On 26 March 2013 I gave a presentation on Dudley’s progress towards Making it Real. I am happy to report that at this event the new Director General for Social Care, Local Government and Care Partnerships at the Department of Health, Jon Rouse, cited Dudley as making great strides in Dementia Services and in its Making it Real social care transformation programme, and indicated that he will be visiting us within the year to see for himself the great work that we are taking forward.
Jon will be spending a whole day in Dudley in June and will be combining his visit to the Dementia Gateways with a discussion on Making It Real in Dudley followed by a meeting with Changing Our Lives.
Here are my comments to accompany the presentation:
Slide one: Introduction
My key messages are about collaboration, the need to recycle decreasing resources creatively and some early signs of progress. This is a marathon not a sprint. I am not here to spin. We cannot lose sight of the unprecedented fiscal challenges, increasing demographic demand for care and support, and the wider consequences of legislative change; especially housing reform and welfare benefit.
We know that demand for acute mental health services is already up 37%
We know thousands of families locally will be impacted by the “bedroom tax”
We know the greatest rise in homelessness locally is for 16-25 year olds (many of whom are hidden in statistical returns due to sofa surfing.)
We know the local food banks (of which there are five) are now regularly running out of food.
We know Local Government and therefore our contracted and grant funded organisations have been hit by 25%-30% decreases in funding with more in the offing.
I would suggest the job for everyone working in social care is to think about how we adapt to the wider context. Making It Real provides a focal point to do just that. I am here to talk about how Making It Real is being implemented locally; what we are learning by having a different conversation with citizens in the borough and because I want to encourage everyone who is working hard to deliver this agenda. This is a message of hope and an emphasis of what we can do.
When we started writing our Local Account, our officers went and met with a range of community groups. This quotation came from a person who attended one of those sessions and for me neatly summarises the difficulty in accessing the Care and Support system and the risk of having a social care offer that invests heavily in complex and intensive care packages to the detriment of preventative and more community based support.
Slide two: Strategic Context
Public Health has now moved to Local Government (April 2013) and the Dudley Clinical Commissioning Group is now officially operating. In addition and at the same time Healthwatch Dudley has now come into being. In our case DCVS the Local CVS has won the tender- an excellent organisation that will challenge health and social care provision in the Borough. This represents a huge opportunity to engage with the community together and drive Making It Real across all organisations.
In January this year, the Police, Fire Service, Council, Department of Health and doubtless others all consulted separately about the budget. On average 20 people attended each event; which for a population of 310,000 does not represent huge success. I personally would not spend my evenings running around from one consultation to the next so why should we expect the public to do so? By contrast a hyper local blog run by a company called Podnosh with the Police recently attracted 700 people; all of whom wanted to talk about policing in their communities.
My point is not that the medium is king but that we need to understand how people want to get involved and what works for them rather than asking the same questions in the way. We have developed a technical term for this in Dudley. We call it “You said; we did.”
Slide three: Engagement structure
This graphic demonstrates how we are actively trying engage with existing groups of people who use care and support services and carers in delivering Making It Real. We do not yet claim to have full representation and engagement; we are committed to achieving this.
Slide four: Making it Real in Dudley governance structure
This is our local governance structure. We have taken the key themes from “Making It Real” and translated them into workstreams. We will have representation from the community on each workstream and at Board level. This representation is not about replicating the usual suspects model. People will come representing the organisations they are members of to represent the interests and concerns of those wider groups and will be paid accordingly.
Slide five: Production of the Dudley Local Account
Our performance team put together a map of all the consultation activity we were undertaking across the year both statutory and non statutory returns. We are an intelligence rich organisation.
However, the public expressed frustration about the volume of consultation “please stop sending me these surveys” and a lack of clarify about what we did with the information they took the time to provide to us. So we issued 11,500 invitations to participate in the Local Account issued to people in receipt of care and support and carers
We marketed the Local Account via local press, public buildings (leisure centres, libraries, customer services), the Dudley CVS, statutory boards and forums (Peoples Parliament- LD, Older Peoples Forum, Carers forum, MH Partnership Board, ULOs) & BME Groups. We joined up to the Budget Consultation process.
Our final report structured according to MIR headings and adopts a more conversational style
– Information and Advice
– Active and supportive communities
– My support, my money
– Risk Enablement
– Personal Budgets
Slide six: You say we do
On the “we do” topic there is much afoot. In the last eight months we have:
Established a new target operating model:
We want our preventative services to be visible, easy to access and (wherever possible) free to access: http://www.gadgetgateway.org.uk is a great example of this an online magazine that demonstrates what assistive technology does including reviews by customers. It also tells people where they can get it. (If you are in a Council tenancy it costs nothing!)
We have built the Dudley Community Information Directory for universal advice and guidance.
We have established an award winning Dementia Gateway that has a philosophy of ask once – co-ordinates a range of specialist services into one place from handymen to telecare to information and advice to respite. We are now co-producing the same model for our mental health services to have a prevention and recovery gateway (encompassing therapeutic support, welfare benefits advice, employment support and guidance on self-employment.)
We are working hard on choice and control. Our new resource allocation system (RAS ) launches imminently – it is built with an eye on market forces so we can ensure sustainability and encourage people to be creative.
We are aiming to offer a default Direct Payment mechanism in the next 2-3 months. We have also developed light touch proportional finance checks so people don’t get bogged down with bureaucracy.
We have set up a social enterprise innovation fund to encourage the growth of micro provision. This has kick started bread therapy – Bread2Share, an alternative to domiciliary care called Plan B and a small army of hairdressers!
We know our emergency carers payments need to be improved and are going to market to re-commission both assessments and emergency support for people.
Dudley CVS and commercial providers have asked us challenging questions about our contract monitoring systems and how they improve the quality of care provision. We will be piloting an outcomes based approach with CVS members shortly so we what different might mean.
We are working on market position statements for all aspects of Care and Support so we understand the community view of gaps in provision and have a collective debate about where we invest in the future.
Slide seven: Increasing engagement
So how do you know when you have representative engagement? We are populating an engagement bank that will give people the opportunity to “Take Control and Get Involved” on their own terms by topic or theme. We will know which parts of the borough are represented and which are not; we can then work out what it is about our approach that needs to vary in a more targeted way.
We hope to work with Healthwatch and wider statutory partners to shape and refine this tool. Dudley CCG is committed to the Engaging Together agenda and is already undertaking creative work with the community.
Slide eight: Stimulating the marketplace
The last slide really tries to link up the “you said/we did approach.” The community should have an active say in the type of care and support required and how good it is. We should also be consulting about the end to end impact of budgetary decisions and not just individual services.
Making It Real tells us what people want to see and experience. It is our job to deliver that vision together.
Matt Bowsher Assistant Director – Quality and Commissioning. Dudley Council