Volume 5 • Issue 3 • October 2012

www.adass.org.uk Futures

Landscape hardening... Plus Norman Lamb in focus Plus Tribute to Lord Alf Morris

PAGE 2 PAGE 6 PAGE 14 PAGE 18 Sandie Andrea Richard John Keene Pope-Smith Webb Ransford Our take on Learning the Bringing How to pay the social lessons from North and for Dilnot care Olympic Winterbourne South and the Games View together funding gap Comment

An Olympian Service

Weren’t we all completely enthralled It is down to us, as leaders in social They will not do this without playing a by the Olympic and Paralympic games care, to harness and direct the potential full part in releasing and empowering this summer? What amazing feats that so many people harbour, to make the potential of the whole system. of bravery, courage, resilience, skill, a difference. There is no more important challenge dedication and hard work. Our gold medals are people’s lives than our current funding dilemma. We think principally of athletes, of released from dependency, diverted While we are well on the way to medals and individual and team from engagement with the care system, implementing the Health and Social Care endeavour. But supporting them were supported to direct their own care and Act, we are also dealing with the worst armies of physios, medics, trainers safeguarded from harm. fiscal challenge in decades. We watch and managers. Behind them were the cautiously for signs of the white smoke families and friends, whose support has The other day, I met the leader of a new, of a long-term funding solution but have been lifelong and unconditional. user-led addiction recovery service, so far only seen wisps of dry ice at the created from one person’s idea and opening ceremony! Making the whole thing happen were already in touch with 25 recovering the teams who created and funded addicts. She has a clear vision of If we succeed in our Olympic effort the bid, built the remarkable facilities, developing a ‘hub’ for activities and, in by unlocking the potential of our planned and executed the events. There her own words, “keeping people well in communities, what will be our legacy? were the volunteers who welcomed and order to reach the potential we didn’t It will be measured by how we have guided visitors. And there were people think we could.” In unlocking her own assisted every member of society to of all nations who cheered their heroes potential, she is now doing the same achieve his or her personal Olympian to perform their ultimate best. for many more. For me, here is the goal and galvanised communities as active partners in the endeavour. We, the In Adult Social Care, our Olympic Olympic future. Team GB support team of public service, challenge is not so much winning races The attributes that will keep us all in are here to facilitate and mobilise effort as releasing people’s potential to peak Olympic condition (and allow us to and endeavour when required. live lives fulfilled, independent, safe release our own potential) are those of and self-governing. skill and resolve to make a difference. We How we organise and deploy the resources at our disposal will impact on There are many ways of releasing have ambitions of Olympian proportions the outcomes they achieve. We must potential and, as we have seen, those and as with any athlete, also need the set aside silos and differences, support fantastic 2012 London Games didn’t just resilience to get up and carry on when innovation and have the inspirational bring success to super-fit athletes, but to things get tough. We are team players, vision to make the difference this time. many others besides. supporting others in the squad and playing for our country. Just as London 2012 rose to the In our imaginary Olympic sport of challenge of producing the ‘best games releasing potential, there are elite Health and Wellbeing Boards will provide ever’, so must we now produce our best athletes, but there are other participants, the system leadership to take our task results ever. supporters and enablers of many kinds. forward. They need to achieve fully their All of these have huge potential to own potential to bring maximum benefit Sandie Keene contribute to our common goal. to our communities. Vice President, ADASS

In this issue 3 Upfront Norman Lamb sets up his 14 An untidy future? ADASS Honorary 25 An end to silly arguments: John round table... Praise for Jo Williams... Secretary Richard Webb in profile Jackson tells it how it is in Oxfordshire ASC guide for leaders and Chief Execs... Winterbourne View reviewed... 17 Cutting Edge: The MJ’s Jamie 27 Towards excellence: Oliver Mills gets Managing the markets... Hailstone faces the people behind the TEASC off the ground facts 8 Agenda Comings and Goings... 28 The College of Social Work: Bernard Policy review... The Business unit in profile... 18 Open Letter: John Ransford pens a Walker describes a new membership note to Jeremy Hunt... offer... 10 Landscape hardening: Sarah Pickup looks back over her first six months 20 Interview: Care Minister Norman 29 End of life: making a difference to Lamb talks to Futures how we die. Rick O’Brien reports 13 Morris major: David Townsend remembers ‘the right man at the right 23 Registration: The HCPC’s Marc Seale 32 Last Word: Bernard Walker and all time...’ explains the ins and outs... those meetings, meetings, meetings...

2 ADASS Futures, October 2012 upfront WELCOME TO...

...EASTBOURNE and to the annual children’s and adults’ services conference. It is now some 30 years since the AMA and the ACC, Focus ‘obsessively on forerunners of the modern LGA, joined up with the old ADSS to create this conference. And six since integration’ – Minister this became a partnership between NEW CARE SERVICES Minister Norman Elsewhere he affirmed the Coalition’s ADASS, ADCS and the LGA. Lamb is planning a series of ‘round table’ commitment to Dilnot, and to the Throughout those decades it has meetings to help force the integration cross-party talks which he believes are proved the seminal yearly event in agenda between health and social care. essential to a proper settlement. A former which all aspects of social care, and Shadow Care Minister and the initiator In an interview, Mr Lamb told ADASS latterly education, have been put of the original cross party talks two years Futures that “I’m convening a round table under a microscope and given the ago he reveals that “I got drafts from the to get the key people who’ve done all the detailed sort of examination only the two of them (Andrew Lansley and Andy work on integrated care together to work top managers, politicians and policy Burnham) which I was shaping into a with the Department. Firstly this will be leaders can give it. shared document. to discuss with the Department and the And this year will prove no exception. NHS Commissioning Board how we can “But this was in the run-up to the general We shall have leading government really make this happen. election, and was rather de-railed by a ministers to take us through the bare-knuckle fight over death taxes, if “Chris Ham from the King’s Fund said in latest Coalition thinking on their you remember.” January that in the past ten years the Departments’ policies. Free schools? NHS had an obsessive focus on cutting Acknowledging that local authorities Academies? Transitions? And in adult waiting times and improving access are facing financial pressures he warns care, of course, the draft Bill and the to the service. But in this decade there that “We’re all having to live with this onward drive towards integration needs to be a similarly obsessive focus extraordinary and personalisation. And for all of on delivering integrated care as a model challenge to public us, working with people to achieve of care.” finances and the level good outcomes in the context of of the deficit and we significant budget reductions. According to the Minister: “You have to have to get that under get the right incentives into the system Many thanks to all the hundreds of control. It’s in all our to allow it to happen, rather than it people who have contributed their interests to do so.” happening as it tends to now – almost time and expertise to making this despite the system rather than because (See Power to the a memorable event; to Amanda of it.” Norman Lamb People, Page 20) Fry and her colleagues in North Yorkshire for their skill in balancing the demands of such a complicated THE ASSOCIATION PRAISED former LINDA SANDERSON HAS been elected the programme, and to Keith Hinkley President Jo Williams last month new vice president of the Association.She and his colleagues in East Sussex when she announced her retirement will take up the post next April following who have so kindly offered to help from the Chairship of the Care Quality the ADASS agm when current vice throughout this week. Commission. president Sandi Keene becomes President. I do hope you leave buzzing with “The good wishes, and the good will, of Linda was formerly Director of Adult, fresh policy initiatives and new adult social services directors will be with Community and Housing Service in Dudley solutions to problems old and new. her for the future.” before taking up her current position as And I hope you enjoy the hospitality Corporate Director of Social Care, health that Eastbourne has to offer, and Housing with the LB of Hillingdon. networking opportunities you will have had, and the sheer camaraderie She said she was `very proud’ to have been that this conference always manages elected to such an important position. to draw from all of its delegates.

Richard Webb Honorary Secretary, ADASS Jo Williams Linda Sanderson

ADASS Futures, October 2012 3 upfront

Two cheers for the NHS Confederation

THE ASSOCIATION MANAGED only a justified when there is a clear payback preventative, community-based services muted welcome for a recent survey from for the NHS. “Despite, and sometimes will reduce high end costs for both the NHS Confederation which warned because of, budget reductions many health and social care.” that ‘without action’ the current shortfall local authorities are investing in The Association, however, agrees that the in funding for social care will only get enablement services which will reduce costs of funding the recommendations worse. ongoing demand for both social and of the Dilnot report should not be taken health care support. ADASS unhesitatingly agreed: according from health service budgets. “As reforms to ADASS President Sarah Pickup, “all “We recognise that the NHS has are implemented it is vital that the right the demographics point to the fact that substantial savings of its own to make levers and incentives are in place to an already serious situation is bound to to help meet the costs of rising demand integrate or align services and budgets deteriorate over the coming years.” and new treatments. But we firmly wherever this will deliver better outcomes believe that increasing the spend on or better value.” There was less agreement, though, over the place delayed discharge occupied in the Confederation’s explanation of events. “As far as delayed discharges from hospital to home are concerned,” Mrs Pickup said, “it is still the case that more people are delayed by having to wait for ongoing NHS services than by having to wait for social care services.” And, contrary to the Confed’s view, she insisted that some transfer of resources from the NHS to social care can be Many authorities are investing in enablement Care services ‘fit for purpose’

AN IMPORTANT NEW guide to adult • How we have got to where we are The Association stresses in the report social care for council leaders and chief that this is not an exclusive list but that • The main features of the White paper executives has been released by the it `charts some of the key themes of the and Bill Local Government Association, Solace reform and demonstrates the extent to – the Society for Chief Executives – • Some of the key issues councils which ADASS is already engaging and and ADASS. might want to think about pushing forward in these important areas.” The guide – The reform of adult social • Next steps care and support – is part of a new- Looking towards the future the found commitment from the three report discusses the LGA’s current organisations to “work together to campaign called show us you care’ ensure that a strong and united local aimed at securing the Dilnot reforms. government voice helps inform and The reform of adult social It highlights, too, SOLACE’s call for a Thecare reform and ofsupport adult social shape this crucial agenda.” careA guide and for councilsupport leaders and chief executives `deep and wide reform to create a A guide for council leaders and chief executives And according to a foreword from modern care system fit for the 21st Sarah Pickup, ADASS, David Rodgers, century, and with ADASS taking LGA, and Terry Huggins, President forward work in a number of areas of SOLACE, the guide is intended to including personalisation, sector-led explain: improvement, market development, commissioning and procurement and workforce development.

The reformThe of reform adult socialof adult care social and caresupport and support

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4 ADASS Futures, October 2012 upfront Time to get real

ADASS ARE TLAP acknowledges the need for this The Partnership is mindful of the PARTNERS in and continues its development of challenges that still remain in delivering our care good practice materials for delivering transforming adult social care, particularly and support services personalised services, alongside in the context of an extremely difficult with the people linked initiatives including the financial climate and need for integration who use them, Towards Excellence in Adult Social with health. The Government’s White writes Martin Farran. Care programme. We know it’s not Paper and draft Bill on social care will be a Martin Farran We are committed about ‘reinventing the wheel’, but crucial driver for the sector in 2012/13 to to, and responsible for delivering the acknowledging that community practice further develop personalisation. implementation of Think Local Act needs a refresh to meet the current However, transformation will come about Personal, where the Making it Real challenges faced by the sector. only if it is a genuinely collaborative outcomes framework is a step forward endeavour. We need to dissolve the in transparently measuring our progress Birmingham, Stockport and councils in traditional boundaries that lie between us towards personalisation and community- the West Midlands are amongst the early as councils, the third sector, providers and based support. adopters of Making it Real who’ve found the markers support the opportunity to individuals. And we need to listen to the Personalisation can help to grow monitor and evaluate progress, linking voices of those using care and support, and nurture strong and inclusive qualitative feedback from people carers and families so their insight and communities. We need a strategic who use services and carers into their experience can help us get this right. approach to participation, and must local accounts. For more information on Making step up to the role of building our local it Real and Strong Partnerships community’s capacity, and shaping and Providers are signing up too, signalling a for Better Outcomes, visit www. harnessing its energy. Co-production move towards all parties coming around thinklocalactpersonal.org.uk/mir can be an intrinsic part of social care the table to enable more productive transformation and will help us create local market relations – advice that’s Martin Farran is ADASS Policy Lead, wider links between public services, their been set out in the TLAP protocol Personalisation and Board Member, reform and civil society. Stronger Partnerships for Better Outcomes. Think Local Act Personal The DH comes to NCASC

THE DEPARTMENT A MYTH-BUSTING session on care and The sessions will provide the opportunity OF Health will be at support funding reform, covering the for questions and discussion with this year’s conference, Government’s position on the Dilnot Departmental officials and sector leaders. sharing information Commission’s recommendations and For more information or answers to on the latest key next steps, specific questions on any of the above issues, challenges and areas, follow us or contact us via Twitter AN UPDATE on the White Paper developments from or our special NCASC facebook webpage policies ‘three months on’, with details Charlotte Tuck 2012, writes Charlotte (see details below) and we will do our best of changes that have already been Tuck. to answer them in the relevant session. implemented and significant pieces of This includes the reform of care and work that are underway, Charlotte Tuck is Communications and Engagement Manager, Department of support, the Prime Minister’s Challenge A MASTERCLASS for directors of adults’ Health on Dementia, and the development of and children’s services on developing health and wellbeing boards and local collaborative leadership across the local Twitter: @CharlotteatDH @JanineatDH Healthwatch. health and care system to break down @AmyatDH @LauraatDH @dhgovuk organisational boundaries and create The Department has planned a range Website seamless services and care for local of interactive sessions on our stand Our dedicated Facebook page communities, including: [http://www.facebook.com/ AN OVERVIEW of the draft Care and BRIEFINGS on the government’s DepartmentOfHealthAtNcas2012] will Support Bill, including its purpose and dementia agenda, including the progress contain further details on our sessions passage through Parliament, and the of the Prime Minister’s Challenge and and on who will be available for opportunity to feedback your comments sharing of best practice examples of discussions, and provide a space for your there and then on its individual clauses, dementia care from across England. comments or questions.

