11th January 2012

Jon Ainger is a Director at iMPOWER. To contact him to discuss this blog or any aspect of our work, please e-mail jainger@impower.co.uk or call 020 7017 8030. 

I started to take a good look at myself, and tried to focus on the moment I was happiest in my career.  This process took me back to the moment when I first truly understood the value of local public services. 

To continue reading Martin's life story and why he is so passionate about the public sector please see attached. 

On the face of it this is a good thing. It tackles two big issues that we at iMPOWER have been talking about (and doing something about) for the last couple of years – a holistic approach to social work which looks at the whole family, and the management of demand as a key tool for reducing cost and improving outcomes.

It is clear that some families need help, and that right now that means lots of people making lots of appointments to talk about different but closely related things. Many of the councils we have worked with recognise this and we undertook some pioneering work with Norfolk County Council to understand exactly what this felt like for families. The results were a depressing image of a disjointed and frustrating experience. Having one person who acts as a gatekeeper for a family makes life simpler for everyone, and allows them to focus on change instead of diary management.

Working with families can also be a great way of managing demand. Again, the councils we work with understand the inter-generational grip that crime, abuse, mistreatment and poor parenting can take. They also understand how difficult it is to break this cycle. Working with an individual may solve the problem for one person, but working with a family creates the opportunity to change how the family unit works, reduce the likelihood that the current generation will end up in care, prison or both and reduce the demand on the public sector.  The recently published study of the Hackney model, ‘Social Work Reclaimed’ provides many examples of where working with parents to provide children with structure, routine and a sense of security has had a significant impact on outcomes.

So far, so good; but as the details of this initiative emerged some real challenges appeared. First of all, whilst central government is providing £448m this only represents 40% of the cost, with councils being asked to find the remaining 60%. Council finances are in a parlous state and there is a real risk that funding will have to be taken from other important services. This may feel like too great a risk for councils fighting to maintain their OFSTED status, but the cost of ‘troubled families’ – Mr Cameron estimated that £9bn was spent on 120,000 families – far outweighs this.

Second there is a lack of clarity about exactly what the troubleshooters will be doing, and who will be doing it. The Family Intervention Projects have made great strides but the problem still exists. Councils, and Mr Cameron, need to be clear about exactly what troubleshooting means and how it will make a difference before investing so much money in it.

The question of who is equally important. It has been suggested that charities may undertake this work, and whilst their skill and commitment is not to be questioned this poses a number of risks. There will be a new set of individuals involved in families lives; the role and morale of social workers, family resource workers, CAMHS professionals and others currently involved could be undermined further as a different set of ‘experts’ are brought in to do their job; and what happens when the troubleshooters head off into the sunset (or their next assignment). How will their work be carried on by the local social workers left behind? We need to move on from an ‘initiative-based’ approach to working with families, to something much more sustainable delivered through mainstream services and funding routes. This will only work if there are joint teams and a clear approach to skills transfer.

Finally, I mentioned at the start that we believe in a holistic approach to social work. It is interesting that the infographics released along with Mr Cameron’s speech focused on the implications for the justice system – for example the statistic that 24% of prisoners had been looked after.  Whilst this is a useful way of making the costs real, and of looking tough on the causes of crime, the ambitions of this initiative should be far wider than this.

Despite these reservations, the government’s commitment – financial and political – to addressing these problems is good to see. I believe that Mr Cameron’s proposals are a positive step, but only one step on a much longer journey.  At iMPOWER we believe that real change will not be seen until a joined up approach to working with families in a holistic way becomes a part of everyday life for everyday social workers and not a tool for creating headlines and political capital.

4th January 2012

David Colbear is Manager at iMPOWER. To contact him to discuss this blog or any aspect of our work, please e-mail dcolbear@impower.co.uk or call 020 7017 8030. 

To keep people out of hospital and living well in the community requires health and social care to work closely together ‘hand in glove’ towards common goals.  It is fundamental to being able to tackle the problem of sustainable public services in the long term.  But different cultures and approaches to care, professional boundaries and different language means this has been very difficult, if not impossible to achieve.  One such example is a District Nurse’s ‘holistic assessment’ covering ‘head to toe’ from a physical  perspective, not including any mental health or learning disability considerations or indeed any social care needs. 

