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Achieving a Sustainable Financial Future

for Bristol City Council’s Social Services

(Children’s Services and Adult Social Care)

Brian Parrott

Independent Social Services Consultant

March 2005
TABLE OF CONTENTS

Summary of Key Recommendations ................................ ................................ ...................... 3


A Consultancy Purpose and Approach ................................ ................................ .............. 5
1 Preface ............................................................................................................................5
2 My Brief............................................................................................................................5
3 Timescales.......................................................................................................................6
4 Outcomes ........................................................................................................................7
5 People Who Have Assisted My Work ..............................................................................8
B Understanding the Financial Situation ................................ ................................ ............ 9
1 Background......................................................................................................................9
2 The National Context .....................................................................................................10
3 Risk Assessment ...........................................................................................................10
4 Action Required .............................................................................................................11
C Policy Options and Ideas For The Future ................................ ................................ ......12
1 Strategic Direction .........................................................................................................12
2 Commissioning ..............................................................................................................15
3 Where This Approach May Lead ...................................................................................18
4 Action Required .............................................................................................................19
D Specific Services ................................ ................................ ................................ ............. 22
1 Overview........................................................................................................................22
2 Older People and Disabled Adults .................................................................................22
3 Learning Disabilities and Mental Health.........................................................................24
4 Children’s Services ........................................................................................................25
E Leadership, Management and Partnerships – Fit for the Future ................................ .27
1 Overview within the City Council:...................................................................................27
2 Issues for the City Council: ............................................................................................29
3 External Partners ...........................................................................................................30
4 Within Social Services: ..................................................................................................31
5 Financial Management and Cash Limited Budgets........................................................32
F Conclusion................................ ................................ ................................ ....................... 34
1 Sustaining Change – How to Ensure It Happens...........................................................34
G References................................ ................................ ................................ ....................... 38

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Summary of Key Recommendations

Most Importantly:

There must be a visible unity of purpose between leading Elected Members and Senior
Officers of Bristol City Council to make fundamental changes to Social Services and the way
the City Council operates corporately. There must be no ambiguity about who is responsible
for ensuring that the changes are made and the timescale for implementation. Changes must
be made in leadership approach, behaviour, relationships, services and finance.

Key Recommendations:

My recommendations to the City Council are clearly set out in the report. The key ones are
that:

1. You should recognise the many positive achievements in Social Services over recent
years and not let the current media spotlight create an unbalanced picture.

2. You must implement urgently the Action Plan deriving from the work of Neil Haddock
and the Review of Financial Management 2004/05.

3. You must actively manage, throughout 2005/06, the considerable risks acknowledged in
the Social Services budget at the time it was set in March 2005. You must establish a
three year financial framework 2005 – 2008 linked to your strategic direction and to
service delivery plans.

4. You must agree and publish, at the earliest possible date, clear Bristol City Council
strategic direction and priorities for Social Services. These must be combined with a
strong commissioning-led approach to all services. It should assume that the Council
will provide cost effective services through its in-house services and also have a
proactive market development approach to working with independent sector providers.

5. You must make fundamental changes to many services and the ways they are delivered
– modernising, integrating with others, ceasing, reviewing, externalising and developing
alternatives. These should be in accord with "Every Child Matters” and the
government’s Green Paper on Adult Social Care “Independence, Well-being and
Choice” and subject to proper processes of consultation.

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6. You should re-examine the way Elected Members, officers corporately and senior
managers in Social Services (and perhaps in other services) work together across the
range of interfaces and at different levels in the City Council. You should agree new
“ground rules” for the future which enable a whole range of difficult policy areas and
difficult relationship issues to be dealt with effectively.

7. You must ensure a fundamental culture change in Social Services to one which is more
open and where managers and staff are more effectively engaged and empowered by
senior management. There must be a new financial discipline - with cash limits,
performance management and clear accountability.

