Leadership issues from the White Paper: Our Health, Our Care, Our Say

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Leadership issues from the White Paper Our
Health, Our Care, Our Say

• Andrew Cozens
• Strategic Adviser (Children, Adults Health
  Services)
• 19 July 2006

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Summary

• Review the implications of the White Paper, Our
  Health, Our Care, Our Say for adults services in
  councils.
• Consider the implications for political and
  professional leadership.
• Highlight how local leaders can be supported by
  regional and national activity.

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A new direction for social care and health

• Better prevention and early intervention public
  health and well-being.
• Giving people more choice and a louder voice.
• Tackling inequalities.
• Better support for people with long term
  conditions.

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What does it mean for adult social care?

• Leadership
• Integration
• Prevention
• Integrated services

• Improving provision
• Joint commissioning
• Workforce
• Resources?

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Implications of the White Paper

• Key themes independence, choice, diversity of
  providers, well-being.
• Duty of DASS and Lead Member to champion social
  inclusion in the council and community.
• Joint responsibility with DPH to undertake a
  strategic assessment of the health and social
  care needs of the population to support
  commissioning.
• Responsibilities for information, assessment and
  service quality of the services provided in the
  area, included self-funded.

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Implications of the White Paper

• Steps to bring the infrastructure of local
  government and the NHS closer together
• Reorganisation of PCTs.
• Greater engagement of PCTs in local strategic
  partnerships.
• Use of local area agreements to improve health
  outcomes in local communities.
• Steps to align budget and planning cycles.
• Consideration of social care presence in
  Government Offices of the Regions.
• Rearranged performance assessment to support the
  outcomes framework needed.

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Implications of the White Paper

• Service integration
• Supporting self-care and self-managed care.
• Common assessment frameworks.
• Integrated networks and teams.
• Assistive technology.
• Joint commissioning.
• Personal health and social care plans.
• Information prescriptions.
• New roles for community hospitals and joint
  centres.
• Connected care.
• Single complaints procedure, with strengthened
  advocacy.

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Implications of the White Paper

• Strengthening community and political engagement
• Enhancing the role of Health Overview and
  Scrutiny Committees to monitor and challenge
  progress.
• Community call for action
• Local triggers of cause for concern in
  communities and a requirement to respond.

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The political dimensions

• A local authority is required to appoint a person
  to the post of Director of Adult Services.
• The local authority should provide adequate
  resources in order to enable the Director to
  carry out his/her responsibilities.
• (Section 6 of Social Services Act 1970 (as
  amended))
• Local authorities will be required to appoint a
  Lead Member for Adult Services with
  responsibility for ensuring a strategic approach
  to services for adults, in particular promoting
  well-being, preventing social exclusion and
  protection of vulnerable adults.
• Local authorities shall ensure that there are
  effective and transparent relationships between
  the DASS and the political leadership of the
  council, including arrangements to scrutinise
  effectiveness.

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The political dimensions the lead member

• Clear political accountability for the
  effectiveness, availability and value for money
  of all local authority adult social services (and
  preventing unnecessary use of healthcare
  resources).
• The necessary political leadership to engage with
  local communities and ensure that adult social
  services are effective in meeting the needs of
  adults with social care needs, their families and
  carers.
• A political focus on safeguarding vulnerable
  adults and promoting a high standard of services
  for adults with social care needs across all
  agencies.

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Early preoccupations

• Scope of the role.
• Engagement across the Council, with childrens
  services, partner organisations, communities and
  neighbourhoods.
• Grip fitness for purpose, how to start making a
  difference.
• Focus setting priorities.
• Leverage commissioning for the whole
  population.

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Working principles

• Improvement in services for adults takes place
  within a complex health and social care system
  the onion attempts to represent this at the most
  simple level.
• The framework for the strategy presents three
  key consistent challenges
• how much are we doing
• how well are we doing it
• what difference is it making?
• We suggest that this focus may lend itself better
  to an outcomes based approach.

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Strategic assumptions

• At the core of the strategy lie the outcomes (the
  ends ) that councils and their partners must
  prioritise in accordance with strategically
  assessed local need.
• living the life I choose
• being a valued member of the community
• being treated with dignity and respect
• feeling safe, secure and free from discrimination
• being healthy
• enjoying economic well-being.
• (taken from CSCI proposed outcome framework
  November 2005)

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Strategic assumptions

• We recommend that all councils consider how to
  articulate their vision and planning for adult
  services across these five strategic dimensions
• the local community strategy (local government,
  encompassing the priorities of the local
  strategic partnership (LSP) and the local area
  agreement (LAA)
• the local delivery plan (NHS)
• local overview and scrutiny programmes
• performance frameworks
• budget and planning cycles.
• We are also working with a performance
  improvement framework which offers a range of
  support including
• peer challenge
• annual self assessment
• financial probity and audit
• Inspection
• sector led intervention.

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Improvement support dimensions

• There are three aspects of an integrated health
  and social care system which need to change if
  improved outcomes are at the core
• governance and strategy
• infrastructure and organisation
• delivery
• Any support across these dimensions may be
  offered nationally, regionally or locally.

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improvement support dimensions are derived from
patterns for improvement Audit Commission.
These improvement drivers were identified as
fundamental after the first round of learning
from CPA
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Leadership issues from the White Paper Our
Health, Our Care, Our Say

• Andrew Cozens
• Strategic Adviser (Children, Adults Health
  Services)
• 19 July 2006