Health and social care staff working in an acute setting are frequently faced with the difficult challenge between sustaining life or supporting someone (who is in the final days or hours of life) to die in a comfortable and peaceful way. This is especially difficult for those entering the acute hospital through the Emergency Department. Even when a plan has been made for this eventuality it’s still emotionally challenging and stressful for all.

My father would be 100 this year if he was still alive so perhaps we are thinking about him more than usual. My mother’s affectionate claim “he wouldn’t know the price of peas” reflected his very traditional role as provider, not shopper. The peas arrived on his plate without discussion about their cost or value. Fast forward to 2018 and consideration of price – food, consumables and services – is the business of us all.

The Care Act reinforced Local Authorities’ responsibilities to monitor the quality of independent care businesses, however the fragility of the care market is one of the things keeping Directors awake at night. ADASS’ own budget survey identified the increase in Care Providers closing down and handing back contracts. When a Provider fails, the knock-on effects to people who use care and support services, Care Workers and Council’s own staff are devastating. So how can today's innovative technology help mitigate risks by identifying potential provider failure?

ADASS President, Glen Garrod, details his week and the activities ADASS are undertaking to influence the upcoming social care green paper. 

The development and sustainability of a diverse supply of small scale providers of social care – a local micro market – has been an ambition of many local authorities as part of their quest to offer choice and more personalised care.As you might expect, some councils have been more successful than others. Generally, the task has proved challenging and slow to mainstream, ending up being stored away in the “Too Difficult” box. I wonder, is it now time to re-open and re-package the box as “Difficult – but Worth It”?

Using evidence to ensure change programmes make the biggest difference.Senior social care leaders from around the country are taking part in a programme to rapidly develop their capability to deliver effective organisational change. The ADASS Accelerate programme, which has been co-designed by the association and Newton, includes residential sessions, ongoing mentoring and cross-industry insight.

Brian Parrott, former Director of Adult Social Services, Chair and Non-Executive Director of NHS Trusts and Chair of Suffolk Family Carers, shares his thoughts on the comparisons between New Zealand's Social Care system and the UK's.  

The new President of ADASS, Glen Garrod, gives his view on the importance of "disruptive influences" in the evolution of health and social care. 

Cathy Kerr blogs on life and work after leaving the DASS role, CQC reviews, DToCs and the ADASS Accelerate programme...

Last year, Channel 4 aired a brilliant series called Humans. The protagonist was a ‘synth’ and the context was the rise of robots providing a range of public and private sector services including, in some instances, personal and wellbeing related support. Slight ‘spoiler alert’ but a rules based health and care plan delivered by a robot did not fully achieve dignity, choice and control. This is television, not real life but it did prompt thinking on the relationship between technology and care – which can be a bit of a marmite topic.  So does technology make things better?...

Rachael Byrne, Executive Director at Home Group and ADASS sponsor, talks about how the home can enable independence for people with learning disabilities. I'm sure you've heard many a housing organisation talk of the 'home' being about so much more than bricks and mortar. It's a drum we bang regularly but with good reason. Read more ...

In my discussions with DASSs about the role of care technology in their Strengths Based transformation programmes, the subject of robots comes up more and more often. In particular, we’ve talked about the cobot, or collaborative robot. One memorable example of a cobot is in the film Aliens. Sigourney Weaver’s character Ripley is desperately trying to protect a child from the attentions of the alien. She climbs inside a giant cobot in the loading bay of the spacecraft and shouts “Get away from her ….” before proceeding to give the interloper a damn good thrashing...

Ali Rogan, Chair of the Alzheimer’s Society’s Dementia Friendly Technology task and finish group and external affairs advisor to Tunstall, blogs about a series of new information sheets...