8. You should prepare, before the end of May 2005, a detailed Action Plan covering Social
Services, the “corporate centre” and Elected Members to ensure the achievement of all
the changes required, identifying who has lead responsibility/shared responsibility. You
should state clearly the outcomes expected, timescales and risks. You must ensure the
changes in Social Services and corporately are both achieved and sustained, however
challenging.

Brian Parrott
March 2005

Notes:

“You” means the leadership of Bristol City Council, including in Social Services.

“Must” means it is imperative. “Should” means you are very strongly encouraged.

“Social Services” means the Social Services and Health Department

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A Consultancy Purpose and Approach

1 Preface

1.1 This report is about the future – moving on as quickly as possible from the current
perceptions of “failure” and “crisis” to restored confidence about future prospects. It
considers fundamental issues, including:

 What is the learning from recent experiences?


 What should be the future direction?
 What are the underpinning essentials?
 How do you ensure that these are sustained?

1.2 This report will not be a lengthy analysis of all that I have observed or discovered in the
weeks since 4 January 2005. The purpose of this consultancy assignment has been to
quickly get alongside Members and Officers of the City Council, and to use experience
from colleagues in other places, to understand the underlying issues and to help
facilitate the beginnings of change. This has been a dynamic process, happening as I
have gone along – not something to be started after I have produced a report and gone.

1.3 Over recent weeks I have shared my developing perspectives on issues with people
informally, encouraging energy to be focussed on the things which are most important.
The challenge now (that is, both sides of the forthcoming May elections), is to move
forward in a new direction. The work which Bristol City Council asked me to undertake
is complete. Hopefully my work and this written report will be a contribution to a better
future.

2 My Brief

2.1 The brief for my work was set out in a letter from the Chief Executive to Members and
other people on 18 January 2005:

The brief to which he is working at the request of the Leader of the Council and myself, can be
summarised as follows:

 Ensure understanding of the nature of the financial situation in Social Services, its
underlying causes, trends and comparisons with other places.

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 Review the policy options already considered by the City Council and other ideas to
maximise outcomes for service users within the available budget and bringing the recent
pattern of overspend under control.

 Review the effectiveness of Social Services management and operational arrangements


and partnerships with others in the face of this challenge.

 Discuss ideas and thoughts openly with people about how changes can be made which will
impact on financial performance and which are realistic, affordable and deliverable within
the short or medium term.

These four themes are reflected in the sections of this report.

2.2 The way I have interpreted this brief has been to “go anywhere” and “talk with anyone”
who might be able to assist, within the obvious constraint of time. I have been tough
minded and interrogative where appropriate, to get to the bottom of an issue. I have
ranged across issues of policy, strategy, leadership, management, history and culture
where so ever they have relevance to financial performance – whether past, current or
future.

2.3 My work has complemented the timely investigation into financial management
undertaken by Neil Haddock, resulting in the report “Review of Financial Management
2004/5”. My work has provided further validation to the soundness of his conclusions
and recommendations, and I would endorse the urgency of implementing the action
plan which follows from his report.

3 Timescales

3.1 There are four different timescales for action in relation to what both Neil Haddock and I
are saying to the City Council, and all four timescales must be followed; they are not in
any way in conflict with each other.

3.2 Year end 2004/05: Financial rigour and establishing a sound City Council
budget for Social Services in 2005/06 with clear, published cash limits in relation to:
Children, Mental Health, Learning Disabilities (Bristol uses the term “Learning
Difficulties”), Older People and Disabled Adults (separating out expenditure on younger
people with physical and sensory disabilities from older people)

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3.3 Post-election: With the appointment of the new Cabinet (May 2005), the need for
well informed financial awareness for the new City Council - whatever its political
composition on 6 May – to enable it to strike out on it’s chosen policy direction, making
use of my commentary and advice both in this report and in informal feedback.

3.4 Year end 2005/06: A robust basis achieved as early as possible in 2005/06 for
planning the implementation of new organisational configuration in April 2006 (or April
2007), consistent with Every Child Matters and the Government’s Green Paper on Adult
Social Care.

