News

Stephen Ladyman has had an eventful first year as community care minister. While reforms to the children's system have been taking all the headlines, Ladyman has been overseeing a more low key but equally radical transformation of adult services.

He has quickly got to grips with his Department of Health brief and is widely recognised as a robust minister who says what he thinks and gets things done. It is a far cry from last June when the parliamentary private secretary to the then armed forces minister was promoted.


"The first question I was asked by a journalist was, as I'm a junior minister, whether this reflected a downgrading of adult social care," Ladyman recalls.

There was also scepticism about his suitability for the role - his CV had little obvious connection with social care, bar an interest in autism.

But it was Ladyman who took the initiative by launching the new vision for adult social care which represents a "once in a lifetime opportunity" to change the shape of care for a generation. He aims to consult the sector on the changes needed in adult services, collate the responses, analyse them and have concrete proposals ready within four months.

This ambitious time frame - it took the Department for Education and Skills eight months to come up with the Every Child Matters green paper - typifies Ladyman's approach.

"I get frustrated at the pace of reform, but that's because I am ambitious for the sector and I sometimes think I have more confidence in what it can achieve than it does itself," he says.

Ladyman has thrown down the challenge to managers and front-line workers to be "radical and say the unthinkable". Using forthright language - "I will use the barrel of a gun if needed"; "my job is to ensure change happens fast enough"; "the vision must and will deliver" - he has made it clear change will happen with or without the profession.

But Ladyman admits he is working with a relatively blank canvas. Apart from the long-term goals of making services more "person-centred, proactive and seamless", his influence on the debate will be limited. "I'm not a social worker and I don't know how you see social care," he admits.

Preventive agenda
When pushed to provide more detail he says: "I don't want to impose my thoughts on everyone else. I have started the ball rolling but I don't want to go much further than that. If it is my vision it will be more difficult to implement than if it's ours."

He says it is a reflection of the fact that social care professionals are used to being instructed from above that he has been asked 'where is the green paper?'.

"Perhaps that says something about our view of adult social services - perhaps we're imposing our thinking too much [on clients] and that reflects in the way we care for them," he says.

There is already a shift to a more preventive agenda within the DoH. Ladyman wants to see that develop further with the vision, while reflecting wider societal trends.

"We are over-reliant on the state to step in where families used to. It is not possible for the state to replace all informal services, but the more we can strengthen this the easier it will be for the state to do."

This will hardly be news to social care professionals. But when put together with another Ladyman mantra - promoting dependence, not independence - it suggests he sees more adult social care in the future being carried out in people's own homes rather than institutional-style settings.

Ladyman says: "We ought to be looking at stopping inappropriate hospital admissions wherever possible. If we create savings in one part of the system we have to ensure that resource is reflected in another part."

By that he means investing at the front end rather than when a person is in crisis, similar to the approach taken on delayed discharge of older people from hospitals, a policy he describes as a "huge success".

The figures seem to bear this out. Delays in the discharging of patients have dropped by 25 per cent since the policy was introduced last October. But the fining system has its critics and concerns have been raised that it could be leading to people being discharged too quickly.


Ladyman denies this. "The quicker we can get people out of hospital the better. There will be service options to suit everybody and speed and quality can go together."

He is so convinced of the system that he is considering whether to extend it to mental health acute wards and community hospitals.

Care homes
All this is bad news for care homes. During one of Ladyman's first ministerial speeches, he said the prime minister had given him the task of "sorting out the problems in the care home sector", and over the past year it has been on the end of numerous tongue-lashings from him.

Again, he is eager to get on to the subject. "If I could claim any success over the past year it has been to start addressing that debate and being a bit more ambitious in what we're seeking for older people. I think people are beginning to open their eyes to that. But the care home sector, being as it is, thinks everything can be solved by giving it more money. I've never been against care homes, I just want to see quality providers."

He supports councils paying more to care homes that meet the highest standards, but shies away from an idea he considered last year for the government to establish a formula for working out a care home's costs and fee levels. "The best way for councils to establish a fair market place is to allow tendering," he says.

Key to creating Ladyman's vision of a quicker and more responsive system is the single assessment process, a "complicated" system of multi-disciplinary assessment of needs led by a single professional.

"It's a complete departure for some areas, but the benefits are huge," says Ladyman. Its introduction in April was dogged by questions over systems' ability to capture and share useful information. Ladyman admits "there are some areas where it has not gone as well as we'd have liked".

He adds: "We must ask ourselves about information sharing generally. It is the biggest debate with the Children Bill - it's the same here."

Another area he wants developing is direct payments, as this fits with his idea of empowering the client. Only about 9,600 adults receive payments to organise their own services, something Ladyman attributes to professionals "not liking letting go".

He says: "People come into social care because they want to help and they feel they can best do that by doing the care themselves. Changing that mindset is difficult for some professionals to make and that's probably at the root of the problem."

But he believes care providers could have been more active in engaging older people to make them aware of services.

The fear of change is a mindset he finds frustrating. "When we propose something which is good for the sector, such as the protection of title, the first people to complain are social workers."

Ladyman is content with his first year but says it is not for him to judge whether it has been a success. He must be doing all right because there are already rumours that he is in line for promotion at the next ministerial reshuffle.

Such a move would be a blow to the vision, but you feel Ladyman has unfinished business.