25 November workshop: summary

The third workshop brought together the Caring for our future engagement discussion leaders and reference group members. Its aim was to provide an opportunity for participants to review and assess the emerging priorities for action proposed by each of the six engagement worksteams, alongside key recommendations from the Commission on Funding of Care and Support and the Law Commission. This note summarises discussions during the workshop. It does not represent a statement of Government policy.

The workshop was structured around discussion of four core components for social care reform:

•    capable communities
•    informed citizens in control
•    high quality services and a great workforce
•    a clear partnership between the state, communities, families and individuals.

Through group discussions and plenary sessions, attendees considered:

•    the outcomes that would characterise delivery of each of these four components in a reformed care and support system
•    how the priorities developed by each engagement workstream would contribute to delivering each of these outcomes, assessed by impact and time taken to impact
•    what further action would be needed to deliver these outcomes ie what gaps were revealed.

Main points from discussions

Discussion 1: four mixed groups considered how to define the outcomes that would characterise delivery of the four core components in a reformed care and support system.

Key points from the discussion:

•    ‘Capable communities’: the outcomes identified were:
o    connected not isolated
o    support for families and carers
o    accessible environment
o    resources controlled by the community
o    communities can use their gifts and skills
o    information is used and is dynamic.

Other points included:
o    a need to define the word ‘community’: what does this include?
o    sustainability is a key outcome that was not mentioned. However, the prevention workstream had taken an asset-based approached that would contribute to this.

•    ‘Informed citizens in control’: the outcomes identified were:
o    people have meaningful choice
o    people are able to influence the options available through choice
o    people are supported to make the right choices for them
o    services are focused on people
o    people feel empowered
o    people have the right support to live the lives they want
o    people know and understand how to access and use information
o    people have support to use information when they need it.

Other points included:
o    outcomes in this context should be defined: should the focus be on outcomes for the user? Do they have to be measurable?
o    having information about how to access care and support and knowing how to access that information is essential. People do not need to understand how the care and support system works necessarily but they do need to know how to achieve the outcomes that they want
o    personalisation means having the care that people feel they need delivered in the way that they want.

•    ‘High quality services and a great workforce’: the outcomes identified were:
o    a diverse market fit for purpose
o    a skilled workforce that meets people’s care needs
o    information to support carers
o    assessing quality outcomes informed by user input
o    bringing the community into play.

•    ‘Clear partnership between the state, communities, families and individuals’: the outcomes identified were:
o    sustainability
o    carers
o    peace of mind
o    plan and engage
o    clarity on rights and responsibilities
o    positive relationships.

Other points included:
o    this component should be renamed to include the private, voluntary and community sectors.

Discussion 2: reference groups considered which of their priorities for action would contribute to delivering the outcomes described under each core component.
In mixed group discussions, the priorities assigned to each core component by reference groups were then assessed according to their impact (on a scale of most to least) and the time taken for this impact to be felt (on a scale of quick to slow).

Key points from this discussion

•    ‘Capable communities’:
o    It was felt that most of the relevant priorities had not been listed against this component so there was a lack of relevant material to review.
o    A universal offer on information needs to be defined; this should be both for state funded users and self-funders.
o    There was a question about the definition of ‘integrated leadership’: if this were community leadership, it would be relevant for this component.

•    ‘Informed citizens in control’
o    It was noted that many of the priorities were interdependent which affects the sequencing of priorities.
o    The impact of some priorities will build up over time. It was quoted that people tend to overestimate the short run impacts and under estimate the long run impacts of specific measures.
o    Good information for state funded users and self-funders is essential to affect the behaviour of the market and for people to become capable and informed consumers.
o    Wider availability of brokerage could have a quick impact.

•    ‘High quality services and a great workforce’
o    It was noted that improving information for consumers and developing joint commissioning frameworks based on outcomes could have a significant impact in the short term.
o    Leadership is very important to deliver the outcomes needed but it may take longer to get this right and realise the benefits.

•    ‘A clear partnership between the state, private sector, voluntary and community sector, communities, families and individuals’
o    It was thought that the care costs an individual faces as well as achieving a sustainable market with the right balance of resource would have a significant impact.
o    There was a view expressed that the first priority is to make sure social care is improving before focusing on its interaction with other service areas.

