by Peter Hay, director for people at Birmingham City Council
I’m not good at New Year resolutions but this year I made one and so far I’ve stuck to it! I promised to spend more time on the frontline of our services. I want to shadow staff, to see the reality of the support we deliver, and hear ideas for new ways of working.
So far I’ve had 10 visits. There have been three half-days shadowing social workers, a full day with a GP and time with day care, intermediate and extra care teams. I also spent a day with health visitors – it made me appreciate all the more the value they add to the lives of children and families. Soon I’ll be shadowing an Approved Mental Health Professional too.
The experience has already proved invaluable. As a director, you need to make a conscious effort not to have all of your time sucked into the “machine” of local government and NHS processes and neglect what’s really important – in my case the citizens of Birmingham. It’s important to have protected time to spend with frontline staff and people using our services.
Seeing things first-hand can help confirm existing knowledge but it can also throw up surprises. Mostly, I’ve found, it helps you to see innovative work already underway that needs additional support, sharing and development.
I’m glad I’ve spent time with NHS and social care services. Seeing both sides has helped build up an understanding of the systemic nature of people’s needs – this is essential if social care and our health partners are to meet the challenges we face.
Strong relationships and brave conversations
My visits so far have shown me plenty of work we need to back. Going into see families working with our social workers in children’s services, I have been struck by the skill of some social workers who managed to build relationships with mothers who previously had children removed.
A real emphasis on purposeful work, based on strong relationships delivered by clear, open and direct communication has seen significant movement. It has allowed children to both stay and thrive in the care of their family. That’s a powerful demonstration of the brave conversations we have at the heart of our work.
A social worker new to Birmingham showed me some superb work to find the right long-term family for a child whose care history leaves him with some difficult behaviours. Attention to the child’s needs and wants through building a relationship with him and then careful support to his placement have seen huge progress. His prospects of long term stability have improved just as much as his behaviour and better school results.
I have also seen great coordinated work across agencies, with close working relationships with drug and alcohol services and mental illness. That closeness has included clear shared aims and coordinated visits and work programmes, all getting the best from the public purse with the “troubled families” at the heart of our strategies.
At the other end of life, I have seen strong plans to enable older adults to live at home longer, all part of a huge effort over years to support more people to remain in their own homes for as long as possible. That sounds like the simplest of actions. Everyone supports it. Yet at the frontline it can require patient and skilled negotiations to allay the fears of relatives and professionals about risk.
Getting out and listening to carers has been insightful, confirming that our ask to avoid hospital admissions and improve community support is the right one.
Yet with resources going in opposite directions, building this into the way our system works is like attempting to defy gravity. Some of our staff are working out how to hard wire informal carers into professional networks and showing some great results.
In services for younger adults with long term needs arising from disabilities, the cumulative effects of austerity are most evident. Our plan might be coherent, but just as we are talking more inclusive transport, people are seeing reviews of their mobility allowances.
I was told about recently about work to build up use of public transport with our citizens, for it to all go wrong in bad weather as bus after bus refused to allow a person in a wheelchair on board because of a lack of space. We need to build in some agility to the best laid plans.
The frontline of our practice with people has always mattered most, but it matters more than ever in the sustained era of austerity we are in. Some of the answers to meeting the huge budget and service challenges are, I believe, more likely to be out there in practice than in management meetings.
Six years ago, in the first round of austerity, social care leaders had some clear ideas on how to shape the response. There were savings to be made by reshaping workforces and moving towards models of prevention, for example. At that time there was also scope for what might be described as more traditional management approaches to cost cutting.
Now, after another extremely tough spending review settlement for social care, things are different. This is a sustained period of austerity. In Birmingham we’ve had to identify £120m in savings from care budgets already. We have another £80m to find. In a city with more than one million residents this is no easy task.
Our challenge is to find a way to meet the demands and expectations of our citizens for less. We will improve our chances of succeeding if we support social care staff that are pioneering new and different ways of working.
The last few weeks have been a powerful reminder that we have some heroic and amazing staff making a real difference to lives while trying to create sustainability for the future. I look forward to sticking to my resolution and spending time with more of them.