Adass Conference Speech Harrogate October 2009

Adass Conference Speech Harrogate October 2009

ADASS CONFERENCE SPEECH HARROGATE OCTOBER 2009

EMBARGO: 11.20 am, THURSDAY OCTOBER 22, 2009

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Good morning. Good to be in Harrogate again. Earlier this morning I was delighted that Linda Bellingham was able to join us to talk about her experience of looking after her mother who had dementia. She was only able to come because she was knocked out of strictly come dancing recently (I didn’t vote). It reminded me that the last time I was on stage in Harrogate Hall, 42 years ago, was in a country dancing competition. And I was also knocked out early on.

So that was 1967 – I am part of the baby boomer generation, benefiting from a good health system, educational opportunities that meant I was the first generation in my family to have further education and get a degree. To not only contribute to a pension but, unlike my father and his father, have expectations that I might get to enjoy it in retirement.

Last year was the 60th birthday of NHS and babies born since the start of the welfare state will soon be retiring in big numbers. Thinking back to the context of the time when it was created we can see why the Welfare State didn’t cover social care in the way we need it to now. Neil Hunt has just talked to us about the prevalence and experience of people living with dementia – this is just one aspect of the changes we have seen in conditions and complexity. Now a third of the UK population are over 50 and the numbers are growing. We are strong in our 60’s and 70’s, many still active in our 80’s. My colleague Simon Leftley told me that a couple of weeks ago his wife, daughter and 85 yr old mother in law all took part in a 3 mile charity run. At 92 yrs old Vera Lynn was back in the Top of the Pops charts! And many babies born today are likely to live to 100.

These huge demographic changes will kick in by 2015. But not everyone will be in good health. Or living with close families or in supportive communities. When I speak to people using our day services in Essex I often hear that they have no close family left and very little contact with neighbours. Large numbers of people need and use social care services at some point – on average 2 out of 3 of us women in this hall and half the men. For those people social care is hugely important in having a life or getting a life of some quality. But we know that it is not well understood by the public, in part perhaps because, up till now, we have served people who are disadvantaged or socially excluded and we have an important role in listening to and representing their views.

My focus today is on the leadership challenge we have, as councillors and directors in local government, as directors and chief executives of private and voluntary organisations, to create the vision for the new sustainable social care infrastructure, fit for the 21st century, and to have an ambitious agenda for the next year and the next government.

Working in social care, we could take the view that this is the most difficult time – extreme economic pressures and downturn in public spending, alongside the continued upward demand for social care services, and the last few months before a general election.

But we must make it a year of opportunity. We have the burning platform for change, a good crisis not to waste.

It will take strong leadership from us, and particularly across 3 major priorities this year:

  1. Transforming the social care offer – and telling people what they can expect from us.
  2. making the most of the money we have in the system and shaping the options for the future
  3. Having a workforce to do it.

They are of course inter-related and inter-dependent and we need all 3 ducks in a row.

There is just time to say a little about these priorities but the conference agenda this week has sessions which go into more detail and give us thinking time together.

TRANSFORMING THE OFFER

I am of course referring to the reform agenda, “Putting People First” which is about creating a new infrastructure for people who need care and support whether it is publicly or privately funded, provided through paid or unpaid carers. A system for all our citizens, who have fast rising expectations of the services they pay for, through tax, self-funding or charges.

There is widespread political support for this agenda and so we can expect there will be continuity in this as a long term strategic direction.

Putting People First is a 3 year funded programme and we are half way through, so how do we know if progress is good, adequate or insufficient? How do we know what people using services and their families and carers think and whether outcomes for all are improving? Some of these questions can only be answered over time, which is why in Essex we have commissioned a 3 year study to feedback on the difference it has made to people’s lives over that period.

The ADASS Survey of all Local Authorities in March this year confirmed councils are starting from vastly different places in implementing this reform programme. They had started working on different parts of the system, for example, some were introducing personal budgets, others were focusing more on developing prevention services, and others providing information, advice and advocacy for their communities. The survey informed regional and national programmes of work to support progress and a range of tools are being published this week at conference.

