Examination of Witnesses (Questions 280
- 296)
MONDAY 6 JULY 2009
MR MARTIN
CHEESEMAN, CLLR
DR GARETH
BARNARD, MS
SUE TALBOT
AND MR
PETER WEST
Q280 Dr Pugh: Is the impression of
all the witnesses that in general the quality assessment framework
and the Supporting People outcome framework is fine as it stands
but needs sculpting or improving?
Cllr Barnard: It needs to be translated
into language such that those who use the service can engage in
it.
Q281 Dr Pugh: It strikes me as self-evidently
obvious, but I can assure you it is not always done.
Mr West: There is a real issue
that we as a regulator must address: if you have that amount of
bureaucracy on the Supporting People side and add the bureaucracy
of registration and an ongoing review on the social care side
there will be problems for small providers, or any providers,
if you do not get this right. There must be joining up at government
level in terms of the frameworks. We follow the frameworks that
the government set on regulation. In practice it means our working
with TSA and others to ensure that all of us do not ask the same
questions, overlap and all the rest of it. There is quite a big
challenge there. Because the Department of Health is extending
the definition of personal care I believe there is a chance that
this will be more common than before.
Q282 Dr Pugh: I am very glad to hear
this. The provider in question, Abbeyfield Homes, is a small one.
Their observation was exactly yours. What was developed for large
organisations delivering large or many packages of care was not
changed or distilled differently for them. Therefore they were
involved in huge overhead costs which they had difficulty in dealing
with. How do you see them going forward? The observation was that
they were good when they were done but the benefits needed to
be considered. How best can that be done?
Mr West: Which are these?
Q283 Dr Pugh: The value improvement
projects in Hampshire and places like that.
Mr West: I am not familiar with
that.
Cllr Barnard: That was essentially
a project to implement best practice. As with all these things,
it is quite difficult to spread best practice wider than those
areas that undertook it because of fitting together the different
bureaucratic structures of councils. But certainly in terms of
working more directly in evaluating Supporting People projects
there is a lot of evidence that that is happening; it has started
to move forward. Remember that people began from a very different
starting point.
Q284 Chair: Perhaps Mr Cheeseman
may be able to answer it since we understand it is within his
remit.
Mr Cheeseman: To date I am not
sure that they have been disseminated as widely as they should
have been.
Q285 Chair: Who should be disseminating
them?
Mr Cheeseman: We now have regional
efficiency improvement partnership boards (REIPS) within each
region. Part of their role is to disseminate those areas of good
practice. It is also important that they are linked up. They will
write to local authorities, go through the LGA or seek advice
through seminars.
Q286 Anne Main: Have you seen any
evidence that they have done it at all?
Mr Cheeseman: They may well have
done it, but at the moment I cannot point to any particular evidence.
That may be due to my ignorance rather than anything else.
Q287 Chair: Is it right that the
function of REIP is that local authorities in a region are supposed
to get together and share this information?
Mr Cheeseman: Yes; they are basically
sharing good practice.
Q288 Chair: Are they just left to
get on with it? That is fine because they would want to learn
from one another's good practice, but is that what they are supposed
to be doing? If that is the case presumably nobody is checking
up.
Mr Cheeseman: They are co-ordinated
through the assistant directors of the REIPs within the Department
of Health. They have a co-ordinating role to ensure that happens.
Q289 Dr Pugh: The impression I get
is that there is good practice but also some serious mistakes
are being made. To some extent all of you are struggling with
the newness of it and the fact that the structure, formula and
finance are changing all the time. Therefore, it is probably too
early to say what is the best way to implement Supporting People.
Ms Talbot: What we know from inspection
work is that there is a real potential to be realised around the
individual who needs assistance. At the moment there are a number
of different professionals who are in some way involved in supporting
an individual with a range of needs. When I speak to councils
one of the pleas they make is: what are the opportunities between
the Department of Health and the CLG to progress a positive light
touch assessment and support planning arrangement? How about progressing
a multi-skilled frontline worker who is capable of delivering
it?
Q290 Dr Pugh: Is that not what the
local strategic partnerships are meant to do?
Ms Talbot: They are ambivalent
and a bit worried about that for some of the reasons Mr West spoke
about earlier in certain categories of personal care in terms
of ensuring adequate protection for people.
Q291 Chair: Perhaps I am being naive,
but in the area of facilitating elderly people's discharge from
hospital, for example, health bodies and social services have
been working together for some time to arrive at a joint assessment.
I do not recall them worrying at that point about the fact there
might be different regulations coming along from the Department
of Health and social services. I do not have a real sense of why
you believe local authorities are not working together across
boundaries more than they are.
Mr Cheeseman: I think we are working
across those boundaries.
Q292 Chair: You do not believe there
is a problem at local level?
Mr Cheeseman: There is a specific
question on RIEPs and value improvement projects. That is one
area where by our answers we are saying that possibly the information
has not come out as well as it should. However, that is not to
say there is not a lot of other good practice relating to Supporting
People which has not been disseminated to local authorities. If
you look at where we were six years ago at the start of Supporting
People lots of services had come in for which we had no strategic
plans as to why we were delivering those services. There has been
a systematic review of all of those services, so we are ascertaining
whether they were needed and, if so, how they should be delivered
and where the gaps in that service existed. That has been a very
systematic approach and we have made massive progress over six
years, and the nature and type of those services have also developed.
