Partners In Time

The government’s proposal to transfer seven agencies to the
Social Care Institute for Excellence as part of a Care Services
Improvement Partnership has sparked concern. The transfer has
raised questions about the relationship between the Care Services
Improvement Partnership and Scie and the latter’s independence from
the Department of Health.

The transfer will see 150 staff and £30m move from the
Department of Health to Scie but staff will remain employed by the
individual agencies. The following agencies will come under the
Scie umbrella: Change for Children, Health and Social Care Change
Agent Team, Integrated Community Equipment Support Team, Integrated
Care Network, National Child and Adolescent Mental Health Services
Support Service, National Institute for Mental Health in England,
and the Valuing People support team.

Yet there are advantages to the move including opportunities for
maximising dissemination of knowledge and good practice. More
possible benefits from the partnership were highlighted by the work
of the Department of Health change agent team (CAT), which was
evaluated last year.(1)

The CAT started work in March 2002. It was designed to tackle the
delayed discharge of older people from acute hospitals by
supporting local change and implementing contingency arrangements.
The CAT model of working with councils experiencing difficulties,
while also developing a range of good practice materials for wider
use, is one that the DoH has little used and – until the
establishment of the CAT – it had never been attempted on such a
scale or over this lifespan.

The terms of reference for the CAT seemed straightforward
enough:

• Offer targeted interventions to help eliminate delayed
  discharges.
• Support implementation of key aspects of the National Service
  Framework for Older People that impact on delayed transfers of
  care.
• Assist with the development of a more integrated approach to
  the commissioning and provision of services.

In practice, the work of the team involved intensive work with
individual sites, and activities that reached out to a much larger
group of areas, such as the establishment of a London and South
East Development Programme and four Learning and Improvement
Networks.

The achievements of the CAT are evident: delayed discharges
nationally are down by more than 4,000, or the equivalent of eight
district general hospitals, since 2001. The further reductions
associated with the introduction in January 2004 of reimbursement
for delayed discharges have been acknowledged by the health
secretary John Reid to have been “driven forward” by the efforts of
the CAT’s work with staff.

The Care Services Improvement Partnership aims to build on the CAT
approach. In particular, the Integrated Care Network receives
financial support from it and is consistent with its values.
Similarly, CAT has also already established links with the National
Institute for Mental Health with the development of a joint
programme and joint events.

The evaluation of the CAT found that it was well regarded and
credible; it has been productive and has engaged with a large
number of areas. The greatest strengths of the CAT are in its
capacity to work with local sites and to tackle practical issues,
as well as addressing wider implementation needs and developing
appropriate tools notably around reimbursement, discharge practice,
and commissioning.

The diversity of the CAT programme was a further strength, but it
also posed the greatest challenge to the team in ensuring that
there was overall coherence. These issues will be multiplied in the
multi-service Care Services Improvement Partnership. The evaluation
identified as priorities for the CAT in 2004-5 the importance of
building links between its components and ensuring
cross-fertilisation of knowledge and experience.

Other conclusions concerned the relationship between the DoH and
the CAT. At a time when the DoH is undergoing major change with the
implementation of organisational changes in the NHS(2) and a
devolution of responsibility and autonomy to local level, there is
a need for a new model of strategic direction and support that is
different from the old style command and control. The CAT is one
model but it is still in development.

While the CAT was initially established with a remit of 12 months,
it was extended twice and the current contract runs until the end
of March 2005. It is proposed that the Care Services Improvement
Partnership will then take over the CAT’s work. This continued
existence (albeit in a different form) provides a welcome response
to a growing unease about what would happen if the team merely
ceased to exist, particularly where there are concerns about the
sustainability of change in the longer term.

Some challenges that could face the Care Services Improvement
Partnership within Scie may be the risk of seeing the focus of
partnership as a social care responsibility alone. Further
challenges might emerge around how best to integrate the diverse
constituencies of interest that surround the various programme
elements. But neither of these is an argument against pursuing the
Care Services Improvement Partnership model.

The approach and achievements of the CAT provide a powerful example
of what can be achieved through a well managed, properly resourced
and highly skilled support team. As the evaluation also concluded,
the experience also points to the development of a consistent model
of managing change in health and social care that has wider
potential for application at relationship between central policy
and local delivery. The Care Services Improvement Partnership could
provide just such an opportunity for maximising these benefits.

Melanie Henwood is an independent health and social care
analyst with particular interests in community care, older people
and their carers.  She is also an adviser to the Jospeh Rowntree
Foundation, and is a specialist adviser to the House of Commons
health committee and a lay member of the General Social Care 
Council.

ABSTRACT
This article draws on findings from an independent
evaluation of the Department of Health’s change agent team that
helped reduce delayed discharge. It looks at lessons for the
proposed Care Services Improvement Partnership at the Social Care
Institute for Excellence. It finds the partnership can contribute
more than the sum of its parts, while also recognising the need for
caution and clarity around the ends and means of service
improvement.

REFERENCES

(1) Melanie Henwood, All Change Please: Evaluation of the Change
Agent Team, 2004
(2) See Department of Health’s Shifting the Balance of Power
programme including Securing Delivery, April 2001, and Next Steps,
January 2002.

CONTACT THE AUTHOR
melanie@henwood-associates.co.uk