NEW DIALOGUES AUGUST 2017 REWIRING CARE AT HOME Achieving the art of the possible in home care reform Supported by New Dialogues is a series of think pieces supported by the partners of ADASS NEW DIALOGUES AUGUST 2017 WHO WAS ON THE PANELS? LONDON MANCHESTER JAMES BULLION, director of JILL COLBERT, corporate adult social services, Norfolk director for children, families and County Council wellbeing, Trafford Council JOHN GREEN, head of joint IAN CRABTREE, director of adult commissioning, London social care transformation, Borough of Havering Lancashire County Council IAIN MACBEATH, director of STEPH DOWNEY, service adult social services, director for adult social care, Hertfordshire County Council Gateshead Council TONY PILKINGTON, managing JULIE GONDA, acting executive director, Younifi director, Bury Council STUART ROWBOTHAM, director JASON LANE, commissioning of adult social services, London manager for adult social care, Borough of Bexley Leeds City Council MARGARET WILLCOX, TONY PILKINGTON, managing president, ADASS, and director director, Younifi of adult social services, HAZEL SUMMERS, strategic Gloucestershire County Council director for adult social care, (roundtable chair) Manchester City Council (roundtable chair) JOANNE WILLMOTT, assistant director, Wigan Council 2 NEW DIALOGUES // AUGUST 2017 ADASS | YOUNIFI INTRODUCTION Bullion, director of adult social services at Plenty of change is afoot in how care is Norfolk County Council, when the issue of delivered to older people in their homes. The barriers was raised at the London Better Care Fund, the Care Act, the roundtable. “There’s the money of course, personalisation agenda and the adoption of but actually it’s a lot more to do with new technology are all driving this activity but recruitment, retention and the development there is also growing evidence that progress of the workforce.” is being stifled by traditional thinking about John Green, head of joint commissioning how home care should be delivered. at the London Borough of Havering, agreed To examine the barriers to reimagining and added that pay is not a primary care at home and explore how the system motivation for home care staff: “If it’s about could be reshaped and better supported to the money, they are in the wrong job improve outcomes for service users, anyway because remuneration is generally ADASS organised two roundtable low. When we talk to frontline care workers, discussions involving adult social services their motivations were often about being leaders from across the country. treated properly, getting support, and having a package that enables them to do their job. The topics discussed during the Money was in the background, but it wasn’t roundtables included: the be all and end all for them.” l The challenges about how we ensure At the Manchester roundtable, Wigan enough capacity and the right capacity in Council’s assistant director Joanne Willmott our care markets suggested many of the workforce issues are l Whether we are risk averse when it due to the reputation home care has as a comes to helping people to help career path. “In Wigan we’ve been themselves developing an ethical home care l Achieving wider person-centred care partnership and the thing driving us to do rather than care focussed on solutions to that was the need to correct the current particular conditions or needs narrative around home care and how it is l How to better connect communities, misrepresented in the media - political neighbourhoods and people, and the role coverage around ruthless organisations of technology delivering very poor quality, 15-minute visits and the exploitation of staff through zero- The roundtables - which were made hour contracts,” she said. possible by sponsorship from Younifi, a company that seeks to use technology and STOPPING THE CHURN services to deliver better social care - took On the morning of the London roundtable, place in London and in Manchester during the news was reporting new Skills for Care April 2017. This report brings together the figures showing that 928 adult social care discussions from both roundtables to workers quit their jobs every day. Picking up highlight the key themes and points raised. on the reports, Younifi managing director Tony Pilkington noted how many of those WORKFORCE CAPACITY leaving their jobs “are still very passionate When it comes to identifying the biggest about providing care”: “It’s the organisation barrier to change in care at home, both and the pay rate that these people are roundtables rapidly settled on the same struggling with. How much opportunity is culprit: recruitment and retention. there for stimulating these people to set “What’s stopping the capacity to change themselves up as micro-providers?” the way we work?” responded James Iain MacBeath, the director of adult social What’s stopping the capacity to change the