Silo Thinking on The Increase in Adult Social Care

One Council we are working with has some particularly exciting and bold plans to integrate health and care. In addition I know that there are some great projects going on in adult social care in many other authorities. And yet, when we asked the staff, only 13% of staff agreed with the future direction of adult social care.

Why is this?

There has been, quite rightly, a strong focus over the last couple of years on seeing adult social care as quite an integral part of the wider health and care economy. However, there is a growing but false assumption that it is therefore unhelpful to talk about adult social care on its own at all. The logic goes; it is part of a system and therefore must be addressed in such a way. Now whilst this is true, it does not mean that adult social care should not be the master of its own destiny nor should it neglect its own perspective at a time of immense change.

From our work and discussions with around thirty different health and care systems recently I have come to the view that adult social care is having an identity crisis. In fact, it is developing a three-way split personality.

1. Delivering integrated health and care – blurring organisational boundaries to deliver person centred care
2. Delivering significant short term savings – responding to demographic pressures and contributing to council savings
3. Delivering a set of process changes to be compliant with the Care Act.

These are all essential, but aren’t being dealt with together. The tough but important job is to join these up and offer a coherent vision of what adult social care will be in April 2015. (And by proxy what the future for the service looks like more generally.)

There are a whole range of questions Directors of Adults Services have started asking to see how joined up they are. Here are a few you may want to consider initially:

• Have your staff received more briefings on Care Act and on Better Care than on the overall vision for adult social care (incorporating these)?
• Do your savings plans reference the opportunity from implementing Care Act changes in a way that best manages demand?
• Do your integration partners know where you are planning to make savings within adult social care?
• Do you have an overall way of seeing the overlaps and potential tensions between different changes – e.g. having a version controlled adult social care customer journey?
• Do you have a simple and consistent narrative of explaining to managers and front line staff how the changes all join up?

Creating a simple story isn’t easy. It is a complicated picture and there are unknowns and potential tensions. But unless we are able to identify a consistent story of where adult social care will be that staff can identify with, balancing all three of these change drivers, then we have little chance of delivering any of them properly.

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