Incoming ADASS President Ray James has a vivid metaphor to help approach the conundrum facing social care leaders in the run up to this year’s spending review. Will social care `fall over’? Can it be sustained on the current financial base...?
RAY'S ANSWER IS to use the analogy of the pressure cooker, where the heat has been turned up close to the maximum and the heavy weights have been placed on the lid in order to hold back the steam. Inevitably, more and more of the steam will escape in the next few years, but just how seriously is what we all need to see.
“Sadly I suspect that if I get scalded, or if staff working in the sector are the only ones to get burnt, then the pressure will be allowed to build. But if politicians begin to feel the heat, then that may increase the likelihood of some difficult choices being made – and some of them will be the right choices about social care locally and nationally. Ultimately, what we must, must do is make sure that citizens don’t get burnt over the next few years.
“We need to be able to afford to care, and we need politicians to show that they care as well in terms of the decisions they’ll take around the funding settlement. With the technical expertise of others, hopefully I can be one of the voices. This has to be a shared message across the sector with providers and commissioners with one voice saying very clearly to politicians in an evidence-based way – and heaven knows, the evidence is there – that the sector isn’t sustainable as it currently stands.”
Born in London’s east end 50 years ago, Ray is the only son of Irish parents with whom he is still in deep and close contact. His mother, a former nurse; his father a convenor for a furniture trades union.
“All my ancestry is Irish,” he says. It meant a `wonderful upbringing’ enjoying a combination of the City of London for most of the time, and warm summers being taken care of by relations on a family farm in Ireland. It’s where he learned to help out, the value of hard work, experience the opposite of what living a city life is all about. “It’s only by looking back that you begin to appreciate it all. I was so fortunate to get the contrast that I did. “
He got to 11, passed the 11-plus, got a place in the local grammar school.. “but was a stroppy sod even then and refused to go. I was determined to go where my mates were going." And so he did. Born in Hackney but growing up in Leyton (where his parents still live) he had a traditional catholic education at the local catholic secondary modern and took his A levels in 1983 in Chemistry, Physics and Pure Maths.
His reasons for not taking up the place at Loughborough University are complicated and very much to do with the anxieties brought about by the severe depression of the early 1980s. But rather than take the degree in Sport and Chemistry which awaited him, Ray opted instead for a career in local government taking up his first post as a Scale 1 clerical officer in what was then called the social services staffing section in the LB Waltham Forest in March 1984.
He was fortunate enough to benefit from professional training funded by the local authority which was to lead to two professional qualifications and a Masters in leadership. “No - I didn’t go to university first time round. I try to get some street cred by saying I worked my way up from Scale 1,” he says deploying a self-deprecation which is intended to, and does, charm.
Four years later he arrived in Newham with a role in the corporate centre via spells at Redbridge and Waltham Forest and then, in 1991 moved to the London Borough of Enfield where “many roles later I remain to this day."
His career path combined managing support services, before specialising in Commissioning and extensive partnership work with the NHS. He was head of commissioning with the social services department before becoming an assistant director for adults (2003) and then director in 2006, his responsibilities include, health, housing and adult social care.
Of all the developments in the public sector over recent years, he considers personalisation to be one of the big success stories. "Many other sectors could learn a lot from social care and the way we have tried, via a person-centred approach, to help people who use services and their carers gain much more control and influence over their own lives and the lives of others. That’s been one of the biggest changes during my time as a director, and it so fits with what’s important to me and my value position.
“I’ve seen the sector change from being populated by probably one or two too many people who thought they knew what was best for others and that that was their contribution to make through that expertise. Now there is an increasing numbers of people who relish helping others to make informed choices about what really matters to them and to their quality of life, and who see their role as empowering people to make decisions rather than taking decisions for them.”
Yes, he is well aware of the financial challenges and pressures being put on the pressure cooker: “That challenge has grown significantly in recent years and is going to be a dominant theme in the time ahead. My presidency will see a general election and a Spending Review – clearly there’ll be priorities we’ll have to set early on in order to make sure that we influence that and get the right settlement.”
For Ray, where there’s a limited and decreasing amount of money with increased demand, either fewer people get a service, or on average we spend less on people who do. There’s no other way in which to work that equation other than perhaps working on prevention more effectively. So this impels us to “an honest conversation with local people about the limited resources within which their skills and abilities can be brought to bear on what matters most to their quality of life. This way they can help the public pound go perhaps further than we might do ourselves.
“I try not to duck it: it’s better to be open about those challenges. Politicians have got some unenviable choices to make about the state of public finances over the next few years. Our role is to try to make sure that they are informed enough to make the right choices. They can’t avoid the inevitability of having to make some decisions that will put social care funding on a more sustainable basis than it currently is, both nationally and locally.