On the night before Christmas there was a knock at my door. I opened it and was met by a smiling woman with an array of presents. She apologised for troubling me on Christmas Eve and asked whether I knew where my elderly neighbour was, as it was unusual for him to be out at this time of the evening. I invited her in and broke the news to her that her friend of 40 years had died six months ago.Understandably she was shocked and extremely upset. I asked whether she knew why she had not been notified. She explained that she was divorced from my neighbour’s cousins but still kept in touch at Christmas despite the family split. We exchanged best wishes for Christmas and the New Year and I promised I would let his family know that she had come to visit. Following discussion with the family, I discovered there was no comprehensive list of contacts for his sons to follow. Even though they did their best to inform immediate family and friends, they hadn’t known there was still this link with a separated member of the family.Sometimes this scenario is inevitable as even the best laid plans have gaps. However, if my neighbour had talked more openly with his family about this link, his boys would have been able to inform everyone who was dear to him so they could be included in the grieving process.In relation to EOLC meetings and events, there were a number that I attended towards the end of 2017. Some key highlights include:

Making sure that your adult social services department has a good relationship with your local media is essential. Working closely with your local paper or radio or TV station not only showcases some of the positive work your department does, but also enables to you highlight and campaign on local issues as effectively as possible. The following top tips are crucial when it comes to reaching out to local media.

Care technology (telecare) services can play a key role in reducing the cost of care, particularly when aligned to preventive or strengths based approaches. As care technology experts we help local authorities to understand the quality of their existing telecare service, providing objective assessments of the potential to deliver significant financial benefits alongside better outcomes for service users.We see the same mistakes being made by local authorities in their approach to care technology; here are the top five...

ADASS blog on the NCAS Conference 

Thank you, Alison.  Needless to say I agree with so much of that – especially the bit about the beneficial value of cake and bubbles. In my experience these are underestimated factors in effective multi-disciplinary team working - shamefully overlooked in the research literature.May I add my welcome to the conference and to Bournemouth - as well as cake and fizzy drinks, most ten year olds like ice cream and 3/4 million scoops of ice cream are sold in Bournemouth every year. Of course its other great attraction for me is its close proximity with the home of a certain chef.My working world is Gloucestershire, not so far from here as the crow flies but a little further via the A34, a road which must be a source of great amusement in the crow community. I’m hugely grateful to the Leader, Members and Chief Executive of Gloucestershire County Council for their support in enabling me to serve this year as president of the Association of Directors of Adult Social Services  – especially in these challenging times for the authority. I'm also grateful to my colleagues, both in the Council and the NHS, who have been a terrific support...

The new winter wonderland is fraught with complexity and uncertainty. This means leaders are skating on very thin ice indeed. Whilst it’s encouraging to see a growing appreciation of the intricacies and pressures of health and social care economies, the need to look at the resilience of the whole system is never more important.

The pressures facing social care require no repetition, and a radical rethink is required. The new normal must consist of a greater reliance on prevention, and more focused provision of lower-cost, sustainable and safe alternatives to traditional services. True transformation is never easy. Yet like ‘eating an elephant’ it is doable if it is broken down into manageable chunks. Below are five principles to be applied:

Julia Ross, Chief Strategist for Pi Ltd, blogs on DToCs, A&E and the importance of data...In the 1970s, when I was a young social worker in A&E, most of the emergencies referred to us were mental health, hopeless drunks, homeless people and child protection.  Older people were rare referrals but in those days there were many geriatric hospitals and residential care homes. Today’s system leaders are increasingly viewing A&E as controlling demand, capacity and flow throughout the whole NHS  system and mainly focusing on older people. This is fundamental to the acute and primary care health economy but even more importantly it is also crucial for social care and therefore for the whole health and social care system.  

I got a Fitbit for Christmas, we all have smart phones and we live our lives through our iPads, but what we really need is connectivity and for things to work.What Directors of Adult Social Care are increasing telling me is - we don’t know enough about digital technology. Whilst Directors understand the principles, they want to know how to take the digital agenda forward as part of service improvements and investment plans.

Collectively, we have the power to create solutions, challenge policy and shape services – the very services that our communities are relying on. The role that local government currently plays is going to change massively with the proposed changes to the Local Housing Allowance (LHA). Rachael Byrne, Executive Director – New Models of Care, Home Group writes a think piece ahead of the ADASS Spring Seminar 2017

ADASS Spring Seminar 2017Tipping over the edge or coming back from the brink? Addressing the challenges for publicly-funded home careCordis Bright write a think piece on the future of Home Care ahead of the ADASS Spring Seminar 2017

We know form should follow function, but does that leave a change in behaviour bringing up the rear? The journey towards accountable care can be confusing and convoluted. Firstly, there must be a simpler way. Secondly, we need to make sure we empower residents, services users and staff to engage differently and take control.“To ACO or not to ACO” that is the question….a conversation with a DASS colleague the other day did prompt some light hearted reflection our somewhat Shakespearian integration journey. It has become an epic (hopefully we end in neither tragedy nor comedy!) and the language of accountable care is such, a Mastermind contestant would struggle with as a specialist subject.

