21st May 2018
Adult Social Care: Five ways to apply the Chief Executive Factor
As we anticipate an Adult Social Care Green Paper, Alex Khaldi, who has joined Grant Thornton recently to lead Social Care Insights, has some advice for Chief Executives as well as a link to new propositions.
I don’t need to remind any Chief Executive of the outlook for Adult Social Care. We all know that the demand and funding numbers don’t add up and the sector is under-invested. And we know it will take time to fix, whatever comes out of the Green Paper and Budget. But as an advisor to the sector, part of my job is to look beyond the obvious and help Chief Executives think about the smart ways they can create success and sustainability. We all know that a new funding deal, supported by a sustainable tax raising regime, is going to be the bedrock needed for the future. But unless the opportunity for reform is grasped concurrently with any new deal, the economics will again take over and before long, we will be at crisis point again. The Chief Executive Factor is now much needed, working with partners, care leaders and politicians to create a local social care deal in the small window we have over the Summer and
Autumn months. I think there are five issues Chief Executives can focus on, adding difference and stretch to the local debate:
1. Market oversight and intervention. We are starting to recognise the importance of well-functioning markets, the lack of good data and the yawning gaps in dialogue between commissioners and providers. Capital investment in the care estate has to come from somewhere, and better for Councils to capture value than to allow it to leak into investment funds. Market management requires new skills but it will start with a clear purpose and vision set from the top.
2. Data insight: As Adult Social Care becomes more visibly co-dependent with the wider system (wasn’t it always?) The Chief Executive has a right to demand that the full force of data science is properly utilised. The future is here, but its deployment is largely absent from social care.
3. From demand management to demand resilience: After a period of experimentation with operating models and demand interventions, best practice operating models for Adult Social Care are within our grasp. Yet we still (often) have the same story – multiple and repeated triaging, leaky front doors, multiple hand-offs, and patchy practice. The Chief Executive needs to ask – how are we going to take what we have learned and make bigger changes to our operating model and practices?
4. Better outcomes for everyone in a place: The bias towards balanced budgets has meant less focus on the wider picture. ‘Unmet need’ is a loaded expression, but Councils have a wider duty of care than defined by statute. Nowhere is this better illustrated than in disability – Councils might be providing care, but are they enabling disabled people to lead fulfilled and independent lives in the community?
Honestly, I think many of us would say the answer is no.
5. The future of care: If the job of the Chief Executive is to be two steps ahead, then how are we enabling the system to think at least one step ahead?
Technology, data, the role of culture and behaviour, and the social determinants of health and wellbeing are just some of the issues local commissions, convened by chief executives, might explore.
You will notice I haven’t mentioned integration in the above. It’s obviously important, but let’s remember the ‘social model’ is powerful and distinct. Tackling some of the issues I have mentioned enable leaders to discover the heart of social change, whilst integration is more a mechanism (and a very powerful one) for applying that change.
Thinking beyond the obvious about social care is why I brought my team to Grant Thornton. Inspired by the Firm’s vision for a Vibrant Economy, we are trying to play a small part in turning social care away from being a perceived burden and problem to something that creates value, happiness and public good.
We want to help you create something better, rather than just avoid something worse. Some of our thoughts you can see here on our website: https://www.grantthornton.co.uk/services/advisory/public-sector-services/adult-social-care-insights/
By Alex Khaldi, Head of Adult Social Care Insights, Grant Thornton UK LLP