04 April 2008
The creation of an adult social services organisation a year ago opened up an opportunity to transform the quality of care for older and disabled people – and the infant Adass is rising to the challenge. Its president, Anne Williams, explains
One of the greatest social policy ironies of the present day lies in the justifiable expectations that arose from Lord Laming's report on the murder of eight-year-old Victoria Climbié. Consolidating child protection and child care services and setting them into a new, clearer, more rational and effective path seemed to be the most effective way of safeguarding children.
It is still too early to say whether separating children's services from adults', following the 2004 Children Act, has achieved the objectives sought. But undoubtedly it has also led to a more critical and creative scrutiny of adults' services and their new tasks in local government.
Departments of adult social services sprang up much more swiftly than the legislation allowed for. But 12 months ago, the launch of the Association of Directors of Adult Social Services seemed an almost iconic moment: a time for services for older and disabled people – so long regretfully a Cinderella corner of too many local authorities – to begin to find a new and more exciting place in the sun.
The political drivers were the growing political strength of older people and the rise in families and carers coming into direct contact with social care services. Both increased demands for social care finances to be set on a fairer and more secure foundation.
From the outset, the association has been committed to changing its own internal structures to meet the challenges. It has helped members to set up new and very different departments, while trying to influence several powerful policy initiatives that have emerged from central government. These are all deeply interconnected, but the most significant has been the move towards 'personalisation' of care services.
The association is working to transform adult social care to ensure that the essential values of social work – empowerment and individualisation – become a reality for users everywhere.
This requires a fundamental review of the relationship between the state and its citizens, based on ideals fostered in the direct payment debates of the mid-1990s, which sprang mainly from within social care services. In time, it will influence all areas of public service.
The challenge is significant. It involves casting aside the last remnants of the Victorian Poor Law; fashioning policies that put users and carers right at the centre of financial decision-making about the services they receive; and ensuring quality, creativity and quantity within budget. But reviving the best aspects of social work doesn't come without risks: to users, to adult services departments, and to professionals. But if it results in a clearer understanding of entitlements, a transparent understanding of budgets and a greater infusion of NHS and local government funding into prevention services, it will all have been worthwhile.
A start has been made with last year's direct payments pilots. We are still awaiting the evaluations of these. In the meantime, councils are preparing to receive their individual shares of the ring-fenced £520m social care reform grant. The extra money will be available from this month and spread over three years. It will be used to provide better information for adults in need of care, early intervention and prevention and personalised budgets.
There will be a strong regional impetus to this, with far closer working at that level between the NHS and local authorities as the Department of Health encourages the work of the soon-to-be appointed regional deputy directors of social care.
With the closer integration of Adass regions into this wider picture, the association will play an increasingly big role in the implementation of the new policy, in line with last December's multi-agency concordat, Putting people first: a shared vision and commitment to the transformation of adult social care. Signed by Health Secretary Alan Johnson, representatives of Adass, the NHS, the Local Government Association, the Department for Communities and Local Government and the Treasury, it set the seal on a new era in the relationship between directors of adult social services and what Johnson referred to at the time as 'half the government'.
It reflected much more. In liaising with this wide cross-section of interests, we were able to begin to face up to a further challenge to adult social care services over the coming decades.
The split of adults' and children's services gave local authorities opportunities to bring together new patterns of services that could be harnessed creatively to meet the needs of a growing population. Directors of adult social services across England can now be responsible for various additional services alongside their adult care responsibilities. More than 50% run housing, others are responsible for libraries, museums, cultural services, leisure, sport and community safety.
Together, they form a bedrock of activities that make living in a particular authority or council worthwhile. It is through these services that directors can influence provision in a way that dovetails with those other social care priorities and fundamentally affects individuals' quality of life and sense of wellbeing. It is this wider, universal approach that puts directors of adult social services and their departments at the heart of local government.
At the same time, though, concerns about the need to protect elderly and vulnerable people from abuse are not only getting louder but are likely to intensify as personalisation becomes more widespread. The opportunities for abuse will increase, and our safeguarding systems will have to be made proportionately stronger to prevent it.
Adass has already argued at the top table for extra statutory powers to buttress its adult protection role and we haven't been totally disappointed. However, as that debate develops in the coming year, each authority will have to find its own way of making sure that adult wellbeing and adult protection remain equal priorities.
Social care services have been tightly stretched over the past three years and more, as our joint annual surveys of budgets with the LGA have shown. There has, however, been an increased flexibility as budgets from other local authority functions, such as housing, leisure and culture, have become available. Extra money has come into the pot from different quarters. And that will be helped by the injection of the social care reform funds from the beginning of this month.
But it is still not enough. We have long disagreed with the idea of free personal care, as recommended by Lord Sutherland, chair of the Royal Commission on Long-Term Care for the Elderly, which reported almost a decade ago. In advance of the promised green paper on social care funding, Adass will be presenting a forceful case to the Department of Health and the Treasury for extra funds, with recommendations on how those should be raised. However, despite the pressure on resources, we are proud to have achieved good Gershon figures for efficiency savings.
On top of all these other challenges, the government wants us to take on responsibility for a substantial number of people with learning disabilities currently cared for by the NHS. We think that policy is right. People with learning difficulties have a far greater chance of leading flourishing, normal lives within a community context rather than in NHS accommodation. And the Health Care Commission has shown that they have not exactly flourished within the NHS.
It really is important that not only is the transfer of assets from the NHS to local government completely transparent, but also that sufficient resources are made available ,not just to provide the quality of service as it is now, but to bring it up to the standards that people with learning disabilities expect and have a right to enjoy.
It seems much more than just one short year since Adass was born. A lot has been packed into it: and there's a lot more to come.
Anne Williams is the president of the Association of Directors of Adult Social Services
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