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.
I was at an event recently when a young woman spoke of her experiences in moving towards supported living. There was a mixture of excitement about the responsibility of becoming independent. Powerfully, she told us that she had been comforted and inspired by hearing the phrase Don't wait for the storm to pass, learn to dance in the rain.
It struck me that it is good to advice to many leaders in social care. After four years of budget reductions alongside the continuing rise in need alongside the most significant change in legislation for 60 years it is tempting to focus on the day to day – wait or hope for the storm to pass. The alternative for directors and senior colleagues – as well as other leaders in the sector - is to seek to shape the future through the evidence base about the benefits and risks of national policy.
As we move towards a general election, the profile of health and care has come into focus. Following the election, the anticipated spending review will mean there will be no avoiding the focus on health and care at a time when priorities and the debate will continue to rage about spending priorities and the national debt.
I am reminded of the charitable purpose of ADASS....
“Furthering the interests of those who need social care services regardless of their background or status and promoting high standards of social care services”
We can easily lose sight of our major purpose as we seek for the best way to address the next initiative or the next crisis. Our job is to promote approaches at a national and local level that promote excellence in social care.
As leaders, never has there been a greater need to challenge ourselves and others in making sure that social care makes the contribution it can. Our paper Distinctive, Valued and Personal, spells out what social care does and could do if it were adequately resourced.
Needs in our local communities are changing with more and more of us needing co-ordinated, person centred care based around their needs and those of their carers. The desire for people who have such needs is for as much choice and independence, choice and control as possible. The complaint from the public who experience health and care services as fragmented, impersonal and episodic. The task is to make sure that for those who need it co-ordinated, personal and consistent. This must sit alongside good preventative approaches in ways that enable us all to ensure our own wellbeing and delay the need for care treatment and support. This is in the DNA of social care.
Turning to the specific priorities this year extent of the pace and scope of change led to an extensive list of priorities.
- The Care Act
- Integration with health and other public services
- Financial and workforce sustainability
- Commissioning for better outcomes
- Safeguarding and quality
- Transforming Care (following Winterbourne View)
- Sector Led Improvement
- ADASS review
During the year the Supreme Court judgement on Deprivation of Liberty Safeguards, the workforce and winter pressures have also featured highly. And then of course there is how we contribute information and advice to inform policy as we approach a General Election.
The Care Act is now law and April 1st arrives with a phenomenal amount of activity at national and local level. Credit is due to the Department of Health and the Care Services Minister, Normal Lamb for a partnership with the Local Government Association to implement the Act. The contribution of ADASS has been extensive with input across 48 workstreams through the final stages of the Bill, support to the statutory guidance and development of the regulations and planning for implementation. The collective effort across ADASS from members of all categories was brilliant and made a very real difference.
The major issues are understanding the costs and being confident that not only are the provisions of the act funded, but the overall funding for social care is sufficient. Of course the other dimension is how many people who are currently self funders or carers will take up the offer of additional funding or help and the extent to which removing ‘thresholds’ for safeguarding support and engaging partners will impact.
There is still much to consider regarding the changes planned for April 2016. Parliament has put a stake in the ground, declaring the system people can and should expect in the early part of the 21st century. There is widespread support for the 2015 changes, but more concern about the 2016/17. There is a need to ensure that not only are the additional responsibilities funded and enacted, but that there is a commitment to protect social care funding overall. Adding more people to a state funded system on the one hand, whilst significantly reducing overall funding on the other puts, in jeopardy the realisation of the overall aspirations of the Act.
There has been much activity in the area of integration. There has been a preoccupation with the Better Care Fund, a laudable attempt to lever in care closer to home and moving resources around. The competing pressures on the system created inevitable tensions between ensuring that current service capacity (not to mention solvency) is not undermined whilst ushering in a new era of community provision.
There has also been the development of Pioneers and Integrated Personal Commissioning. There has been a huge focus on Winter Pressures after Christmas. Representing ADASS on the Cabinet Committee has served to emphasise to me the importance of joining up work not only to address the increased demand for services, but to make sure we collectively understand the key factors that create such demand. In the new year an extra £37m was allocated across all authorities in recognition of the additional demand and need experienced for care and support services.
