Leading the Care Act

Report from SCIE Roundtable held on 5 March 2015

SCIE Report 72

Published: May 2015

We need to move from a leadership model where people say “My organisation is the only thing that matters”; to a leadership model that understands the importance of wider outcomes – and in particular the outcomes for people who use our services.

Lord Michael Bichard, Chair, SCIE

The Care Act is a bold piece of legislation not least in terms of its intent to place power in the hands of users and carers. But it will be judged not by its intent, but by what it delivers; and that to some extent is going to be dependent on the capacity of leaders to respond.

We are facing some major challenges if we are going to move from the traditional model of leadership to the kind of leadership that the Care Act demands. In the past, it has often been about building the reputation and scope of single organisations, and the way we have fragmented government in the past has played to that agenda.

If we are honest, leaders have sometimes pursued the agenda of their own organisations so enthusiastically that they have not taken account of the consequences of their actions and their effect on others who are seeking to work in the sector. We need to move from a leadership model where people say: ‘My organisation is the only thing that matters’; to a leadership model that understands the importance of wider outcomes – and in particular the outcomes for people who use our services.

Leaders in the statutory sector have been too slow to understand the value of the voluntary sector. They do not always understand it and sometimes they have treated the voluntary sector with scant regard. We have all also been slow to develop the kinds of skills that we need in the future: the skills to build sustainable coalitions, to design services around clients, to commission and procure, and to win ownerships across a shared community. Regulators have not always focused strongly enough on how organisations have or have not worked well together to deliver services.

The kind of change required takes real courage for leaders to look beyond their organisation. Loyalty towards our own organisations is not more important that loyalty towards the client. Leaders need to be honest and self-critical if we are to adapt to the aspirations set out in the Care Act.

The Care Act is the most ambitious set of reforms to care and support services since the Beveridge Report (1946), and will require skilled, resilient and committed leadership at all levels of the health and social care system. This roundtable will explore the kind of leadership we need to make the Care Act a success.

Key messages

A number of key messages emerged from the discussion, which we have grouped under the following headings:

Challenges and opportunities

1. Demographic changes, funding challenges and increasing demand all imply that we cannot plan, commission or deliver care and support in the same way as we have in the past.
2. Delivering joined-up care is also complex in a fragmented, increasingly pluralistic system with multiple players
3. Preventative approaches require looking at the system more broadly than just health and social care to include, for example, transport, leisure and employment services.
4. There are vested interests that will challenge the need to share power with different parts of the system – including with people who use services and carers.
5. Policy-makers seem to start with a top-down approach, and then as their term in office comes to an end, they realise it does not work. We have to start with a bottom up approach.

When there was more money, people weren’t happy with the service they received then either. I kind of dread the world when there would be loads and loads of money because we would be even more “done too”!

Sue Bott CBE, Deputy Chief Executive, Disability Rights UK

The role of leadership

6. Leadership is about making good things happen, not just meeting management targets or providing a service defined in the organisations’ own terms.
7. It is the job of leaders to make the complex, simple. Whilst we all need to draw upon management theory and practice, it is not as important as providing a high-quality service to individuals and we should try to avoid using unnecessary jargon.
8. Leadership is about co-production, not command and control. Leaders should be willing to take a risk, step back and share that power with people who use services, not just consult on it.
9. Leaders across the system need to agree between them what outcomes they are trying to achieve for communities, and then align resources and activities to deliver these outcomes. We need to ask: What is the right outcome for the person? And then use this as the starting point for commissioning and planning.
10. The leadership role should be about setting a culture that accepts it is not all going to be perfect and that accepts that in order to improve outcomes, learning will have to take place across the whole system.
11. Political leaders need to set clear policy priorities and outcomes, and to align local leaders so that change can happen at local level
12. Regulators are taking the lead in emphasising the importance of organisations being well led and well coordinated, with other parts of the care and support system.

The challenges for us as leaders are to: ensure everyone is clear about the value base of the organisation, develop an open culture, be clear that we are all there to deliver outcomes to citizens, and to encourage everyone to understand their role in delivering those outcomes.

Professor Martin Green, Chief Executive, Care England

Systems leadership at all levels

13. The biggest single indicator of quality in any service is the quality of the first line manager and registered manager – they are probably the most significant leaders in the system.
14. The system does not work if we do not have strong leaders who are service users and carers.
15. Health and wellbeing boards show how accountability can be shared and also show that no one organisation can solve any issue alone. A range of organisations need to be involved in leading change across the whole system.
16. We need to consider the context in which the system works. Too often we see the system as ‘receivers’ and ‘givers’ rather than about mutuality and the contribution that comes from everybody.
17. Integration is not about structures and organisational change; it is about building the cultures and supportive behaviours that ensure services work seamlessly together for the benefit of people who use services.
18. We need to engage all levels of staff in the concept of personalisation and co-production – not just senior leaders.
19. Systems leadership needs to be complemented with practice leadership, including supporting newly qualified staff to become the leaders of the future.
20. The way we finance and commission services needs to be reconsidered. It can lead to the squeezing out of niche, small and local providers.
21. We need to look at how we use volunteers and how we citizens can support themselves.

If we combine lay people having a powerful voice, politicians having more discretion to do things differently, and a need to renegotiate the deal about care with the public, we will be able to meet some of the aspirations of the Care Act. It will need us, however, to manage that process together.

Andrew Webster, Associate Director, Integrated Care, Local Government Association

Co-production with people who use services and carers

22. There is a business model basis for co-production. It can save money and can support the design of seamless systems of care and support.
23. Each organisation in health and social care should develop the leadership of the people who use services. It is a free resource, but you need to invest to begin with in building the skills, confidence and capabilities of people who use services.

The biggest difference was having lay people at the table… Managers and professionals couldn’t misbehave if there were lay people at the table. The second thing was having all the money available on the table as well.

Andrew Webster, Associate Director, Integrated Care, LGA

Leadership styles, skills and values

24. We need distributive model of leadership throughout different levels of the system, rather than a model that is reliant on having a small number of charismatic leaders.
25. Leaders need to be good at managing and leading strategic and cultural change. It is good leadership that makes the difference – not just developments like pooled budgets or better IT systems.
26. Leaders need to be authentic about who they are and the values they hold.
27. We need to go back to base values when we are considering the role of leaders. Different organisations’ targets may conflict, but many leaders in the health and care sectors share the same values.

We need to move away from this pompous vision of ourselves as leaders. We talk about cultural change, but we always think it’s others that need to change, not us. Do we, as leaders, really know if we are contributing to or impeding the success of our organisations? Good leaders know when to give up their roles and their power.

Tony Hunter, Chief Executive, Social Care Institute for Excellence (SCIE)