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
    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.

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