Working together for the public good
The statutory guidance on the responsibilities of a DASS includes:
Promoting local access and ownership and driving partnership working
and
Maintaining clear and effective arrangements to support the joint planning, monitoring and delivery of local authority social services with the NHS…
Although the world of social care has – and continues to – change significantly since this 2006 guidance was published, the responsibilities remain the same.
Integrated care systems (ICSs) are now established and as a DASS, you should understand their core components and how to work effectively using these arrangements. Better results and experiences for local people are achieved by councils and NHS effectively working together.
It is easy for fragmentation and disagreement to occur, but the people who suffer most from this are the people we support. As a DASS, you should identify and address issues and remain tenacious in your plans to resolve them, even when it is very tough.
Look at an overview of the key components of ICSs, and see how The King’s Fund sets out implications for local government, including the positives but also pointing out that the focus on NHS resources and performance could crowd out wider system priorities and undermine the sense of equal partnership many systems have worked hard to nurture.
Whether or not this is one of your local issues, you should articulate and champion the priorities you think should have more attention and should be resourced through the ICS arrangements. The general purpose of ICSs aligns quite well with adult social care’s ambitions to bring partner organisations together to:
- Improve outcomes in population health and healthcare.
- Tackle inequalities in outcomes, experience and access.
- Enhance productivity and value for money.
- Help the NHS support broader social and economic development.
NHS culture is different from that in councils; it is also different between ICSs. It is important, therefore, that you take time to understand these cultures so you can work within them to best effect, and work together to change the culture when needed.
Although culture and behaviours can be quite different within and between different systems, NHS England believes collaborating as an ICS will help health and care sectors tackle complex challenges. These are ambitions we in social care can support, such as:
- Supporting people to stay well and independent.
- Acting sooner to help those with preventable conditions.
- Supporting those with long-term conditions or mental health issues.
- Caring for those with multiple needs as populations age.
- Getting the best from collective resources so people get care as quickly as possible.
- Improving the health of children and young people.
Your approach with the NHS on these and other areas will include the associated challenge of balancing the work to firefight the short-term pressures (including the expectations the NHS has about how social care will respond to short-term NHS pressures) while leading and supporting joint work that identifies, plans and implements the changes needed for sustainable, good quality, responsive services over the longer term. Addressing the well-known considerations of workforce capacity, budgetary constraints and demographic changes will also be part of this.
The level of experience and understanding of adult social care (and local government) is very different among Integrated Care Board (ICB) executives. It is reasonable to assume you will have a role in educating and supporting executive level NHS staff to understand important elements of how adult social care operates. Similarly, you will learn from them, to achieve a better understanding of the NHS world and its pressures.
In a complex environment with these many competing pressures, it is easy to lose sight of what needs to be focused upon. Although written strategies and policies provide a general framework, the key to improvement is the impact derived through good culture and effective execution of plans.
Diagram 1 in the Ideas, information and innovation section provides the key areas for you to consider as a new DASS working with NHS partners, although you will want to cast your net more broadly once you are satisfied the main foundations are robust.
Regularly discuss, agree and refresh your local ‘common purpose’ with NHS leaders regarding priorities and deliverables for the short and longer term and ensure you know how to achieve them.
You will also need to be prepared for escalated, high-pressure situations, such as the well-known ‘winter pressures’. In situations such as these, it is common for NHS partners to establish a range of daily, or even more frequent, meetings for monitoring and oversight. You will need to make an informed judgment as to whether or not attending these meetings is the most effective use of scarce social care management capacity and to decide if and when it is worth doing so.
Delegating to your most competent and appropriately skilled operational manager may be best and this will avoid the risk of decisions being considered at a level above the most suitable management competency and knowledge level.
It is fair to say that both the NHS and councils can sometimes use tactics to try to reduce demand and to achieve financial benefits in times of pressure, even though the actions may impact on the other party adversely. Part of the ambition of ICSs is to reduce some of the difficult behaviour that used to occur.
Our contribution is to call out some of these activities in the hope that a more transparent environment reduces the risk of wasted public money on such activities and improves the experience for the people both we and the NHS support. Some of these are set out in Diagram 2 in the chapter Ideas, information and innovation: find out more.
When it comes to managing longer-term change in this kind of complex partnership, it is particularly important to ensure you (and/or members of your leadership team) have a strong mechanism for determining whether or not the direction of development and associated decisions is reasonable.
Changes will range from substantial step changes in organisational arrangements (e.g. establishment of a provider collaborative delivering health and social care services) or more tactical projects (e.g. a phased project to improve joint operational working arrangements in a specific area).
As a DASS, you will determine, for any given change, what your role needs to be. This may range from deciding to take on direct overall leadership and accountability yourself through to agreeing that an NHS senior officer takes on the leadership. You could also support one of your management team to lead.
A range of joint leadership options is also possible, but it is vital to be clear about who is responsible for what, otherwise you end up with the classic issue of lack of accountability and oversight.
The readiness criteria in Ideas, information and innovation: find out more is a good initial checklist to help you consider if the key elements of any given proposal are robust before they progress.