We have recently noticed increasing tensions by those in leadership positions, as well meaning initiatives to ‘change the game’ come to nothing.    In England, the Health and Wellbeing Boards currently being set up are Lansley’s proposal to solve the problem.  Immense expectations are being set on Health and Wellbeing Boards around their ability to get over the hurdles of integration.  Where strong personal relationships exist at a leadership and operational level, no doubt some of these Health and Wellbeing Boards will succeed.  However in many cases the lack of strong personal relationships, particularly in the light of such fundamental change at the leadership level in the NHS, mean that they will struggle. 

Bringing health and social care together more formally to underpin the Health and Wellbeing Boards can help to overcome this reliance on strong personal relationships.  In our experience doing so can make those involved think very differently, and better decisions can be made as a result.  Herefordshire is one of the few places that have already done this with health and social care responsibilities delivered together through its provider organisation, Wye Valley NHS Trust.  Its approach is beginning to pay dividends.  At Herefordshire iMPOWER have helped implement a single personalised approach for community health and social care to support this move – believed to be one of the first in the country.  With joined health and social care responsibilities, it was a straightforward decision to combine reablement and Intermediate Care into a single service.  In addition the development of the single personalised approach provided a forum for social workers, district nurses, occupational therapists and physiotherapists to understand for the first time how their professions truly interlinked.  Despite the ‘general assessment’ of needs, it has strengthened professional competencies, by creating clarity around where expertise is required.  In particular all professions now understand how hard social workers work as the ‘glue’ around all of the professional input, as well as providing professional expertise around complex social needs.

However the facts show that at a local level, decisions to combine health and social care responsibilities are rarely taken – there is too much to lose.  Only if there is a very strong imperative will organisations combine responsibilities – for Herefordshire this was financial sustainability in a very rural situation.   Integration decisions around health and social care made at a national level but planned and organised locally will mean more have the ability to benefit from the potential this provides.    The announcement from the Scottish Government around its proposed model for integration of health and social care, due this month, is therefore an important landmark, and could well help change the game around health and social care provision to deliver sustainable public services.  English authorities should take note.

If you want to know more about how to overcome the practical issues of integrating health and social care please contact Martin Cresswell, David Welsh or Georgina Owen.   

13th December 2011

Martin Cresswell is Chief Executive at iMPOWER. To contact him to discuss this blog or any aspect of our work, please e-mail mcresswell@impower.co.uk or call 020 7017 8030.

David Welsh is a Director at iMPOWER. To contact him to discuss this blog or any aspect of our work, please e-mail dwelsh@impower.co.uk or call 020 7017 8030.

Georgina Owen is an Assistant Director at iMPOWER. To contact her to discuss this blog or any aspect of our work, please e-mail gowen@impower.co.uk or call 020 7017 8030.

Please visit the SOLACE website to read the full article: 

Positive relationships are the key to productivity

Consider the best relationship you have ever had. Maybe it’s one you’re in now; maybe it’s in the past; maybe it’s in the future. When you think about the characteristics of that relationship you would probably include some or all … 

http://solacesummit.wordpress.com/2011/10/07/positive-relationships-are-the-key-to-productivity/ 

Number of adoptions achieved

The number of children in care has increased considerably over the last 15 years, from 50,800 in 1996 to 65,520 in 2011 – an increase of 29%. The number of adoptions completed over the same period has not increased by 29%. In fact they have not increased at all. But is this really surprising? To keep up with the increased “supply” of children, the demand would need to increase at the same rate. But why would 29% more adults choose to adopt now than in 1996? Fertility treatments have improved significantly since 1996, meaning that more people are able to become biological parents than before. (In particular, Intracytoplasmic Sperm Injection treatment has revolutionised the treatment of male factor infertility over the last 10 years enabling many men to father a child who would previously had to depend on donor sperm). That’s not to say that all adopters adopt because they can’t have their own children, but it would be silly to dismiss this as a factor. Similarly the economic climate is likely to have an impact on the number of adopters coming forwards. This year we have seen family disposable income fall by the biggest drop on record – adopting a child is a big financial commitment and perhaps one that is less easy to make now than it was a decade ago. Is it really realistic for us to expect the rate of adoptions to have increased?

Although the age profile of looked after children has not seen a marked change over the last 15 years (81% of children in care in 1996 were aged 5 or over compared to 76% in 2011), the needs of children being placed for adoption have changed significantly. Children entering care today, and consequently being placed for adoption, have far more complex needs than they did in the past. For example, the number of babies left brain damaged each year in Britain has doubled in a decade. Official statistics show that there were 1 million babies registered with Foetal Alcohol Syndrome (FAS) in Britain in 2004, compared to 500,000 in 1994. A lot of these children will find themselves in care, and some will be placed for adoption, however finding adopters who are willing, or able, to take on children with complex needs is not an easy task. And yet we are expecting our local authorities to place these children as quickly as they placed children with less complex needs in the past.