ADASS Futures, October 2012 5 upfront Beyond Winterbourne View

Following use of the Mental Health Act develop the following: the serious ‘Tool Kit for Improvement’ • Whole life planning and links to incidents exposed at To encompass: Children’s Services Winterbourne View - Learning re Safeguarding and in 2011 there has • Work force planning. required improvements been a significant The final DH report and Concordat (ie: role and influence of Adult level of scrutiny and will also include an outcomes and Safeguarding Board) Andrea Pope-Smith activity to ensure performance framework, and that there is a comprehensive stakeholder - Alternative models of care / best consideration is being given to how the response, and to develop an improvement practice examples National Learning Disability Programme framework for the future, writes Andrea Board can be developed to monitor and - Integrated commissioning and Pope-Smith.. scrutinise implementation and progress. contract monitoring review ADASS has been involved throughout approaches Other considerations for the with regular updates on progress Concordat are: - Quality Frameworks provided to the ADASS Executive and the LD Policy Network. • Ensuring good quality information and - Whole Life planning (links to advice are available and easily accessed Children’s Services) The following reports have now been published: • Role of Healthwatch to encompass - Engagement and Involvement people with a learning disability and model/s • CQC LD Review – National Overview family carers (150 inspections) - Performance and outcomes • Role of Healthwatch England in monitoring (including role of the • Interim Report - Department of Health monitoring progress Learning Disability Partnership Board) • Serious Case Review – Winterbourne • Development of key performance The aim is to develop the toolkit alongside View indicators the publication of the DH Concordat • Internal Management Review – NHS and emerging projects and to share the • Audit of local services – to establish outcomes / products across all regions. • Internal Management Review – CQC baseline of current position. At the NCAS Conference in Eastbourne The final DH report will be published in In addition to this work there are three there will be a workshop called ‘Beyond October 2012. other areas of activity underway: Winterbourne View’, jointly chaired by The DH have facilitated a number of • ADASS and SHA (LD Leads Group) are ADASS and the Challenging Behaviour stakeholder events to ensure that all working together to develop a joint LD Foundation and will include Shaun key issues are reflected in the final Self Assessment Framework to replace Gallagher (Acting Director General), report. ADASS presented the following the current NHS LD Self Assessment National Valuing Families Forum and issues which we believe need to be and the Valuing People Now Learning National Forum for People with a strengthened on the final report: Disability Partnership Board Learning Disability. Assessment. The draft questionnaire • Full and proper reference to adult The workshop will summarise key issues will be shared with the LD Policy safeguarding and learning, highlight best practice and Network and ADASS Executive prior to explore how we work together to ensure • Importance of joint/collaborative confirmation and submission to DH. the incidents at Winterbourne View do health and social care commissioning • ADASS and SHA (LD Leads Group) not happen again. • Potential for expanded care and case are to begin work on a commission management model providing regular from the NHS Commissioning Board contact with people in more complex to develop a specification and quality settings framework for community based models as an alternative to Treatment • Whole system leadership to and Assessment Unit provision. ensure change and improvement Awaiting Terms of Reference/Brief requirements are delivered from Geoff Baines (SHA). • National standards framework for • West Midlands Regional Health and Advocacy Social Care response: • Issues relating to mental health and A Steering Group has been set up to

6 ADASS Futures, October 2012 upfront Beyond Winterbourne View Markets get set for a boost

The Developing Care Markets for Quality and Choice (DCMQC) programme, to be run by the Institute of Public Care for the Department of Health and in cooperation Andrew Kerslake with ADASS, is now underway following a ministerial launch by the New Minister of State for Care Services, Norman Lamb on September 18 (See interview, Page 20) The programme has been designed to support local authorities in preparation Programme delivery will start early in 2013 for their planned duty in the proposed The programme which was of care to one where the local authority’s Care and Support Bill: enthusiastically welcomed by directors, role is to ensure there is a range of “A local authority must promote the commences with a series of regional different types of provision available. efficient and effective operation in its briefing session for each of the nine The range of provision should not only area of a market in services for meeting ADASS regions. In mid-October each facilitate choice for those in receipt of care and support needs with a view to authority will then receive a description state funds but for all who might need ensuring that any person wishing to of the options that are available and a care and support. brief self-diagnostic tool to complete, access services in the market: Professor Andrew Kerslake, Associate in order to identify where they believe Director at IPC, describing some of the (a) has a variety of providers to choose their own relationships with their local ambitions for the programme, said: from; markets have reached. “The range and experience of local (b) has a variety of high quality services Later in the autumn the plan is for each authorities varies widely. Some are still to choose from; region to hold a workshop at which engaged in procurement processes that (c) has sufficient information to make authorities will plan out the options they leave control with the LA as a central an informed decision about how to wish to take and agree an overall regional purchaser, others are beginning to meet the needs in question. programme. Programme delivery will explore, based on their detailed market commence early in the New Year. analysis, a different relationship with The programme will be delivered across their care markets. every local authority in England between ADASS president Sarah Pickup said: now and March 2014 and has been “ADASS genuinely welcomes this “This might involve recognising that the designed to offer a range of options development programme. It has some financial restraints on LAs affect providers to help councils in their new role of distinctive and unique features which every bit as much as it affects the local facilitating the social care market. mean that it will help all councils authority; that a thriving care market individually with current commissioning provides employment and stimulates At a minimum the expectation is that and new duties. ADASS is also very local economies. And that as we get older by the end of the programme each local mindful about the potential of the we no more all want the same kind of authority will have developed a market programme to establish a view about a care and support any more than we all position statement, a document designed common baseline and best practice. We want the same type of car or house. to give providers and consumers a succinct, also expect the programme to start to “The DCMQC sets us on a different path. analytical view of their local care market. help councils with further developments It is one where the local authority such as the role of markets and housing, However, several authorities will already develops an oversight of the market and or how growing community capacity will have such documents and will be then uses all its knowledge, experience reach into new markets”. engaged with their local providers in and powers to encourage a diverse care looking at how they can increase the Clearly, the programme will only kick-start sector. Such an oversight should be diversity of provision in their localities. a process that will need to be ongoing. It based on research and consumer surveys, For those authorities, there is the signals a change, that began under the if it is to provide the range of care and potential to use their time in other ways previous government administration, of a support that people say they want and designed to develop their markets at continued movement by local authorities increase people’s potential to remain either a local or at a regional level. away from being providers or purchasers independently within the community.”

ADASS Futures, October 2012 7 AGENDA

Streams of activity

We were delighted to welcome Looking forward, the next of our Consultations have continued to flow Catherine Cunningham back from her seminars with SCIE is to be held at Local into and back from ADASS. So far this maternity leave in July, writes Mary Government House on January 11 on year 17 responses have been made – all Gillingham. Catherine is now working the theme of leadership, so do hold the available on the publications section of part-time, two days in the office and half date in your diaries and look out for the the website. With the publication of the a day a week from home usually. This booking forms. White Paper and draft Care and Support means we make full use of our four desks Bill we are anticipating plenty more Another stream of activity is the surveys on the fifth floor of Local Government action before the end of the year. ADASS runs on key issues. While we try to House and when we are all in together, space these out to reduce the risk of survey We are always grateful to ADASS spill over into the hot desks. overload, they are hugely important as members who are able to contribute Also in July we held two one-day a source of current information. As we their expertise to feed into these seminars. The first was a successful aggregate the results nationally and responses. Consultations are often partnership with the British Geriatric make the findings available, it shines a initiated by government departments Society on Integration. This was the light on the overall position as well as but ADASS also feeds into Select second one of these and it is fast allowing individual authorities to position Committee Inquiries, All Party becoming an annual event. There was a themselves against the overall picture. Parliamentary Groups, independent strong focus on the critical factors needed Commissions and approaches from arms In the spring we concentrated on for successful integration, both from a top length bodies or partner organisations. the annual budget survey and the down and a bottom up perspective. updated position on implementing Looking ahead we are again planning to The other seminar was the next in our personalisation, ahead of April 2013. For offer a placement to a graduate trainee series run jointly with SCIE and was an the current survey on procurement we on the next cohort of the National Skills immediate and first chance for ADASS have used an online tool and this will Academy scheme. This has proved very members to consider the White Paper, give valuable data on how collectively successful for all concerned this year. Caring for our Future, together with authorities are commissioning residential the draft Care and Support Bill. If you and homecare services. This will inform weren’t able to attend either of these, the ongoing dialogue with independent the presentations from both days are providers at a national and regional level available on the Events page of the and give a much needed overview based Mary Gillingham ADASS website. on existing practice and forward plans. ADASS Business Manager

Bournemouth – Judith Geddes Brian Rice Comings and Goings Medway – Rose Collinson Ted Unsworth March – September 2012 Colin Foster Movers New DASSs Margaret Geary covering North Lincolnshire – Denise Hyde Southampton and Portsmouth DASS Cambridgeshire – Adrian Loades roles Shropshire – David Taylor Barbara Peacock moved from Blackpool – Delyth Curtis Sandwell to Medway Solihull – Ian James New Associates Hounslow – Judith Petterson Mike Briggs – Ex North Lincolnshire Sandwell – John Garrett Penny Furness –Smith – Ex Bournemouth – Jane Portman Southampton Jersey – Richard Jouault Valerie Beint – Ex Shropshire DASSs who have left Mimi Konigsberg – Ex Hounslow Jersey – Stuart Brook Associates who have cancelled Somerset – Miriam Maddison membership Southampton – Penny Furness-Smith Peter Smallridge Shropshire – Valerie Beint Eileen Means Blackpool – David Lund Jan Stubbings Deceased Hounslow – Mimi Konigsberg Leo Goodman Glenys Jones

DASSs’ contact details available at www.adass.org.uk/index.php?option=com_content&view=article&id=180&Itemid=161

