We have reached the solstice, the turn of the solar year and I am about half way through my Presidency. There is a curious turning point in the principal policy obsession of the year so far that has been marked by the Cabinet Secretary's announcement on the future of social care and health integration on 12th December and the parliamentary debate on 15th December. The year ends with the abandonment of the National Care service idea by the Labour Party, the abandonment of the SNP ideas about a nationally driven lead comissioning arrangement (38,000 social workers to transfer to the NHS) and a confirmed policy regarding the future of integration - one which closely mirrors the proposals developed by ADSW. I think therefore that it is worth reflecting upon the way in which this has come about, the errors and successes along the way and the issues coming up.
In 2009/10 ADSW developed a series of policy positions which were brief, clear and assembled into a document we called a manifesto. The intention being to have a comprehensive range of policy positions which could anchor our work and guide us when contemplating change proposed by government. Just today, I quoted from the manifesto in offering a statement of support to Scottish government to mark the re-introduction of the Self Directed Support (Scotland) bill which is to be published in January. I didn't have to think twice - we had a position and I could quote it.
The manifesto was published in October 2010 - just as the challenge of integration started in Oban at the Labour Party Conference and in Inverness as the Highland Council and Health Board announced their local proposals. It was readily apparent that these ideas were politically compelling as they appear to offer a quick solution to a range of pernicious problems with the delivery of health and care to older people. Problems such as apparently inexplicable differences in charging policies between local authorities, assessment delays, bureaucratic duplication and - above all else - delays in the discharge of older people from hospital. ADSW understood the need to engage with this issue, to respond to the felt need and to try to shape policy so that we didn't throw the social work baby out with the problematic bathwater.
We decided on the primacy of local evidence based decision making. We gave support to any locally agreed partnership agreement for integration that sprang from local circumstances and enjoyed local consent. We decided to commission IRISS to provide us with an overview of the best evidence of what works in integrating services and I want to thank Alison Petch for a great piece of work, completed under time pressure, agreed, published and ready for MSPs returning from their summer break on 6th September.
In my speech to Conference on 18th May I announced this commission and set our position firmly and clearly as "a friend of good government". (ie 'We know what you want to achieve and we'd like to help you avoid the pitfalls we see')
On the back of the IRISS document we published a position statement, sent it to Scottish Government, I spoke about it in London and shared the research with ADASS who took it into David Cameron's Future Forum which was advising on the issue for England. We took every offered opportunity to promote these ideas and took every invitation to attend engagement events. We worked closely with SOLACE and COSLA without ever compromising our particular position and thanks to the energy and commitments of key office bearers, Peter Macleod, Kenny Leinster and our past Presidents, Michelle, David and Alan, a national consensus began to emerge in November.
At this time Cabinet discussions became extended as - we understand - Cabinet Secretaries' gave serious and detailed consideration to the draft proposals and the implications they would have for their interfaces - Justice, Children and Families, Local Government etc.
The announcement when it came contained reference to just about all our points including the challenging ones of dual accountability and a joint financial framework. It is permissive of local variation and allows for the Highland variant without prescribing it, allows for the outcomes framework to be governed through community planning and importantly proposes to replace the CHP as sub committee of health board with a Health and Social Care Partnership accountable to local authority and health board.
Nicola Sturgeon opens the Debate 15th December 2011
The debate on 15th December lasted 2 hours 40 minutes. (http://news.bbc.co.uk/democracylive/hi/scotland/newsid_9660000/9660309.stm)
In her opening statement Nicola Sturgeon said "We are not starting from scratch or with a blank sheet of paper. There is a great deal to be proud of in Scotland in health and social care provision . There have been significant improvements in recent years in standards and outcomes, with improvements in waiting times, patient safety and delayed discharges from hospital. In a reference to Sir John Arbuthnott's work in the 'Expert Group', Jackie Baillie moved an amendment to "welcome the Scottish Governments acceptance of the need for legislative underpinning following the conclusions of the Expert Group" and in so doing concurred.
The Parliamentary debate was hard on ADSW in charactering our briefing as negative "the tone was less than desirable for this debate" (Denis Robertson Aberdeenshire West SNP), "goes on to say why social work should stay in its silo" (Richard Lyle Central Scotland) and most worrying of all, "I agree with most of those who have spoken that ADSWs briefing wast most unhelpful. I hope that the ADSW will get round the table and share its concerns. (Sandra White Glasgow Kelvin SNP)
On the other side, Dr Richard Simpson (Mid Scotland and Fife LAB) said "Although the ADSW has concerns about the move, its president, Andrew Lowe said:
"We consider the announcement represents significant progress and we support the clear emphasis on making better use of joint resources."
Finally, I was greatly relieved and appreciative of Minister for Public Health, Michael Mathieson's closing comments:
"Notwithstanding some members concerns about the ADSW's views on the issue, it has been helpful to the government in our dialogue in recent months and weeks and I have no doubt that it will play a constructive part in the future."
So this engagement teaches us all a lot to take into the future. We can have great impact, but we can get burnt. We can engage with ideas, but ideas can be misunderstood.
Coming up we have a three month consultation on the proposal and we have set 12th January for a full day seminar on the issue. I am minded to write to those MSPs who spoke agin us and clarify our position and we must turn our mind to focussing on the detail (where the devil always resides) and understand what is proposed by the "single, senior, locally accountable officer" the parameters of the "integrated budgets" etc.
2012 looks to be equally action packed and the need for clear leadership from ADSW will continue. Peter and I have worked as a team this year and our work has been underpinned by the manifesto, we therefore need to look to you to support us in taking the work forward and continuing to influence the course of events in a positive manner.
Happy Christmas
Andrew
