Fiona Connolly, director of adult social care and interim strategic director for adults and health at the London Borough of Lambeth, discusses the importance of local care leaders working across the health system.
What makes a good leader in social care? After 25 years’ experience in local government, I’m clear that it’s an ability to ensure delivery of effective and high-quality services, and to influence, facilitate and negotiate across the entire care and health system.
This system-wide role is the key shift in recent times in what is expected of senior post-holders in adult social services, and sets the tone for the future. We have a responsibility now to work across organisations, and to work with people who need care and support, to secure sustainable and responsive services. There’s really no other job like it.
When this leadership is lacking, the consequences are all too evident. We see it most acutely in the mercifully rare cases where things go tragically wrong: almost always, the system has failed to link and coordinate. But we see it, too, in day-to-day practice on the ground. If teams are not enabled to work across the system, what they do becomes task-based rather than people-orientated.
When we get it right, however, the rewards are gratifying. We are starting to glimpse the possibilities on my patch in south London. I won’t pretend we are anywhere near having all the answers, and we hope to share our experience, and learn from others, through the A caring society programme.
Austerity certainly casts a long shadow. It will be hanging over us for a good while yet. But it has concentrated minds on making the best possible use of available resources and, in some but by no means all localities, has finally landed the message that the system is inter-dependent: if I don’t care about my local acute hospital trust, Guy’s and St Thomas’, having 20 delayed discharges due to social care, they will suffer as a result.
Equally, my local mental health trust - South London and Maudsley, a huge provider working across four boroughs – has changed fantastically in the last three or four years, restructuring its organisation to fit with what we have wanted to do in Lambeth. I’m not convinced that would have happened in the past.
A caring society
A project to bring together innovative thinking, people and practice to shape a 21st Century social care system.Find out more
You may have heard of the Lambeth Collaborative: we have been working on it for eight years! That’s a measure, though, of the scale of the challenge we all face in transforming services and support for the 21st century. The Collaborative brings together people with mental health needs, carers, commissioners and a wide range of providers to rethink and reshape the local offer, from information and advocacy right up to hospital provision.
In summer 2018, we finally established the Living Well Network Alliance, pooling the bulk of the local authority and health (CCG) mental health budgets for working-age adults for an initial seven years with a mandate to achieve 14% efficiency savings over that term. But it’s not about the money – we have to make savings in the prevailing public spending climate, for sure, but our unswerving focus is on improving people’s lives.
This is all about alliance contracting: a single contract between the commissioner and an alliance of parties signed up to work together across organisational boundaries to achieve outcomes, sharing risk and gain. I believe this is the way forward: providers don’t feel they are on their own, while commissioners are able to redesign services much more effectively without repeated re-tendering, which may save a few pounds here and there but disrupts services and demoralises staff.
Having established the precedent in adult mental health, we now aim to move on to explore the potential for alliance contracting across the care and health system in Lambeth. Note that of the £66 million pooled for mental health in 2018-19, less than £10 million comes from the local authority. That’s a measure of NHS buy-in and a reflection of system-wide leadership.
Sceptics will say it’s much easier to pull off this kind of initiative in London than in other parts of the country. It’s true that we benefit from strong support from local politicians, who not only sign off on our ideas but share actively in the commitment to deliver on them, and it helps that we pay the real living wage as a minimum on 99% of local authority contracts. But at the same time we face particular challenges, not least a distrust of authority shared by many people in the community.
This makes it all the more essential that we move forward in lockstep with our local people and look to develop new leaders from their number. If public services are truly to be transformed for a new era, then that transformation has to be achieved in concert with those who use them.