Dont ask: what can we do for the NHS? But what can we do together for all our citizens?
In my speech to this years NCASC I warned that the year ahead offers tremendous opportunities and serious risks. However, even if the difficulties we face seem like barriers, fences and locked doors, by sharing the sort of best practice which is shaping new directions for social care, we are discovering the keys which unlock doors and help us glimpse the possibility of perhaps a better, albeit different, future.
I was inspired in my lock-and-key metaphor by a lady from Leeds called Elsie. She was nursing her husband at the end of his life and had her own serious health problems to contend with. She found that getting the help they needed was both frustrating and confusing. She said it was like getting a bunch of keys. She didn't know which key fitted which lock. Sometimes she struck lucky and the service was great; at other times she just couldn't get through. When she received the single, golden key of an integrated care team her life was transformed and her husband was supported in a dignified death.
Elsies story has had a deep impact on me.
We need keys to unlock the doors, padlocks, chains and fortresses of budget restraint, relentless demographic pressures, health inequalities, a low-paid workforce and serious resistance to quality improvement which all potentially bar the way to a better, brighter future.
As leaders we will have to craft the keys we need by creating new conversations, promoting new opportunities for innovation and harnessing potential within families and across communities, uniting too the voluntary, public and private sector to a new shared endeavour,.... which is why my theme today is one of unlocking the potential of citizen and state.
"We are not the only sector with a contribution to make to this effort. A significant key to our lock is the engagement of the private sector"
Our first key is recognising that promoting everyones active and engaged citizenship is a prerequisite for our future. The need to build our support systems by recognising the strengths (not deficits) of people is now an established direction. We may call it by different names in adults and children's services (coproduction, restorative practice, self-management, to name a few) But at its heart is the respect and empowerment of individuals within their families and communities to help them achieve potential; self-reliance, and social and economic contribution irrespective of their circumstances. And we can help or hinder their progress.
To help, we need to build community infrastructure and expand the offer of our universal services to embrace all members of our society. It will impact on our community planning decisions for accessibility and inclusivity; development of innovative housing and transport solutions, and investment in - and encouragement - of social entrepreneurs. First and foremost it will involve the engagement of citizens at every level and at the heart of decision-making and prioritisation.
We are not the only sector with a contribution to make to this effort. A significant key to our lock is the engagement of the private sector. Vibrant new partnerships can be created by developing a higher level of community engagement between private sector companies, social enterprises and the wider third sector. Building on shared values between companies and the voluntary sector, revitalised corporate social responsibility is successful as a long term investment for business, rather than a gift. It benefits both parties.
In Leeds, for example, we have a network of local neighbourhood organisations whose volunteers are in the main themselves retired people. They can draw on ex-teachers, administrators, nurses and engineers who want to use their skills and be active. One of the Leeds organisations has joined up with First Direct Bank with a proposal for staff volunteer time in return for a varied training programme covering communication and listening skills, health and safety, safeguarding and caring for people living with strokes, dementia and disabilities.
First Direct initially released 210 hours of volunteer staff-time and have been so impressed with the outcome that they have now contributed some of the company training budget to support the mutual benefits derived by both organisations.
The achievement of this kind of thing will be an imperative if we are to square the circle of the strategic dissonance of underfunding with the new duties of prevention, promotion of independence, rights and entitlements, which are enshrined in the forthcoming Care Act. No-one from the sector can resist the aspirations and direction in which this legislation takes us.
But we will need every ounce of ingenuity and creativity to ensure its successful and costed implementation.
"Its gratifying to know satisfaction rates remain high. But the percentage of people who do not have a positive experience is stubborn to move"
We have started the progress of implementation with an innovative approach - a partnership between the Department of Health, the Local Government Association and ADASS with DH-funded and LGA-led joint programme management. As a sector, we are intent on ensuring there are support mechanisms and materials available to prevent the need for authorities to start their thinking and preparations from scratch. We will support implementation and development of shared solutions along with advocating for, and financial modelling of the true costs of delivery.