The New Year has started with a flurry of meetings to drive the London and National End of Life Care Programme agenda, and there are great opportunities ahead. John Powell, ADASS End of Life Care Co-lead blogs... 

A diagnosis of dementia invariably leads to a wide range of emotions and questions, and an updated guide by the Alzheimer’s Society will make useful reading for anyone wishing to understand more about the condition and find support services available. About 850,000 people in the UK have dementia and it’s possible to live well with the condition. However, it’s really important to get information and support after a diagnosis to boost reassurance and signpost help available from councils and a wide range of other organisations to make things easier.The guide, now in its second edition and endorsed by ADASS, will also be useful for close friends and family of someone with dementia, as it contains information for anyone taking on a caring or supporting role.

The National Hospice at Home Conference was, as always, an extremely well attended event and I was honoured to present at it. I was particularly heartened by the delegates’ recognition of the vital role that adult social care plays. However, I was also struck by delegates’ lack of awareness of the various service provisions within social care even though they have been established for many years. Extra care housing and the role of care teams in providing end of life support did not appear to be well known, nor the benefits appreciated.

Whilst there will always be a need for higher intensive care packages and care homes, new methods of care delivery closer to home need to be properly supported by commissioners to ensure people receive the support they need and prevent them from moving up the care pyramid...

Over the last few days we have all seen the torrential rain and wind across the country and its devastating impact on local communities. Worryingly, these events are becoming more common. We are remember the floods from last Christmas and the pictures of people being airlifted to safety. Often the images which stick in people’s minds are the actual pictures of the impact of the floods on people’s homes, power loss, rivers with burst banks etc. But what about the less visible impacts on communities.

Local authorities have been variously engaged with STPs. Manchester’s John Rouse, previously Croydon Council CE and more recently Director General in the Department of Health is just one example, others are chaired by Council CEs. Sustainability Transformation Plans (STPs) have now been given the responsibility for delivering the final three stages of the Five Year Forward View. They are here to stay and they are likely to become increasingly powerful for two reasons.

John Powell gives an update on his work as End of Life Care Lead...As I started to prepare my presentation for the National Hospice at Home Association Annual Conference in September 2016, I began to reflect on the last four years and how Adult Social Care has contributed to improving people’s end of life experience.

This column was first published on 31 August 2016 in the MJThis ADASS column comes with great sadness, with responsibility for writing it falling to me instead of our President, Harold Bodmer, who passed away suddenly on 20 July. His death came as a huge shock to all of us at ADASS and in the wider health and social care spheres, but most of all, to those closest to him. We appreciate the touching tributes sent to us and we have sent them all on to his family, who I’m sure will be grateful for everyone’s kind words and recognition of his dedication to his work.

Martin Farran, Director of Adult Social Care, Housing and Public Health, in the City of York Council and represents ADASS and the LGA on the People and Communities Board which reports to the Five Year Forward view. He has written a blog on the six principles. As a health and care system, we often make bold statements about redefining what it is we are, or should be doing to create a sustainable set of arrangements to meet future demand. Often we look for innovative approaches, highlighting that the status quo can not continue and that change is paramount. But what is sometimes missed is the underlying behaviours and approaches, regardless of the systems or structures, which determine whether someone has a positive or negative experience of the health and social care system.