Adoption as the best outcome

The Prime Minister is quoted by the BBC as saying, "It is shocking that of the 3,600 children under the age of one in care, only 60 were adopted last year - this is clearly not good enough.” Isn’t it? How many of these young children were returned to their parents? Or to live with family under Special Guardianship Orders (SGOs) or other arrangements, such as long-term fostering, which enable stability and consistency without the requirement for an adoption order? In 2006/07, 740 SGOs were granted, compared to approximately 240 in 2005/06. Over the same period adoption numbers fell by 300. Adoption is not the only option for children in care, and the increased use of SGOs (and corresponding decline in adoption) demonstrates this. When age at placement and other variables are held constant, there are no differences in breakdown rates between adoptive placements and placements with permanent foster families. Qualitative studies find that some children prefer to be fostered and others prefer to be adopted. (What works in adoption and foster care? Clive Sellick, June Thoburn and Terry Philpot, Published 2004).

To consider adoption as the only good outcome for these children is as best naïve and at worst dangerous. Local authorities work incredibly hard to achieve the best possible outcomes for the children in their care, and this involves considering range of permanency options of which adoption is just one.

Number of adoptions as a measure of quality

It was interesting that of the 15 performance measures included in the league tables published this week, the media chose to report only the indicators relating adoption rates and speed of adoption placement. As a result Nottinghamshire, who are in the top 10 authorities for achieving placement stability and consistency, were slated for taking the third longest time to place children with adoptive parents. Whilst the speed and rate of adoption are useful things to measure, they should not be considered in isolation. As noted in the Guardian (Adoption tables don’t tell the whole story, 8^th November 2011), over the years 2009-10 and 2010-11, 10 of the 57 children adopted in Nottinghamshire were over five, and four were disabled. Seven sibling groups were adopted, one of them a group of three children. In four years, only two adoptions did not work out.

No national statistics exist for the breakdown rates of adoption, however it is widely quoted that on average, one in five placements from care with adoptive parents or permanent foster carers not previously known to the child breaks down within five years of placement. The league tables published this week only consider the number of adoption placements made by each authority in relation to the number of children with an adoption plan in place. What is not measured is how many of these placements are successful after 6 months, 1 year or even 5 years. Performance measures such as these risk incentivising speed of placement over everything else, including quality of match and longevity of placement.

A way forward

Could local authorities be more proactive in encouraging people to adopt? Yes. Does it take too long to assess adopters and place children? Absolutely.  Are there children currently in care who would be happier and achieving better outcomes if they were successfully adopted? Regrettably so.  The answers to these questions are easy. Unfortunately however, whatever the media reporting of the facts may imply, changing this situation is not.

At iMPOWER we have been working with a number of local authorities to tackle both the supply and demand sides of the equation. This means not only working with staff to improve all processes for achieving permanence (including adoption), but also seeking to tackle demand by promoting effective and targeted prevention and early intervention. By identifying families early on who may experience difficulties in fulfilling their parenting role we can offer support to enable children to stay at home. And after all, ensuring children are happy and safe at home is the best outcome for everyone.

Caroline Throssel is a Senior Consutlant at iMPOWER. To contact her to discuss this blog or any aspect of our work, please e-mail cthrossel@impower.co.uk or call 02070178030 

Adoption – I agree with Dave

This is a note with some personal reflections on the adoption debate.  Before I start, a disclaimer – adoption is complex, and is about much, much more than just performance management.

This morning the government has shone a spotlight on the widely varying performance of local authorities in England.  And whilst there is much about the coalition’s approach to local government with which I disagree (e.g. the great bin collection red herring, chief executive pay etc.), in this case I can’t disagree – this issue needs a spotlight.

Adoption isn’t a particularly emotional issue for me – I don’t have personal experience of the extreme highs and lows that many prospective parents must go through as part of the process (although my parents in-law do).  But I do have a very clear point of view on it through observation – that to me it appears that the ‘process’ has been both captured by the professionals, and, at the same time, often lacks effective performance management at local level.  And that this can lead to mistreatment and mishandling of prospective adoptive parents.

