Prevention, innovation and integration have been broadly accepted as the route to relieving social care pressures, but an overhaul of leadership and governance is also vital. Mark Rogers outlines his proposals for transforming the health and care system.
Fond as we appear to be of the ‘what’s out, what’s in’ lists which abound at this time of year, in one respect 2017 will pick up exactly where 2016 left off – in returning to the wicked issue of how to provide those who need it with timely, accessible, high quality, integrated and sustainable health and social care services against a backdrop of escalating demand and continuing resource constraint.~
In the weeks before, during and after Christmas and the New Year we have been inundated with facts, figures and human interest stories, all of which broadly reach the same conclusion: there are wonderfully talented and committed people working in the NHS and adult social care (and beyond), but they are increasingly struggling to keep up with the pressures placed upon them by indecision and a fragmented, under-reformed and demand-intensifying system.
There is much talk of this system being under such stress that it is fast approaching breaking point. In a number of areas it is being reported that the collapse is already starting.
It must be alarming to acute providers and local authorities alike that the pressures on A&E clinicians and social work assessment and enablement professionals, while well recognised, appear almost beyond amelioration because human resources are so stretched by the immediacy of the expectations being placed on them that ‘firefighting’ is inhibiting more strategic service reform.
The degree of acuity is variable due to the pressures and their impact is not uniform across the country. Nonetheless, there is something approaching a broad consensus that the regular suspects of more prevention and early help, more integration, more innovation and, inevitably, more money should all be given significant investment, time and attention – now.
I do not disagree with any of this, not least because a good deal of what is being reported accords with the local experience here in Birmingham and other parts of the West Midlands.
What is to be done? Addressing the aforementioned issues would help, especially investment in more prevention. But there is another factor which needs to be tackled.
For many – maybe even all places – it is the prerequisite to long-term reform and sustainable success, namely, a new approach to the leadership and governance of the health and care system at both the national and local levels.
The timing for such a revamp is perfect because the new(ish) Government is still thinking through its particular approach to devolution and could do worse than use health and social care as a worked example for how to strike a new balance between what is decided and taken responsibility for at Westminster and what should be ceded to local determination.
Here is an initial proposal. At national level why not immediately establish a ‘grand committee’ to bring together the key movers and shakers from the NHS, its arm’s-length bodies and crucially, the Department of Health and the Department for Communities and Local Government to formulate new policy and law on the long-term funding and integration of health and care.
By coming together in this way, the committee would have the opportunity to ensure truly compatible approaches to delivering an inclusive ‘triple aim’ to underpin a long-term health and social care sustainability and transformation initiative.
Such a committee could, nay should, also be constituted in such a way that it draws on ex officio membership from the relevant local government sector bodies – the Local Government Association, the Society of Local Authority Chief Executives and the Association of Directors of Adult Social Services – utilising their invaluable advice, guidance and extensive experience of implementation.
Locally, working initially with the existing 44 Sustainability and Transformation Plans’ (STPs) footprints – which, in due course, could be incentivised to rationalise themselves – equivalent local grand committees should be formed.
Fortunately, there is a pre-existing legal partnership framework to work with in the shape of democratically-led health and wellbeing boards. These should be beefed up through rapidly prototyped devolution deals empowering them with the authority and responsibility for agreeing and providing the home for consolidated or even unitarised local leadership and governance of the NHS and social care.
In this way, local areas could truly be said to be taking responsibility for prioritisation, strategy and crucially, resource decisions in the interests of the communities served by a single or consolidated STP footprint.
Inevitably, eyebrows and questions will be raised, not least because there is legislation, regulation and above all, culture, custom and practice that will get in the way.
This is why it is the perfect time for a new government to reimagine the leadership and governance of health and social care because what we presently have is clearly not working well enough for anyone – especially the vulnerable. We cannot wait a moment longer to reform the system.
Article first published on the MJ website 10 January 2017 here
I’d like to send you my very best wishes for 2017. I imagine that Christmas and New Year are already something of a distant memory but, nonetheless, I hope you managed to enjoy some peace and relaxation.