Paul Smith, the Director of Foundations, the national body for home adaptations (and a member of the ADASS Housing Policy Network) has written this piece in relation to DFG's and reducing care home admissions. As budgets get ever tighter Directors are faced with the dilemma of needing to spend  money on services that meet immediate and pressing need whilst wanting to invest in those things that will deliver better outcomes for people and save money in the longer term. Housing solutions have a fundamental part to play in the prevention agenda and the increase in DFG funding as part of the BCF gives us an opportunity to take that longer view - but are Director's and their CCG partners convinced that the returns will follow the investment? Paul provides a thoughtful contribution to help Directors and encourages a wider view of how DFG's should be used.Neil Revely, ADASS Housing Co-Lead

As we enter Carers Week 2016, ADASS President Harold Bodmer reflects on this as one of his priorities for the year.

Pat Jones-Greenhalgh, ADASS Lead for Dementia blogs about the opportunity that Dementia Awareness Week gives us to take stock of where we are and where we need to be...

During the same week that Harold Bodmer made his inaugural speech as ADASS President, the New York Times ran a story about 100-year-old Ida Keeling, who, on a sunny April afternoon, laced up her mustard yellow sneakers and took to the track at the Fieldston School in the Bronx.

Over the weekend, Andrew Cozens retweeted a good-natured question about whether Leicester winning the Premier League was comparable to a cat winning the Grand National; we all know Andrew loves Leicester and is a long standing racing man. With the success of Claudio Ranieri’s men plus the Tigers making the Rugby Champions Cup semi-final, Leicester seems to be on the crest of a wave.

This column was originally published in The MJ and can be viewed on their website.Place matters. People who understand and are committed to improving the lives of local communities have always been the most effective leaders of meaningful change that makes a lasting difference to the quality of life for local people.That is especially true of care and support services that are so central to the lives of many of the most vulnerable members of local communities and their families and carers...

Today (15 March) is an opportunity to celebrate the impact of social work on lives across the world, with this year’s event focussing on the dignity and worth of people. Social work enables millions of people every day to retain their independence, live meaningful lives and come together to form safe, inclusive communities.

It is now six months since Mark started working for ADASS as a Policy Officer. During this time he has really enjoyed the challenge of the role, getting to grips with social care and thankful to everyone for making his feel so welcome. 

This blog by Ali Rogan, External Affairs Director, Tunstall Healthcare, describes the latest ADASS toolkit for carers “Guide to supporting carers through technology enabled care services”

Phil Porter reflects upon the importance of a modernisedworkforce to meet increasing  needs and expectations, and how ADASS isprioritising  sustainability of the workforce in the face of  fragilemarkets and reducing resources.

Phil Porter is co-chair of the ADASS WorkforceDevelopment Network along with Joan Beck.

Bev Maybury gave a presentation on commissioning to a recent seminar jointly organised between ADASS and SCIE. Her first thought when asked was: if only there was magic formula! And the second? She was reminded of sitting in an old school room with an imposing maths teacher telling me that algebra was not complex. I just needed to understand why ‘X’ had a certain value…

Blackburn with Darwen Borough is experiencing significant changes in the population structure over the coming 20 years with increasing complexity of care needs impacted by deprivation and the number of people over 90 almost doubling, writes Steve Tingle. Financially the picture isn’t any brighter. We’ve done some work across Pennine Lancashire and the combined gap across health and social care in the next five years is in the tens of millions… 

Andrew Webster's blog - 31 July 2015

Andrew Webster's blog - 24 July 2015

Andrew Webster's blog 10 July 2015

How do we get better at-home based support and prevention? How far should local government go in terms of its role and responsibility of prevention in the community? How proactive is it prepared to be, to support those who are lonely and isolated, or those where there may be some concerns? Linda Sanders poses the questions, and tries out some answers…

Andrew Webster's blog 3 July 2015

Andrew Webster's blog - 26 June 2015

Richard Humphriesleads us on a walk through the past five years of health and social care –reorganisation; upheaval and cuts. Tracing the roots of a new King’s Fundreport back to the Barker Commission, he points us firmly on a clear andconcise route to devolved integration.

SEASONED SOCIAL CARE leaders will need no reminding of the NHS’s propensity for serial reorganisation. Andrew Lansley’s shake-up, enacted in the Health and Social Care Act 2012 and famously described by former NHS England boss David Nicholson as “so big you could probably see it from space” – was intended to ‘liberate’ the NHS from top-down control and reduce bureaucracy. Two years later space travel is not required to see the consequences, write Richard Humphries. 

