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For social care directors the most important everyday priority is ensuring the most vulnerable are protected and cared for, in spite of ongoing and growing challenges.
But on the first day of this year’s Association of Directors of Adult Social Services spring seminar yesterday, politics came first.
Social care minister Caroline Dinenage - with a broad smile and relaxed, friendly manner - exuded the natural warmth of a skilful TV presenter who can engage and win over an audience, much like her father and veteran broadcaster Fred.
While her emphasis on the importance of personalised support and a demand that the NHS places greater emphasis on the social care system will have been welcomed by delegates, with the green paper looming large some of her words were likely to have prompted mixed emotions from those looking on.
She hailed the efforts of directors and their staff in reducing delayed transfers of care, but then described closer scrutiny as “a powerful force for good”, suggesting local area reviews and delayed transfers of care targets could be here to stay.
Ms Dinenage then praised councils pushing ahead with innovation that increases quality of services and creates efficiencies, but she did so to highlight wide variations in perceived performance across the country, bringing to mind the potential introduction of regulation for commissioning recently mooted by health secretary Jeremy Hunt.
She also emphasised the importance of a wide-ranging workforce strategy with effective training and attractive career paths, but did not mention the impact of Brexit and admitted the government had “limited levers” as most social care providers were in the private sector.
Significantly Ms Dineage hinted that the social care system needed extra resources before it would be possible to implement widespread reforms, but then she implied there was disagreement in government on the issue, with those involved “wrestling with dilemmas” over funding.
She was followed by her opposition counterpart Barbara Keeley, who distinguished herself from Ms Dinenage by repeating Labour’s pledge to immediately invest heavily in social care on taking office. But her call for a greater focus on the individual and prevention echoed many of the social care minister’s points.
However, Labour’s plan for an as-yet undefined national care service would have, as NHS England’s national director for disabilities and former Adass president Ray James put it, “exercised” many people in the room.
Ms Keeley attempted to ease concerns by saying the concept had been inherited from the last Labour government and details are yet to be finalised.
But with Ms Keeley’s calls for an end to a “postcode lottery” and backing for nationally set care criteria, she raised the prospect of a prescriptive, top-down and centralist approach under a Labour government.
With the raw politics over, chief officer of the Greater Manchester Health & Social Care Partnership Jon Rouse then described the pioneering integration model being developed across the city region.
While he admitted it is “still early days” when asked what evidence had emerged that health outcomes are improving, he struck a chord with delegates struggling with NHS dominated integration efforts elsewhere in the country.
“The difference between the Greater Manchester Health & Social Care Partnership, other STPs and integrated care systems is that our governance is rooted in local democracy,” he said.
But he also sounded a stark warning on the efficiencies even the most advanced integration models can achieve when he admitted the funding gap for social care across the region is expected to be £200m by 2020.
The message was you must hold your nerve when investing in meaningful transformation.
In a comical, but no less powerful analogy, he said he felt like the cartoon character Road Runner being chased by the coyote when trying to balance overall budgets.
Mr James’ subsequent update on the previously faltering transforming care programme, which aims to significantly reduce the number of people with a learning disability out of long-term placements, offered both “thoughtful” and “plain” provocation - and a timely, moving reminder of the harsh, yet sometimes inspiring, reality on the ground.
He said, with more than a hint of frustration, that six years after the programme had been launched more than 2,500 adults remain in long-stay patient settings. However, he said good progress had been made recently and the government is due to decide shortly on dedicated funding, which would give further impetus to this vital, but previously sidelined, work.
But in a challenge to delegates, he said the said the biggest cause of “inertia” is long-term “posturing over money” by both the NHS and councils, with stalemate sometimes running over years while vulnerable adults languished in inappropriate settings.
He had earlier played a video featuring Gavin Harding, a man with a learning disability who is advising NHS England on the programme as one of the ‘experts with experience’, which served as both a wake-up call and inspiration.
Mr Harding, who Mr James said had spent time in assessment and treatment centres and would have been described as having “behaviour that challenges”, was awarded an MBE for services to people with learning disability and had been elected mayor of Selby in North Yorkshire.
Mr Harding’s rallying cry to Adass was “get on with it” and his “steely gaze” was deliberately left on screen throughout the session.
“If ever you needed an articulation of the benefits of having an asset-based approach and the crucial work we do for people with a learning disability, Gavin is among the best exemplifications of that I’ve come across,” Mr James said.
During his inaugural speech today, Adass president Glen Garrod sounded like a man who would heed Mr Harding’s call.
Clearly impassioned, determined and moved by the opportunity to lead Adass at such a critical time, he asked delegates to play their part in galvanising public opinion and securing the reform the social care system so desperately needs to protect the most vulnerable and prevent inequality, isolation and misery.
His tenure looks set to mark a pivotal period not only for the social care sector, but also for the thousands of people whose dignity, security and freedom hangs in the balance.
Jon Bunn, senior reporter