The period ahead is, without a doubt, going to place considerable individual and collective demands on us. It will be, to quote Pete Wylie, “The Year Of Decision”. This is because we now have a new vision and four priorities to guide our work; one of the trickiest budgets ever is nearing the end of its consultation period and will be set at the end of February; and the “go” button has just been pressed for the implementation of the future operating model – perhaps more simply expressed as “the way we’re going to be doing things around here”.
These three factors, both singly and in combination, mean that 2017 will be a year we remember for taking a good deal of significant and decisive actions.
There is a clear expectation that the whole of the council – that’s you and me (and possibly Bobby McGee if she is amongst us) – will be thinking constantly about how to ensure that everything that we do makes a difference to the outcomes linked to the priorities of children & young people, housing, jobs & skills and health & wellbeing.
To help ensure the focus on delivering these priorities and the corresponding priority outcomes is both forensic and sustained, I am introducing Challenge Panels. Starting no later than the beginning of April, the Panels will, through a continuous rolling programme, examine every aspect of the council’s activity and seek to ensure that all services and spending are:
- making a direct positive and measurable difference to the priority outcomes;
- the very best value for money; and
- making the most of the opportunities available to work closely with other areas of the council, partners, other local authorities and, of course, our communities.
The Panels will be chaired by, and made up from the most relevant senior officers across the council, along with other experts, and will put service leads/budget holders through their paces to show how they are making a positive difference everyday to people’s lives.
This initiative will ensure that every penny of our £850m controllable spend are put under the microscope. (NB Overall we are actually responsible for some £3bn but big chunks of that bigger budget are ringfenced – e.g. to schools, housing, etc.) The Panel Sessions will ensure that we are not only aligning all our resources to our priorities, but also strengthening accountability and transparency for impact and budgetary control.
Whilst the 2017/18 budget is yet to be set (28th February), it is inevitable that there will be a number of big and very challenging savings included in it. To anticipate this, and in addition to the Challenge Panels, my CLT colleague Angela Probert (Strategic Director for Change & Support Services) has begun the process of setting up a “Big Ticket” Budget Board that the Deputy Leader and I will co-chair. This Board will take responsibility for ensuring that the relevant Strategic Directors and other officers are supported and, crucially, held to account for implementing those savings whose achievement is central to the delivery of the whole budget.
Having a robust budget and, crucially, a set of strengthened assurance arrangements for its delivery are essential if 2017/18 is to be a year in which our reputation for financial planning and execution are to be seen as beyond reproach.
And, central to achieving not simply the budget requirements but, most importantly, the council’s vision and priority outcomes is the introduction of the Future Operating Model (the FOM). In essence, this programme of change is about ensuring that our organisation has a strong and fully integrated corporate centre that enables the People, Place and Economy Directorates to work with elected members, partners, other bodies and communities to identify and put in the place the range of services that will make the most impact on the four priorities and their supporting outcomes.
The FOM has three key elements that will fall into place over the next 18 months.
Firstly, there is a review of the shape and functions of both the corporate and senior leadership teams to ensure that the most senior level of the organisation is equipped to deliver the challenges ahead.
Secondly, all support services that are currently not already part of the corporate centre (i.e. Not nested within Change & Support Services or Legal & Finance Directorates) will be reviewed with the presumption of consolidation into the corporate centre – which itself will be further reshaped.
Thirdly, there is to be a broad and deep review of the layers of management across the organisation and the “spans of control” that managers have – i.e. how many people they are actually responsible for.
For further detail on the Future Operating Model please follow this link.
This change programme is large scale and, dare I say it, will alter radically how the council operates, looks and feels. Regrettably, it brings with it the now inevitable s188 notices because, along with this necessary future-proofing, we are also in the position of needing to reduce our staffing costs still further if the council is to live within its significantly reducing means (another £78m of savings in 17/18 alone).
As you will know from things I have said or written previously, I don’t make any of these changes lightly. Despite the rumours, I am – like all of you – human and, as such, immensely saddened by the necessity of almost continuous downsizing. I do not like losing colleagues to budget cuts.
However, as you know, there just aren’t credible alternatives to staff reductions, so my determination has always been to ensure two things.
