17 November workshop: discussion summary and slidepacks

This workshop brought together the Caring for our future engagement discussion leaders and reference group members. Its aim was to provide an opportunity for the leads and reference group members to share and test the emerging findings to date on each workstream area. This note summarises discussions during the workshop. It does not represent a statement of Government policy.

Each engagement workstream was asked to prepare a slidepack in advance summarising early findings and emerging thinking:

Key points from discussions

Quality and workforce:
•    There was agreement that commissioning is not being used effectively as a lever for driving quality with too much focus currently on cost. The incentives around quality should be aligned at all levels in and across the health and care system to drive the right behaviours.
•    A diverse and vibrant market that provides choice together with empowered and informed consumers will help drive up quality of care.
•    It was widely acknowledged that a better trained and equipped workforce that can work across traditional health and care boundaries underpins a high quality system. It is the interactions and relationships between frontline workers and people who use services that sit at the heart of high quality care. However, to attract the right people into the sector, they need varied and challenging careers with opportunities for progression. Greater emphasis should also be placed on developing high quality leadership in the sector.

Personalisation and choice:
•    There is strong support for personalisation but while the policy direction is clear, substantial behavioural and transformational change is needed to make personalisation a reality for service users including those people funding their own care.
•    There was a strong feeling that personalisation is more than just personal budgets and should be at the heart of wider public service delivery. Commissioning should be based on outcomes not solely on the basis of cost. For those who do have personal budgets, independent brokerage was considered important in helping people to achieve their outcomes.
•    There is strong support for better information and advice to enable service users to be empowered users and consumers of care. Linked to this was the suggestion of a universal offer on information and advice for service users. Similarly, there were discussions on whether a better understanding of rights and responsibilities through a ‘Care Constitution’ (aligned with the NHS Constitution) would empower service users.

Integration:
•    The discussion confirmed many of the key issues and thinking emerging from the integration workstream.
•    Further consideration is needed about how housing can support better integration and how people funding their own care can benefit from integrated services.
•    It was widely felt that behaviour and culture change is needed at all levels of the system for integrated working to become mainstream practice.
•    There are many examples of good joint working locally but this is the exception rather than the norm. Perceived rather than real barriers are often cited as the reason for not doing so.
•    A market-based system underpins social care but differing attitudes in health towards competition could act as a potential barrier to greater integration.

Prevention and early intervention:
•    There was a general feeling that more action is needed to help people take responsibility for maintaining their independence, improving their health and wellbeing and planning more effectively for their health and care needs. There should be greater emphasis on preparation and the concept of life planning as well as greater clarity about the role and responsibilities of the state versus the individual.
•    It is felt that a more risk-based approach to preventative interventions is needed and that by identifying trigger and transition points, interventions can be targeted more effectively.
•    There was a discussion about how the incentives and levers need aligning to support a move to a more preventative approach across health, care and wider support services.

A more diverse and responsive care market:
•    There was general agreement with the direction of travel set out by the markets workstream in their slidepack, in particular on the need to focus care services around individuals (and the outcomes they want to achieve) and to build more strategic relationships locally between users, providers and commissioners. Building the commissioning capacity locally was felt to be critical.
•    There was strong support for a better information and advice service. Linked to this was a call for greater transparency and real ‘live’ information about both the demand and supply side of the market.
•    There was agreement that a quality mark of some sort, which helped users differentiate between different services, would be highly beneficial.
•    There was a wide ranging discussion about the need to shift resources from specialist services to universal services and a focus on whole population approaches. It was felt that when working within the current quantum of resources, this would be necessary to manage pressures.

Overall reflections:
•    There is a wealth of international evidence and practice on the key reform areas that we can learn from and build upon.
•    There is agreement that the care and support system should not be solely for those who are state-funded; the offer for the citizen should be clear.
•    Better information is needed in and on the care and support system. This includes information:
-    for service users to have informed choice, navigate the system and plan and prepare for care
-   for providers to understand their customers and design services around their needs
-    for commissioners to understand the market and to commission more effectively.
•    Attendees felt that a key challenge was working out what would be a real catalyst for changing behaviours and culture to make the transformation needed to improve care and support.
•    A number of workstreams wanted to consider the role of housing in more detail.
•    A strong theme to emerge across the workstreams was the importance of better integration across health and social care but also wider support services.

Attendees:
•    The following list sets out details of those people who attended the workshop, supported by Department of Health facilitation and secretariat:

  • Alan Rosenbach, Special Policy lead, Care Quality Commission
  • Alex Fox, Chief Executive, Shared Lives Plus
  • Bridget Warr, Chief Executive, United Kingdom Homecare Association Limited (UKHCA)
  • David Behan, Director General for Social Care and Local Government Partnerships (attended 1 – 3pm), Department of Health
  • Geoff Alltimes, Ex-Chief Executive of Hammersmith and Fulham Council and Co-Chair of the Future Forum integration workstream
  • Gill Ayling, Deputy Director, Older People and Dementia, Department of Health
  • Glen Mason, Director of Social Care Leadership and Performance, Department of Health
  • Gordon Morri, Managing Director of Commercial Services, Age UK Enterprises
  • Helena Herklots, Services Director, Age UK
  • Imelda Redmond, Director of Policy and Public Affairs,  Marie Curie
  • Jeremy Hughes, Chief Executive, Alzheimer’s Society
  • Julia Skelton, Head of Professional Practice, College of Occupational Therapists
  • Julia Winter, service user
  • Julie Jones, Chief Executive, Social Care Institute for Excellence
  • Julienne Meyer, Professor of Nursing, Care for Older Adults, City University London
  • Lisa Christensen, Director of Children’s Services, Norfolk County Council
  • Luisa Stewart,Deputy Director, Dignity and Safety    DH
  • Mark Goldring, Chief Executive, Mencap
  • Martin Routledge, Programme Manager, Think Local Act Personal
  • Michelle Mitchell, Charity Director, Age UK
  • Miranda Wixon, Managing Director, Home Care Partnership
  • Nick Kirwan, Assistant Director of Health and Protection, ABI
  • Niti Pall, Chair and Clinical Lead, GP
  • Paul Burstow,Minister for Care Services (attended 1 – 3pm) , Department of Health
  • Peter Hay, President, ADASS
  • Philippa Russell, Chair, Standing Commission on Carers
  • Robert Varnam, Clinical Lead for Commissioning, GP and Co-Chair of the Future Forum integration workstream
  • Ros Altman, Director General, SAGA
  • Sally Warren, Deputy Director, Social Care Strategic Policy and Finance, Department of Health
  • Sharon Allen, Chief Executive, Skills for Care
  • Shaun Gallagher, Director of Social Care Policy, Department of Health
  • Sheila Bremner, Chief Executive, Mid Essex Primary Care Trust
  • Sue Adams, Director, Care and Repair England
  • William Vineall, Deputy Director, Policy and Legislation, Department of Health

(See the ‘Who’s who‘ page for more details of the non-Department of Health attendees listed above)

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