Social care workforce pressures - are alliances part of the solution?
If our workforce really are our most important asset in social care, it’s time for a rethink. You can’t have failed to hear about the crisis in social care and the large number of vacancies that are exacerbating pressures in the already overstretched sector. In my blog mini-series, a collaboration with Andrew Burridge, NWADASS, I examine why there’s a problem in the first place and provide some practical advice and solutions for changes we can make right now, as well as in the longer term, to recruit and retain more of the right people to work in social care.
This week I’m thrilled that Linda Hutchinson of LHAlliances has agreed to guest blog for the penultimate of this mini series. Linda is the leading expert on alliance contracts in public sector in the UK. She has completed numerous assignments to date with Clinical Commissioning Groups, local authorities and government departments. Linda is a highly experienced senior professional with twenty five years’ experience in frontline health services. She has a strong track record of innovation and delivery of major change programmes in university, health, government and regulatory sectors. Here Linda writes about the role that Alliance contracting could play in helping to alleviate workforce pressures in Adults Social Care in the longer term.
Whole System Alliances – part of the solution? By Linda Hutchinson
The challenges of recruitment and retention in Adults Social Care are not going to go away soon. For as long as I have been involved in regional and national discussions, these challenges have always been there. Maybe not as acute as they are now for the reasons that are outlined in the previous blogs in the series.
One thing I have learnt is that sometimes help can come from a change well outside the field of vision of the problem itself. For instance, in the early 2000s, it was noted that there was a significant reduction in violence and abuse of staff in Accident and Emergency depts. This was linked with reduced waiting times which came from government policy and, importantly, daily concerted collective action, including getting consultant doctors to work differently and working with partner organisations, to speed up discharge processes and move people on from their hospital stay quicker. It wasn’t posters in A+E receptions telling people not to use abusive language, it was a change at the other end of hospital activity that had a knock-on effect.
What can we do outside of direct activities on recruitment and retention that may have a positive impact? Kath has already talked about reframing the narrative of social care careers and working in partnership with others.
I would go one step further and say that the way in which we all work together can change a frustrating experience of working ‘in the system’ to one that is rewarding, enlightening and collegiate. We have found this in the Alliances we have set up.
Whole system Alliances
Our Alliances follow the project alliancing or alliance contracting approach. They are intense collaborations where a group of organisations have shared responsibility for a public sector funding allocation for a set of support and services for a given population or group. The annual budgets for our Alliances range from £2 million to £75 million and involve support and services for homelessness, complex lives, mental health distress or disorders, children, prevention and wellbeing.
When we set up an Alliance, we make sure that the remit for the Alliance isn’t about units of activities, beds, hours. We talk about people and their lives.
And we make no apology about being aspirational be it ‘ending homelessness’ or ‘ensuring every citizen whatever their abilities or disabilities, can flourish, contribute to society and lead the life they want to lead’.
These statements and the objectives and success criteria that flow from them, become the guiding lights for everyone working in an Alliance. The way you deliver, co-ordinate, improve everything has to lead to that common goal, regardless of your own role, title, organisation.
The Alliance Member organisations are free to develop support and services in the way they see fit to deliver on the vision. This is usually in close dialogue with people with lived experiences, those who use services or their families as well as other people and organisations.
In an alliance you are not alone.
In an Alliance, there is a strong sense of collective responsibility and freedom to try new approaches. This means that people can be open about how they work. No longer do you have set activities for set roles, it becomes more fluid, even around the statutory responsibilities.
For instance, one of our early Alliances was set up for those with severe and enduring mental illness in Lambeth. The Alliance comprised NHS, social care and two community and voluntary sector providers.
One aspect of this new collaboration was that the assessment panel which decided on the ‘package’ for people with worsening mental illness moved from being solely a social worker responsibility to a mixed team. This relieved the pressure on social workers to be up to date on all that was available in the borough. The new panel could help consider and access alternatives to inpatient or residential placements from a much earlier stage.
This led to a 43% drop in those being admitted per year. In addition, 69% of those who were already in secure or specialised placements were moved into specially purchased and adapted flats, their own homes or supported living accommodation.
For the workforce, they had easy access and regular contact with those outside their own organisation. This benefit was described by Richard Sparkes, general operations manager, adult social care, at Lambeth Council: “The outcomes achieved by [the Alliance] so far are testament to what can be achieved when these core principles are put into practice and people are encouraged to embrace and think beyond traditional professional roles and boundaries. This commitment across the alliance partnership has enabled people to achieve outcomes that have embraced creative ways of achieving greater independence and personalised support focusing on the person and not a pathway or specific service need.” People-Not-Process-May-2018.pdf (lambethcollaborative.org.uk)
We don’t have figures for recruitment and retention in social care and whether the new way of working made any difference. But it is not difficult to imagine that it is better to have a wide range of colleagues to call on and work with than feel isolated and overwhelmed with referrals about people who you know you are unable to do the best for.
I remember at the time one of the senior people on the Alliance Leadership Team saying how good it had been when she realised she now had others who could help her solve problems from her own organisation whereas before they were hers alone to manage.
Permission and expectation to collaborate
Of course, there are many examples of amazing collaborative working without there needing to be an Alliance. I would not push people to consider an Alliance where one is not needed or not possible. Moving to a financial and risk sharing arrangement is a big step and not for everyone.
What an Alliance does do though is demonstrate the commitment from commissioners through to frontline to shift the focus from activities and processes to people. There is recognition that no one organisation can solve the issues alone and a clear expectation of collaboration.
An Alliance provides the authorising environment to ‘do the right thing’ rather than consider whether or not this is in the job description or my organisation is being paid to do it. Everyone is equally responsible for achieving the vision.
In one Alliance, at a recent shared training event, when people were asked to introduce themselves, they spontaneously said they were from the Alliance and didn’t give their own organisation. Now that’s collaboration.
I think Linda’s model provides us with some real food for thought about how we change peoples’ experiences of working in Adults Social Care so that they feel more engaged, more positive and more empowered to make a difference. For me Alliances are a key part of the jigsaw in how we move to strengths based approaches in social care and give us a different way of working across different parts of the system in a more collegiate way. Next week in the final blog in this series, we’ll be looking at the key themes that have emerged that help us to rethink social care recruitment and retention.
