much with those just yet!