In March 2017 I left my DASS role in London. A combination of a difficult journey, a role extended to cover 2 boroughs, and relentless pressure on budgets, I consider I was lucky to have the opportunity to step off the treadmill (before I fell off). But I did so with some trepidation; despite all the pressures, I loved my job, my team, and being involved with ADASS.
So, time to get a better balance, but not quite ready to hang up my boots completely, I bid for various pieces of work and, a year on, share some observations.
My main project has been the CQC local system review programme. By the end of April, I will have supported CQC with 10 of these. Neil Revelly has supported a similar number and it has been interesting to meet DASS and CEO colleagues who have also joined the review teams. Neil and I – with Simon Williams from the LGA - have written separately about the programme, and we’ll do another piece on this soon. I took this work on with slight hesitation; were these reviews commissioned because government just wanted to check up on LAs and how we were using the £2bn? Would the reviews look at whole systems or just at LAs - and DTOCs? As special advisor would I just be there to make up the numbers / tick a box? Would CQC give some strong messages back to govt – not just to the areas being reviewed?
My concerns were unfounded. Whatever the original motivation of govt, CQC has been clear this is about how whole systems work to help older people live well – including looking at wider determinants of health, housing and preventive services. CQC have listened to and drawn on the advice and input from the special advisors. There has also been a strong emphasis on using the reviews to help local systems – how can the review- and the subsequent report – give local partners some leverage to effect changes. Ann Ford, who heads up the programme, often says, the reviews aim to provide ‘a mirror, not a stick’. As a recent DASS, I know how difficult it is to find the capacity to prepare, and this is a distraction from business as usual, but I hope has been helpful in some way. While DTOCs and hospital attendance data were the indicators used to decide review areas, the emerging themes are much broader, and some emerge consistently - are there strong and trusting partner relationships? Making progress is difficult if this is absent. And in every area I have visited there is a clear theme about social care markets – quality and capacity is essential and needs national focus.
The DTOC point takes me to my next area of work – representing ADASS at the national weekly Discharge Steering Group – the DSG. Led by NHSE, this meeting brings together key partners to look at issues relating to DTOC, doing some of the detailed consideration to inform decision making, for example on target setting. Let’s just say my initial meeting was an interesting experience, and I do still come away some days wondering how the detailed focus on DTOC is really helping systems. But we know this is political, that delays are a marker of how a system is working, and I do think the regular attendance of ADASS, the LGA and other partners has gone some way to building a better partnership at a national level with NHSE, NHSi and others. If we stay in the tent we have greater chance to influence / shape. I hope that findings of CQC reviews, and other work, will serve to reinforce the critical role of social care, and the importance of looking at how whole systems work together.
The final piece of work I will mention is the joint work with Newton to develop the Accelerate programme. As a trustee of ADASS, I was aware of our need to look at new opportunities for senior leaders, and it has been a real honour to be part of the team developing this programme. As evidence of the need for this type of initiative, the programme was heavily oversubscribed. The first 9 participants, who are all Directors or Assistant Directors, commenced their first module this month. I wish them well, and their feedback will help to inform future programmes.
PS – I was also elected – well, no one else stood – as co chair or the ADASS Associates, so look forward to meeting Associate friends and colleagues.