My observation is that at least part of the problem is that adoption services aren’t designed for prospective parents.  They aren’t even really designed for the children (when you see some of the delays in the process at first hand, this seems less controversial as a claim).  Instead they’re designed for the professionals to manage their risk.  Oddly, also, the bar that parents have to clear for adoption is set at a much higher level than the bar below which parents have to fall before the social workers at the other end of the system take the child away for its own safety.

Up until recently this hasn’t been a big problem from a council perspective.  Firstly until Baby P the numbers of children coming up for adoption were relatively stable.  And secondly, prospective parents are often so desperate for children that they put up with all sorts of poor handling, unnecessary delays, and in some cases professional opinions that seem to lack common sense.  So there was an unhappy equilibrium, but an equilibrium none the less.

Now, things are diffferent – with pressure being placed on the performance of adoption services at local level, at least partly because with much higher numbers of children in the system now, the continued under-performance of the service has led to big bottlenecks.

Under those circumstances, the only way to get sustainable improvements in performance is either to hugely increase the performance scrutiny – at local level – of adoption services, or to create a service which sees prospective parents as their customers.  Or, ideally, both.

I am not a social worker, but I’m the son of one who used to specialise in work with children.  And as someone of mixed race, with an Indian mother and a white English father, I could not understand why my professionally qualified mother thought it was ok for her to have mixed-heritage children whilst it wasn’t okay for her department to place children for adoption with parents of different heritage.

Changing the culture and performance of adoption services is not just about more scrutiny.  We have to get to the heart of the cultural norms within the professional service.  I’d love to hear challenges and comments!

Jon Ainger is a Director at iMPOWER. To contact him to discuss this blog or any aspect of our work, please e-mail jainger@impower.co.uk or call 020 7017  8030

http://jonainger.wordpress.com/2011/10/31/adoption-i-agree-with-dave/

The natural tendency will be to cut services, with libraries, parks, care services all becoming common battle grounds for the complex budget discussions with members.  This crude and simplistic approach strikes at the very fabric of our society, and could be argued to be inherently unfair.

There is a new and different way to solve the problem and maintain a degree of fairness. It will not remove all tough decisions, particularly regarding the number of staff employed. But for many, where councils are the largest employers in the local economy, the over simplistic rationalisation programme and grant cuts agenda only adds to the local challenges they must deal with later.

Authorities need to consider how to work with citizens to change the demand and pattern for services.  Already iMPOWER has proven with a number of Councils that by gaining a different insight into how citizens behave, and what drives their decision making, you can change what they require/demand from the local authority.

Take special educational needs transport for example. In general, parents believe (because they are told by public servants), that they are entitled to require the council to make arrangements to take the child to school.  Not only nationally are these costs spiralling out of control, when councils try to change these arrangements parents are naturally resistant, and the relationship breaks down. Our work with councils on this one issue, where perhaps £650m is spent on nationally, enables them to save between 15% and 25% with improved relationship with parents.

We have achieved this with councils by helping them to take a different view of how to work with citizens to reshape services. Call it personalising services, call it localism or big society, but to change demand council need to engage with citizens differently, and to achieve that, councils need to accept they need to reassess how they understand their citizens.

Over 30 years of international research has shown that people do not make decisions because of their economic, social, ethnic, geographical background - they make decisions based on the type of person they were, in essence their core personal values. As an illustration, very often we see the individuals with least available time or financial resources  volunteering to support society - it's not where they are but who they are that drives this behaviour.

By understanding who our citizens are, we can work with them to reshape services.  iMPOWER is working with an increasing number of councils to achieve budget savings in this way.  Examples of services it can support to reduce budgets and sustain services include reablement in care services, increasing direct payments, engaging with citizens to make parks and libraries sustainable, waste and cycling, home care, foster care recruitment, and many other services where citizens play a part in shaping their outcome or benefit from services.

The blunt instrument approach - you are taking something away from citizens – leads to reduced satisfaction in services, and worsening outcomes for citizens.   Process change, focussing on back office costs, procurement improving simply is not enough to solve the crisis we now face.  If councils want to survive in a modern environment, they must accept that their understanding and therefore attitude towards service users needs to mature.

