Ladyman vows to listen, but warns profession: there will be change

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
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

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

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

“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

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.

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