On the side of the angels

Richard Humphries belongs to the dwindling band of advocates for
social care in the Department of Health. As the first chief
executive of the newly formed Care Services Improvement Partnership
(CSIP), he will have a key role in shaping ministerial views of
social care and in ensuring that government policy is implemented
on the front line.

It was a difficult birth for CSIP, which brings together seven DH
organisations responsible for a range of service development work
in the field, including the National Institute for Mental Health in
England (Nimhe) and the Valuing People support team (see panel,
facing page). Humphries himself used to head another of the seven,
the health and social care Change Agent team set up four years ago
to help undo the logjam of delayed discharges from hospital.

Having initially decided to farm out CSIP to the Social Care
Institute for Excellence, ministers went off the idea after the two
sides fell out over plans for the new organisation with then
community care minister Stephen Ladyman accusing Scie of having
“blown” its chance. Instead it will stay within the DH with a brief
to promote service improvement and joined-up approaches across
social care and health.

Humphries has a long record of trying to bridge the divide between
health and social care. Before his stint with the change agents, he
headed social services and housing in Herefordshire while chief
executive of the health authority, the first time the two roles had
been combined.

It gave him the experience of complex organisational change which
will be an important part of the new job.

With its £39m budget, CSIP will be more focused than its
predecessors, he says. “It was becoming increasingly clear that the
challenge of joined-up services needed joined-up support to enable
service improvement.” Initially at least, each partner will be
funded at the previous levels – Nimhe’s share is £24m – but
the money will have to be used in a more cross-cutting way and
priorities will change over time. The partnership will be regional,
based in Nimhe’s eight offices across the country.

Much attention will be on getting to grips with the adult green
paper, where CSIP’s role in helping providers and commissioners
develop new models of care is highlighted. The history of social
care is littered with supposedly seminal reports whose lofty ideals
have never been realised in practice. This time, Humphries says, it
will be different.

“In the past we’ve tended to produce policy and expect people to
get on with it. The whole point of CSIP is to roll our sleeves up
and help people make it work. We want to anticipate problems before
they become crises – all too often people are too far down the
curve before they get help.”

He insists that CSIP won’t be a posse of government bullies sent in
to sort out errant services – even the term “task force” is too
strong for his taste. “I wouldn’t use that phrase because it has
the slight smack of hit squad and that is emphatically what we’re
not,” he says. “A support force, yes, but definitely not a hit
squad. We want to be on the side of the angels.”

But what about the slow developers? “Did you see Gordon Ramsay last
night? The thing about Ramsay is that he rolls up his sleeves and
helps – he doesn’t just bollock them out of sadistic pleasure, he
does it because he wants them to change.

“I’d like to think that we’d challenge in a friendly way when we
think that people need to gee themselves up a bit. I’d have
welcomed that in the past; I think we all need a bit of a prod and
sometimes a kick because it’s so easy to get complacent.”

Whether administered by angels or would-be Gordon Ramsays, the
litmus test used by the 300-plus CSIP staff from a variety of
health and social care backgrounds will be “would this service be
good enough for me or my family to use?” The question of how the
necessary service improvements are to be funded will have to be
publicly debated, Humphries says, but the answer may lie in the
wealthier society and the growing social expectations which give
rise to the question in the first place. “The tectonic plates are
shifting; we’re starting to get a whole new generation of older
people who will be more affluent and we get into issues such as
co-payment. I don’t think it’s as simple as saying ‘if only the
government would spend more on social care’.”

CSIP’s panoptic vision goes beyond the green paper, extending to
the public health white paper and its emphasis on well-being and
prevention, bringing the various national service frameworks to
bear and embracing the “huge policy agenda” for mental health,
mental capacity and long-term conditions. It will also be working
with local authorities on the Gershon efficiency savings, helping
to achieve, in Humphries’ words, the “right relationship” between
needs and resources.

Inevitably, ideas about “what works”, both new and imported from
other localities, will be highly prized and Humphries hopes that
social care agencies will help to road-test some of them.
Individual budgets, connected care centres and self-assessment will
be among the early themes.

No part of the government’s welfare reform programme would be
complete without talk of choice. The abysmal performance on direct
payments – fewer than 20,000 recipients after eight years of
availability – will be tackled, although Humphries is clear that
this will produce choice for service users only if the independent
sector is supported to diversify what it has to offer them.

“We’ve got to balance our efforts on promoting individual budgets
with developing capacity and making the workforce fit for purpose.
And we’ve got to make it much easier for people to access services
and set up their own care arrangements without a bureaucratic
quagmire.”

Since his mission is to cut red tape rather than increase it,
Humphries is sensitive to claims that he’s just adding to the
regulatory paperwork. He believes that CSIP’s distinctive
contribution will be practical programmes of support which
organisations such as the Commission for Social Care Inspection
aren’t necessarily best placed to provide. “We’re not performance
managers, we’re not regulators, so that means we can concentrate
our energies on what needs to be done,” he says.

Difficult decisions will have to be taken about the role of social
care professionals. If users have more choice and the right to take
risks, where does this leave social workers who have a duty of
protection? Won’t they be blamed whenever things go wrong? “I think
we’ve got to write into agreements what the role of the worker is
and where their responsibilities begin and end,” says Humphries.
“It’s not enough to say, ‘don’t worry, it’ll be all right if
anything goes wrong’ – if I were a social worker I wouldn’t be
happy about that. I’d like to invest some time in some smart
thinking about how we clarify the responsibilities that go with the
choices that people make.”

The green paper conjures up a seeming utopia in which social
workers cease to be “gatekeepers” blocking the way to services and
become “navigators” helping users get what they need. For Humphries
it is “entirely appropriate” to consider the similarities between
navigators and independent financial advisers, putting together the
packages best suited to individual clients.

He would like to see more social care professionals working in
primary care and education settings, but he claims not to be
particularly wedded to structural integration between health and
social care. Social care should be more about values than
structures, he says, although he doesn’t disguise his dislike of
what he calls the “municipal model”. “Social care has not been
helped by being overly associated with the local authority,” he
says.

“It’s very much about allowing a thousand flowers to bloom in
social care. We’ve got to cultivate a few of them so that we will
meet the preferences of a whole new generation of people who simply
won’t be content with what the local council can do for them.
They’ll vote with their feet and their wallets unless we
deliver.”
 
Partners for improvement
The Care Services Improvement Partnership comprises:

• National Institute for Mental Health in England 
• Valuing People Support Team
• Health and Social Care Change Agent Team
• National Child and Adolescent Mental Health Support
  Service
• Integrated Care Network
• Integrating Community Equipment Services
• Change for Children