8 ADASS Futures, October 2012 AGENDA A full and exciting year...

Another full • CONTINUED CONTRIBUTION and YEAR, with plenty of active engagement in a series of high Mary Gillingham pausing, listening, profile Commissions relating to adult Business Manager thinking, talking and social care, to include inquiries held - most importantly - by the Commission for Dignity in Care doing, all round, writes and the Equalities and Human Rights Jonathan Gardam. Commission, Jonathan Gardam This year, 2012, has • WIDE PARTICIPATION and engagement not disappointed its across ADASS policy networks to projections with the Coalition pressing include the submission of 17 detailed Jonathan Gardam on at pace with the reforms of health consultation responses to date in 2012, Policy Officer and social care, as well as wider reforms (and 28 in total since September 2011), to welfare, housing and the relationship • SUPPORTING THE development between central and local government, and roll-out of shadow Health and all of which have a bearing upon Wellbeing Boards, directors and their teams and colleagues. • DEVELOPMENT AND launch of the Adult social care itself has more than Influential “The Case For Tomorrow” kept pace with these reforms and has report, setting out the key challenges often been ahead of the game, which has Fionnuala Morrissey and opportunities in the context of allowed ADASS to draw upon a vast bank Project Administrator services and support for older people, of expertise and experience in working across the sector to bring about ongoing • CONTRIBUTION TO the development of improvements to the benefit of local the Silver Book describing good practice people and communities. in the treatment of older people at the point of admission to hospital, Key activities to date include: • SUPPORTING THE development of • SIGNIFICANT ENGAGEMENT with Making It Real measures, launched by the Department of Health through a Think Local Act Personal, Catherine Cunningham myriad of policy workshops, meetings Project Administrator and consultation responses to help • STEADY PROGRESS towards to April provide shape to the White Paper and 2013 Personalisation Targets, draft Bill, and to keep making the case • PUBLICATION OF ADASS Budget for an urgent and sustainable funding Survey 2012 based upon a 95% solution for adult social care, return rate. The survey received wide • FOLLOWING THROUGH the ADASS coverage and references across the leadership role in working in close sector and is considered a seminal partnership with stakeholders to learn paper describing the financial Drew Clode the lessons of the Southern Cross pressures being tackled by councils, Policy/Press Adviser collapse, to include development of • KEY CONTRIBUTIONS and leadership financial viability reports and market in the development and evolution of development approaches, sector-led improvement for adult social • LEADERSHIP AND high-level care through the Towards Excellence in commitment in the sector response to Adult Social Care (TEASC) Board. the distressing case of Winterbourne Next year promises to be just as full, and View and ongoing support of improved with the ADASS extended membership and commissioning practice and working Lizzie Comely the commitment of the ADASS Presidential with providers on transparency of Graduate Trainee Team, Executive, Regions and Policy quality (See Upfront, Page 6), Networks, ADASS is well positioned to meet • HIGH PROFILE contributions (oral and the challenges and opportunities of the written evidence) to Parliamentary reforms and policy decisions that lie ahead. policy activities to include Select Committee Inquiries on Social Care Jonathan Gardam and Public Expenditure, ADASS Policy Officer

ADASS Futures, October 2012 9 The first six months: Sarah Pickup

Landscape hardening

THERE IS A real benefit in the succession The ADASS line on funding and on Dilnot system we use in ADASS; the year as vice has been that the proposals provide a president gives you a chance to meet sensible solution to the question that and get to know people you will spend a was posed to the Commission, i.e. how lot of time with in your year as president. to remove the unfairness of catastrophic Also there will be some things you start care costs falling on some people and as vice president and carry into the to find the right balance of funding following year meaning not everything is between the state and the individual. new. Equally, the role of the immediate What the proposals do not do is bring past president means that you may be more money into the system, so the able to ease gently into some of your second question which urgently needs new responsibilities. an answer is how we quantify what the My year began as the sector was waiting funding gap is between current resource for a White Paper and a Bill promised levels and the amount needed to deliver for the spring. There was a huge care that will meet the expectations of amount of discussion going on right government and citizens. The first half of my year as ADASS across the sector about whether the The government has been clear that proposals set out in the Dilnot Report president has flown by and as we gather overall resourcing levels and indeed would be implemented and a debate at this year’s National Children and Adult the funding required for Dilnot will be about how to balance support for this matters to be considered in the next Services Conference I have been reflecting with highlighting the fact that these spending review. It will be extremely on the meetings and conferences I have recommendations would not provide important for ADASS, probably with the the solution to the overall shortfall of attended, the people I have met or spoken LGA and finance directors to put in a funding for adult social care and the to, the things I have done for the first time robust submission to the next spending need for this to be addressed as well. and the breadth and scope of discussions review and we are gearing up now to and debate… There was in fact an unprecedented ensure we are ready. outbreak of agreement about this So now we have a White Paper, a draft between councils, ADASS, voluntary Bill and a progress report on funding, and independent sector providers, what do we think and want next? The provider associations and a range of care and support White Paper and draft cross sector alliances. In the long ‘spring’ Bill successfully set out a compelling while we waited for a White Paper, I vision for care and support in the attended a range of meetings and spoke 21st century. The draft Bill provides a at conferences and gave interviews to consolidated and modernised legal various journalists. framework for adult social care replacing The very first interview I did just before all existing legislation. taking up the role of president used as Personalisation and prevention which a headline “ there is no pot of gold at have been driven forward almost the end of the rainbow for social care”.... despite the legal framework will, in Something I said towards the end of the future, be supported and enabled by interview and as the phrase escaped the legislation. The major themes of the from my mouth I knew that would be White Paper and the Bill reflect well the one of the sound bites they picked up. major issues and themes that emerged I have yet to master the skill of spotting during the engagement exercise, as well the obvious sound bite before it escapes as during the debate in the run up to the from my mouth... There is always Health and Social Care Act. something new to learn! The proposed duty for local authorities Several people have referred back to that. to ensure people can access preventative As recently as last month a journalist from services is welcome in principle. The one of the local papers in Hertfordshire embedding of wellbeing as a purpose came to interview me about older people’s within the Bill provides a unifying services armed with a print out of that purpose for the first time. The current headline and the piece that followed. position is that the statutory duties

10 ADASS Futures, October 2012 PROFILE

of local authorities do not reflect the outcomes we all want to achieve. In fact, at present it seems it is no-one’s statutory duty to ensure that people are helped to be as well and as independent as they can be. Rather, local authorities have duties to meet the needs of people above a certain threshold and the duties of health bodies tend to be concerned with access to services and availability of treatment free at the point of delivery. What this can mean is that at times of budgetary constraint, local authorities looking at how to reduce spending can be forced to reduce areas of discretionary spend including preventative services. So the new duty should shift the balance of decision making, though, of course, there needs to be sufficient resources to allow The new duty should shift the balance of decision-making this to happen. the framework is largely one we would package can be tailored to meet the Both the White Paper and the draft sign up to; subject, as always to the needs of authorities at all different Bill are clear about the need to focus establishment of a sustainable system stages of market development work. on the outcomes that people want, of funding and a quantum of resource (see Andrew Kerslake, page 7) indeed the White Paper is framed in a which is adequate to meet all these I firmly believe that we get the best set of “I” statements. These statements expectations set out clearly what everyone should innovation, services and outcomes have a right to expect in relation to One of the other themes that has carried if commissioners are able to take a their care and support from accessing through from last year, and features in round the table, partnership approach information and advice through access the White Paper and draft Bill is the way to developing and commissioning to preventative services to choice and in which commissioners and providers services rather than an “us and them” control in relation to care plans. interact to ensure that the market delivers contracting approach. This requires the range and type of services that offer the establishment of relationships that The reinforcement of the responsibility the choice and quality people want in can withstand robust discussion and to integrate services where this will deciding how their needs should be met. negotiation and is ‘co-production’ in deliver better outcomes and/or better Sometimes as I meet the chief executives action locally. value for money sits well with the of various provider or voluntary Unfortunately it seems that duty to promote integration placed organisations for the third or fourth time commissioner-provider relationships on various bodies, from health and in the same week or even twice in one are not all they could be in some places. wellbeing boards to Monitor, within the day, I wonder how we could work much In fact sometimes, when I rashly accept Health and Social Care Act. more closely together. But of course, an invitation to what feels like a ‘lions’ there is much to do at both national and Among the broad principles and den’ meeting of providers, I am told local level to improve the way in which expectations there are proposed that commissioning – or actually what commissioners and providers work solutions to a number of smaller yet is in reality procurement - practice is with each other to develop services and significant issues. For example, proposals more often that not ‘awful’. Sometimes innovate and to increase transparency to amend the Ordinary Residence rules complaints are about prices paid around costs and prices. so that the responsibility for funding sometimes about the use of 15-minute remains linked to the authority making In the last few weeks ADASS has been visits; the use of per minute billing or the placement rather than potentially delighted to welcome the launch of a about methods of procurement such changing depending on the type of set of tools to assist local authorities as caps on price or the use of reverse accommodation someone lives in. with market development. These tools e-auctions. have been developed by the institute So, while there is plenty of detail to I am sure that all of these things happen for public care in partnership with the analyse and much work to do to take and sometimes inappropriately. Yet, department for health and ADASS and forward some of the specific proposals, other than reverse e-auctions, most of one of the advantages is that a support

ADASS Futures, October 2012 11 PROFILE

these practices can be used properly as Both in health and social care the We are engaged with the Local well as inappropriately. 15-minute visits majority of our resources will always Government Association in driving for things that take 15 minutes are fine: be spent on those with the highest forward the practicalities of sector- per minute billing can be used to enable needs and we must ensure that these led improvement - critical to ensuring flexibility, with the knowledge that time people receive high quality, personalised quality and driving improvement and delivered will be paid for. care and support. However, we will I am also co-chair of one of one of the not be able to afford this if we do not champion groups taking forward the ADASS has recently undertaken a survey do everything we can to reduce the Prime Minister’s Dementia Challenge in of procurement practice and I hope by numbers in this high needs group. We respect of improving care and health. We the time we meet at the conference need to work together in whatever hope that we will be able to evidence we will have the results of this survey. ways best suit local circumstances to real improvements through the actions This will help us in identifying ways in try and ensure that we prevent what is we take. which procurement practices could be preventable, support people to recover improved. As well as speeches and articles, there when this is possible and personalise have been new tools to use. I have Some further work is underway between care and support when there is an started to use Twitter (though not as ADASS and a number of provider ongoing need. regularly as some would like) and have organisations to try and improve tried web-chats as well as participated in transparency around the costs of and numerous tele-conferences; some more prices paid for care. This work aims to “Integration must not manageable than others! provide a building blocks model to be an aim in itself... assessing the costs of different types of The burden of work has been hugely care and also aims to split the costs of There simply must eased by the efforts of the ADASS team, accommodation and care which should the support of the vice president, past support any future implementation be added value.” president and the contributions of many of a Dilnot cap and also the potential other directors who work tirelessly to introduction of direct payments for We have been discussing with partners support and represent the association residential care. what it will take to move integration alongside their day jobs. from discussion papers and pilots to The appointment of a new ministerial reality. At national level there is a great Oh... And then there’s my day job! Huge team at the Department of Health brings deal of agreement between ADASS, the thanks go to my council leader and chief with it a renewed and determined focus NHS Confederation, the Royal College executive and executive members for on one of the other areas of work that of GPs, the British Geriatric Society supporting my undertaking this role demands quite a lot of my time and and others about what needs to be and to my fabulous team of assistant attention, that is “integration”. My firm done and we are working together to directors and many others in my view is that integration must not be an try and find ways to support this. Of department who have not only stepped aim in itself , it should be something we course, consensus at national level does in to cover me and act on my behalf, but consider if we believe that by working not deliver integration on the ground who have often been called on to assist more closely with others we will get locally but hopefully these different with national work... yes it’s good for better outcomes for those we are there professional organisations will at least personal development (!) but it’s another to serve - improved or faster access, set the scene and offer support for call on their time. Not to mention my PA better coordinated care or reduced costs local delivery. who rearranges my diary with endless to deliver outcomes that are least as patience and makes sure I always leave good... i.e. there must be added value. As I go into the second half of my term the office with the right papers, tickets I fully expect an acceleration in the and reservations. In the world of health and social care pace of reform as ministers and the there are a number if different areas Department of Health begin to move to It is a huge privilege to fulfil the role of of work where integration could be implementation phase. At the same time president of ADASS and, as I embark considered: commissioning of services, there are other substantial areas of work on the second half of my term I will access to services, assessment of need that demand attention: I have just taken continue to do my best to do justice to and delivery of services. Each of these on the role of co-chair of the Think Local the role. will have different potential partners. Act Personal Partnership, my co-chair What is clear is that, in the current climate is Martin Green, chief executive of the we cannot afford to duplicate effort or English Community Care Association run parallel systems and that it is a false (ECCA) and this will be one of the forums economy to wait until people’s needs are in which we will continue ongoing work Sarah Pickup at their greatest before offering support. with providers. President ADASS