Achieving personalised approaches to care delivery is a policy key firmly placed in the door of our day to day working practice. We know from our personalisation survey that in many places the key is turned and the door is open to the choice and flexibility to which most of us aspire. But we know that the stubborn and rusty locks which resist turning are those where impenetrable and lengthy administrative and approval systems, along with lack of availability of new models of care delivery, limit choice and potential.
Whatever the reasons for the reported quantity of personal budgets, we are now rightly focusing our attention on the quality of experience of people who use services, and the availability of support, information and guidance for those who fund their own care. Despite our financial challenges, it is gratifying to know that satisfaction rates remain high. But the percentage of people who do not have a positive experience is stubborn to move.
"The driving force behind our actions is the burning platform of fiscal reduction"
The keys needed to address quality issues are held in many hands. Commissioners, providers and regulators all have roles to play, in addition to the encouragement of people who use services and their families to report on their experience. The role of employers to support staff, uphold standards and take responsibility for quality is irrefutable. And the necessary support to citizen commissioners must be available.
Commissioners are rightly in the spotlight to see that their approach to commissioning is informed, proportionate, inclusive and properly costed in order to ensure the safe delivery of care. The recent publicity about 15-minute calls and the regular reports citing individuals experiencing inadequate care must drive us to find better ways of commissioning and supporting more personalised approaches to care.
We must find that golden 'master key' for use across all parties for stubborn resistances to quality and improved commissioning. By working together, being transparent with information and focused on outcomes, we can provide that shot of WD-40 that frees a corroded lock and allows its key to turn.
We know that quality is to a large degree in the domain of our workforce - and the most difficult lock for any of us to turn is that of low pay. Reports of below minimum wage being paid for care cannot be condoned or supported. But the agonising choices being made about how much care to buy versus how much to pay, along with the reductions in budgets mean that this key must be turned by national politicians and a public debate. I hope we can all be active participants in the coming year, making transparent the actual costs of moving below minimum wage where it exists to minimum, and then all wages to a living wage, thus indicating the national value of care for our most vulnerable citizens. The price tag will be significant but must be addressed outside the current financial envelope.
"The volume of pioneer applications shows a system poised to join health and social care services at the front line in order to improve the experience of people who need them"
So it would be remiss of me not to raise the issue of funding. As a sector we are of course very pleased at the recognition of the need to make provision for changing demography, new duties in the forthcoming Act and integration, through the £3.8 billion transfer. Our concerns are now about the additional reductions in local government allocations - how many times a single pound is expected to be spent - and the expectations riding on what can be achieved, and for whom.
If we are able to focus inexorably on outcomes for our populations, and not outcomes for our organisations, there is hope that this will be the key we need. It is one which enables us to consider the totality of our health and care budgets (not just the single £3.8 bn) and base its use around locality not institution. Our negotiations with local and national health organisations are critical to achieve the spending and performance plans required. Achieving the support necessary for local service redesign will enable us to ask: not ....what can we do for the NHS....., but what can we together do for our citizens.
The volume of pioneer applications shows a system poised to join health and social care services at the front line in order to improve the experience of people who need them. Whole-person care is accepted currency with a coalescing of vision around single points of access, proactive care coordination and the importance of primary, secondary and community health joining forces together and - with social care - to deliver a new offer.
The driving force behind our actions is the burning platform of fiscal reduction. We have much riding on the potential of integration to release value in an over strapped system. The underdeveloped evidence base is balanced with a passionate belief that this is right for people. Whatever the bigger-picture issues which need addressing in health,..... the acute sector, financial flows and competition...we need to see a revised health and social care community service working in partnership with citizens.
As we see ever greater integration between health and social care we must never lose sight of the fact that equality must be one of the key driving forces of that process. We live in a diverse society so it follows that we need to understand what that means but more importantly what that means on the frontline. The launch of the Common Core Strategic Diversity principles at the Harrogate conference, available from Skills for Care, will support our quest to embed equality in all parts of our organisations.
"Dont ask: what can we do for the NHS? But what can we do together for all our citizens?"
