Bob Hudson: How the work of the Integrated Care Network is supporting practitioners meet the CSCI agenda

February 21, 2007 in Adults, Children

Social care is at the heart of many of the key developments in public services reform, and the next few years will herald further change in service commissioning and delivery. The Integrated Care Network (ICN) seeks to assist local agencies and professionals in addressing the partnership agenda that arises from these reforms and has produced a range of supporting materials. This article describes four linked publications that address the role of social care in the changing policy context.

The annual report on the state of social care in England from the Commission for Social Care Inspection(1) (CSCI) identifies six policy debates that will shape the future of the sector (see The six issues to shape social care). This adds up to a formidable challenge, not least because it constitutes an agenda that can only be met by social care agencies and professionals working closely with other public services agencies as well as users and carers. A series of publications from the Integrated Care Network (ICN) seeks to support those involved in meeting these challenges.

ICN is one of the Care Services Improvement Partnership’s (Csip) four national Learning and Improvement Networks. It aims to provide information and support to front-line NHS and local government organisations seeking to improve service quality by integrating the planning and delivery of services and has produced four linked discussion papers that address much of the agenda identified in the CSCI report. These reports cover user and carer involvement in partnerships,(2) self-directed support,(3) the governance of partnerships(4 )and whole systems working.(5) All are available free from the ICN website (see References).

The CSCI report states that 81 per cent of councils score well in respect of seeking and acting on feedback from people using services and their carers, but concedes that the extent and form of engagement is variable. It notes, for example, that consultation about commissioning strategies often takes place after proposals have been developed.

The ICN paper on user/carer involvement provides a framework for thinking about different types of involvement, describes the key issues for organisations in approaching the issue and examines the options for involvement, including the use of case study material. It identifies three levels of potential involvement – individual, operational and strategic. Securing effective involvement across these levels is challenging for any organisation but the complexity is increased in the case of partnerships, and the paper identifies the key questions that need to be addressed.

There are many approaches to involvement, and the paper divides them into two categories: those suitable for one-off or intermittent involvement and those that are longer term. In the first category, questionnaires and surveys, structured and semi-structured interviews, face-to-face discussions, focus groups and public meetings are included. In the second are citizens’ juries and panels, membership of decision-making bodies, user/carer forums and self-assessment. These options are examined by looking at established research findings and case studies.

The identification of self-assessment as an example of longer-term involvement ties in with the theme of the second ICN paper, on self-directed support. The CSCI report identifies the increasing use of direct payments – from 14,000 individuals in March 2004 to 32,000 in March 2006. But self-directed support goes further.

The underlying principle here is the move towards a more systematic model within which service users take greater control of their lives and the social care they receive, making their own decisions and managing their own risks. This approach goes substantially beyond traditional conceptions of user involvement towards a stronger emphasis on user control.

The paper examines the seven step model that has been successfully developed by the In Control pilots – setting the budget, planning support, agreeing the plan, managing the individual budget, organising support, living life, and reviewing and learning. Although this might appear to resemble the traditional care management model, there are significant differences. In particular there is a greater role for self-assessment and for the service user to determine how allocated monies shall be spent. The individual budget model which is being piloted in 13 councils takes a similar approach and appears to have substantial political backing.

Interagency partnerships

The third paper focuses on the governance of inter-agency partnerships. Good governance can become very complex when applied to an inter-agency setting.

This issue is fully examined by the authors who explore the conceptual nature of governance, the problems that can occur where partnership governance is weak, and the value of good partnership governance.

Not all partnerships that agencies are attempting to govern are identical, and the paper proposes a framework that invites partnerships to identify the desired depth and breadth of their joint arrangements as a prelude to deciding appropriate governance arrangements. Further discussion centres on the role of a partnership board and the issue of democratic accountability. The authors urge partners to be clear about:

● The type of relationship they want and what type of relationship they think they have.
● The behaviour, responsibilities and accountabilities this entails.
● The language used to describe relationships.
● How all the above may change over time as relationships develop and different issues arise.

Finally the paper includes as an appendix the helpful governance assessment tool that can be used by local partnerships.

Whole systems approach

The final paper takes a bird’s eye view of proceedings by examining the nature of the whole systems approach. The CSCI report is critical of the lack of progress in thinking across the system, commenting that much of the analysis by many councils concerns specific groups of the population “rather than building a picture of the wide range of services that people need over the course of their whole lives”. Indeed, the report even reveals a reduction in the number of pooled budgets using Health Act flexibilities.

The paper argues that whole system working is “not a recipe for a quick fix it is more of an invitation to the underworld of complexity and uncertainty that characterises policy formulation and implementation”.

There can be no underestimating the scale of the challenges ahead for social care. And the ICN, the Housing, Better Commissioning and Telecare Learning and Improvement Networks (and, more broadly, CSIP), have a key role to play in assisting agencies and professionals in meeting these. The collaborative challenges are immense, and it is important to recognise that partnership working doesn’t happen without hard graft.

Ultimately, good joint working will come about because talented and committed local practitioners want it to succeed.

The six issues to shape social care (back)

● Ensuring genuine choice and control for people using social care services.
● Maximising people’s life chances.
● Funding and the balance between state and individual responsibilities.
● The role of councils in improving the well-being of local communities as a basis for independent living.
● Delivery of integrated care to meet the health and social care needs of people.
● Steps to ensure good and safe outcomes for people.

Bob Hudson is visiting professor of partnership studies, School of Applied Social Sciences, University of Durham.

Training and learning
The author has provided questions about this article to guide discussion in teams. These can be viewed at www.communitycare.co.uk/prtl and 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.