12 ADASS Futures, October 2012 Tribute to Alf Morris

Morris major

There have been few MPs whose name is synonymous with an Act of Parliament that In 1976 I had the real luck when I went transformed millions of lives for the better. Aneurin Bevan was one. But the NHS Act he to work as a Special Adviser to David (later Lord) Ennals and particularly introduced was part of Government policy in the immediate post war years and was for Alf at the DHSS as it then was. My long in its formulation… job included writing speeches for Ministers, discussing policy with them, accompanying them on visits, and all local Labour MP – but his mother was the other things politically appointed loving and caring and the family stayed flunkeys are supposed to do. together, despite the younger children (including his older brother Charles who I got to see Alf at work and had the also became an MP) being temporary privilege of helping him. In private he evacuees from the part of Manchester was enjoyably argumentative with an they lived in during the early years of interesting collection of views aside the Second World War. Alf had a fund of from those on disability. Early in his lugubriously funny stories about his time career his independence over European as an evacuee. A bright boy, Alf ended membership had earned him the sack: up at St Catherine’s College, Oxford. but Harold Wilson did not bear grudges. Before winning his parliamentary seat Alf was never a great public speaker, in 1964 in Manchester Wythenshawe (at not charismatic and certainly never By contrast Alf Morris’s 1970 Chronically the second attempt) - which is where vain as a politician but he had qualities Sick and Disabled Persons Act was almost I first met him as a non-enfranchised of perseverance without rancour and a one-man effort: at first as a Private 20 year old student foot soldier in his was always open in a completely Member’s Bill and then, with belated canvassing force - he had already set out unpatronising and kind way to meet government assistance, it became a sprint his political stall: people who asked for his help. to get it onto the statute book before the end of that Labour Government. in a speech in 1957 to the Labour Party He persuaded Tory MPs to support Conference he said “what kind of a him in extending services to disabled Alf’s book No feet to Drag, written with society is it which allows people to make people. And after he had ceased to be Arthur Butler, gives a real feel for the millions of pounds in a day and other in Government his work in a variety of sense of desperate urgency underlying people to exist without even the price of disability causes was wide and usually his work. Over the years and particularly coal?” Plus ca change… successful until the very end of his life. in western countries similar legislation was subsequently enacted. His seat at Wythenshawe became one He was lucky (in retrospect) in that his of the safest Labour seats in the UK and time at the Ministry was probably the Alf’s legacy is world wide. A mark of much of that was down to Alf’s personal last knockings of post war consensual the esteem in which the Act is held was constituency work, even as a Minister. social democratic welfare politics: the that a Thanksgiving Service was held in Thatcherites were already at the gates He always said he was lucky with the draw Westminster Abbey in 2011 to celebrate with results that are still with us, and for for the Private Member’s Bill that became and honour the CSDP Act: the only other an emasculated Labour party. Act to receive this distinction was the the CSDP Act: for him that was a modest 1833 Abolition Of Slavery Act. Alf himself and unfashionable way of downplaying Parliament and politics are not what they was honoured by both Australia and his commitment, genial persistence and were. Alf was the right man in the right New Zealand for his work. drive to get things done and free up place at just the right time. people to lead better lives. What he had Alf’s early life was in a family living in experienced in his life drove him on. extreme poverty and hardship mainly as a result of disability. His father was Labour lost the 1970 election but seriously disabled in the First World War won office again without a majority in and died when Alf was only seven years February 1974. Alf was made the world’s old. His widowed mother at one point first Minister for Disability by that much faced admission to the workhouse with underrated Prime Minister Harold Wilson the children in institutional care. who had in fact set aside Government legislation to make way for the CSDPA in David Townsend was Director of Social There was no financial support as of 1970. Alf had an extraordinary longevity services for the LB Haringey and then right - even his mother’s war widow’s as Minister and then spokesperson on Croydon. He was political adviser to Lord pension had to be fought for by the disability for Labour, from 1970 to 1992. (then David) Ennals from 1976-79.

ADASS Futures, October 2012 13 Profile: RICHARD WEBB

A stronger, untidy future

His mother had a series of brain As a trainee, he would move between tumours which, although she was very different hospital departments, earning independent and made a good recovery the nickname of ‘Mr Benn’: “one day I after her first operation, meant that was in a white coat, shadowing a junior “there were times when I needed to help doctor; and the next I was in kitchen her more and support my Dad and, be overalls, washing pots…it taught me more self-reliant than other kids”. She a lot about what makes organisations Richard Webb died when he was 13, “and I did a lot tick; about how people are treated; and Born in 1971, “only days before the advent of growing up fairly quickly…” A silver about how I’d want to behave if I ever of decimalisation”, ADASS’s third honorary lining was a really close relationship with became a senior manager”. his father until the latter died in 2009. secretary, Richard Webb, was the only child Inside and outside of work, he enjoyed of – for those days – older parents, who When the time came Richard went with himself: “I learned more about life on the his politics, history and English A levels streets of Newcastle and Wallsend, than brought him up in suburban Portsmouth. to University. “I love Portsmouth now,” he I ever did as a student. I suppose I was IT MIGHT HAVE been a small family, says, “but at the time I wanted a change making up for the loss of my teenage but it had big roots. His mother had of scene.” So he chose Durham, where he years – I don’t know how I survived on so moved down with her parents from studied politics. little sleep!” West Hartlepool in County Durham in His student days (1989/92) were the Work-wise, a placement in the 1930s for them to find employment. years of Mandela being released and commissioning, producing a Mental His father was Lancastrian from the mill Gorbachev winding down both the Health ‘Patients’ Charter’ taught him a lot town of Nelson. He too moved south for Soviet Union and the Cold War which about the growing demands of people work in the 1950s to become a scientist had imposed such a tight grip on the to be far more involved in their services working for the MoD in Portsmouth. world’s imagination and creativity. His than hitherto. “Working in mental health, So from both his parents and original, young career ambition was learning from people with so much grandparents he imbued a sense of journalism and, even now, he’s still experience of ‘the system’, was a real having to move round to get work. It interested in how the media work. liberation – community care, with its long brought a whole package of values in its He left University with all the traditional term role in people’s lives, its values base train, and a sense of identity grounded uncertainties over what he wanted to do and its complexity, excited me far more on both sides of the Severn/Wash line. coupled with those equally traditional than working in a hospital,” he recalls. “I see myself as a Northern Southerner. idealisms and notions about justice After this, he worked as a manager for I grew up on the south coast and still and fairness. A number of careers the Community and Mental Health Trust enjoy going back there. But the north is beckoned, but finally he was drawn to in Gateshead: “one of those operational where my heart is – it’s a great place, so the NHS management trainee scheme: “I jobs, managing teams of domestics and varied and, at times, so underestimated suppose it was about wanting to make porters, which have largely disappeared by those who do not know it, and a difference,” he says. Where did that as services have been outsourced.” undersold by those who do .” impetus come from? Youthful idealism? He knew he wanted to work in direct Up to a point. And, as well: “a view about These northern roots are underpinned service delivery and within 18 months wider society and about other people. by family and friends, including Auntie he’d moved to a learning disability Betty (his grandfather’s last surviving “My parents were of a generation service manager’s job in the North Tees sister), who lives in an extra care where being kind to other people, and NHS Trust in Stockton. development in North Yorkshire. “She’s contributing to your community, was 97, absolutely on the ball, very forthright something that you just did. It was Initially, he was very conscious of not and good fun”. He’s recently been filming often related to people’s experiences having a professional background. Did her talking about her memories over the or personal beliefs…What they went it take much to overcome his lack of any last nine decades, including her lasting through in the ‘30s and ‘40s had really professional qualification? One thing he regret that although she passed the 11+, stuck with them and was instilled in me. loved about working in the community the family couldn’t afford for her to take It was ‘think of other people, not just was that it was about so much more up the Grammar School place she had yourself…’ always in an unflashy way,” he says. than diagnosis and treatment.“ I kept won… asking myself, in these circumstances, Possibly naively, he thinks now, he saw what would I want? What would anyone Another early influence was the fact working as an NHS trainee manager as want? It was all about people having an that, from the ages of 7 to 13 he was a way of trying to put those values into ordinary life and the best opportunity to effectively a young carer – “not that action: his first post was almost exactly fulfil their potential.” it ever occurred to me at the time.” 20 years ago, at the RVI in Newcastle.

14 ADASS Futures, October 2012 Profile

It was a baptism of fire, too – especially when dealing with the legacy of institutionalisation, in what were often seen then as ‘Cinderella’ services. “I remember I had three suspensions in my first month there because of issues about alleged abuse.” He recalls, too, going into a unit with four people sleeping in one room – “it was the way things had always been and there was no money to do anything different.” He didn’t necessarily know, at the time, how to put things right. But it gave him, as he says, “enough material to work on and think ‘I can make a difference here ’. And I don’t have to have a professional qualification to do it.” After a challenging year spent as a divisional manager for mental health within the Trust, he was appointed as Stockton’s first integrated general manager for people with a learning Richard in his home city of Portsmouth: a ‘northern southerner’... disability, moving across to Stockton Council, where David Johnston was He stayed in Stockton until 2005, ADCS. A great borough for a first director. Ann Baxter, currently director where one of his most important tasks directorship, Richard thinks, and it was of children, schools and families for the was to set up new drug and alcohol where he discovered ADSS. His first LB Camden was David’s deputy and services (“I felt this was a big issue for West Midlands regional meeting was Richard’s line manager. my generation; and it was an issue on an icy December day in Hereford that was overlooked and where many where he arrived early (unusually for He says: “Of all the people who have people were being stigmatised”), an him!) and linked in with a really strong really influenced my career, Ann has had interest which he sustained into his later network of directors. Since that point a huge impact. She’s a real inspiration. co-chairing of the ADASS mental health, “for me, ADASS always feels like coming She allowed me to take risks; taught me drugs and alcohol network. home” he says. His first spring seminar is how to handle conflict and to learn and recalled, sitting in a motel “somewhere For his final three years in Stockton, he be honest when things don’t always go near a roundabout at Hinckley” listening was director of service development, as planned.” There was a lot of laughter to impassioned debate about the fall of working directly to Ann Baxter and Chris too: “it was a great management team. ADSS and the setting up of ADASS and Willis, the local PCT chief, another big And Teesside had – and still has –lots ADCS. “Coming in new, that was quite a influence. This involved setting up joint of talented people in its milieu: along bizarre experience!” with David and Ann, Glenys Jones, David commissioning and overseeing the local Behan, Richard Jones, Penny Thompson implementation of the new GPs’ contract Four years on, in August 2009, he and Sallyanne Johnson were all either – “I became a big fan of primary care joined Sheffield as Executive Director, playing key roles there or had recently and a believer of the huge potential it Communities: “It’s a great job, a great city moved on to bigger and better things.” has within the NHS. In the context of the and a real privilege to be surrounded, yet latest NHS changes, I’m really drawing again, by lively and talented people.” He Come 2000, David Johnston had moved on this experience and enjoying working sees himself now as very much a local to Devon and Ann, his successor, directly with GPs again.” government director: “If we are serious about people being independent, living appointed Richard as assistant director His first director post was in Telford, the lives they want to live, then our agenda for adults at the tender age of 29: “it was following John Coughlan as the latter has to be much broader. For example, we a bit of a gamble, both for Ann and for moved on to Hampshire, and to help are ambitious about making Sheffield a me,” he recalls. “I wasn’t expecting to found the Association of Directors of dementia friendly city – that opens up new get the job and I just bounded in with Children’s Services. John subsequently territory about spatial planning, community enthusiasm and the aim of putting down became the last President of ADSS, safety, the retail offer.” Sheffield’s Chief a marker for the future.” and the first (joint) President of the Executive, John Mothersole, has been

ADASS Futures, October 2012 15 profile

and for the next generation as well. “The leadership development work which Jo Cleary and Brian Walsh are doing, and Samih Kalakeche’s work on equalities, demonstrate the Association’s commitment to actually doing something to break through those glass ceilings.” Looking ahead, he sees ADASS as being well placed to help shape the future of social care. “We’ve made the right calls on the big issues of the last few years: personalisation, prevention, Southern Cross, Winterbourne View. Others have talked about it; DASSs have done it. “ As citizens, we will all control things more individually He continues: “the challenges of influential in encouraging Richard to take reflects these new realities.” austerity, for us, are significant: they are that broader view. even more so for our customers. We As to his role as honorary secretary and need to continue to make the case for In April 2011, Richard succeeded current the way he sees ADASS developing fairness, for reform and for evidence- ADASS President Sarah Pickup as over the coming years: “I see myself as a based investment; and we need to use Honorary Secretary of ADASS. facilitator, supporting the President, Vice the Dilnot recommendations as the President and Trustees and the ADASS Looking back, the major changes in social starting point to push for a long term headquarters team in particular; working care he has witnessed and been inspired settlement for social care in this country with the regions; and, often behind the by, lie in the shift in power between which is enduring and progressive. scenes, using the role to support and people who use services and their carers, encourage directors in the work that “We have to be aspirational and and the people who commission and they are doing and drawing them into ambitious. And we need to look beyond provide them. “It’s been a big journey for making a national contribution. “ the day job and beyond our borders, individuals and organisations, and it’s too – for example, the rest of Europe has fascinating now, working with the NHS, Trustees have recently been thinking important lessons for us about social knowing they’ve still got quite a lot of about how to apply some of the lessons care’s role as a potential economic growth that journey to make. You just have to from their day jobs as directors in their sector and source of wider innovation.” recognise that you gain more by sharing work with ADASS: giving more time and power than by controlling it.” space to shaping what they do, becoming Fascinated by the future, he talks more inclusive about how people can glowingly of experiments in Denmark And in terms of the Association, he’s get involved with the Association and where directors are talking to engineering a huge fan of the new extended strengthening corporate governance. faculties about how you redesign care membership. Yes, “it’s important we All of this without becoming overly and support services. “We really do need keep true to our values as a directors’ structured and bureaucratic: “ADASS’s to talk to people with different skills if we organisation. That means, it’s also strength is founded upon the huge are going to solve the problems of the about developing the next generation goodwill and voluntary contribution that future rather than simply re-trench into of people who will be leaders of social comes from so many directors across the the past. I prefer big tent to small clique.” care – citizens, people in managerial and country,” he says. professional roles. There’s something Married to Steph – the day of our interview really positive about that. “I’m passionate about how we bring was their ninth wedding anniversary – he new voices to the fore. And I’m really enjoys arts (“David Hockney at the Royal “There’s also a journey for us all about keen that we seize the opportunity of Academy was amazing!”) music, theatre, opening up what we do, mirroring an expanded membership to harness dining out and reading. And he loves a society that is increasingly more the diversity of the Association. As a walking – he’s planning to do Hadrian’s personalised and more digitalised. leadership organisation we need to get Wall shortly - and although he enjoys The future will be untidy. As citizens, much, much better at reflecting the company he also appreciates solitude: we will all control things much more diversity of modern society. We have time away from Blackberrys and phone individually. The idea that we can box a daily mission to break through glass calls – even Twitter! things off and manage in the way we ceilings – not only for the people we did ten years ago is gone. And we need serve but also for ourselves as directors to support communities in a way that