Integrated Personal Commissioning may yet prove, in the longer term, to be the most significant development from 2014. The cultural and technical challenges of introducing this in the health service is not to be underestimated and yet the results of the POET survey by InControl, TLAP and Lancaster University resulted in more than 80% of 4,000 users of social care personal budgets reporting that it had improved at least 10 of 14 outcomes.
We will be engaging strongly with the 5 Year Forward View of NHS England, local development of models of care and testing partnership arrangements. What is clear is that there is strong momentum towards integration, but it seems likely that there will be flexibility of design at a local level. Meanwhile we will be seeking to emphasise the contribution of social care in an integrated environment.
Financial sustainability has a twin track - the need to make sure that the most innovative ways of delivering cost effective services are shared across the country. John Bolton's work for the Local Government Association was a significant component of an ADASS seminar in September. The ADASS budget survey highlighting the 12% cash reductions and 14% saving required as a result of increasing need, continues to be a powerful tool and featured in a large number of radio and telephone interviews. The focus increased as the profile of social care and the sustainability of the cuts became a national issue. Our argument has been that protecting the health service whilst cutting social care in this way makes no sense. A plethora of reports reinforce the point, including those from the National Audit Office, the Nuffield Trust and the much respected Barker Commission.
Probably, the most challenging area for senior colleagues and Councils is the commissioning of decent quality services in local areas as resources tighten. There has been an intense focus on local authority commissioning as a result of increasing focus on aspects of quality whether the length of calls has led to visits that do not allow for care needs to be met with dignity. With an estimated 1 in 10 care workers on less than the minimum wage, the costs of residential, nursing and home care having gone down between 2010/11 and 2013/14. The allegation has been that some local authorities are not paying enough to enable providers to pay minimum wage.
We know that numbers of people receiving social care has reduced in recent years by nearly half a million despite rising need. Of course it is an objective to reduce or delay the need for care and support, but in responses of Directors in the budget survey highlighted the concern of the many Directors that this could mean that people who need care and support do not receive it for lack of funding. The Commissioning for Better Outcomes standards were developed by ADASS and TLAP in conjunction with Birmingham University and published in October. There was a call for inspection of commissioning. Meanwhile it is right that the pilot Peer Reviews took place in March 2015.
Safeguarding has become increasingly important due to increasing referrals as a result of increased public awareness of safeguarding in domestic and community settings and in relation to it becoming the route of choice for addressing complaints and concerns about the quality of regulated care. Making Safeguarding Personal, which is about outcomes focused, person centred responses that aim to enable people to reach resolution and recover what has been signed up to by all local authorities - a success story..
Transforming Care, the post Winterbourne View Programme was a commitment to reduce the numbers of people with learning disabilities, who are in specialist hospitals. At the start of the programme there were 2,600 people in England in such facilities - 2 years later despite a programme to enable transfers of care to community settings the numbers of people were more or less the same. A reformed programme following the publication of the Next Steps report and a review led by Sir Stephen Bubb.
The change in approach takes account of the barriers that has impeded progress over the last two years. This is an NHS England led programme and from now on, the role of Vice Chair of the Delivery Board will be held by ADASS. There will be a renewed focus on ensuring that any future admissions are essential and on plans to leave hospital. Of course this means that all areas will have to get to the position of the best in developing options to ensure that there is the "right care in the right place". The necessary resources, skills in the workforce and co-operative working will be required in abundance.
Sector Led Improvement continues to develop and strengthen. Arrangements and the strengths of the approaches in each region have been highlighted. The annual report of Towards Excellence in Adult Social Care shows that despite the challenges in commissioning and quality, satisfaction overall improved slightly as did the number of people who felt safe as a result of receiving services. This is nothing short of remarkable and is a tribute to the people working in social care at all levels and perhaps, the benefits of a personalised approach.
This year saw the retirement of Mary Gillingham as the ADASS Business Manager after 14 years of dedication and commitment. We welcome Cathie Williams as our new Chief Officer. Due to additional support from the Department of Health it is possible to further enhance our capacity adding to the incredible voluntary effort of Directors, Extended Member and Associates and the incredible commitment of a small ADASS team and our immediate partners.
For me personally this has been an incredible year. 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. The examples are far too numerous to mention. 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.
David Pearson, ADASS President, 2014-15