WM ADASS Regional Account
The West Midlands natural tendency to reticence and understatement is, in many ways, an admirable quality. Not wanting anyone to think “we’ve gorra bob on us” and “jus gerrin on wi’it” (with all due apologies to black country dialecticians!) are two phrases that spring to mind. It sits comfortably too with the current trend towards humble rather than heroic leadership. Trouble is; humble and reticent are a bit out of step with the punitive and judgmental world we work in where the challenges inherent in reconciling national austerity imperatives with local need for care and support seem to be accompanied by increasingly reductionist notions of success and failure.
This, or something like it, has driven the change in our regional approach to improvement over the past 12 months. Not because we’ve all embraced reductionist notions of success and failure (we haven’t!) nor because we’ve all flipped from humble to heroic (don’t think we have anyway!) but because we take great pride in what we do, we care passionately about the people we serve and we owe it to them to be as open and transparent as we can be about how well we are doing. Our reputation also matters as never before, not in any bragging-rights way (ok , maybe a bit), but because our reputation determines the credibility with which we can engage with government and other national players to develop a constructive dialogue about the reality of service challenges and how we make the best of what we have to work with.
We started the year recognising that telling our regional story to a national audience was a challenge that we needed to address and that we could only address through delivering on a credible regional programme. In particular we have focused on:
- Having a coherent regional plan which reflects national as well as local priorities and themes, and through which we can harness the improvement initiatives directed variously from LGA/TEASC/BCF/Care Act/DH;
- producing a “balanced scorecard” that summarises the performance of the region’s 14 councils against a set of quantitative and qualitative indicators that assist in identifying the key challenges, as well as the continuing changes that adult social care is subject too;
- Completing our first round of Peer Challenges and evidencing improvements
- Shifting our focus from “sector” to “system”. In particular support for the Integration Leadership Group which brings together wider system leaders from Councils and the NHS.
Our reputation is on the up; we are seen nationally as leaders in shaping regional system leadership and having a coherent and credible approach to sector and system-led improvement.
It doesn’t stop there of course: this year’s challenges are greater still. Three to pick out: firstly, we embark on a new round of Peer Challenges where we have agreed we will have more “grit” in the process, more focus on issues triangulated with our regional scorecard and with more bespoke teams bringing the right expertise. Secondly, each of these will bring focus to bear on issues of resources and sustainability; a key issue that we will address too through our wider programme as councils face a stark reality of having to shift from orthodox care and support models. Thirdly, our ability to lead the wider system, particularly the NHS, will be central to local support and development.
The following statement provides a summary of the region’s performance as well as identifying the key priorities for improvement over the next 12 months. It is in effect, the West Midlands regional account.
Governance and Leadership
Martin Reeves (Coventry) is lead CEO for ASC SLI and Alistair Neil (Herefordshire) is leading the work on Health Integration (including BCF).
There are currently 7 joint DASS/ DCS and 1 DASS/ DPH (Richard Harling at Worcestershire). There are 5 interim DASS in post: – Stoke, Wolverhampton, Walsall, Warwickshire & Herefordshire (new DASS appointed August 2015). Stoke and Coventry are in process of recruitment. There have been 2 CEO appointments in 2015 in Dudley (Sarah Norman) and Staffordshire (John Henderson).
There were political changes following the recent local elections at Stoke (Coalition), Herefordshire (Conservative) and Walsall (Conservative). There are 7 Labour controlled authorities in the region and 6 Conservative 1 Independent / Con/Ukip coalition. Cllr John Cotton who was acting as coordinator for the regions ASC lead members has moved to a different role in the Birmingham Cabinet.
There are 9 councils with a generally positive direction of travel and 5 with a static or negative movement aggregated to average of the national ranking of each ASCOF indicator between 2011 and 2013.
Enhancing quality of life for people with care and support needs (2013/14) shows a variation of 19.4 and 18.5 with 7 councils in upper quartile and 7 in lower quartile when compared nationally.
In relation to delaying and reducing the need for care and support (2013/14) attributable to adult social care we, have 9 councils in lower quartile, 3 middle and 2 upper quartile. DTOC remains a particular challenge and has been identified as a strategic priority for the region and a joint piece of work with NHSE has recently been commissioned for the region, and Coventry, Birmingham and Dudley are working particularly hard on this but it affects everyone at the moment!
In ensuring that people have a positive experience of care and support and people receiving Direct Payments (2013/14) there is a variation between 26.2% and 75.6% with 6 in upper quartile and 8 lower.
Safeguarding – all 14 councils have signed up for Making Safeguarding Personal – which is good and provides a means of assessing progress as councils develop action plans and have all recently agreed common policies and procedures in line with Care Act changes.
Resources and workforce management
The analysis of the finance data collected for all 14 councils is the subject of a separate paper being produced through the regions Finance leads network.
We are looking at workforce data as part of a new work stream drawing on Skills for Care data which has been identified as apriority for 2015/16.
Health and wellbeing partnerships
Care Act preparedness – 2 councils flagged as green and 12 amber – a further stock take on readiness is currently in circulation and the region has a Care Act support programme that all 14 councils are contributing to and benefiting from.
All 14 Better Care Fund plans have been approved with a new programme of support being rolled out. The region is in active discussion with the national team in terms of focusing support on those HWB in most need as well as drawing on lessons being learnt and where good practice is emerging.
All 14 councils have adopted the Mental Health concordat and are rated as green.
Culture and change
All 14 councils have produced a self-assessment document ahead of the peer summit held in December 2014.
All 14 councils have received and participated in Peer Challenges during 13/14/15, 1 has completed an LGA safeguarding review. The Staffordshire and Birmingham were last to be completed in March 2015 and both have provided updates on the actions emerging from the challenges.
7 councils have published local accounts in 2014, 6 in 2013 and 1 in 2012. – Which is a proxy measure for engagement with service users and the wider public. Councils in the region are currently exploring what local accounts will look like in the future and are starting to look at collaborating across the region. We will also be producing a ‘Regional account’ as part of our annual performance of the region report.
All councils have been represented at at least 3 ADASS branch meetings, 1 DASS/DCS has not attended any meetings but has been represented by an Assistant Director. All councils are actively participating in the Improvement programme and all 10 thematic improvement areas have identified points of contact with each council and they are currently being updated.
All councils have market position statements published between December 2012 and March 2014 – this is a focus for regional and local activity in relation to ‘Commissioning for better outcomes’.
The number of local government ombudsman complaints upheld varied between 0 and 40%.
The number of CQC registered locations in council areas varies from 505 in Birmingham to 88 in Telford and the number of locations not compliant in October 2014 varied between 10% of all locations to 53%.
- Good progress is being made with the principle and application of the region’s balanced scorecard and links to the national ‘risk triggers’ approach
- The financial data in particular provides opportunity for both challenge and learning and is being prioritised for further revision and focus
- Identifying suitable indicators for g. safeguarding, workforce and transforming care are being progressed
- This scorecard effectively looks backwards on year end 2015 and, having established some principles around how the data is collected, will assist in future iterations
- Nationally the region has been working closely with TEASC, in particular in developing an approach to ‘risk triggers’ and our approach is now mirrored in the national framework developed by Rachel Ayling and David Walden
by Ian James
Director of Communities and Adult Social Care at Solihull Council and Regional Chair of West Midlands ADASS