16 ADASS Futures, October 2012 Cutting edge

The stories behind the stats

There is an old adage in journalism, which Over the past 18 months, social care has have been a rarity on some newspapers, is frequently passed down from jaded hacks not just been one of the biggest stories but barely a week went passed without in local government; it has been one of one on our title. to fresh-faced trainees that you should the biggest stories in the country. Barely Among the many, and I do mean many, never be afraid of writing big stories, a day goes by without the national people I had the privilege of meeting press carrying a story about Dilnot, care because they are the ones that always were two veterans of the First World War homes or key council services closing as – one of whom was still living in his own write themselves… a result of public spending cuts. home at the tender age of 104 – and But the all-consuming monster, which a woman who had served as a private is the 24-hour news cycle, means that it secretary to Anthony Eden during World is all too easy to get story fatigue these War Two and had been present at Yalta days. Demands to reform how social care when Winston Churchill, Franklin D. services are funded have almost become Roosevelt and Joseph Stalin all signed almost a daily occurrence, as have that historic agreement. She said she Jamie Hailstone reports highlighting incidents of poor could still remember the stench of practice somewhere around the country. Churchill’s cigars, which he puffed away on from dusk to dawn. Now you might find this hard to believe, but journalists can become quite blasé But not all of these anniversaries were about the subjects they cover. The joyous. There was one 100-year old popular image of a reporter as a tired, who had no living relatives and was just flea-bitten, cynic is not entirely without sitting in her nursing home room alone. truth. No sooner have we carefully After taking her photograph, I asked researched and filed a story, than we the staff for a bit of background and are working on another one. By the was told that this particular woman had time the magazine/newspaper hits the been cut off from her own family and stands, your hard working and humble institutionalised at a very young age. correspondent has usually forgotten She had given birth outside of marriage all about it and is trying to get their in the 1930s and like others at the time, head around some equally complicated was promptly committed to a mental subject. institution. We can all quote endless statistics, The baby was put up for adoption which show the number of people using shortly after he/she was born and her personalised budgets or the impact a mother never saw her again. The poor £35,000 funding cap might have on the woman was kept in an asylum for many elderly. But, as a journalist tutor once years and looking into her gaunt and informed me, we must never forget that lifeless eyes, you could only wonder behind every story is a real person, with about the person she could have been relatives and loved ones. The sector is if society and the social care system facing a great deal of upheaval in the of the day had helped her instead of next 18 months, with pressure from condemning her. all sides, but no one can afford to lose They are all good examples of where sight of the fact that we are dealing with social care matters and why it is real people and not just meaningless important that we get this chance to numbers. reform the system right. Although the I was very lucky – or unlucky, depending less said about the 100-year old who on your point of view – to spend wanted to know if Hailstone was my several years working as a reporter for real surname the better. a local paper in West Sussex. It will not “It’s such a silly name,” she told me. surprise you to hear that West Sussex “I thought you must have made it up.” has a very high number of elderly and older residents. Diamond wedding Jamie Hailstone is a freelance journalist, anniversaries and 100th birthdays might who regularly contributes to The MJ

ADASS Futures, October 2012 17 An Open Letter to the Minister

Dear Secretary of State You are very enthusiastic about your The log jam is caused by the financial There is general agreement that new Cabinet post and have taken issues. In an age when the challenge is the Dilnot recommendations are responsibility for key policy issues which to reduce public expenditure the last sensible and workable. It does seem will remain in the national spotlight. thing any government wants to be faced proportionate for people to retain assets So you have a lot on your plate. My with are demand-led requirements of £100,000 before bearing the full plea here is that you take an early for increased investment in both the cost of care themselves and a cap on opportunity to break the current log jam quantity and quality of care. However, personal payments at £35,000 produces affecting social care. this problem has not been solved in the a reasonable balance between individual past 50 years and the list of competing and state liability. Variations can be The key issue is not as intractable as priorities for investment grows ever made at the margins but the principles some make out. However, if major longer. are sound. decisions are postponed now the problems will become more difficult, A more constructive approach is to There have been rumours over the the pressures more intense and current seek sufficient funding from existing summer that the government wants to strengths put at greater risk. resources as an input to the forthcoming reduce uncertainty by determining this spending review, rather than an ahead of the spending review. It should I must declare a personal interest. I outcome from it. Otherwise existing and do so – at a stroke this would relieve am now in my mid-sixties and may potential service users will be uncertain, thousands of individual anxieties and well be in need of social care support existing services could collapse and create a firm base on which to move when the years take their toll. It is a social care will absorb an increasing forward with purpose. salutary perspective for me that when proportion of the budgets of principal I first started grappling with these It is estimated that this will cost councils to the detriment of other local matters professionally in 1968 I never government an extra £2 billion which requirements. anticipated that we would not have it does not have, but there are already a fully comprehensive or affordable There is no magic wand, but with a cool significant shortfalls in funding; if system by the time I became a potential and proportionate approach there is the demographics create more demand and service user. potential to find a solution which does personal choice increases that is inevitable. not require a massive increase in overall A major contribution to this can be Demographic trends mean that we are expenditure. I am not under the illusion made in the short term by reconsidering living longer and are relatively more that a solution is easy or straightforward, universal benefits to older people. prosperous than previous generations. but something significant is achievable. Quality of life is vital to us all and we must At present £5 billion is paid to 11 million This approach is based on three use all our resources, as individuals and pensioners without any assessment of elements of financing – the level of nationally, to ensure that we can face the need or means. This includes £2.2 billion personal contributions, increased future with certainty and optimism. in winter fuel allowances, also free eye funding for immediate shortfalls tests and prescriptions and over £1 Substantial progress has been made and longer term sustainability. I will billion in free bus travel, all for the over over the past few years. Need is approach them in that order as there is 60s, and £60 million for free TV licences assessed more carefully and services an ascending level of difficulty. for over 75s. Clearly many have need of more closely tailored to those needs. There is general acceptance that, unlike these provisions to support their quality Service users and their families have health care, people with means should of life, but many others are in a secure better information, more consistent care contribute to personal care at the point financial position and could fund these responses and increasing control over of need. Fifteen years ago the majority of costs themselves. the way services are provided. Principal a Royal Commission recommended this local authorities have designed better It is a massive political risk to cease these should be free, but this is unaffordable systems, worked more consistently in payments as part of the austerity savings and probably unnecessary, although partnership with suppliers and user programme. However, reallocating there is some resentment about its being groups and devoted more resources to say £3 billion annually would provide implemented in Scotland. However, meeting demand. significant underpinning for sustainable the current low disregard level and adult social care in the short term. This Your Department has worked open ended personal liabilities are will not be popular, but at least the constructively with the LGA, ADASS and unreasonable barriers to achieving benefits are being transferred within others to plan for the future and the fairness, particularly for those who have the relevant age group to those most recent White Paper and draft Bill provide been prudent in managing their own deserving of financial support. the right framework for the development resources. of a value-based, comprehensive service.

18 ADASS Futures, October 2012 An Open Letter to the Minister

Councils must play their part too. They Your Department has relieved pressure must ensure that processes are carried in the system by injections of cash; out with optimum effectiveness so that what is needed now is a change in resources are used for their intended the system. Social care must remain purpose. Councils are proven as the the responsibility of local authorities most efficient part of the public sector because so much of its success depends and efficiency savings alone cannot on the fit with other local services. solve the shortfall. However there is still However, there should be a financial John Ransford was until recently Chief too much caution about what can be plan which shifts resources on a Executive of the Local Government achieved and we owe it to the taxpayer progressive basis to social care so that Association. Formerly he was Director to ensure all avenues are explored. It demand is reduced for clinical and acute of Social Services for Kirklees then North is not unreasonable to ask councils services. This will require transitional Yorkshire before becoming Chief Executive to account for the measures they are bridging funding but the long term for the latter county. He was also Honorary taking to use resources effectively and gains are enormous through the efficient Secretary of the ADSS, 1994-97. imaginatively and to work with each deployment of resources and increased other and specialist advisers to improve personal contentment and quality of life. their performance. This will not be easy to achieve. There The clue to longer term sustainability is major concern from politicians, is in your job title – Secretary of State professionals and local communities for Health. Since the inception of the which manifests itself in resistance to NHS your post has been principally change. Nothing I am putting to you is identified with it. That is because of its new, but the context we all share is that proven excellence and national affection there is no hope of a ‘golden goose’; all for it. But the bulk of NHS resources are predictions for the state of the economy committed to acute and clinical services, suggest that substantial growth in public primarily for the unwell and injured. This expenditure is a thing of the past. government has already made a major We must seize the moment now, commitment to prevention by realigning otherwise the long grass will simply public health with local authority choke us. If you demonstrate leadership responsibilities. The key task now is to in taking the initiative I predict you promote and maintain optimum health will be rewarded by a widely-based so people use expensive intervention commitment to overcome problems and and curative services when they create a comprehensive, lasting solution. are needed, not as a substitute for A costed implementation plan should be something else. submitted to the spending review. That A decade ago the NHS benefited from will be a real service to people who need massive resource growth in real terms the right support to live dignified lives. and, despite currently having to find efficiency savings, absolute funding cuts have been avoided. Social care Yours sincerely funding has been squeezed by grant reductions to councils. If we are serious about health and wellbeing this balance must be shifted. This is not ‘robbing Peter to pay Paul’; it is providing the right response to assessed need by having sufficient service responses in the right place at the right time. In this context, notions like ‘bed blocking’ can really be John Ransford a thing of the past.