way we work? Money of course, but actually it’s a lot more to do with recruitment, retention JAMES BULLION, DIRECTOR OF ADULT SOCIAL SERVICES, NORFOLK COUNTY COUNCIL ADASS | YOUNIFI NEW DIALOGUES // AUGUST 2017 3 NEW DIALOGUES AUGUST 2017 services at Hertfordshire County Council, Finding ways to make a career in care We know people will said micro-providers could help with retention more attractive is important, added move agencies for 50p because care workers would keep a larger Margaret Willcox, the president of ADASS cut of what councils pay for home care. and director of adult social services for an hour, so people keep But the micro-provider model does have Gloucestershire County Council. “We problems, he added: “Setting up that sort of know people will move agencies for 50p moving between business puts a lot of people off. You’re an hour, so people keep moving between organisations and it’s a slightly more than a personal assistant but organisations and it’s a complete waste of you’re not a domiciliary care agency. Where resources,” she said. “So we are doing a complete waste of is the line where you need to make things South West-wide campaign called Proud more official? This is what we need the CQC to Care, where we are working with carers resources to advise us on.” to say what is it that attracts people to MARGARET WILLCOX, PRESIDENT Another problem is that local authority your organisation and to your role.” OF ADASS AND DIRECTOR OF systems are not always friendly to care Stopping the churn of care workers ADULT SOCIAL SERVICES AT workers who head down that route. “When also matters to the bottom line, Willcox GLOUCESTERSHIRE COUNTY COUNCIL Hertfordshire did it some years ago we found added. Less churn means lower that we weren’t good partners,” said recruitment costs and Gloucestershire MacBeath. “We made it really difficult to pay estimates it could save more than £1m a the new micro-providers. We made them fill year from reduced turnover while the care in all kinds of spreadsheets to get their system as a whole could save £12m in money. We also paid them every four weeks the South West. and made them prove to the very last penny Building on the theme, Bullion shared that they did every scrap of work before we some of the insights Norfolk had gained would make the payment. But we have from working with providers to create a payment cards now, so they could get paid dedicated recruitment website for home daily.” care workers. 4 NEW DIALOGUES // AUGUST 2017 ADASS | YOUNIFI We commission these services to such a tight specification that providers can only ever do what is on the piece of paper JULIE GONDA, ACTING EXECUTIVE DIRECTOR, BURY COUNCIL “The findings from that seem to be that care for the initial six weeks as usual before outcomes-based commissioning, which sometimes it’s the wages but it’s more often working with the provider to develop a long- MacBeath said will require the council to about the relationships within the home care term care plan that would be approved at trust its providers even more. “We won’t be agencies that are causing people to move,” the six- or 12-week review. so draconian at looking at the rotas and he said. “So there is something in Councils also need to end the task-and- making sure providers deliver absolutely supporting the management with retention time culture in home care, said Wigan’s everything in the care package,” he said. as well as providing money.” Willmott. “We created the task-and-time “And rather than asking ‘have you ticked all culture so we need to take responsibility for the boxes?’, we will ask people ‘are you BECOMING LESS DRACONIAN that and liberate frontline staff to do things satisfied with the service from your provider Several participants at the two roundtables differently,” she said. “I don’t think that was and do you need more or less care?’” explained how their authorities were already ever driven by frontline staff or by providers’ We do need to be careful when we look revising how they pay and work with care leadership. It was driven by our approach at payments based on performance, said providers to help address some of the as local authorities. We need to measure Green: “When we’re looking at payment by negativity around the profession. what is important - the impact of the results and that kind of thing, we have to be The roundtables agreed that greater services we are commissioning.” enormously careful about setting perverse flexibility in how home care is commissioned At the London roundtable, MacBeath incentives and driving the wrong type of is a vital step. Julie Gonda, acting executive explained how Hertfordshire Council has behaviours where providers hit targets but director at Bury Council, told the changed its commissioning approach to put don’t achieve better outcomes for service Manchester roundtable: “Flexibility is key.