Last month ADASS and the LGA, supported by the Department of Health, published a series of milestones that councils can use to check progress. The milestones are based on 5 key priorities during the first phase of transformation:

  • Partnership with service users and their carers
  • Personal budgets
  • Prevention
  • Access to information and advice
  • And a broadening of choice and improvement in quality of care and support

Looking forward, the test of success will clearly be the quality of the experience for people. All councils will have good examples of use of personal budgets and support planning. The ones I have seen enable people to be more active, have their cultural needs met, live at home in the way they want to and be less isolated. And we can learn from the way people use their personal budgets to inform the way services need to develop.

But reports and reviews published in the last year (from CQC, Mencap and others) tell us some people are not getting the services they should. We know that most social care funding is spent onpeople who have high needs and are often very frail and in their last years of life, or don’t have mental capacity. So as we transform Adult Social Care we must pay as much attention to the quality of intensive care and support, and the importance of choice and control over these services, as we do to promoting independence and independent living. The work we are currently doing to implement the dementia strategy, the Carer’s strategy, and Valuing People Now reflect this.

Two further points on our role in LEADING the transformation.

  • I think we can be proud of having established a new model of delivering govt policy – through Co-production. The social care sector is driving the implementation of PPF with excellent support from DH. It is a model that works. The next step is to move to true co-production with the independent sector and with citizens.
  • Secondly, Scale and scope of this journey is far greater than we first imagined. It is challenging council’s organisational processes. It is starting to offer, more control and flexibility to citizens, but to offer more choice there needs to be changes to the supply of services, and the independent sector has a critical role to play here. It will probably take a decade to embed a new infrastructure and we need to make the most of the first 3 years of the transformation programme and funding to lay secure foundations for the longer term.

Which leads on to?

USE OF THE MONEY AND SHAPING THE FUTURE options

The first six months of this year has been dominated by the economic position of the country. These are hard times for people using services and seeking support, for their families and carers, and also for front line practitioners, and service providers, as evidenced by the ADASS recent survey on the impact of the recession.

While expectations are rising and needs are increasing, public and private resources are diminishing. Local authority social care budgets are under growing pressure and as I talk to my colleague directors across the country it is clear that most of us are planning for significant budget reductions over the next 3 years, even taking into account low or no inflation or wage increases. In response to this Directors of Adult services are working locally and regionally in Joint Improvement Partnerships to develop services that are proven to be more efficient and better value for money – for example, in re-ablement and telecare. Some councils have embarked on corporate transformation programmes – eg Essex council plans to become a commissioning organisation with its partners, working with a range of delivery organisations and new models such as Essex Cares as a Local Authority Trading Company. 13 councils are piloting Total Place, which brings all public sector resources together.

In one way or another we are all looking for ways of delivering services more effectively, and that includes looking at the way we currently use the resources we have in the system. We welcome the DH work on the “Use of Resources” that is being launched at conference this week. It will assist us in understanding what the best pattern of investment looks like. Of course we need to understand what this investment should look like for the transformed Adult Social Care system, rather than the old pattern of services,.

But however well we use the money currently in the system we know it isn’t enough. Of course ADASS is delighted that social care funding is now high on the political agenda, so high that we saw 2 announcements in the recent party conferences. just a comment on those 2 proposed options:

Concentrating only on residential care costs on the one hand, or on the costs of caring for people in their own homes, risks seriously destabilising an already fragile health and social care system for older people or of creating perverse incentives. Political leaders from all parties need to recognise that the costs of caring for people in own homes, and in residential homes as well as in hospital, all need to be seen as a single, indivisible whole.

ADASS warmly welcomed the Green Paper “Shaping the Future of Care Together” which recognises that a comprehensive solution is needed. We have been pleased to play our part in the Big Care Debate over the last few months, and we will of course be responding to the consultation, as well as contributing to an inter-agency response with partners. Rather than go through the detail of that response I want to make some general points on the Green Paper.

Firstly, what we really like about it:

  • it says it like it is – the current system is underfunded (by about £5b), incoherent and unfair. We know. Financial arrangements are deeply resented by service users, carers, and families, while the rest of the population are either ignorant of them, or find them incomprehensible.
  • The proposals represent a major and far reaching reform of the system of social care and support.
  • It makes a strong case for change, establishing the principles and framework for social care, confirming the strategic direction set by Putting people First.

We know there are several strategic choices to be made. Each has significant implications, particularly around the funding options and the national versus local debate. More information is required to make informed choices, for example the detailed financial modelling, as well as clear assurances to people on disability benefits that they will not be disadvantaged.

