At the Adult Services National Commissioning and Contracting Conference Rosemary Trustam was encouraged to hear about efforts to bring the best to bear on issues despite the looming financial crisis.
‘Never doubt that a small group of thoughtful committed citizens can change the world – INDEED it’s the only thing that ever has” (Margaret Mead)’ .
This was the message from Ray James President of the ADASS at the annual Adult Services National Commissioning and Contracting Conference and perhaps exemplifies such a group of thoughtful committed people – commissioners who genuinely want the best. In opening the conference Ray James urged remaining open to people receiving services and co-production with stakeholders. Relationships not structures were the answer. He said: “Providers are our friends – many bring a depth of knowledge and experience”. Later Martin Quinn CAT Consulting highlighted the EU procurement rules which permit ‘suppliers to be involved in design and terms’. This is a positive message to many good values-driven providers, frustrated by the lack of dialogue to use their expertise to influence commissioning.
Ray James acknowledged the very real sector pressures given the fall in resources, noting providers going out of business/withdrawing from unprofitable work. Quoting Martin Green, Care England, he said, “Without adequate funding to pay for the national living wage, the care sector is at serious risk of catastrophic collapse” He also highlighted quality pressures, with 41% of community-based adult social care, hospice and residential social care services inspected by CQC since last October judged inadequate or requiring improvement. (CQC Board Paper Sept 2015). Acknowledging the huge contribution of social care frontline staff, he made a plea for them to be ‘paid, trained and valued in a way that is consistent with the quality of service society rightly expects of them’. Given the growing difficulty in recruitment, highlighting some specific problems in affluent areas with more competition for jobs, he suggested more engagement of local politicians. He said banks and lenders are waiting for greater certainty about funding for the minimum wage.
Good commissioning he said needs a fair cost of care with market shaping and balance, a collaborative approach to quality and a strong sustainable, high quality, vibrant market that delivers choice & control, that meets individual improved outcomes and upholds individual rights, referring to the Commissioning for Better outcomes toolkit (1).
His vision is of an integrated service across health, social care and other public services, especially housing, with personalised services co-produced with and for local people, their families, carers and communities – underpinned by a focus on individual wellbeing. “More integration is the right thing to do but we’d be deluded if we think the very marginal savings from health and social care integration would answer the financial problems“, he said. The nine integrated personal budget pilots need to design pathways for individuals not “obsess about structural reform” as what makes the difference is relationships.
He suggested that elected members should become more interested in providers’ spend in the local economy – about sourcing local labour, apprentices and sustainability. Price concerns should shift to a more rounded look eg consider are providers helping to nurture the future workforce? As Director of Health, Housing and Adult Social Care at Enfield Council, one of the few authorities with a gold accreditation for Making Safeguarding Personal (MSP) he showed some evidence of progress. Safeguarding has a more integrated model with 50 local volunteer quality checkers providing feedback on services to a Dignity in Care panel; good relations between LAs, CQC, police, CCG, families, providers..; teams randomly sampling safeguarding cases; an independent chair who plays an active role; and commissioners who consider safeguarding issues.
He acknowledged the poor progress in getting people out of assessment and treatment centres under the Transforming Care initiative. However whilst there are barriers of funding and long run provision, he felt the single determinant of making it work is the hearts and minds of local commissioners .
He said the ADASS is trying to keep the door open with Government whilst continuing conversations about the funding crisis. He saw a growing pressure from more responsible journalists; providers representing their issues directly; CQC’s symposium with major providers; and the ADASS and DOH saying there must be a clear settlement for Local Authorities.
A workshop that particularly picked up on co-production and relationships was that presented by Anthony Sadler from Wakefield council and Sian Lockwood OBE Chief Executive of Community Catalysts. Wakefield council recognised that public and local services can’t deliver alone, and that services were not engaging with communities properly. Community Catalysts were asked to help them talk to communities differently and see how it could work. Building on Wakefield’s Connecting Communities programme focusing on decreasing hospital places and increasing community based services, and the three locality prevention/early intervention hubs, they set up a multi-agency cross sector strategic partnership chaired by the Director of Social Services with Public Health, the CCG, Economic Regeneration and Nova (3rd sector infrastructure group), a very positive group motivated for change and inclusion.