ADASS Futures, April 2012 19 Norman lamb

Power to the people

Barely a fortnight into his new job as Care Futures: What do you think are the delayed discharges and for encouraging Services Minister at the Department of three biggest challenges facing social integration. I support that approach, care? And how are you preparing to and will continue to support it into the Health, Norman Lamb gives Drew Clode meet them? future. some of his first impressions of the job, the Norman Lamb: Firstly there is the The second challenge is the whole issue sector, and the tasks that lie ahead financial pressure on the existing of integrated care. I’m a very strong means-tested system – the system that advocate of integration, and this ties in local authorities are responsible for and with using the money to the greatest Norman Lamb commission and in some circumstances effect. From the individual citizen’s point deliver. And the backdrop to this that Constituency: North Norfolk of view the divide between health and over the last decade there has been a social care doesn’t actually make much School: Wymondham College very significant investment in the NHS sense. Too often in the past it’s led to a that has not in any way been matched sort of blockage in terms of being able Universities: Leicester; City by the level of investment in social care. University, London to provide seamless care and support In simple terms; in terms of people’s services for people in need. Parliamentary career needs, services that local authorities 2001: Entered Parliament But if you look around the world – if you often provide are preventative services. look around the UK - the best systems Appointed Lib Dem Deputy It’s always seemed to me to be bizarre where money is being used most Spokesperson for International that we’ve invested so heavily at one end effectively to achieve the best results, is Development of the spectrum – the NHS end – but not all about shaping care around the needs so much at the preventative end. of the patient and service-user: not 2001: Shadow Treasury Minister in around the institution. This requires a the party’s Treasury Team The fact is that we’re all having to live with this extraordinary challenge to fundamental shift. January 2003: Elected to the public finances and the level of the It goes hand-in-hand with the whole Treasury Select Committee deficit and we have to get that under personalisation approach of which I’m October 2003: Appointed PPS to control. It’s in all our interests to do so. a strong supporter and which I regard Charles Kennedy. So the first challenge is the general as a quite Liberal approach – although I appreciate all parties have supported 2005: Liberal Democrat Shadow pressure on resources and the need it. It is a Liberal concept of giving power Cabinet, with responsibility for Trade for me to maximise as far as I can the to individuals which is a very important & Industry amount available for the care system. And then for us to try to make sure principle which we need to sustain. March 2006: Appointed Chief of that we use the money as effectively as Futures: What, to you, does good Staff to the Liberal Democrat Leader possible. integration look like? Ming Campbell Futures: There’s a continuing case Norman Lamb: I describe it as trying to December 2006: Liberal Democrat to be made for reallocating funds meet the needs of the service user or Shadow Health Secretary from the NHS into social care in some patient rather than an institution ‘saying way, particularly if it helps make the this is what we offer’. That means you 2010 Chief parliamentary and NHS more efficient. Is that the sort of political advisor to Nick Clegg MP and investment that you would like to see have to break down the institutional an Assistant Government Chief Whip in a way that would help bridge the barriers and just work effectively together funding gap? to deliver that service. I don’t think that Norman became Chair of the Liberal means you have to set a one-size-fits-all Democrats’ Federal Policy Committee Norman Lamb: I certainly think that model to how it’s achieved. That’s where in 2010. there’s a logical case for it. In my view we local innovation is quite important. just need to look at the whole system and the impact on the individual patient But you have to get the right incentives or service user and where it makes sense into the system to allow it to happen, to spend the money. It seems to me to rather than it happening as it tends to make sense to ensure there is a sufficient now almost despite the system rather resource for preventative care. than because of it. I’m convening a round table to get the key people The approach that‘s been taken so far is who’ve done all the work on integrated an approach that I support: transferring care together to work with the resources for reablement, for tackling Department.

20 ADASS Futures, October 2012 Norman lamb

But for me this transcends narrow party politics. No solution is easy or politically sexy in terms of how it’s paid for. So – we know we’ve got to do it. Let’s have that discussion across the parties. Futures: You were involved in the original cross-party discussions. Norman Lamb: Yes, I initiated them. I talked with Andy Burnham and Andrew Lansley. Got the three of us together in a room. We met twice and agreed to try to produce a statement of shared principle. I got drafts from the two of them which I was shaping into a shared document. But this was in the run-up to the general election, and was rather de-railed by a bare-knuckle fight over death taxes, if you remember… That rather demonstrates my commitment to cracking this, but also the approach I want to take. I’m not a tribal politician. I’m interested in making Richmond House, Whitehall progress on this. Firstly this will be to discuss with There’s a genuine sense of unfairness Futures: Moving on, how far do you the Department and the NHS there. So then the question becomes think that Health and Wellbeing Boards Commissioning Board how we can really whether or not we can pool our resource will adequately bring local government priorities into the overall debate. Are make this happen. Chris Ham from the to protect those people who suffer the they sufficiently well-structured to do King’s Fund said in January that in the catastrophic loss. And there is a strong that? past ten years the NHS had an obsessive case for doing that, therefore I support focus on cutting waiting times and the Dilnot solution, and finding a way Norman Lamb: They give us the improving access to the service. But in of paying for it so that we can bring opportunity to do that – a big advance this decade there needs to be a similarly this long-running saga to a successful really. Up until now there has been this obsessive focus on delivering integrated conclusion. pretty absolute intuitional divide. There care as a model of care. have been some impressive exceptions Futures: Good to hear that you accept to that rule. I admire the attempts to Dilnot in principle. Nick Clegg recently I agree with that. No organisational bridge this divide – North East Lincs, restructuring, you’ll be pleased to hear! spoke of redistributing universal benefits from older people in order to Hereford, Torbay, Kingston in London. Then the third element is the asset fund the recommendations. This is one The HWB creates a platform to achieve it protection: the Dilnot question. I way, perhaps, of funding Dilnot and across the system. It’s now up to us all to completely accept that there is a maybe the funding gap. Do you have make the most of the opportunity. any views on that? fundamental sense of unfairness about Futures: There have been some fears the way the system works. That if you Norman Lamb: The Institute of Fiscal that the HWB will have its powers have budgeted carefully through Studies report have set out a list of curtailed by the NHS Commissioning your working life and protected your options for how it could be funded. Board. Do you have a view on that? resources in order to provide for There may be others that the Institute Norman Lamb: I really do not want HWBs yourself in your older age, then some didn’t deal with. There are a number of to be talking shops, but active advocates catastrophic situation hits you – through options to consider. So let’s just work of change. To really shift towards an dementia or some other condition - and through those, and try on a collaborative improving community and public health you lose everything you’ve worked for. basis with the sector - in my view it’s and bringing a new focus to prevention Then you look next door at someone much better if you try to do it on a cross- which we haven’t had in the past. who has no assets in retirement who party basis. gets everything paid for…

ADASS Futures, October 2012 21 Norman lamb

Futures: Are you happy at the way Does that make me a sad man? I thought public health is settling into local it was really interesting because social government and that it is settling care is so much shrouded by fog. the joint responsibilities to the local Potential providers aren’t aware of authority and Public health England? gaps in the market which they might Norman Lamb: Again I think this is a fill; families have no idea, often, what genuine opportunity. Of course, we’ll might be available. If local authorities always listen to any concerns about could play a central role helping people what might be happening. But it’s long understand their local markets better, overdue for us to align our public health and therefore help the development work with other local services. Tucked of that market, it would be immensely attractive. away in the NHS it often didn’t make Norman Lamb it possible for practitioners to effect I have a 93-year old mother, and the change. responsibility, which can block people, family and I are looking around for Futures: Are you happy with the pace taking that up more widely than might support services as and when they might at which personalisation is being rolled otherwise be the case. be needed. And I have no idea what out across the country? Working alongside ADASS and local might be available, and I don’t know Norman Lamb: I take the view that local government I’ll want to push this: where to go… An awful lot of people government has been capable of being to acknowledge the work of those who get to that point – particularly far more innovative and transformative fantastic authorities who have been truly on the self-funder side – have no idea than often central government has transformational. But to say to the ones what might be available, and the been over the years. ADASS can take lagging behind “ look what can be done, local authority can play a fantastically enormous credit for what has happened and make sure you give really power to valuable role in helping them. in local government. Personalisation was individual service users.” There’s a quiet revolution going on out a very good example of that. In many Futures: With Southern Cross in mind, there about how citizens are treated. circumstances you have taken a lead who exactly should be accountable for We’re not there yet, but we are making and government has recognised what the financial viability of care providers? real progress. This is a shift from a was happening and then given an extra paternalistic state, to a situation where push. Norman Lamb: This goes to the we genuinely give power to individuals. I regulatory framework and whether one Am I happy with progress? I’m absolutely appreciate there’s mixed picture around can do anything to that to guard against the country, but it’s exciting. not complacent. Real progress has financial models that are not sustainable been made, but we need to go much and that therefore may put residents’ At times of great economic train we’re further. The draft Bill sets a right to have safety or health and wellbeing at risk. forced – and this would be the case a personal budget. But someone said to whoever was in power – to think afresh me yesterday that there are places where There is a transfer of risk going on about how we do things and how we the authority has set out a care package between public and private sector with use the money available. There’s an they thought the individual should have, the commissioning of care from private enormous onus on all of us to really and then asked for the individual to sign homes. Inevitably there are some limits challenge ourselves on this because any it, and then it’s called PB. to the risk that you are transferring money wasted is money not going into because the bottom line is we have a the care of people who need that care. We have to guard against that. I’m in no responsibility to protect people against position to judge whether or not this catastrophe. It is hard to escape from Austerity forces us to think afresh, and is widespread, but that isn’t really any that: we live in a civilised society where I’m excited by the response that leads transformational change in terms of we must not let allow older or disabled me to believe that we can achieve giving power to the individual. I don’t people to face that sort of crisis. a more rational use of resources via know if that’s an isolated example or if a combination of giving power to there’s a wider problem. Obviously, the But it’s early days yet, and I haven’t come individuals, integrating care and looking direct payment is the most powerful, but up with an easy or simple solution. in a powerful way how we can improve I do recognise some people are nervous I want to look at what can be done the health of all out community. about taking on that responsibility. through regulation to seek to guard against this sort of thing happening in There are great threats out there because I do wonder if we can make it easier future. of the state of our public finances. But for people to take on that burden. As a there are great opportunities as well, and former employment lawyer I understand I was very excited by the IPC launch of that gives me great cause for optimism. that employing someone is an onerous their market facilitation programme.

22 ADASS Futures, October 2012 Registration

Accentuating the negative?

At midnight on July 31 this year the General Our new name (we were previously “We are investigating Social Care Council (GSCC), who had been the Health Professions Council) better describes the 300,000 professionals from proposals … to list only the regulator of social workers in England the 16 professions working in the health, since 2001, was abolished and its register psychological and social work fields that those who fail to meet of 88,000 social workers was transferred to we now regulate. specified standards rather the renamed Health and Care Professions The decision to close the GSCC was than those who do…” Council (HCPC). announced by government in February 2011 when the Command Paper Since the announcement of the transfer ‘Enabling Excellence: Autonomy and my organisation has committed to Accountability for Healthcare Workers, engaging with the social work profession. Social Workers and Social Care Workers’ Our Chair, Anna van der Gaag, joined was published. To complete the transfer the Social Work Reform Board and my on time required considerable planning colleagues have been meeting and and hard work by everyone involved engaging with employers, charities and across the two organisations. Our past other stakeholders through a range Marc SealeSeale experience of taking on the regulation of activities. We have just completed a Chief ExecutiveExecutive and and Registrar Registrar of hearing aid dispensers, following the series of social-work-specific events for Health andand CareCare Professions Professions Council Council abolition of the Hearing Aid Council, educators, employers and social workers as well as operating department throughout England. This has been an practitioners and practitioner excellent opportunity for us to listen and psychologists joining our Register, learn about the social work profession. was put to good use. In order to build on the success of the initial transfer we now need social workers and their employers to ensure that social workers in England renew their HCPC registration by 30 November 2012. If they fail to do so their registration will lapse and they will not be able to practise using the protected title ‘social worker’.

ADASS Futures, October 2012 23 Registration

“As part of the renewal process we are asking social workers to declare that they will meet our standards on an on-going basis.” Unlike the previous regulator, the HCPC renews the registration of each profession it regulates once every two years. This will make it significantly more inputs. This means that we do not set a We have started to explore a range of straightforward for employers to check minimum number of hours that social options in collaboration with other whether a professional is registered. We workers will need to spend undertaking agencies to establish an efficient and also provide a multiple registrant search CPD; rather their focus will be on the effective regulatory regime. These in the employer section of our website outcomes of their learning activities include an analysis of the advantages where HR professionals and managers and the impact on their practice and and disadvantages of voluntary and can ‘cut and paste’ up to one hundred service users. We hope that, like our statutory regulation of managers of individual registration numbers onto existing professions, social workers care homes. We have also met with a web page for an instant check on will embrace the challenge of seeking the Care Quality Commission (CQC) registration status. out opportunities for learning and for explorative discussions on how, as As part of the renewal process we are continuous improvement. regulators of systems and professionals, we can improve our cooperation. also asking social workers to declare Social workers must still maintain a that they will meet our standards on record of their learning supported We are also investigating alternative an on-going basis. These include the by evidence and we will begin proposals for regulating adult social standards of conduct, performance and randomly auditing social workers’ CPD care workers in England, including ethics (which replace the GSCC’s Codes in September 2014. I would ask for keeping a ‘negative register’. This is of Practice). These multi-profession employers’ support for social workers a new regulatory approach used in standards describe the behaviours we making this transition and also for parts of Australia and elsewhere with expect every professional registered those audited in the future. I hope that unregistered health and social care with us to adhere to. you will agree that our focus on the workers. It operates by listing those There are also the HCPC’s standards improvement in quality of practice and who fail to meet specified standards of proficiency for social workers in the impact of learning on service users rather than those who do, thereby England which are the threshold is a positive step forward in social work addressing instances of poor practice standards for safe and effective practice. regulation. in the workforce in a more expeditious All newly qualified social workers way. Such a system has the advantages should meet all of these standards. “Our focus on improvement of lower costs and simplicity compared to the traditional UK model of statutory However, experienced social workers in quality of practice and are only required to meet the standards regulation, but it will require legislation. relevant to their scope of practise. This the impact of learning on However, a considerable amount of flexibility allows us to recognise that a work remains to be done. Our initial professional’s scope of practice changes service users is a positive proposal was presented to the Council and develops throughout their career. of the HCPC on Tuesday 18 September step forward in social 2012 and we will now begin the process The third set of standards which social work regulation.” of taking the work forward. We are workers in England must meet is our committed to working with stakeholders standards for continuing professional Now that the work relating to the initial across health and social care and intend development (CPD). These standards transfer has been completed, the HCPC to put proposals to the Department of represent a shift away from the approach is addressing the challenging issues Health. of the GSCC’s system of post registration around models of regulation for the training and learning (PRTL). The key to adult social care workforce and social I look forward to our continuing work our philosophy around CPD is the focus care workers in England, highlighted with the whole sector on these exciting on the outcomes of learning rather than in the government’s Command Paper. and challenging developments.