Martin Cresswell

Martin Cresswell is Chief Executive at iMPOWER. To contact him to discuss this blog or any aspect of our work, please e-mail mcresswell@impower.co.uk or call020 7017 8030       

As anyone who has known me for more than 5 minutes will know, I grew up in a very small village in rural Leicestershire, with more sheep than houses (only 58 back in the day when I had a paper round). The village was subject to a 30mph speed limit, but due to the popularity of the area with local bikers, and the “blink and you’ve missed it” nature of the village, very few motorists slowed down to notice the 58 assorted cottages or the lanky youth struggling under the weight of 58 copies of the Herald and Post. At a parish meeting to discuss the traffic problems with the local police, it was suggested that police should come and catch a few culprits using one of those new-fangled speed guns. The villagers were told that as police numbers were short, and there had been no fatality on the road to date, enforcing the speed limit was not a police priority for an already overstretched rural constabulary. So, the options seemed clear. Either one of the villagers had to be ritualistically sacrificed to the road, or we could ourselves don fluorescent tabards and wave speed cameras in the face of speeding motorists. But our offers to volunteer as speed enforcers were rejected. There were not enough speed cameras, no one could train us on how to use them, we wouldn’t be legally able to pull motorists over, numerous health and safety laws would be flouted and there weren’t any spare fluorescent tabards.

Fast forward 20 years, and “Community Traffic Enforcers” are a fairly common sight on the rural highways and byways of the East Midlands. Volunteers may have to raise the money to pay for the speed guns, and their powers may be limited to sending people letters requesting them to abide by the speed limit, but they are still there! And what’s more their presence is making a difference – fewer people are being caught and repeat offending is low. So what changed? Well, as far as I can tell, all it took was someone to say “yes” instead of “no”. Someone who was prepared to investigate how the hurdles could be overcome, rather than just see the hurdles and run in the opposite direction. People are naturally innovative – we wouldn’t have survived for 200,000 years if we didn’t constantly evolve and innovate – what we need is people in the public sector to listen to our innovative ideas with open inquiring minds. Too often bright ideas are stifled by someone with a “can’t do” attitude before they have even been fully explored. For me, the way to create a truly innovative public sector is to empower people not only to come up with the ideas, but also to explore for themselves how they could make them a reality. Oh and to give public sector managers lessons in saying “yes”.

Caroline Throssel is a Senior Consultant at iMPOWER. To contact her to discuss this blog, please e-mail cthrossell@impower.co.uk or leave your comments below. 

But first a huge qualification - we need to define ‘unable to operate’.  It could include, but not be limited to; financial insolvency (multiple causes), political breakdown, a major trades dispute, a profound legal/regulatory issue, extreme service failure or indeed other forms of shock (such as a natural disaster) which render the organisation and local service system unable to perform to a scope and level approaching reasonable expectations.  Where public bodies fail in a profound sense, financial solvency will likely be at the heart of the matter, but one or more of the other factors I have mentioned will almost certainly form part of the picture – either as a cause or effect of the root financial problem.  Finally, we are not talking about a temporary issue -  it is highly likely a part of our definition of ‘unable to operate’ would need to focus on the likely longevity of that position.  The reason why I labour definition of terms is that the solution to failure (the interesting bit!) needs to be very closely tied to the reasons for failure.  Anyone who, like me, has worked on intervention (Hackney and Hull being prime examples in the UK - now a decade ago) knows that local government turnaround is fiendishly complex and multi-layered.  Solving the fundamental problems, not just those that sit on the surface, takes time and unglamorous hard work.

Turning to the current position, I am led to believe there are a number of small district councils that are in serious financial distress.  A combination of factors is at work here but at root their spending power does not match their basic liabilities.  Of course, these Councils, their neighbours and the government can and should do their best to stave off the crystallising of insolvency, but what does need consideration in the process is whether there are deeper issues which will remain unaddressed by the injection of cash and capacity.  A failing Council cannot and should not expect an automatic bail out when things go wrong – should failure occur there need to be hard consequences which result in significant change.  At the same time essential services to citizens need to be protected.  So my sense is that a debate about Council insolvency is a healthy one - where failure happens it is of huge concern for local people but we also need to grasp the opportunity for change it provides.

What would characterise a modern, localist policy on council failure would be a mechanism for local people taking on the challenge of reforming the council in both democratic and management terms.  Central government intervention (backed up by audit and inspection) has characterised the way we have dealt with failure in the past.  But I am excited by the possibility that a Council rescue could involve, at its heart, local people, businesses and other organisations taking on the challenge of rebuilding their council from the bottom up.  That’s why I think we need this debate now – should one of these districts go ‘pop’ at some point soon,  I hope it is local people - and not ministers - that are the prime movers in shaping the plan for recovery.

Alex Khaldi is a Director at iMPOWER. To contact him to discuss this blog or any aspect of our work, please e-mail akhaldi@impower.co.uk or call 0776 413 2182