What ADASS would like to see, potentially in a White Paper, is:

  • Reference to the concept of social capital which was missing from the Green Paper, and a more specific focus on the important role of the family, community and carers in people’s lives.
  • a system that is funded and committed to prevention and independent living on the one hand, and on the other hand can deliver high quality intensive services which provide dignity and choice to the growing numbers of people with high level needs.
  • More concrete proposals about joint working. The Green Paper rightly places great emphasis on the principle of joint working between Local Authorities, the NHS and other services, and ADASS agrees there is scope to do much more. Perhaps this could be achieved through a national concordat setting out minimum expectations. There is a need to promote and incentivise collaborative funding arrangements to deliver the best outcomes for people, reflecting local priorities. We can get more local innovation and greater value for money by looking at the pattern of investment across the health and social care boundary.

After the election we need cross party support setting out a real understanding of what citizens can expect from the whole health and social care system in the future, whether you have acute conditions like cancer or long term conditions like dementia, what you are entitled to for free and what you pay for. The current consultation coming to an end but the leadership challenge is to make sure this Big Care Debate goes on to create a platform for the next government.

New sustainable funding cannot be kicked into the long grass – the current situation is stark.

Having talked about the financial resources, the 3rd part of the trilogy is human resources:

THE WORKFORCE – our greatest asset.

ADASS were delighted that Moira Gibb was asked to chair a Social Work Taskforce focusing on qualified social workers in both children and adults. Social work has a key role to play in the implementation of Putting People First, and in social care services in the future. We are working with Skills for Care, DHand BASW and will be providing sector leadership in developing an agreed set of definitions about what we think Social Work’s role and functions are. We need a confident workforce and confidence in the workforce. ADASS acknowledges that LA's need to do more to support effective Social and to build clarity about the future.

We welcome the proposal to establish a national college of social work as it will provide an effective voice for the profession. We look forward to the final report from the taskforce due out next monthand the Association will play our part in taking forward the recommendations.

However, qualified social workers are around 8% of the total social care workforce, and we need to pay as much attention to the other 92% as we have over the last year to social workers. Six months ago the DH published a workforce strategy. It is helping us to think about commissioning the workforce with the right skills and in the right numbers. But it has been estimated that by 2025 we will need between 50 and 80% more staff.

The key question is where are they going to come from – how are we going to get the right people interested in working in social care? Can we attract young people in through the new apprenticeship and national graduate schemes for example? Fantastic first 20. Many of these additional people are needed for hands on care, and we know that the quality of the direct relationship and experience of this care is the single most important thing we have to get right.

So we need to attract people of the right calibre, who can be supported in developing the right skills and capabilities for working in new personalised public services. Although it’s a difficult time we need to address pay and conditions of the care workforce, the majority of whom are low paid. Although skilled and highly committed, they have limited access to training. Andy Burnham recently said “in the NHS well rewarded staff lead to happy patients. The same should apply to social care.” I agree.

Many of the issues identified in the interim SW Task Force report apply equally to the rest of the social care workforce, for example recruitment and retention difficulties, lack of time for client contact, lack of tools for the job, lack of strong national voice and leadership and being undervalued. It is not the remit of the SW taskforce to address these issues in the wider workforce, So can we now have a cross government, cross sector, high profile Social Care Task Force for the 92%? I am aware of a lot of good work on a lot of fronts, but it needs the same umph (technical term) to drive the agenda.

In providing leadership ACROSS ALL 3 PRIORITIES we will need:

  • To stand by and promote our core values and principles of respect, dignity, individuality, human rights and responsibilities as citizens.
  • To work within strong partnerships locally and nationally– with health, housing, and Schools, Children and Families, using our wider DASS responsibilities and wellbeing duties.
  • To be supported by a strong, coherent and efficient infrastructure of national social care delivery organisations. What directors want from SCIE, Skills for Care, the General Social Care Council and the new National Skills Academy is consistent delivery and innovative, cutting edge practice. The launch of SCIE TV this week is a good example.
  • To work with CQC as regulator and as a partner in performance improvement. Despite the increasing demands, Local Authorities’ performance has improved year on year, and we should all celebrate that. ADASS looks forward to a constructive relationship with CQC, and to the opportunities that a shared assessment of outcomes across health and social care can bring.

Finally a few thank yous.