24 ADASS Futures, October 2012 Integration

An end to silly arguments

The quote below is from the King’s Fund “INTEGRATED CARE IS essential to meet Clinical Commissioning Group, Dr report to the Futures Forum. Here, John the needs of the ageing population, Stephen Richards, that I would spend transform the way that care is provided two days a week based at the CCG’s Jackson, chair of the ADASS Resources for people with long-term conditions and headquarters. We chose Mondays and Network, shares some of his experiences enable people with complex needs to live Thursdays because those were the days in Oxfordshire: how the county’s adult healthy, fulfilling, independent lives. It can that the GPs leading the CCG would be be delivered without further legislative there. These arrangements have been social care and NHS are trying to turn change or structural upheaval.” in place since September 2011 and our the principle into reality expectations are that they will continue My only criticism of the King’s Fund indefinitely. quote would be the final sentence. It implies that integration is relatively From my perspective, the time spent at straightforward. If that were true then CCG headquarters has been invaluable. we need to understand why there has It has meant that I am available for been so little real progress across the meetings with GP colleagues and their country. In fact, this is complicated managers. It has also helped to develop because it requires us to work on a our understandings of each other’s John Jackson number of different aspects all at the perspectives and the variety of views Oxfordshire County Council same time. within both the GP community and also other health colleagues. Thus it has Chair, ADASS Resources Network The starting point has to be the day strengthened relationships with provider to day relationships that exist on the clinicians as well. As we go forward I ground between people working within anticipate that other senior managers health and those working within local within adult social care in Oxfordshire government. If these relationships do will move to a similar pattern of working. not exist or they are based on mistrust, then there is no possibility of delivering One of the things that we have all learnt integrated care whatever is in place on is that most of our activity and efforts the ground. are focused on the same people. Our service users are also the patients with Two anecdotes illustrate this point. In long term conditions who consume her inaugural Presidential address at 70 per cent of the NHS’s budget. What this year’s spring seminar, Sarah Pickup they want from us is a seamless service referred to GPs whose views of adult irrespective of who is meeting their care social care being had been formed by a needs. “Achieving integrated care would bad experience several years ago. This is be the biggest contribution that health not surprising. If we don’t have contact and social care services could make to with people very often we are inevitably improving quality and safety.” going to think negatively of them if our only experience was negative. The fact that we are in the process of commissioning all our social care from Recently, I had a conversation with external providers makes it impossible to someone prominent nationally within deliver the care trust option of bringing health. He recounted a story of a local all service providers together. However, authority colleague who was looking it reinforces the importance of better co- forward to getting their hands on ordination between care providers and public health money so that it could ensuring that there is better information be spent on mending potholes. This for health and social care professionals comment may have been flippant but – GPs, secondary clinicians, community it does not help with our relationships. health professionals, social workers and How on earth can we be trusted if our occupational therapists. real agenda is in conflict with health colleagues? In this way they will get to know what services are available and how they can Last summer I agreed with my Chief be accessed quickly. To do this we are Executive, Joanna Simons and the in the process of implementing a Single Clinical Lead Officer for the Oxfordshire Point of Access which is aimed at health

ADASS Futures, October 2012 25 Integration

Total spending is probably £200m a year. This will require both organisations to understand the risks they face pooling resources. It will require both organisations to be satisfied that the individual budgets being pooled are appropriate and adequate. Longer term, we will need to look at bringing in the budgets spent by the CCG on urgent (or unplanned) secondary care for frail older people. Our best estimate of this is that this is another £200m a year. However, this will be much more difficult to deliver due to the . There has been excellent GP engagement in the Board tariff arrangements governing secondary care (a subject worthy of its own article). Clearing the mists in Oxfordshire Above all of this is our Health and Wellbeing Board (and its three supporting and social care professionals and not the organisation that speaks for people Boards). Six GPs have personal roles general public. This will sit alongside with physical disabilities in Oxfordshire. but there has been much wider GP the public facing services of the county We believe that over time (and with engagement as part of the discussions council’s health and social care team the development of a genuine pooled of our health and wellbeing strategy. We in our Customer Service Centre and budget here too) it can lead to the have also had good engagement of our the 111 service that is being set up in improved outcomes and better use of two largest provider trusts. It has been Oxfordshire. resources that we have achieved for helped by the work being led by our joint adults with a learning disability and It is also crucial that our commissioning Director of Public Health. He has been adults with a mental health problem. is integrated. Within Oxfordshire (like able to build up over a number of years, many other areas), we have achieved this We are also committed (as one of our excellent relationships with both the NHS both for people with learning disabilities targets in our Health and Wellbeing and local government (including our and mental health problems. In the case Strategy) to coming up with a joint district councils who have a crucial role to of learning disabilities, we have had a strategy for supporting frail older play on the wider health and wellbeing single commissioning strategy, a lead people by next April. It is clear that in agenda). commissioner and a genuine pooled the past we were inclined to ‘do our We consulted extensively on our draft budget for a number of years. This is own thing’ and develop a variety of new Health and Wellbeing Strategy earlier supported by integrated teams bringing services without seeing how they were this year. We are proud that the final together social workers, occupational integrated with other services or being version is held in such high regard not therapists and health professionals clear how we would measure success. I only within Oxfordshire. employed by the local provider of health expect that as we work together we will services. identify gaps in services, duplication of I don’t want to give the impression activity and some services that need to that we have cracked things here in As a result we are delivering relatively be decommissioned. the county. As an area with continuing good outcomes for people with a problems with delayed transfers of learning disability and spending If this is to be successful then we have care we clearly have not. In addition, relatively less on meeting those needs. to bring the money spent on frail older like everywhere else, we face the dual We have been able to move on from the people together into a genuine pool pressures of demographic challenges silly arguments about who pays for care to overcome the silly arguments that I and financial restrictions. However, we when it is clear what the right solution is described earlier. Both Stephen Richards will only manage these challenges if we for the individual service user. and I have said publicly that we want to work together. If we don’t do this then see this in place as soon as possible. Our In the last few months we have come we are certain to fail, and let down the current plan is to try and bring together up with a joint commissioning strategy people of Oxfordshire. all adult social care spending on older for adults with a physical disability people and community health spending John Jackson or long term condition which has on older people into a genuine pooled Oxfordshire County Council. been co-produced with the user-led budget by next April. Chair, ADASS Resources Network

26 ADASS Futures, October 2012 towards excellence

Driving home improvements

It is now getting on for 18 months since All of these components rely on good which was discussed at the TEASC board the Towards Excellence in Adult Social Care information to support improvement. on September 13 this year. From the outset, this has been seen by As well as moving forward quickly in the (TEASC) board began to develop the model TEASC as the essential enabler for the autumn with an interim development, of sector-led improvement in adult social care model of sector-led improvement to through agreeing a set of base data work. Information capacity has been THE CARE QUALITY Commission’s from councils, the report describes lost over the last few years, as the CQC (CQC) annual performance assessment three broad options from April 1 2013, assessment process ceased and as a of councils’ adult social care was ranging from the minimal option of result of the ever increasing pressures on abolished in November 2010, and repeating the production of Adult Social reducing resources. the Local Government Association Care in England next year, to taking the (LGA) reached agreement with the The remaining national collections opportunity now of deciding what types Department of Health(DH) to develop provide only a limited set of information, of information are needed to support and implement the model in adult and there is in any case a significant improvement, reflecting the priorities in social care in line with their three core time lag before these data are available. the Care and Support White Paper and as principles: councils are responsible for ADASS has been working closely with service become more integrated. their performance; they will be held the DH on the zero-based review of It is not difficult to get enthusiastic to account by local citizens, which will data, with both trying to strike a balance about the opportunities, but of course lead to further improvement; and they between wanting better information on we must respond in the context of ever will take collective responsibility for the outcomes while reducing the burden. reducing resources, while making the sector as whole. The new collections will start next year, most of tools such as LG Inform, which and will not be available to support The TEASC board is made up of ADASS, will be publically available from the improvement until 2014/15. the LGA. DH, CQC, the Society of Local autumn. Sector-led improvement both Authority Chief Executives (SOLACE), the The challenge facing the TEASC board needs good information to support Think Local Act Personal Partnership and has been how to make sure good it, and the information itself will drive the Social Care Institute of Excellence, information is available for different further improvement. The next few chaired by ADASS. This is, by any kinds of uses at local, regional and weeks provide a window of opportunity standards, an impressive partnership of national levels in the context of reducing to think through what information we the adult social care sector as a whole, resources. Benchmarking performance is will need, and to get involved in the and they have been determined to co- at the centre of regional plans for sector- discussion. produce the model. led improvement, and so there is real

momentum behind the steps to be taken The key components are now being to provide the information necessary. assembled and implemented by the ADASS regions, in effect in real time. Two important steps forward have now ADASS has agreed the mandate for its been taken. The first is the publication role in sector-led improvement, and at the NCAS conference of Adult Social regions are gearing up programmes Care in England, produced by TEASC. of challenge from one’s peers, as This started life at the beginning of the practical demonstrations of collective year, under the somewhat uninviting responsibility for improvement. Most working title of ‘A narrative of progress councils have engaged with local in adult social care’. The purpose is to citizens to produce their first local use the remaining data collections account, and the four remaining councils provided by councils and published by judged adequate by CQC in 2010 are the Information Centre, supplemented well on their way towards demonstrating by published ADASS survey information, the improvements they have made over to provide a baseline which can be used the last two years. to identify priorities for improvement at a local and regional level. The ADASS mandate forms the basis of the approach which will be taken with The second step has been to come up the LGA, if areas of underperformance with proposals to strengthen knowledge are identified through the approaches to and information capacity quickly to improvement. The board has allocated make sure that sector-led improvement Oliver Mills further funding in this year to support succeeds. These proposals are set out National Programme the plans of the nine regions. in the ‘Scope and Future Options’ report Director, TEASC

