Fixing the Plumbing and Wiring in Adult Social Care - Towards Practical Action

This article is about a topic that doesn't typically get the blood pumping or lead to marches on the street. But I'd argue that if we don't tackle the issues explored it will be very hard to make the changes to social care that people need and that frustrate innovation.

The Time to Act Roadmap identified a range of barriers to progress towards its agreed vision, some of which it described as issues in the “wiring” – i.e. system or policy features that got in the way of positive progress.

Social Care Future (SCF), in engaging with people who draw on support, local leaders, workers and support providers, had been hearing regularly about similar issues.

In support of the Time to Act (TTA)  Reform Group’s work SCF decided to undertake some initial work to clarify and focus what we called “Plumbing and Wiring” issues in adult social care. We hoped to generate some ideas for potential solutions to bring to the TTA group and other national bodies in a position to influence or address them.

We gained support from Dunhill Medical to undertake this initial work. We decided there needed to be local and national components to this work -   all of the issues are experienced locally, but some are local system, policy and practice issues and some are nationally determined or controlled.

We wanted to tease out which issues were local and which national, and which issues were genuine blockages in the system and which were issues of how rules / systems were interpreted.

We did not expect to be able to address every issue or to describe every barrier to progress and find solutions. We did believe, however that we could:

1. Help bring some clarity and specificity to some of the issues

2. Ensure that people who draw on support and local leaders and workers had the opportunity to identify which issues were most important to them and why and contribute ideas about solutions

3. Contribute to a process whereby some initial issues could be explored by key national bodies with a view to identifying solutions and early activity to pursue these

4. Bring a wider range of issues, their impact and possible action on them to national attention for medium term action – looking for opportunities over time and via ongoing work of the TTA group.

Nationally in work led by Martin Cattermole and Martin Routledge, we undertook a series of on-line sessions, starting with exploratory workshops with people who draw on support and then our wider movement community, including local leaders and workers from councils and support providers striving to achieve local change.

This initial work steered a series of six topic-focussed sessions exploring issues seen to inhibit changes to services and support that could drive progress towards the vision at the heart of TTA. People talked about barriers faced, their ideas about “plumbing and wiring” issues underpinning these, their impact and potential solutions.

Not surprisingly people found it easier to identify barriers and problems than solutions and were sometimes challenged in getting to granular aspects of plumbing and wiring issues (though many ideas did emerge). Also understandably people identified issues of resources, culture, co-production, leadership and practice as at least as important as specific “technical” issues.

Following the sessions we have been undertaking follow up discussions in some of the areas identified to help “go deeper and get specific” about issues and solutions

Locally  - This part of the work was led by Simon Stockton and Ali Smith using the Working together for Change approach. We engaged with seven councils and their citizens looking to make progress on important and difficult local issues like improving support to family carers, making direct payment practice better, driving progress on prevention/early action, collection and use of information. While the priority for the places was to use the approach to coproduce local solutions and plan action for improvement, we asked the councils to identify local and national plumbing and wiring issues that impacted on their ability to drive forward on the issues. We spent individual and collective time with the councils teasing out some of these issues and with support from Impower undertook a survey and roundtable to further explore them.

Put together, these national and local elements have given us a lot of material. As well as identifying specific technical, regulatory or policy issues the process has thrown up ideas and proposals for additional action and support that would be needed beyond the plumbing and wiring issues or alongside these to enable change. We agree that activity in both spaces is needed. At the same time there is a risk that if we lose focus on some specific issues it will be difficult to achieve focused action on them.

For this reason we want to use the outputs from this initial project to both separate out a small number of focussed plumbing and wiring issues to plan and negotiate action around, while at the same time:

1.   Creating a longer list of plumbing and wiring issues and potential solutions for further attention

2.  Identifying other actions that would be helpful in optimising impact of proposed changes and exploring how and by who these might be taken forward

We are holding a national Time to Act workshop with people who draw on support, council colleagues, people in policy and regulation roles and people with specific technical expertise on December 9th. This session is kindly supported by Think Local Act personal and facilitated by Kate Jopling. At the workshop we will start with four key areas from the work that flow straight from what people who draw on support described as frustrating them using support to live the lives they wanted. People have started to offer ideas and suggestions for useful action and we we will work more on these at the workshop to develop plans for real action to address them.

Social Care Future will be taking what we have learnt from this work into thinking about what the proposed National Standards for the National Care Service would look like if they stared from what people who draw ion social care want from it.