Andrew’s Blog – 12 June 2015    

Andrew’s Blog - 29 May 2015 Helloeveryone, I hope you’ve had a good couple of weeks and that you enjoyed thelong bank holiday weekend.   The weeklyintegration catchup yesterday was a quick one because many people are away onleave. But it still managed to cover the Future of Health and Wellbeing Boardsdocument, the support offer for the Better Care Fund, evaluation of theprogramme and the Queen’s Speech.  Alyson Morleyreported that the Future of the Health and Wellbeing Boards document is nearlycomplete and that it will be launched at our Annual Conference at the end ofJune. She is currently working on what our support offer will look like –especially with regard to helping boards being more ambitious.   The LGA is exploringthe option of co-designing, with partners, a peer implementation support offerfor the Better Care Fund team. Tom Shakespeare is leading on this. Weare also considering programme-wide evaluation and are working with ourResearch Team to scope this.   The Queen’sspeech on Wednesday had nothing substantial in it for health and social care.However, a full ‘ On the Day Briefing’ is available to read onthe LGA website. It gives a breakdown for what each new Bill will mean to localgovernment. Our focus nowwill look towards the new Budget, scheduled for 8 July, followed by a likelyspending review in the autumn.   Pauline compiles the Care and Support Reform bulletin that goes out eachmonth to leaders and professionals of local health and caresystems. She also produces a digest of information specific to care providers –highlighting the products that they most need to support them in implementingthe Care Act reforms.  Pauline chairs the monthly communicationsmeeting of the implementation product providers and is responsible forevaluating and reporting on the effectiveness of implementation communications. Pauline’s role has recently expanded beyondthe Care Act to include the whole Care and Health Improvement Programme. She isnow responsible for planning communications and disseminating key messages andinformation to local authorities and care providers in a succinct way acrossall the care and health programmes Pauline is currently compiling a ‘forwardplan’ which aims to capture all events, announcements and media opportunities relatingto health and care. If you know of anything that is coming up and worthcolleagues knowing about it, please inform Pauline so she can include it to theforward plan. The forward plan will soon be available on Sharepoint for anyonewithin the team to view.    Finally, afew people have asked for a copy of our team structure so I’ve attached it tothis week’s blog. I hope you find it useful, especially in continuing to buildthose good working relationships with each other. 

AndrewWebster is Director for all the Health Care Improvement Programmes, based atthe Local Government Association. He writes a blog each week updating allcolleagues within the organisation on what has happened across all the healthand care work streams in the previous week, and encouraging them to engage withhim. Andrew also uses his blog to introduce people on his team and highlightwhat they are working on. 

Dancing in the rain…

For David Pearson this has been an incredible year. He writes: The opportunity to promote the interests of those who need social care services and represent leaders in social care in this country is an enormous privilege. The level of respect and goodwill towards ADASS and its objectives nationally and internationally from such a wide variety of sources has been humbling in its generosity. I pass the baton - and the umbrella - into the capable hands of Ray James, as we support him in negotiating the storms and helping us all to dance in the rain. 

An appearance on a Radio 5 Live Investigates in February alerted ADASS President David Pearson to the growing misapprehension and misunderstanding of how adult safeguarding works in England. How do we make sure that the public understand more completely the complexities in the different responsibilities different agencies have for the task? Click here to read his views…

Physiotherapists are often found at the point where health and social care meet: their focus on improving the quality of life for their patients naturally bridges the two sectors, particularly when it comes to older people. For social care, this equates to reduced pressures and potentially big savings at a crucial time, writes Professor Karen Middleton...

