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 

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