Ready, Willing and Able? Local Perspectives on Implementing Prevention in Social Care in England

There is a growing emphasis on prevention to reconcile demographic pressures, resource scarcity and expectations of better quality care and support. The Care Act 2014 placed a statutory duty on English local authorities to prevent and delay the development of needs for care and support. However, evidence suggests that the prevention approach has secured less impact than intended. Given that existing approaches have achieved such limited results, new ways of addressing this apparently intractable challenge should be considered. We argue here that theory-based models that support the understanding of, and responses to, implementation barriers and facilitators can provide tools to support the development of more successful implementation. Drawing on in-depth interviews (n = 20) in selected English councils and analyses of their policy documents, we explore the ‘Ready, Willing and Able’ (RWA) model, which posits that those three preconditions must be satisfied before new practices can be implemented sustainably. We argue that RWA can provide a straightforward and parsimonious framework for identifying implementation barriers and facilitators. Using the model to identify potential bottlenecks prior to the implementation can help local actors clarify baseline barriers to progress. RWA could help to inform opportunities to target identified problems, by reinforcing facilitators and moderating barriers. Despite the Care Act 2014 placing statutory duties on adult social care in England to implement prevention, and the expectation that it will deliver cost–savings, little is known how to implement prevention successfully. Financial austerity and increasing demand make it more critical to adopt theory-based analyses of barriers and opportunities for the successful implementation of prevention. The ‘Ready, Willing and Able’ (RWA) model helps implementers to systematically identify factors that may facilitate or hinder the adoption of prevention strategies and services. By helping to identify potential bottlenecks, RWA can help to identify where and why targeted improvement programmes might be beneficial. However, it is likely to provide only one of several necessary tools for successful implementation.