Community Catalysts started by researching what existed by talking and listening to local people, helped with local connections by the Wakefield community team. They looked to identify both key people and ‘anchor organisations’ – those neighbourhood key community run places that local people rely on eg community centres, as building on these makes better strategic sense.
They identified two very different local areas of Havercraft and Rye Hill, an area with a high level of deprivation with strong involved ward elected members and Knottingley which included a large estate funded by Big Lottery with £1m over ten years. In Knottingley, there was a lot of disconnected activity and waste as groups worked independently. Small grants were given out by the mining charity and others by businesses out of corporate responsibility, but this wasn’t coordinated. Local people were desperate to join it all up and there found some amazing people. By bringing people together, they could bring resources together, eg. the Community centre manager Holly and the Pastor found that Holly had money to train while the Pastor needed training for his volunteers.
People were fairly cynical at first feeling consulted to death with no obvious result so Community Catalysts spent time really listening and building confidence that action would follow. Some had previously felt patronised and that their abilities hadn’t been recognised. “People think as I have problems I haven’t anything to offer’’.
“When people not used to speaking out are heard by people not used to listening then real change is made”. John O’Brien
They learnt what worked and what didn’t eg a public health investment in a mental health community connector resulted in a good scoping exercise, but lack of involving community groups meant they were flooded with complex people beyond their capacity and skill. Positively, they learnt people cared and wanted to make a difference, about older people socially isolated; a need for kids to have somewhere to go and about those with mental health and disabilities.
There were great examples of people working together. When the Post Office closed, the Methodist church took over and fund-raised, knowing older people would struggle and had a food bake. Sure Start closed and a parents forum formed to replicate some of this and ran a community picnic which gave them a buzz and confidence. Havercraft Derby and Joan club used by 70 older people was often the only time they got out. The woman running it had sourced transport using a community bus, but when this grant was cut she personally paid for a taxi for people to get there. Because the Local Authority doesn’t know what is happening in the community, it isn’t aware of what a little money can do.
A community centre in Knottingley funded by Big Local had a dynamic manager keen to become a self sustaining business which could become an ‘anchor organisation’. A GP surgery had a practice manager trying to do outreach and run luncheon clubs, but the community felt negative about the surgery, so the Catalysts helped facilitate discussion. The strategic CCG links to the GPs helped this.
From their findings, the project plans to build community assets through such as developing the new relationships, identifying and supporting a network of community anchors and enabling stronger links between the community health and social care, as well stimulating enterprise and social entrepreneurs and linking adult social care into this.
Alex Crawford Deputy Head of Commissioning and Planning, UH Bristol NHS chairing had made sporting memories a theme throughout, and we heard from Tony Jameson-Allen of the Sporting Memories Foundation using a shared interest in sport to connect people in communities with dementia, depression or who are just lonely. This particularly helps men who if on their own or isolated through their illness, often don’t have networks. (www.sporting memoriesnetwork.com)
Other keynotes included Albert Heaney Director of Social Work for Wales and Steven Pleasant Chief Executive of Tameside MBC outlining the issues and challenges for Health and Social Care Integration in Wales and Greater Manchester and Colin Angel from UKHCA on “Sustaining the Market for home care” as well as a comprehensive range of workshops including Laing and Buisson’s work on the serious underfunding in residential care.
Whilst the looming financial crisis in care is not denied, it was encouraging to find such efforts to bring the best to bear on the issues and to hear the emphasis on relationships and working together.
Some of the presentations can be found at http://www.psconferences.co.uk/presentations/oct-2105/
Reference
(1).http://www.adass.org.uk/policy-documents-commissioning-for-better-outcomes/