3.5 2005-08: A three year planning vision as to the strategic changes required in Social
Services, wherever its future organisational home, backed by a medium term financial
plan which is realistic and deliverable. “Recovery” from recent experiences may take
longer than one year. Emphatically, it will not be a “failure” if all the changes required
are not fully achieved by end March 2006.

4 Outcomes

4.1 The outcome of my work is a mix of:

 Absolutes: Things you must do. The time for debate is past.

 Strong Encouragement: Things you should do. Matters for decision by Elected
Members or the Social Services Senior Management Team.

 Options: Ideas to think around, to develop further or to reject - but not to be


avoided or deferred

4.2 It will be apparent already that there is a difference in style from many reports you have
had previously. One of my concerns about Bristol City Council is a past pattern of
inadequate implementation of the recommendations of reports which would have helped
you to avoid some of the current weaknesses.

4.3 In this report I do not dwell at length on background, detailed analysis, commentary, or
produce lengthy conclusions and recommendations. There is much more I am saying
directly to people which I only touch on in this report. My work over recent weeks has
been as a catalyst to “get things moving”, engaging people and encouraging them to
work more effectively with each other, with others within the City Council and laterally
across partner organisations. The thrust has been assisting you to re-find your strategic

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direction, your confidence and your self-worth as a City Council responsible for Social
Services. I hope this report gives a clear indication of what you now need to do.

4.4 Over the weeks I have been in Bristol there have been significant changes to the Social
Services Senior Management Team: a new Acting Director, two interim “acting up”
Divisional Directors, one interim external Divisional Director and one unchanged
substantive post holder. These people will need support and assistance from many
others if they are to successfully drive the improvement process.

5 People Who Have Assisted My Work

5.1 During a short but intensive time in Bristol, I have met with Elected Members of all
political parties, individually, in twos or in groups; in leadership, executive, opposition,
scrutiny and backbench roles. I have talked with a wide range of staff in Social Services
and corporately, and received letters and emails from individuals and organisations.

5.2 Specific workshop sessions have been held on finance, services to older people, people
with learning disabilities, children needing placements, working with the trade unions,
and the new Social Services Senior Management Team’s strategic direction. The
product of all of these is reflected in my feedback.

5.3 I have talked with the Commission for Social Care Inspection, local NHS Trusts, trade
unions, independent sector care providers, a sample voluntary organisation and a user
of services. I have been assisted most especially by Bo Novak who has been active in
many of the discussions; and also, Sian Calnan, Christine Foster and Jenny Ford. I am
very appreciative of the help I have received from Helena Thompson and members of
the Performance and Improvement Team; Stephen McNamara and the Legal Services
Team; and administrative and secretarial support colleagues to Members, the Chief
Executive and Social Services Senior Management Team.

5.4 Outside Bristol, I have been helped by local government colleagues in Medway,
Nottingham, Portsmouth, Salford, Southampton, Suffolk and West Sussex, as well as by
the Association of Directors of Social Services, Local Government Association and
Treasurers national budget survey. Some of the material and learning from other
places is also woven into my feedback.

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5.5 My thanks to all who have assisted me, always at short notice and often at huge
inconvenience. The level of underlying consensus about what needs to be done and
the goodwill around is striking. The opportunity is yours to seize.

B Understanding the Financial Situation

6 Background

6.1 The Review of Financial Management 2004/05 report, based on the consultancy work of
Neil Haddock, sets out the position fully and accurately. The scale of the likely financial
overspend in 2004/05 and the underlying deficit going into 2005/06 have been widely
publicly reported. Frequently the facts have been wrong. The Social Services overspend
at the end of 2004/05 is likely to be around £7 million - not £17 million - on a net
revenue budget of £113 million, and a gross revenue budget of £173 million.

