A common cause: working towards collaboration

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The social care sector has been deeply saddened by the recent death of ADASS president Harold Bodmer. I didn’t know him well personally, but he seemed a warm and measured man who cared deeply about social work and the care sector more widely. He presented at our conference a couple of weeks ago, and something he said has really stuck with me. In response to a question about the often strained relationship between care providers and some social services directors, he said, ‘We have a common cause’.

He was reflecting on what I think is a step-change under way in the social care sector; the slow decline of combative relationships between commissioners and providers, and the emergence of a more collaborative culture across local systems. The Care Quality Commission recently published a fantastic report Building bridges, breaking barriers which describes the huge difference joint working can make to the lives of older people (also referred to in our own 2014 report) while recognising the progress still needed. It is clear that professionals have to work more closely together across divides of health and care, commissioner and provider, to understand the seemingly conflicting demands on organisations to do what is best for the people they support. The wellbeing of these people is ultimately the common goal.

Collaboration can be particularly difficult in social care. Intense financial pressures on both commissioners and providers over the past five years have stretched relationships to breaking point. The social care sector is fragmented; it does not have an identifiable brand like the NHS and it lacks the national and local infrastructure to drive a shared purpose. Providers can be reluctant to collaborate due to fears about staff poaching or losing a competitive edge in a period of radically reduced resources. This can mean care providers are side-lined, or only marginally consulted, when statutory organisations are responding to national initiatives.

However this ‘competitive’ behaviour is far from universal. Social care providers often collaborate in local forums, sharing good practice and working closely with commissioning teams. In some parts of the country, care homes are moving beyond a short-termism driven by fear of inspection and banding together to proactively improve quality. A great example of this is the Devon Care Kitemark, which provides the opportunity for care operators across the private and voluntary sector in Devon to exchange information and ideas, promoting best practice and supporting each other regardless of their status as ‘competitors’.

It’s essential that care providers are given the opportunity to engage with any local initiative to improve outcomes across health and care; where there is no established forum to engage with, statutory bodies should work proactively and in collaboration with local care providers to create one. This is especially important given the key role that providers play in the functioning of the wider health system. An example of this pivotal position is admission from care homes. Unnecessary A&E visits can put additional strain on hospitals, and unnecessary admissions can mean otherwise avoidable distress for residents. Care home residents aged over 75 are three times more likely to be admitted to hospital as an emergency than the rest of the population aged over 75.

We also know that care home residents can experience variable access to health services, often resulting in wider costs to the NHS. This has been recognised in the NHS five year forward view, and the Enhanced health in care homes vanguards are making important steps towards joining up health, care and rehabilitation services.

Here at The King’s Fund we are contributing to this vital area of improvement in partnership with long-established leaders in care home improvement My Home Life. We’ve set up a learning network for care homes to learn, develop and collaborate – with each other and with NHS and local authority commissioners – across six localities, with a view to building a more joined-up culture. We are currently in the process of seeking to recruit teams of stakeholders to discuss improvement in care homes and their role in wider systems improvement – and we’re keen to hear from those who are developing innovative partnerships.

In the fragmented social care system, NHS and local government commissioners along with providers across the statutory, voluntary and independent sectors should actively seek out opportunities to collaborate. This can be in the form of iterative contracting approaches, inclusive provider forums or collectively developed strategies and plans. But ultimately, it means prioritising the development of relational skills among leaders across the system, so they are able to work around short-term organisational issues and focus on their common cause.


George Coxon

Various inca devon based care home owner,
Various inc Devon Care Kite Mark
Comment date
28 July 2016
Thanks for the mention in your latest blog Patrick. You speak wise words here. We say in the many common points made in our provider led Kite Mark words that 'we're it it together' and want the same things. Great care, positive stories reflecting the pride and humour we achieve in ensuring well lived lives of people living in 24/7 care. With staff having elevated status and a greater balance of telling stories of happiness , thrills, amazing day by day life of both residents and staff as well as fully engaged families friends and other loved ones(whoever they might be!?) A very recent blog from one of our care homes here sets out some comments on 'what we learn from each other '. http://www.pottles.co.uk/blog.html The principle of being open, honest, receptive and reflective as well as humble and non complacent feels the only way to success / survive in a very pressured environment where demands are growing, scrutiny and expectations are increasing, workforce challenges are becoming extreme for both H&SC and cost pressures are causing many care homes to say enoughs enough Terms like ' victim blaming' often heard and what feels like relentless attention of those determined to stigmatise the care sector as a no go zone for people to work in or live in for those needing full time care.
Our Kite Mark work will feature again as a session at the KF 'enhanced health in care homes ' event in December I'm also facilitating a session on EoLC on the day too. - this an area we see as the most important thing to get right in care homes. We aim to get it all right of course. A Devon report a little over 2 years old now produced by our local public health directorate showed over 100 admissions to hospital from care homes in Devon (c900,000 total Devon population). Your point about admissions from care homes is well made. One I expect we will talk more about over the coming months. Others will have thoughts on this too I expect Meanwhile keep speaking up on our behalf Patrick. We really appreciate balance and wise comments about another of our Kite Mark strap lines ' sharing to learn' & getting over our preciousness. If it's good pass it on and get involved. We are stronger and better together.

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