“Social work is in my psyche, it’s part of who I am. I passionately believe in the social work values and principles that brought me into the profession.”
Thus speaks Sandie Keene, who becomes president of the Association of Directors of Adult Social Services next week at its annual spring seminar. Keene, director of adult social care services at Leeds council, maintains her social work registration with the Health and Care Professions Council and says her commitment to social work values is embedded in her leadership approach.
“I have a desire to represent those who don’t have a strong voice themselves and that’s an inherent part of social work values in terms of being alongside the people we come into contact with,” she says. “We need to value our staff and value their contribution. If we want to give the public more control we should be doing that with our staff.”
Listening to social workers
In terms of her day job at Leeds, this has meant ensuring practitioners’ concerns are heard; one result is that the council intends to bring in a new IT system “in response to pleas that we have had from our staff”.
It has also meant championing a return to community social work, with the placing of social workers with four of the city’s 37 neighbourhood networks, community groups that provide services to help older people stay in their own homes under contract from the council, often led by older volunteers. Under the council’s plans, the social workers would work with people eligible for social care, help them develop a personal statement setting out their aspirations and the neighbourhood network would develop a support plan with them to achieve it.
However, she admits things are not perfect. “If workers were here, they would be talking about workload. We need to be monitoring this and expecting realistic levels of work from individuals and supporting them in the pressured roles that they do.”
More cuts to come
Those pressures are increasing in a funding environment that has seen £1.9bn taken out of adult social care budgets in England from 2011-13, equivalent to a 7% reduction per year in real terms. Keene says responses to Adass’s annual budget survey indicates there will be more of the same in 2013-14; and councils are facing deeper cuts to their funding from government in 2014-15 than they had been expecting following this year’s Budget and last year’s Autumn Statement from chancellor George Osborne.
All this means that a key date in Keene’s one-year presidency of Adass is 26 June, when Osborne will set out government spending plans for 2015-16. Though the NHS, schools and overseas aid are protected, councils will have to share in the £11.5bn of cuts earmarked for that year. Adass is developing a business case, as part of negotiations with the Department of Health, to ensure these cuts, and their impact on adult social care, are as small as possible.
This will seek to demonstrate how councils can further improve the efficiency of their operations, including through closer integration with health, but also to be more enterprising and innovative, by harnessing communities’ assets to deliver care and support and making best use of technology. Such approaches need to be “industrialised in scale”, she says.
Efficiency is not enough
However, Keene warns: “We can’t pretend that we can enterprise and innovate our way out of this problem; we need to have solutions based on [additional] finance.” Besides a solid settlement for local authorities, this will involve calling for the government to extend into 2015-16 the current practice of the NHS transferring resources to councils – £859m this year – to spend on social care services that reduce pressures on the NHS.
She says that Adass will “have realistic discussions [with government] about the impact” if the required funding does not materialise, in terms of deepening unmet need, something she warns could result in a “vicious cycle” and “downward spiral” that forces councils to focus on crisis intervention at the expense of prevention.
This outcome would be contrary to the government’s vision for social care that will be put into law through the forthcoming Care and Support Bill, currently in draft form; this would put a host of new duties on councils, including to conduct safeguarding enquiries, assess and provide support for carers, commission preventive services and information and advice, promote a vibrant and diverse market in care services.
Squeeze on care providers
Keene warns that ongoing funding shortages would create “severe difficulties” in implementing the government’s reforms, due for implementation in 2015. A third area that could get worse unless funding pressures are addressed is the ongoing squeeze on council fees for care providers, what Keene sees as the “thorniest and most vexed problem for directors, because of the current financial situation”. The result has been a breakdown in relationships in some areas and a number of successful judicial reviews by care provider associations against the way councils have set fees.
Fees have been brought down in Leeds too but the council has worked with providers to develop a quality framework for care homes that links fees to the achievement of quality standards and was developed on the basis of close analysis of providers’ cost base. The council brought in a consultancy, Ernst & Young, to help deliver the framework and Keene says third party involvement was crucial in preventing conflict.
“Sometimes a third party can challenge providers more easily about profits than a council can,” she says. “Sometimes a third party can challenge the local authority about benchmarking its fees against other authorities.” She suggests this could be an approach other councils might pursue if relationships become difficult with providers.
Critical time for personalisation
As with all her recent predecessors, furthering personalisation and self-directed support across England will be a top priority for Keene, but she takes over at a seemingly critical time for this agenda. Councils will need to have got 70% of service users in the community on to personal budgets by 31 March; Adass is conducting a survey to verify whether this has been achieved.
At the same time some of personalisation’s most fervent advocates, including self-directed support charity In Control, wrote to care minister Norman Lamb recently to warn the agenda was at “high risk of failure”. Their concerns centred around restrictions placed by some councils on how people could spend their personal budgets and with which providers, social workers’ ability to sign-off personal budgets without having to refer decisions to panels and unsuitable resource allocation systems. They pointed out that research evidence – notably the 2011 National Personal Budgets Survey of 2,000 service users and carers – showed that giving people maximum freedom over how they spent their personal budget delivered the best outcomes.
Keene admits that councils need to move “further and faster” on ensuring personalisation delivers genuine choice and control. She says Adass will facilitate the sharing of good practice between councils through its regional networks and the Think Local Act Personal (TLAP) partnership of organisations dedicated to promoting personalisation. For instance, she wants to see more councils sign up to Making It Real, TLAP’s set of indicators of progress on personalisation that signatories are supposed to measure their performance against, including through assessment by service users and carers.
But she says it is up to individual councils whether to use panels to sign-off personal budgets or preferred provider lists – another target of criticism for In Control and the other signatories of the letter to Lamb.
If that weren’t enough, her presidential year is the first for the new health service; councils are taking on significant new functions – particularly public health – at the same time as primary care trusts are being replaced by GP-led clinical commissioning groups as NHS commissioners.
Keene is a fervent advocate of care being co-ordinated around the needs of the service user – in Leeds social workers work alongside health colleagues in integrated teams based around GP practices to support older people and those with long-term conditions. She is optimistic about the potential for councils to work closely with GPs within clinical commissioning groups (CCGs) to this end, but has concerns about partnerships with other players in the new landscape: the regional commissioning support units responsible for supporting CCGs and the local area teams of NHS England, who will be responsible for commissioning specialist services and primary care.
This amounts to “massively greater complexity”, she says, that it will be up to the new health and well-being boards – council-led committees designed to bring together the planning of health and social care in every area – to resolve.
All of which means that Keene’s year in the presidency will be as eventful, challenging and critical for the sector’s future as any in recent memory.
Interview with 2012-13 Adass president Sarah Pickup