Closer health and care is central to the solution, “but I ‘m disappointed when people talk about its being the answer to all the financial challenges. There’s no international evidence that says it’ll make that scale of difference. The future has to combine integration with a sustainable financial settlement for both health and social care. Frankly if budgets get completely pooled the history of the last few years suggests that increasing proportions of spend ending up in the acute sector. And I don’t think that’s the system we want in the future. We want care to be closer to people’s homes.
“Integration is clearly going to be an important theme, and the NHS England Five Year Forward View is most welcome: it’s great Simon Stevens and his leadership team are openly inviting people from social care to join them in helping to plan and shape and organise things for the future.”
But, for Ray, it should be done in a way that involves practitioners in localities from all backgrounds with the GP contribution as `crucial’. “When its done well it can make a profound difference. But when it’s reorganised around GPs without their contribution, then we increase the likelihood that existing behaviours will continue. But however we organise the system, if behaviours don’t change the structure will be a bit of an irrelevance.”
The Manchester example is interesting, he reckons. And he can’t see anybody standing for the London mayor in 2016 without standing on a platform that is about at least what Manchester has got in terms of health and social care. “They’ll face some tough choices about the future of local hospitals and A and E. But I firmly believe that it’s through that devolution to a local approach with people who are committed to that locality that you will get the degree of consensus building and commitment to work together to make absolutely the best use of limited resources.”
He speaks with authority: most of his early experience of ADASS has been with the London branch which he chaired for three years before becoming vice president in 2014. It was there, incidentally, he developed an earlier capacity for writing odes. Ode writing was inspired at the occasion London chair James Reilly was stepping down and Ray wanted to write an ode to mark the occasion. He was given plenty of ammunition by ADASS colleagues, many of whom will recall that the ode was entitled Mr Cardigan. “I probably owe James a drink by way of an apology for mentioning this!”
It was during his period as chair that “I was fortunate enough to be on the presidential team in a role which started as one of two assistant honorary secretaries which then changed to become the regional lead. The benefit of that was the reasonable learning curve I had leading up to the presidency, having seen it at close quarters for a few years.
With that and his in-depth experience of the Association in mind, does he think it has shaped up to meet the challenges mentioned above? “ADASS has grown in the respect it’s afforded by many senior stakeholders, civil servants, Ministers and others because of the approach we have collectively taken.” He pauses, then: “This is the moment to pay particular tribute to some of my predecessors that have navigated some of those issues. David Pearson’s thoughtful gravitas. The way Sandie Keene was able to build alliances. And just the brain of Peter Hay…I’ve seen a number of presidents in close quarters. They’ve all been distinctive in terms of the particular things they’ve bought to bear.
“But the balance they’ve had to strike has been between exerting influence in a way that is impactful, while making sure that we still get invited into the rooms where decisions get taken. This is something they’ve all worked at in their own particular way. And that’s a balance which I’m keen to try to work out over the next 12 months as well.
I deliberately chose to stand for this year because I felt that if I was going to be president then the 12 months of the new government and parliament would be the best time to do it in terms of having some influence on policy. I was also mindful that there would be a Spending Review during the year; the Care Act is being implemented; it looks like integration is going to pick up pace; the quality of care is rightly getting an increased profile; concerns about the sustainability of the market are rising, and there are ongoing substantial cuts to local government funding.
“Yes. There was a lot of `be careful what you wish for Ray’ when I put myself forward. There might even be another general election! So I think it’ll be a challenging and interesting year. I’m looking forward to the challenge: I have a fire in my belly that is all about trying to ensure that the people we seek to serve - their needs and interests - are represented in all the important debates.
“And yes, I approach it with a measure of trepidation: that might help keep me sane. But I also approach it knowing that there are lots of remarkable people in this organisation whose expertise and wisdom I’ll be able to call upon. I’ve been touched in recent months by the number of people in different parts of ADASS - and actually the number of former presidents - who’ve taken the time to offer me some kind words of encouragement and to let me know that they’re there for advice should I need it. I’ve no doubt that I’ll be taking them up on that. By 2016/17 there’ll be some really sharp difficulties in some parts of the country unless some more sustainable funding solutions are reached.”
His 22-yr old daughter Beth has recently graduated from Bristol University and is seeking to pursue a career in genetic counselling – “person centred, empowering, health and care integration in one role,” he quips,
He reads mainly on holiday, although the books closest to his bedside are two autobiographies, one of Stephen Fry and the other of a golfing hero Ian Poulter – a devotion which explains the loud pair of summer tartan golf trousers that were recently delivered to his front door.
Going back to his pressure cooker analogy he admits there are three valves which help him relieve the pressures of the day to day: golf, his family, and the commitment and dedication of the thousands of front line workers without whom social care as we know it just wouldn’t be what it is.
Ray James, ADASS President, 2015-2016