Whatwas it like at the back end of 2014 going into 2015 coping with the hugeprofessional and management pressures caused by large additional numbers ofolder people being admitted into hospital – the so-called winter pressures? Andhow did adult social care services prove their indispensability? Andrew Milroytakes us through those months step by step as a local authority is seenstepping up to very difficult plate…

2015 has begun. A general election looms. All eyes are onthe state of the NHS, routinely portrayed in the media as an institution inpermanent crisis. The most visible symptom of this is the pressure on accidentand emergency departments, the front door to an increasingly stressed hospitalsector. When the state of hospitals isn’t hogging the front pages, anincreasingly stressed GP sector hoves into view. Either way, we are told, theNHS is in deep trouble and that older people have something to do with it. RuthThorlby puts things in context…   

2015has begun. A general election looms. All eyes are on the state of the NHS,routinely portrayed in the media as an institution in permanent crisis. Themost visible symptom of this is the pressure on accident and emergencydepartments, the front door to an increasingly stressed hospital sector. Whenthe state of hospitals isn’t hogging the front pages, an increasingly stressedGP sector hoves into view. Either way, we are told, the NHS is in deep troubleand that older people have something to do with it. Ruth Thorlby puts thingsin context…   

As a small unitary authority in the Northwest with high levels of deprivation, Blackburn with Darwen face multiple challenges in supporting vulnerable people in leading independent lives. From 2008 onwards they have turned to innovative solutions using assisted living technology (ALT) to manage rapidly growing and changing care needs. Sally McIvor tells us how it’s done..

The legal requirements placed on us by the DoLS judgement have to be met. But to do this we will need to make further cuts elsewhere and reduce or stop services to other people. “The next couple of years will be years of choice for the nation. Whether we rise to the challenge of caring for ever-growing numbers of frail older people and people with disabilities. Or fail them,” says ADASS President David Pearson.

Bringing personalisation into the heart of our thinking about - and practice - with people with autism is central to the new autism strategy published recently. Zandrea Stewart explain…

Two recent reports cast doubts on the proposed BCF changes for April next year. One suggested a delay would be called until the financial implications were clearer. The other that BCF money was already being used to plug gaps elsewhere in social care. Here, David Pearson looks at the smoke and mirrors of it all...

Incoming President Peter Hay writes.

Richard's presidential address at the start of his year promised that ADASS would open new spaces in the debate about care. Richards personal style and commitment have taken this into conversations with a new government and different players. ADASS has continued to exert a strong presence as the voice of leadership in social care, whilst placing new emphasis on the importance of sector wide roles.

Basing this month's blog on her speech to the National Children and Adults Social care Conference (NCASC), ADASS President Sandie Keene sees the current changes within the sector in the round, with the Care Bill, integration and the Transformation Fund being building blocks in a much wider enterprise of meeting need. Opening the door to individual wellbeing means having a single key to spring a single lock to a seamlessly provided service.

Talk following the latest BBC Panorama disclosures concerning Castlebeck and Winterbourne View Treatment and Assessment centre was that it was a bit of a 'damp squib'. Yet it seems to me that is wrong. No, it wasn't as harrowing as the first undercover exposé. Nor were the additional signs of potential abuse anywhere near so brutal. But after what we all witnessed in the first programme, it is shocking that there is anything approaching abuse still to show.

My first meeting with our new Care Services Minister Norman Lamb coincided with the launch by the Institute of Public Care at Oxford Brookes University of its major new programme to help local authorities develop care markets for quality and choice. The initiative flows from the general duty towards all local people, to be enshrined in the forthcoming Care and Support Bill, for local authorities to provide information and advice services, as well as promote local market arrangements `so that there are high quality services to meet peoples choices.

If anyone had asked ADASS "what would you do with £2bn?", I think we could safely bet that reimbursing people for the sale of their property to pay for care would not have been high on the list. Whilst many in the care sector understand that individuals facing catastrophic care costs and the loss of life long savings and assets is wrong, it wasn't on any of our campaign lists.

Mike Farrar, the chief executive of the NHS Confed recently warned that the current health reforms represent a potentially fatal distraction from the real tasks facing the NHS in managing the money and tackling the desperate need to strengthen care provided in the community.

There's more than enough space taken up by reviews of the last year, and life is for living forwards. So as time moves into 2012 heres a view on what the year to come may hold, with the knowns, the unlikely and the complete unknowns all getting a show. 

The emerging findings and conclusions of the engagement exercise were presented to the Secretary of State last week. The Secretary of State and the Minister for Care Services released the presentation with clear interest in the recommendations, accompanied by an obvious enthusiasm for care reform. Those who claimed that the reform of adult social care was in the long grass, should start booking the mowers in for a service, just in case!