Can the Directors Deliver?

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…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:

• Challenge discrimination in all its forms and use your role to
  tackle inequalities.
• Work in partnership with the community to bring about the
  cultural change that is needed in social services.
• Ensure that housing is part of strategic planning. Home is
  crucial to well-being.
• Ensure there is a range of services in your locality, working
  closely with providers to encourage innovative services that make
  choice a reality.
• Plan with, and for, our ageing and increasingly diverse
  society.”

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.