Cornwall Council: right care, right support, right funding stream

One of the most significant challenges in adult social care finance is managing the rising cost and complexity of support for working age adults, particularly in a way that balances financial sustainability with improved outcomes for individuals. Councils are increasingly focused on understanding the root causes of high-cost care, making better use of existing funding streams, and reshaping care and support to promote greater independence, choice and control.

The challenge

During the development of our category strategy, demand management strategy and market position statement, it was identified that our benchmark costs for working age adults support was an outlier among comparator authorities. Therefore, we completed a deep-dive analysis of root cause and developed our key interventions to address our concerns.

The action

In 2022, adult social care in Cornwall commenced a piece of work to review high-cost placements for adults aged 18–64.  This work included looking at the provision through several lenses: reassessment of need, housing funding stream, responsible commissioner (who pays) funding stream, optimising support and strength-based, personalised ways of working, validating staffing levels, and then finally using CareCubed to validate a fair cost of care. In 2023/24 and 2024/25, Cornwall Council delivered £12.4m in efficiencies and is on target to deliver a further £6.8m in 2025/26, totalling £19.2m over a three-year period.

Review

Targeted strength-based assessments were undertaken to inform needs, and progress was made towards independence of individuals since the last assessment.

Housing funding stream

This was assurance to ensure that individuals had the right type of tenancy arrangement and received appropriate housing benefit towards these costs and security of tenure.  Previously, adult social care had been picking up some of these hidden costs outside of their legal duty.

Responsible commissioner funding stream

This primarily sought to ensure that a person’s assessed need was a need that adult social care should meet and fund. This resulted in a number of people becoming the responsibility of the NHS to fund under continuing healthcare funding.

Optimising support and personalised care and support

Support plans were adjusted to reflect the appropriate use of shared support. Unnecessary one-to-one interventions were reduced, enabling individuals to live their “gloriously ordinary” lives, and we reaffirmed the values we work to for a life, not a service, supported by the implementation of tools driving independent living such as 24/7 Grid.

24/7 Grid is a care planning tool used to help an individual plan better how to spend their personal budget, plan their week and release their budget to do more. This tool has enabled young adults to move from institutional care and reclaim their lives, living in their community with the right level of care and support.

Validating staffing levels

Provided assurance through the review of staffing levels aligned to the commissioned volumes and ensured providers work towards assuring that the ‘right care, right support’ principles are applied.

IESE CareCubed tool

This tool is used to establish true and fair cost of delivery support. Where this is found to be in excess of the established range, commissioners will negotiate with the provider accordingly.

The outcome

Cornwall Council are on track to deliver £19.2m in efficiencies by the end of this year, having already delivered more than £12.4m in the last two years, while also improving the self-reported experience of people who draw on care and support.

Increased co-production of the design of services with people with lived experience has led to increased offers of alternative, less restrictive types of care and support that are more person-centred and reflect the choice of individuals more so than prescriptive contracted services. This is evidenced here with a film made by people with lived experience who are working alongside Cornwall Council.

Promoting the opportunity for self-directed support as a first point offer to individuals who need support in the community has led to improved outcomes self-reported by people drawing on support services, as well as for those who support them as unpaid carers (ASCOF statistics).

Ensuring a personalised approach to support planning with a person who recognises their strengths and abilities, as well as using individual service funds and direct payments to promote choice and control, has led to improved experiences and outcomes for individuals supported by Cornwall’s adult social care services.

Commissioners working to shape the market offer with care providers that can respond with increased access to community opportunities has led to a reduction in the need for high volumes of restrictive one-to-one support levels and increased confidence to create more shared support opportunities that can meet people’s needs more effectively and efficiently.

Reflection

The key lesson for us was to have a single overview of all the different interventions through a coordinated project approach. Social workers considering the elements of spend within a personal budget that may be the responsibility of health or housing was a key consideration, alongside ensuring the right level of support to maximise independence for a person-enabled delivery of the cost efficiencies, as well as great outcomes.

We need to ensure the programme of work is not just financially driven but has a strong focus on individuals’ experience and outcomes. Considering an individual’s needs not only on their own but alongside their friends or family who may also receive support (or people they may share a home with who have similar interests or ability to share support resources) has enabled a more rounded approach to support planning and driven forward cost efficiencies for the person and the provider. Personal budgets can go further toward ensuring quality of life is improved and is not reliant on a service-led approach.

We need to develop clear, standard operating procedures with partners such as care providers, the ICB’s continuing healthcare (CHC) team and promoting best practice opportunities to social work teams. Establishing transparent and mutually beneficial relationships with care providers enabled honest conversations about the true cost of care and helped determine where care costs were burdened by contract requirements or where prescriptive support levels being insisted upon were driving up costs unnecessarily. Addressing these in partnership led to a win-win position for both commissioner and provider.

Cornwall Council is proud of what it has achieved and maintains the view that with the right approach and resource commitment, there is no reason why this cannot be replicated in other local authorities.

7 July 2025

Contact information

Alison Bulman

Strategic Director, Care and Wellbeing
alison.bulman@cornwall.gov.uk

Karen Hooper

Head of Commissioning for Working Age Adults Services 
karen.hooper@cornwall.gov.uk

Social care finance in focus themes

Building trust through governance and assurance

New ways of working to improve outcomes

Workforce matters