Firstly, that if someone finds themselves having to leave then let’s be clear, this is not personal. Circumstances dictate that we urgently need to shape the council of the future, in doing so retain the key skills we need and, at the same time, reduce our costs. As we go through this process, I ask all managers and other decision-makers to facilitate these arrangements with a mind to ensuring respect and dignity for each individual affected. We should be treating our colleagues exactly as we would wish to be treated and, in particular, not forgetting the contribution made, in many cases over a considerable number of years.
Whilst you reflect on this, please read the article available via this link and then you’ll never forget just how far a thank you goes.
Secondly, for those continuing with the council we have an expanding staff offer that supports continuing professional development and enhances the contribution to making a positive difference. I, and others, have written previously about the development of the Improvement Hub which is our response to this and I will reiterate that I am wholly committed to ensuring that, as we get to grips with the new vision and priorities, as we understand the 2017/18 budget, and as we deliver a new operating model, you and me (and, yes, Bobby McGee) will be able to access the support, challenge, development and learning we need to excel.
So, I’ll finish as I started with wishing you all the best for 2017. The Year Of Decision.
Last Friday was my third Chamberlains. And, just like all the others, it was fantastic.
As we have come to expect, there was strong senior political and officer support (the Deputy Leader jointly MC’d with Nick Owen for the first half, whilst I had the after-dinner slot), but the focus was on the finalists and award winners themselves. Across the nine categories we heard about the many amazing things that colleagues do every day to make a positive difference to people’s lives – from helping the homeless to consoling the bereaved. Everyday acts that show the extraordinary lengths to which the best amongst us go in our shared mission to make Birmingham a city where every child, every citizen and every place matters.
The most poignant moment of the evening was the posthumous award made to the widow of Kevin Duffy whose three decades of service to communities through his various roles in our libraries brought tears to the eye.
And the funniest moment was Nick Owen’s risqué joke about the Halifax which I am, of course, too modest to repeat (in writing anyway).
So, a magnificent evening, the credit for which goes to our winners for showcasing the brilliant work they do, but also our organisers and sponsors without whom the Chamberlains would not be possible.
Categories, Winners and Sponsors:
Local Hero (sponsored by Amey)
Danielle Baker & Ruth Bowles
Leadership (sponsored by KPMG)
Special Recognition Award
Communities & Inclusion (sponsored by Wilmott Dixon)
Lighthouse Young people’s Centre
Collaboration & Partnership (sponsored by Veolia)
Employment & Skills Service Birmingham
Outstanding Customer Service (sponsored by Places for People)
The Funeral and Property Protection Officers
Team of the Year
Birmingham Control Centre
Employee of the Year (sponsored by Acivico)
Give them all a big round of applause!!!
And with the above still very much in the forefront of my mind, I also want to write about the considerable challenge that we have ahead in relation to the 2017/18 budget.
When faced with what might appear to be a modern day equivalent to Sisyphus and his dreaded Boulder, I am comforted by the Chamberlains because they remind me that we have so much talent and such a strong value base to draw upon across the City Council. And we’re going to need it – and more – because the hill that we’ve been climbing since 2010 has become a mountain.
Our in-year position is not what anyone wants it to be, but 2017/18 is another of those “annus horribilis” when we have another spike in the quantum of savings we need to make. This time, of course, the gradient is so much steeper because all the “easy” savings are long gone.
So, what are the messages?
There are three things I need us to focus on:
- Deliver your savings targets for 2016/17. If you don’t, then next year simply gets a whole lot harder just when we don’t need it.
- Make yourself familiar with the very-soon-to-be-published Vision and Priorities document that the administration has just signed off. It tells you all that you need to know about the future focus and direction of our work.
- Engage every step of the way with the budget formulation work that the Strategic Directors are personally charged with leading, supported by the wider Senior Leadership Team. We are, as you would expect, being closely guided by the Leader and Cabinet to ensure our planning aligns with the Vision and Priorities, but the heavy duty leg work to translate this framework into realistic savings ideas needs our collective brainpower.
You can expect to hear more from me about the steps we need to take towards setting a budget for next year (and beyond).
For now, just know that we are moving from the Alps to the Himalayas.