6.2 The origins and causes of the Social Services budget problems, which emerged very
publicly late in 2004, are clearly identifiable in any retrospective analysis of expenditure
in 2002/03 and 2003/04. They were known to Senior Officers and some Elected
Members during the budget setting process for 2004/05 and should have been better
appreciated at the time by the Council’s scrutiny and audit functions.

6.3 During 2004/05 a steady rise in spending (particularly in children’s and older people’s
services and latterly, learning disabilities) continued, but without offsetting
underspending adjustments possible at year end as in the previous years. This

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combined with the continued effects of increased demand, price rises and the need to
meet new regulatory requirements.

7 The National Context

7.1 Many of these features in Bristol are replicated in other big cities and comparable local
authorities. Others have faced pressures from the cost of children’s placements,
especially the growth of independent foster care agencies; the specialist needs of
children with disabilities; and increasing numbers of people with learning disabilities with
complex needs and physically disabled people with specialist needs. For both the latter
groups there are high costs associated in providing supported living in their own homes
or residential care, and frequently with the extension of direct payments.

7.2 Bristol does not diverge significantly in its spend across care groups from the average of
comparable authorities and, like others, has historically supported its children’s services
budget pressures from adult services. Early indications from the recent ADSS / LGA /
Treasurers national budget survey are that many local authorities across England are
under particular pressures from children’s services and adults with learning disabilities
in failing to achieve end year (2004/05) balanced budgets.

7.3 However, Bristol’s problems have been compounded by poor information, and the
absence of financial and activity profiling, reliable forecasting and commitment
monitoring. Moreover, there was an inability or reluctance to share the underlying
situation and risks properly with Members, other than at a general level, before it
“exploded” publicly late in 2004.

8 Risk Assessment

8.1 Regrettably, concern continues about confidence in current projections as to the outturn
position in 2004/05 and extrapolations into 2005/06 as an assured basis for budget
setting in a number of significant areas of Social Services.

8.2 Many projections for 2005/06 spending needs are simply rolled forward commitments,
as at November/December 2004. Although budgets for 2005/06 are based on
judgements about future volumes of service, they are not yet based on the aggregate of
scrutinised and projected commitments in relation to existing people or modelled
volumes/costs of new people.

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8.3 The Council has constructed its budget for 2005/06 on the basis of “pressures” (i.e. the
cash sums required to sustain current activity, in the current form, at the current levels
and to meet new unavoidable expenditure), less increases in funding from Central
Government, Council Tax, charging for services and “savings”.

8.4 Many of the savings proposals incorporated in the budget for 2005/06 require
negotiations to take place with third parties – NHS Trusts (Acute, Mental Health and
PCTs, all of whom have their own financial challenges), provider organisations, trade
unions etc. Savings assumptions may need to be varied or deferred depending on the
progress of these. Working together on these will be a test of the unity of purpose of
political, corporate and Social Services leadership. Some of the proposals require
statutory or other forms of consultation, with necessary timescales, and a willingness to
implement in the face of some probable public opposition, adverse publicity and threat
of litigation. In spending related to Older People, proposed reduced number of
placements, home care changes, meals service changes, continuing health care and
increased charging will all prove challenging.

8.5 The scale of the financial variables and uncertainties for 2005/06 is considerable, even
assuming all other aspects of spend can be managed close to target. Rigorous work
has been done to interrogate the rolled forward commitment position into 2005/06 and
all spending pressures, but much of it from a background of inadequate information and
poor financial and activity management. These weaknesses and the still early days of a
new Social Services Senior Management Team support the wisdom of a proper three
year financial planning period for Social Services, regardless of new organisational
arrangements being introduced during the period.

9 Action Required

9.1 2005/06 should be viewed as the first year of a three year “Financial Recovery Period”,
with explicit agreed limits as to any latitude needed in the first year. The new financial
management arrangements must be carefully monitored throughout the year. Even if it
does not prove possible to spend exactly in line with budget in the first year, this should
not be viewed as a “failure” – providing the tough new financial discipline required in
Social Services has become firmly established. There must be no relaxation whatsoever
on this imperative.

