Time for a specific focus on adult social care leadership

If it fully delivered on its huge brief, the review of leadership in health and social care led by General Sir Gordon Messenger (alongside Dame Linda Pollard) would be the first detailed examination of social care leadership in England there has ever been.

There have been leadership development programmes, to be sure, but a review that looks to ‘improve processes and strengthen the leadership’ of social care in England? One that ‘will shine a light on the outstanding leaders’ in social care to ‘drive efficiency and innovation’? Not in the memory of anyone I know working in social care.

Given its short time scale, and despite an extensive engagement exercise (including with The King’s Fund), it will focus on the NHS and, even there, pick its targets with precision.

In truth, of course, the review will do no such thing. Given its short time scale, and despite an extensive engagement exercise (including with The King’s Fund), it will focus on the NHS and, even there, pick its targets with precision. The signs are that it will at least avoid falling into the worst trap: identifying coherent recommendations for parts of the NHS and then assuming that they will also apply to social care (what I call ‘and-social-care-itis'). Instead it is likely to acknowledge the differences between social care and NHS, pay homage to the leaders in the sector and – perhaps – identify one or two recommendations that could apply to social care. It will not, however, be a root and branch review of social care leadership. It will not provide a road map for improving social care leadership to the Secretary of State for Health and Social Care, who commissioned it, or the Department of Health and Social Care, which will be expected to act on its recommendations.

What it could – and ought – to do, though, is call for such a root and branch review. Social care is going through unprecedented change, with a worsening recruitment crisis, fundamental changes to the means test soon to be implemented, planned reform of the provider market to establish a ‘fair cost for care’ and the establishment of integrated care systems. The list could go on.

Those changes are impacting a sector that is simply unlike any other, including the NHS. It is split between commissioners of services (local authorities but also individuals paying for their own care) and providers, of which there are – remarkably – around 17,700. These providers are typically very small; half employ fewer than 10 people and two thirds employ fewer than 20 people. It has a huge workforce, with around 1.2 million people in around 1.5 million jobs. The average wage is very low (for a careworker, just over £9.00 an hour) and a high percentage of roles are on zero-hours contracts. Culturally, there is also a strong – if variable – emphasis in the sector on personalisation of services, ensuring users have choice and control, and use of co-production to develop them. There is a strong expectation – again not always met – of keeping the diverse needs of service users at the heart of the organisation.

It stands to reason that in a sector that is different to all others, leadership also needs to be different. Understanding those differences, appreciating the skills that leaders need and helping develop them is surely a task for someone, if not Messenger. The review could draw on our own overview of social care leadership, which found that some of the most inspiring leadership in social care came from staff and that, often, the best leadership was very local indeed. It should also identify – and consider how best to spread – the qualities of leaders in the sector. In particular, there is a quality of ‘values-based entrepreneurship’ that marks the sector at its best. It can be seen in the founder stories of many of the best organisations in the sector, large and small, and from the private and voluntary sectors. It often involves an individual who has a need for social care, often for a relative, realises by existing providers and sets up a company or charity to help fill the gap. Some fail but many succeed (one of the UK’s largest care home groups, Barchester Healthcare, began in this way). We should be finding these examples, ‘shining a light’ on their experiences and helping them and others access the skills they need to thrive.

Now would be also a perfect time for such a review because government is, for the first time in many years, acknowledging that it needs to better understand and involve itself in the social care market.

Now would be also a perfect time for such a review because government is, for the first time in many years, acknowledging that it needs to better understand and involve itself in the social care market. This recognition – developed early in the first wave of Covid-19 – has led to plans for more investment in data and plans for the Care Quality Commission to have oversight of how local authorities commission care. If central government can focus on these issues in social care, why not the leadership qualities that will be needed to deliver on these plans?

So, given all these changes and challenges, action to 'strengthen the leadership’ of the social care sector is essential. When Messenger delivers a largely NHS-focused report, we should not shoot him for that but rather use it to argue for a review that can genuinely focus on social care.