ADASS Futures, October 2012 27 collEge of social work

Seeking pride of place

Turn right out of Euston Station, head for social workers as members. Discounted Adi Cooper’s piece outlining the business Tottenham Court Road and you’ll pass a rates start at £40 per membership for case for social work in the April edition of employers of 200-500 social workers Social Work Matters, the College’s on line landmark building undergoing significant (a 33% reduction) and departments magazine, highlighted one of the early refurbishment. Look closely at the hoarding or organisations can apply jointly in priorities for the Adults Faculty. We need and you’ll see it’s soon to be the new order to qualify for the lower rates. to provide evidence that good social Details can be found at http://www. work is both cost effective and produces headquarters of the Royal College of GPs. collegeofsocialwork.org/membership/ better outcomes for people. We are now It boasts some impressive state of the art Corporate-membership-offer/ starting to work with ADASS and others facilities to identify a College champion wherever The standards for employers of social social workers are employed. THE COLLEGE OF Social Work is a more workers are the responsibility of the modest affair, occupying a corner of the Local Government Association. One way of linking academics with SCIE offices just off Trafalgar Square. practitioners is through on line But its objectives are similar, combining Social work with adults lies at the heart debates. These take place for an hour driving up standards of practice and of the work of The College and ADASS over lunchtime and a summary is education with speaking up on behalf has played a key role from the outset, subsequently published on the College of people who use their services. One of particularly through the contributions of blog. Early examples have been older the recommendations of The Social Work Maurice Bates as co-chair of the Board people’s transition through services Taskforce which followed the death of and Jo Cleary as one of its members. and end of life care. We are looking to Baby P was to establish a College of Social Earlier this year we hosted a summit establish several Communities of Interest Work. It fills a vacuum virtually empty highlighting the contribution of social reflecting either particular areas of for forty years when social work as we work to adult care services and made practice or methods of working. know it today emerged as part of the a number of recommendations to Paul It’s really important for us to engage implementation of the Seebohm report. Burstow in advance of the White Paper. with students and newly qualified social The College opened to paying members These illustrated why social work can workers. This is in order to develop a in April, and this encapsulates one and should be at the heart of adult social culture where active involvement with of its major challenges, to provide a care in the future. Examples included their College becomes a natural part sufficiently attractive offer to convince evidence of the value people who use of every social worker’s career. We are the vast majority of social workers that services put on the contribution social unlikely ever to be able to match the the very modest annual fee represents workers make to their lives, the key grandeur of the new building on Euston value for money. Participation in the role of social work in safeguarding, and Road. But we can aspire to make a real development of social work through details of innovative forms of practice. impact on the quality and influence of active membership of The College needs social work for the benefit of people who The College welcomes the White paper’s to be regarded as a key obligation of use services and beyond. support for the role of Principal Social being registered with the Health and Workers recommended in the Munro Care Professions Council. Review to be extended to adult services. The Social Work Reform Board They would then have the responsibility bequeathed a number of responsibilities for quality-assuring the safety of practice, to The College. These include and facilitating feedback between front implementing the Professional line staff, management and the Chief Capabilities Framework (which describes Social Worker, whose appointment we are how social workers should plan their awaiting with keen interest. careers), developing an e-portfolio for continuing professional development, Last month’s introduction of the strengthening the calibre of entrants assessed and supported year in into social work, endorsing social work employment for newly qualified social degree programmes, producing guidance workers marks a significant step forward on practice learning and supporting in developing a proper career structure partnerships, particularly those between for social workers. This has been practitioners and academics. developed in conjunction with Skills for Care together with the higher education Bernard Walker And now The College is offering bulk sector and delivered through local Chair memberships at discounted rates to partnerships. The College of Social Work, employers who want to sign up their Adults Faculty

28 ADASS Futures, October 2012 end of life care Choosing where to die

Over 561,000 people die in the UK every information to those responsible for end impact on local health and social care year, and sustained changes to the quality of life care (Eolc) in various settings. communities. of support they and their families/carers Eolc is recognised nationally as a DH The NEoLCP has good support from receive can make a huge difference to their QIPP workstream – quality, innovation, the DH Social Care Directorates, ADASS productivity and prevention – and and local authorities, and is keen to experience of death and bereavement. sustained improvements have been seen develop these partnerships. They are key MANY DO NOT die in the place of their since the strategy’s launch. For example, to embedding improvements as part choice – usually their home or a hospice. by 2010, deaths in hospital had fallen to of core business, following the health For example in 2005, 58.3 per cent of 53.3 per cent, while the percentage of reforms and alongside emerging local deaths were in hospital, which may deaths in the usual place of residence Clinical Commissioning Groups plus not have been the choice of the dying rose from just under 38 per cent in 2008 Health and Well Being boards, and as person or the best use of resources. to 41.5 per cent in 2011. part of the new policy framework for social care, ‘Care and Support’. The Department of Health’s national end Many factors influence the provision of life care strategy for England (2008) of Eolc. New treatments are enabling Embedding the social care framework was the catalyst for a fundamental more people to live longer with complex into front line social work practice, and change. Developed in partnership or long-term health conditions. This the commissioning and direct provision with 300 stakeholder groups and in turn puts pressure on resources, of social care services, has focused on organisations, the strategy gave the funding and staffing. The changing NHS specific initiatives submitted by the NEoLCP responsibility for translating this landscape will affect the way services are ADASS regions for NEoLCP support. new approach into practice, supporting commissioned, delivered and monitored. These are sustainable rather than time- and enabling staff and employers across Local authorities have a significant role limited, and include initiatives to: in the commissioning, provision and health and social care. • Support integrated working between quality assurance of social care support social care and primary health care The NEoLCP aims to: services, while facing reduced budgets • Promote high quality, person-centred and the need to prioritise services. • Develop support specifically for those with dementia care for all adults at the end of life, Consequently Eolc needs to be planned across all care settings and health and delivered in a streamlined and • Identify needs and deliver integrated conditions. co-ordinated way, providing the best training and education programmes quality of care cost-effectively. • Support people to live and die well in • specifically for social care staff in their preferred place. ADASS is already addressing the issues, different sectors and jointly for social Social care is a key priority for NEoLCP in collaboration with NEoLCP. As a and health care professionals senior manager in adult social care at – along with Acute Care, Primary Care, • Offer localised involvement and Wirral Council, I’ve worked extensively Commissioning, Electronic Palliative Care support to individuals approaching with health colleagues on delivering Co-ordination Systems and the National the end of life and their families/carers. End of Life Care Intelligence Network. integrated models of working across Working in partnership, the programme health and social care. I was delighted The productive axis between ADASS develops resources and provides to join NEoLCP, working with fellow and NEoLCP has helped to advance the Social Care Lead Prof Margaret Holloway, service improvement agenda and build Professor of Social Work at Hull a wider network of supportive national University, to reinforce the vital role of partnerships. These include the NHS, social care in helping people to have a Marie Curie, Help the Hospices, National dignified death. Council for Palliative Care, The College of Social Work and Social Care Institute of The Social Care Framework Supporting Excellence. People to Live and Die Well was rolled out between July 2010 and March 2011 in Contributions to key policy documents the nine ADASS regions. During Phase 1, by ADASS and NEoLCP – e.g. the NICE eight test sites were also commissioned, quality standards – have ensured that and their results were disseminated at a the development of guidance support showcase event in October 2011. A wide and learning materials reflect the range of initiatives has been developed social work value base and practical beyond these projects, reflecting the considerations of social care. importance of this area and its wider

ADASS Futures, October 2012 29 end of life care

Promoting Eolc in education has been October. With applications across health practice, and more rapid dissemination achieved in several ways. The College of and social care, it is web based and can of learning and targeted programmes Social Work (TCSW) recently co-badged be used for generic Eolc developments. of support. a ‘Route to Success’ guide for achieving The often complex nature of Whatever the challenges, we can best quality Eolc practice in social work. commissioning and providing Eolc be proud of the excellent resources RTS training modules have also been means integrated service delivery in local areas and the commitment developed by NEoLCP for domiciliary models are essential to best practice and professionalism of practitioners, care and care home settings. These and would positively impact on some of trainers, providers and commissioners in are used widely by care agencies and the pressure points in health and social supporting the improvements needed residential and nursing home providers, care economies. There is real potential in end of life care on a sustained and with positive outcomes. to develop access between local GPs comprehensive basis. A range of resources is available to and social care teams, and to promote support learning and best practice in innovative models of Eolc support on Eolc, including End of Life Care for All discharge from hospital. (e-ELCA) which is free to access for social National initiatives for GPs to develop care staff in England and offers specific electronic palliative care co-ordination modules on social care: http://www.e- systems (EPaCCS) and identify the cohort lfh.org.uk/projects/e-elca/index.html of their populations who are likely to These packages are underpinned by a die within the next 12 months could structured approach to competency- be cross-referenced with social care based learning, to support employers information to support anticipatory and train their workforce in Eolc skills. care, advance care planning and well A useful guide, developed with Skills informed decisions about wishes at the for Care and Skills for Health, is at: end of life. The development of EPaCCS http://www.endoflifecareforadults. (which replaced Locality Registers and nhs.uk/publications/ support the elicitation, recording and corecompetencesframework sharing of people’s care preferences, and key details about their care) can Learning tools are further also support improvements in care co- complemented by quality assurance ordination and service delivery. and accreditation programmes such as the Gold Standard Framework. A more systematic approach to Contract specifications in some local measuring progress is an important authorities have also been adapted consideration for ADASS and NEoLCP. explicitly to reference Eolc standards and An advisory tool to demonstrate accreditation frameworks. ‘what good looks like’, and support networking and sharing of best practice, In relation to social work practice, the has recently been developed by Association of Palliative Care Social NEoLCP and endorsed by ADASS. This Workers (APCSW) is co-ordinating the will be circulated to Adult Social Care Eolc champions network for NEoLCP. Departments in the coming months, The Social Care Institute of Excellence to build a more complete picture of is also developing and disseminating implementation of the Social Care materials to support best practice, Framework. Regional workshops start in while Skills for Care have supported November, to cross-reference learning the implementation of the Social Care across the new regional footprints. Framework and there is continuing liaison over e-learning and other training The challenge is significant, taking into initiatives. account the work still required, size of the workforce, competing priorities Eolc developments must be informed in adult social care and the impact of by an effective commissioning Rick O’Brien health reform. But this new approach process. A substantial part of NEoLCP’s Joint Social Care Lead , to reporting the scale and coverage of activity is focused on improvements National End of Life Care service improvements in Eolc will assist in this area, and a new interactive Eolc Programme (NEoLCP) with future prioritisation, sharing of best commissioning tool is launched in ADASS Lead on End of Life issues

30 ADASS Futures, October 2012 National children and adult services Harrogate International Centre | 16-18 October

For further details and booking go to www.local.gov.uk/ncasc LAST WORD

Meeting, meetings, meetings Like most parents I was regularly Not that the Council was that different. skilled operators in action and then asked by my children what I’d done at When cabinet government replaced trying to learn their techniques. High work that day. More often than not I’d the committee system it did wonders quality discussions which increased my just reel off a list of meetings only to for my capacity to be the party bore. understanding of complex issues. Wit be met by the response “but that’s not I could go on at great length and in and humour, drama and oratory. There work, what did you actually do?” great detail about such thrills as fly were many occasions when Council tipping, tree stumping, traffic calming, meetings provided better value than So much of our working life is spent the list is almost endless. And people any local repertory theatre. in meetings. They possibly rival sleep thought I was a social worker… as the activity which takes up the In retirement I could say I’ve finally highest proportion of our lives and it’s Perhaps the problem is that I have a reached that happy place. Surprisingly not unusual for the two to take place low boredom threshold. One of my though, meetings are one of the things simultaneously. tutors at university was unimpressed at I miss most. Perhaps it’s the comfort of my suggestion that the only purpose a familiar environment within which To the bemusement of many people of lectures was to entertain. If I wanted I think I have some skills. It could be I’ve always described being a director information, I’d rather read a book than the opportunity to get together with of social services as the best job in listen to a series of notes recited in a familiar faces. Or maybe the sense that the world. That implies enjoyment monotone. meetings really are a good way to get and while this was largely true there things done. is a downside to everything. Meetings I never had the courage to sit through certainly came into that category for me. some council meetings wearing Having taken a complete break from headphones as I frequently fantasised. all forms of work, I’m enjoying going Now I’ve retired I dread to calculate The nearest thing to mischief was to meetings again but now am in the how many hours of my life have been competing with likeminded colleagues fortunate position to be able to pick spent in council committee rooms to include song titles from increasingly and choose the ones I attend. I’m also or their equivalent in the NHS. It’s obscure lyricists in our responses to certain that if it comes to the choice no wonder so many GPs are now questions. between a visit to B & Q and going to a wondering whether ploughing their meeting, there’s only ever going to be way through interminable agendas is Often when leaving my office I’d one winner. really what they want to do. say I was off to my happy place in anticipation that becoming lost in In my experience this can be my own little world was a much more particularly problematic in the NHS. attractive proposition than paying I would regularly attend meetings on attention. This perk was always three consecutive weeks, generally counterbalanced by the frustration with the same people, discussing the of thinking about the many more same papers and making the same productive ways I could be spending decisions. The only difference would be my time. the meeting’s name. It wasn’t unusual to have over a thousand pages of Meetings weren’t all bad by any means. Bernard Walker background papers. I eventually gave There was, in fact, much to enjoy. Chair of the College of Social Work’s up confessing that I hadn’t read them Taking important decisions, sometimes Faculty of Adult Social Care, and all when, although everyone else unexpectedly, which would make a real until recently was Executive Director, agreed, nothing changed. and lasting difference. Watching really Health and Wellbeing for MBC Wigan

ADASS Futures is published as a service to members of the Association of Directors of Adult Social Services and is available on our website www.adass.org.uk ADASS represents directors of adult social services in England. Although members are very welcome to write articles for ADASS Futures, features and news items appearing in the journal do not necessarily reflect the views of the Association. Contributors should contact the editor at the contact points listed below. ADASS Futures is published by ADASS, charity registration number 299154, and all contents are copyright. Contents should not be reproduced without prior approval. Editor: Drew Clode tel: 020 8348 5023 email [email protected] Design: Liberata Design and Print Studio

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32 ADASS Futures, October 2012