In plenary discussion:
•    It was considered that leadership ran through all components as it is so essential to delivering change. This would include user leadership, community leadership, relationship leadership and integrated leadership.
•    It was thought that insufficient attention was being paid to sustainability and what this meant for both the state and the individual. This should include measures to reduce demand, for example through prevention and integration.
•    Assessing priorities assigned to an individual component by reference groups meant that a priority may not be considered important to deliver those particular outcomes but could make an essential contribution elsewhere.
•    Focusing on individual priorities meant that there was a risk that the approach to reform became incremental rather than transformational.
•    There was concern that discussing the headlines for each priority was reductive and that attendees did not have enough understanding of the thinking and detail behind each priority to be able to assess it.

Discussion 3: In mixed groups, attendees assessed how far the steps so far discussed might take us towards achieving the outcomes we wanted to see and considered the gaps where further action would be required.

Key points from the group discussion

•    ‘Capable communities’
o    It was considered that the priorities identified would make a low contribution to achieving the outcomes described for this component.
o    The gaps which would need addressing included: a view that a clear vision is needed for capable communities and that describing this needs more work.

•    ‘Informed citizens in control’
o    It was considered that the priorities identified would make a medium contribution to achieving the outcomes described for this component.
o    The gaps which would need addressing included: true diversity of provision and sufficiency of supply to make choice meaningful.

•    ‘High quality services and a great workforce’
o    It was considered that the priorities identified would make a medium contribution to achieving the outcomes described for this component.
o    The gaps which would need addressing included: transformational leadership, a person centred workforce, totality and allocation of resources and commissioning for outcomes not services.

•    ‘A clear partnership between the state, private sector, voluntary and community sector, communities, families and individuals’
o    It was considered that the priorities identified would make a high contribution to achieving the outcomes described for this component.
o    The gaps which would need addressing included: taking an asset based approach, shifting cost/demand patterns (sustainability) and housing.

In plenary discussion

•    It was agreed that the fourth workshop, on 2 December, should focus on:
o    considering whether the outcomes articulated under each core component would describe the overall vision for care and support
o    understanding how the workstreams’ emerging priorities, with the recommendations from the Commission on Funding of Care and Support and the Law Commission, could fit together to deliver this vision
o    reviewing the gaps identified during this workshop.

Attendees:
The following table sets out details of those people who attended the workshop, supported by DH facilitation and secretariat.

  • Alan Rosenbach, Special Policy Lead, Care Quality Commission
  • Alex Fox, Chief Executive, Shared Lives Plus
  • Andrew Kerslake, Director of Institute of Public Care, Oxford Brookes University
  • Imelda Redmond, Chief Executive, Marie Curie Cancer Care
  • Jeremy Hughes, Chief Executive, Alzheimer’s Society
  • Jim Thomas, Programme Head for Workforce Innovation, Skills for Care
  • Julia Skelton, Head of Professional Practice, College of Occupational Therapists
  • Julie Jones, Chief Executive, Social Care Institute for Excellence
  • Julienne Meyer, Professor of Nursing and Care for Older Adults, City University London
  • Lisa Christensen, Director of Children’s Services, Norfolk County Council
  • Mark Goldring, Chief Executive, Mencap
  • Matthew Sowemimo, Head of Public Policy, WRVS
  • Michelle Mitchell, Charity Director, Age UK
  • Miranda Wixon, Managing Director, Home Care Partnership
  • Nick Kirwan, Assistant Director of Health and Protection, Association of British Insurers
  • Peter Hay, President, ADASS
  • Philippa Russell, Chair, Standing Commission on Carers
  • Sian Lockwood, Chief Executive, Community Catalysts
  • Sue Adams, Director, Care and Repair England
  • Paul Burstow MP, Minister for Care Services, Department of Health
  • David Behan, Director General of Social Care, Local Government and Care Partnerships, Department of Health
  • Shaun Gallagher, Director of Social Care Policy, Department of Health
  • Gill Ayling, Deputy Director, Older People and Dementia, Department of Health
  • Glen Mason, Director of Social Care Leadership and Performance, Department of Health
  • Luisa Stewart, Deputy Director, Dignity and Safety, Department of Health
  • Sally Warren, Deputy Director, Social Care Strategic Policy and Finance, Department of Health
  • 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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