We have a build-up of floating support and a linking up of areas
where before you just had a housing-related service; now it is
linked with a health-related matters or drugs or crime. That is
a big advance on where we were six years ago.
Q293 Dr Pugh: Can you say something
about the role of the local strategic partnerships in integrating
the care provided to the individual? I imagine that at an LSB
meeting you just talk in broad-brush terms and beneath that there
must be a high level of operational co-ordination. Has it grown
and, if so, is that in any way attributable to the better functioning
of local strategic partnerships?
Ms Talbot: At the moment the structures
are talking to each other and generally there is a degree of alignment.
When it comes to the individual, support plans are undertaken
by housing people and there is social work care, management assessment
and care planning. There is a potential for a common approach
and to be more holistic in recognising and responding to people's
needs. People are keen to move forward with that in practice based
on the individual's experience, but it is about how that can fit
with current arrangements under the Community Care Act and Supporting
People guidance.
Q294 Mr Turner: Are you confident
that local authorities and their partners are ready to undertake
joint assessments of need and commission services accordingly?
Mr West: Local authorities now
have to produce joint strategic needs assessments and that is
something we would look at in our assessment, but we are really
keen to see the proof of the pudding. The fact you may have a
very glossy council which seems to have everything in place does
not necessarily mean that it is acting together on the ground.
We think that things like leadership and attitude towards involving
people who use services are sometimes more important factors in
terms of joining up. Structures can help and hinder, but in our
experience they are not the only thing. In inspections we find
good authorities that may not have a perfect structure and partnerships;
it may not have signed up lots of shifting money agreements but
it is delivering the services. It is a factor but not the most
important one in our view.
Ms Talbot: Some joint strategic
needs assessments are well cited on the issues relevant to Supporting
People when one is particularly thinking about the older person
and demography. We have also seen some good evidence in some places
about the focus on inequalities. Older people and inequalities
are the bread and butter of the Supporting People programme. Many
councils have identified shortfalls in the previous assessment
and in the current year they look to include the supported housing
agenda to a much greater extent so there is better feel for the
whole person and the community.
Cllr Barnard: I want to try to
link that particular question to the broader issue raised earlier.
If the LSP has as its core priorities reducing inequalities and
setting out very clearly a preventative agenda one of the great
benefits of the Supporting People agenda and linking the assessments
together is an effective commissioning body which is exactly what
you described. You start with the LSP at the top which says this
is the broad agenda for the local authority area and underneath
it is the operational commissioning body. I totally accept that
it does not have to involve a plethora of documents; what it must
have is committed professionals who say they will make it happen.
This is not just for the individual and very targeted services;
it goes right up to the top and the broader universal services.
If that bit is right and there is an understanding of the broader
need the targeted services tend to come out better as a consequence.
Some authorities are better than others. If the LSP takes a very
strategic view on the planning, delivery and linking of the funding
streams there is a good chance that strong commissioning and assessments
will follow.
Q295 Mr Turner: Is not one of the
problems in having it based on the committed individuals rather
than a structure, although the two are not necessarily exclusive,
that if they move on to bigger and better things, retire or whatever
those who replace them may not necessarily have the same commitment,
whereas if there is a structure it supports people in that sense.
Cllr Barnard: In an ideal world
you have both. A lot of structures are pretty robust. What I am
saying is that it is the real work and drive that make the difference.
You will see areas up and down the country which have health and
social care partnerships that on paper look like model partnerships
but joint working is a tad flaky.
Mr Cheeseman: As to Supporting
People, the funding was there and part of the structure was that
various groups and individual agencies worked together, and it
is part of the LSP. That provides some practical targets for the
LSP to work towards and expand its joint assessment outside Supporting
People, so it provides a good framework on which to build.
Q296 Chair: I want to ask you finally
about the Supporting People teams. If local authorities disbanded
their SP teams would it not be a huge loss of expertise in the
locality?
Mr Cheeseman: It probably depends
on individual authorities. From my point of view, having a Supporting
People team and the expertise that that has built has been invaluable
for kick-starting a lot of other more mainstream adult social
care and housing work. I believe that it is one of the first effective
commissioning teams we have. Therefore, I utilised them; I brought
them into a wider commissioning group and used their expertise
very much to build upon and improve it for the rest of the organisation.
Having said that, it is important that there is also an understanding,
even if it becomes a general commissioning role, of what the Supporting
People role is. I would not want that to be lost.
Cllr Barnard: Given the maturity
of the Supporting People programme, it has to be seen now as an
imbedded and integral part of commissioning in a local authority
area. That is the way you get links to the other programmes and
initiatives that we talked about. Local authorities need that
flexibility to determine how to deliver the capacity. It may be
they continue to do it through a team-based approach; it may be
that elsewhere they choose to imbed it in a broader commissioning
strategy, but in the current climate encouraging local authorities
to maintain commissioning capacity and use it effectively will
possibly receive a more positive welcome than to suggest they
have a specific team, unless that team is grant-funded which it
is not. That takes us back to the start.
Mr West: We agree with that. We
are very interested in making sure that PCTs and councils are
joining up on their commissioning and there is the opportunity
for a full join-up across the piece. Despite all we have said
which may sound a bit critical supportive housing is an absolutely
critical part of meeting adult social care needs. To have a high-level
commissioning strategy that looks at prevention and so on is the
way forward in terms of use of resources and effective commissioning.
If there is a positive from that in terms of joining up to other
commissioning resources that is all to the good.
Chair: Thank you very much.
| 