And all this will mean changes for our workforces. Integrating front line multi-professional teams will mean a review of the skills required. Social workers will be released to become leaders of community capacity building and helping to redesign the offer of support. Their work will draw in the voluntary sector and carers support workers within the locality team, ensuring that the right levels of advice, guidance and advocacy sit side by side with the universal offer. Re-energising the pride, positivity and can-do attitude of the social work profession is a priority.
Despite the challenges, there is an opportunity for social work to come of age with a golden key for a new, shiny front door that opens at a single push and welcomes all in need of a health or social care service. But will forging new relationships with citizens, enterprise and integration be enough? Probably not.
Alongside all the familiar and challenging levers in the lock is the need to release the innovative potential of technology. The other day I visited a company in Leeds on the cutting edge of technological support to Individuals giving a glimpse to the future technological solutions with us now.
Bringing company and companionship into people's homes electronically via interactive TV is increasingly recognised as making a significant difference to isolation and an important preventive development alongside the more familiar telecare interventions. Expanding the potential of social media, apps, chat rooms for self-help and web based direct access to services will become the norm sooner rather than later.
"Given the right mind-set, we can see opportunity at every turn"
And using new information sources to target more precisely our increasingly scarce resources will also be imperative. If supermarkets can anticipate how to stock their shelves on the basis of the weather forecast, why cant we aspire to better anticipation of need through combining all the information sources we could have access to. As well as realising the availability of real-time, joint health and social care data, a vital component of planning and managing an effective health and social care system will be developing the links to the so called 'big data agenda.
Combining DWP, utilities, police, fire and other sources and actively engaging citizens in the control of their own web-based information could be a solution to improve targeting and truly find out how many of our resources are ineffectively used at present. Integrating and using information in core, mainstream business at every level will need to be a given.
But focusing on future innovation when our eyes are on surviving and sustainability will be a challenge in itself, requiring all the ingenuity, energy and ambition of leadership. Much has been written about leadership in lengthy and weighty tomes. There are no simple soundbites, but the sector is looking to us, as leaders, to deliver. And critical to our success will be the way we support and share best practice with each other through programmes such as the Pioneer Initiative, the Care Bill Implementation Board and of course the sector-led improvement programme.
"Despite the challenges, there is an opportunity for social work to come of age"
We are already adding enormous value to each other in the development of sector-led improvement with every region now actively engaged. Programmes of support are being developed including regional improvement workshops, a self-improvement tool, peer support and challenge initiatives, reviews, training events, master classes, buddying arrangements, benchmarking and so on. The list of activity is impressive.
There are still some sceptics and to those I would like to give the example of one regions activity. In 2011/12, the first year of the peer performance assessment this region agreed to a detailed analysis of performance for all authorities which showed one authoritys results to be poor. Despite a known context, this could not justify the performance.
The DASS and senior team welcomed the review and support from regional colleagues, however uncomfortable, as it was an external assessment by the sector itself, using respected colleagues to produce a powerful message, with indisputable feedback from users on their direct experience of accessing services.
The authority reported that the regional review starkly illustrated the impact that preoccupation with internally focused challenges had had on the outcomes they achieved. These issues included a senior management restructure; an interim senior management team in Adult and Community Services and a Council restructure linked to budget savings which reduced not only staffing capacity but significant loss of organisational memory and experience.
The result of the review prompted a re-focus on issues... uniting elected members, senior management, corporate colleagues and ASC staff. Early signs are that since the 2011/12 performance assessment, the authority has improved in 16 out of the 18 measures reviewed.
That testament says to me that SLI is an important tool to craft the keys we need for improvement and change and reinforces the need to consider carefully the unintended consequences of budget reductions to non front line services.
Never underestimate the importance of leaders creating an environment where shared endeavour will unlock the potential of our citizens and organisations. I hope I have shown that potential can come in many forms and from many directions, some of them unexpected. Given the right mind-set, we can see opportunity at every turn.
But what about Elsie, whose bunch of keys so inspired my thinking? If we can realise the potential that is presented in the areas I have touched on today, there will come a day when the Elsies of this world will need just the one key on their key-rings. And the key will fit all locks. All the locks will turn. And their doors will open to give admission to the seamless service that Elsie and her companions-in-care want, need, and are entitled to.