Take part in the debate…
…and visit www.communitycare.co.uk which is mounting a green paper campaign in tandem with this series of articles, including an online discussion forum for all our readers to air their views on each week’s theme. We will compile your views into a report to be discussed at our green paper conference, Power to the People: Will the adult green paper deliver?, taking place in London on 27 June. The new director of adult social services role raises many questions.
About the Panel
Our panelists are drawn from the Inter-Agency Group on Adult Social Care, a coalition set up to analyse the impact of government policy in this area.
John Dixon, Association of Directors of Social Services’ disabilities committee
"At first sight it might appear paradoxical for the green paper to require both a transfer of control to service users and a stronger leadership role for the local authority and the director of adult social services.
But for there to be a safe transfer of control – and risk – to service users, there must be a safer and more assured environment for them to exercise their choices. There needs to be a clearer strategic direction and less fragmentation of systems. Local authorities are well placed to provide that strategic view and an infrastructure. That infrastructure should enable individuals to run their own lives and other organisations – public or independent – to provide services.
If we are to exercise that sort of leadership as local authorities, the vexed question as to whether other organisations have a duty to co-operate will be less significant.
For years now, social services have been providing services to fewer individuals at ever greater cost, and retreating from the ideals set out by Seebohm. The green paper offers the chance to recapture the lost ground, and for the director of adult social services to take authorities firmly into the well-being role – not just in buying care packages, but the development of housing, transport, employment and a barrier-free environment.
It also means that our direction may be more ambitious than it was five years ago. Then people saw social services as having common ground primarily with health. Now the scope is much broader and, in order to provide support for that role, we need to be dealing as much with the Department for Work and Pensions and the Office of the Deputy Prime Minister as with the Department of Health.
Which is why, if we are to be concerned about employment development and accommodation, for example, as well as commissioning more traditional services, it would be better to become adult services than adult social services."
Jeni Bremner, programme director, education and social policy, Local Government Association
"The delivery of the green paper will require political and managerial leadership nationally and locally. At a local level councils are statutory community leaders charged with delivering social, economic and environmental well-being for all the citizens in their area. This green paper will require action across all these areas; it challenges us to deliver independence and autonomy for all our citizens.
Effective care services, home care and chiropody support well-being, but independence requires more. Fear of crime, poor or inaccessible transport and inaccessible buildings also undermine independence and choice.
This agenda is wider than local government, it also involves the local voluntary and community sectors, the NHS, and private and independent providers. Not least the leadership of people using the services and those caring for them are required to achieve the outcomes in the green paper.
The local authority needs to engage and enthuse all of these partners to build a shared vision, agree priorities in a time of scarce resources, agree what we mean when we talk about prevention and shape the framework for enabling independence. The new director of adult services will need strong partnership and alliance building skills as well as strong management skills.
Nationally this agenda also needs strong leadership and effective partnership. Local government and local partners will be developing this agenda in housing, education, leisure, transport, planning and community safety. We also need national government to make those links and to allow local partners the flexibility and freedom to develop and deliver creative solutions. There can be no one-size-fits-all solution to this agenda but, as the Inter-Agency Group on Adult Social Care shows, there is energy and support among partners to make this happen."
Jo Webber, policy manager, NHS Confederation
"If we are serious about integration and strong leadership across health and social care partners, we should be hitting this issue head-on.
At the NHS Confederation we think it’s a missed opportunity that the green paper did not identify a more radical solution, one that is already working in some parts of the country – shared posts between primary care trusts and local authorities.
Problematic issues, such as shared governance structures and joint accountabilities between health and social care, would disappear overnight and this solution seems to make sense when you look at the bigger picture.
After all, we are all here to provide care for the people who need it and we have to make sure that the director of adult social services will add value to the process of delivering the right care packages to the right patients at the right times.
Local leadership and accountability is essential to improve care, but leadership is vital at all levels in partner organisations – and the director of adult social services role is only one of these.
But, if this new post is going to be the future, the role in co-ordinating the annual planning round for older people must be linked into the formal structures of primary care trusts to avoid the silo mentality we are all trying to avoid."
Heléna Herklots, head of policy, Age Concern England
"An ageing population is likely to mean that in the future more older people will need care and support from social services. But, increasingly, older people may not want to use some of the traditional services now on offer.
The director role entails planning up to 15 years in advance, so will mean engaging with everyone likely to use or be involved with social care during that time – potentially, all older and middle-aged people. This will be necessary to ensure that new services meet the needs of an increasingly diverse older population.
The Inter-Agency Group on Adult Social Care rightly points to the importance of local leadership and accountability, particularly to help achieve a balance between preventive approaches and delivering services for people with higher needs. Local leadership will have to show respect for the rights of service users and carers.
With this in mind these are five key issues for the director to address:
Angela Greatley, chief executive, Sainsbury Centre for Mental Health
"As a senior officer of the local authority the director of adult social services will have to work for their own members and carry out the collective agreements of the council. They will also be charged with exercising leadership and co-ordination across local providers of mainstream public services. Experience tells us that this can be difficult.
What is often called the democratic deficit for health has led to uneven and sometimes uncomfortable relationships between local government and health. The director will have to manage these and develop a new approach to service commissioning and delivery. Housing is of particular importance for people with long-term mental health problems. It is recognised that a lack of housing and poor housing support contribute to social exclusion. Dealing with housing is another one for the director’s to-do list.
There is a huge task to develop needs assessment (something the NHS still struggles with) and manage the social care market to meet need. This has to be done while the community and voluntary sector is calling for a level playing field when contracts are awarded. Mental health care already works with the private and the voluntary sector and their importance is recognised. But, when the money is tight, will the director become the whipping-boy for the dissatisfactions of providers?
So far so gloomy, but there are also considerable opportunities in the role. It is important that a senior officer in local government has the adult brief. It is important that work will begin to develop individual budgets and address individual need. The mental health world will look with interest to see how local government can tackle its long-standing difficulties."
Independent View
Peter Beresford, professor of social policy, Brunel University
"Leadership is a buzzword in social care. Sir Nigel Crisp, NHS chief executive, has set up a social care forum and a health and social care leadership network. And, since 2004, social care has had its own national director – Kathryn Hudson.
The green paper stresses the ‘vital leadership role’ to be played by the new director of adult social services in local authorities, heralding it as ‘an essential part of our vision for adult social care’.
But question marks hang over the strength and unity of its traditional leadership. With the planned absorption of the Commission for Social Care Inspection and recent attacks on the Social Care Institute for Excellence, there are concerns about the status of social care’s own organisations. Fears grow about social care being lost in health. That’s why leadership is so important.
But if leadership is just another expression of the dominance of managerialism and doesn’t fully include and connect with service users and face-to-face practitioners, the new role is unlikely to bring many benefits."
Training and Learning
Questions about this article to guide discussion in teams are at www.communitycare.co.uk/prtl. Individuals learning from the discussion can be registered on a free, password-protected training log held on the site. This is a service from Community Care for all GSCC-registered professionals.
Abstract
In this article, leading professionals from the social care sector look at the green paper's proposals for the role of adult social services director. What will be needed from the post-holder and will they be able to meet expectations?
Forthcomimg Articles
In the coming weeks, our adult care series will examine refocusing on prevention, performance management and strategic commissioning.