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9.2 After the political, public and media profile of the last three months, and Neil Haddock’s
work and my own, there is now widespread understanding of the true nature of the
current position, how Social Services got into it and what needs to be done to remedy it
for the future. This includes remedying weaknesses in Social Services, the corporate
finance function, Member processes and Member / Officer working arrangements – and
the relationships between all the people and functions involved.

9.3 I am very willing to explain at greater length my analysis and advice for the future in
relation to all aspects of the financial situation. Dwelling on it at length in this report is a
diversion from my intended focus on the future.

B Policy Options and Ideas For The Future

1 Strategic Direction

1.1 There are many good things about Bristol Social Services, with well regarded, high
quality services provided to very vulnerable people, and skilled and committed staff, as
evidenced in the recent TV documentary series “Someone To Watch Over Me”. Social
Services have been consistently well funded in the past by the City Council, and will be
again in 2005/06. Politically sensitive subjects nationally like adoption, child protection
and discharge of older people from hospital are well managed in Bristol. It is important
to recognise these positive achievements and to value what people are doing, whatever
the adverse media spotlight.

1.2 At the heart of policy options and ideas for the future must be a clear, agreed, widely
understood strategic direction for Bristol as a city, for Bristol City Council, and the
individual aspects of Social Services – Children’s Services and Adult Social Care (Older
People, Adults with Physical and Sensory Disabilities, Learning Disabilities and Mental
Health). It is the absence of such a strategic direction which has encouraged some of
the lack of confidence within the City Council and the lack of public understanding when
it comes to individual aspects of service change, with their related investment and
disinvestment.

1.3 The need for such a clear strategic direction was formally recommended over six years
ago in the 1999 Audit Commission / Department of Health Social Services Inspectorate

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report of the Joint Review of Social Services in Bristol City Council. In the second point
of its “Forward Agenda for Bristol Social Services”, it said:

“[A need to] Define Strategic priorities and targets for each user group, with
consistent thresholds of intervention:

The Authority should aim to identify a limited number of priorities for each user group.
Expressing these priorities in terms of improved outcomes for users and carers, re-
casting access criteria, where necessary, to ensure that they are commonly understood by
the public and consistently applied by staff.”

1.4 The need to develop and embed a clear sense of strategic direction and top priorities
must now be addressed with commitment to ensure delivery and sustainability of
services. By “strategic direction” I mean explicit service priorities and targets expressed
clearly and succinctly.

1.5 Statutory requirements and central government’s tough performance review regime
narrow your room for manoeuvre as a City Council. They do not eliminate it, especially
in a large unitary authority and a regional capital capable of attracting major investment
and therefore able to influence the shape of both public and private sector activities.

1.6 Bristol City Council’s strategic role as a council with Social Services responsibilities
must centre on enabling strategic and developmental partnerships with the NHS, with
other public and not-for-profit organisations and services, and with the private sector
(not only as it currently exists, but as it might be encouraged to become). This includes
advancing preventative and proactive approaches which span the functions of more
than one organisation – for example, in the areas of opportunities in early years and
later life, health (in)equalities, community safety and personal well-being.

1.7 Allied to this strategic focus must be clear leadership and unremitting focus on the core
essentials of social services, namely:

 Personal dignity and independence; protecting vulnerable people

 Person-centred services based on fairness, eligibility and choice (where possible);


recognising the pressures on carers.

 Positive partnerships and integration with others, within the City Council and
beyond

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 Affordability

1.8 Therefore, the formulation of a clear strategic direction is much wider than:

 Should the future of adult social care services be with Health or Housing?
(Answer: It must be with both)

 Should the Council favour directly provided in-house services or private sector
provision? (Answer: It must do both, dependent only on ensuring the most
personally appropriate and most cost effective services are offered to people in
Bristol)

Future vision for services to people is not the same as future organisational
arrangements.

1.9 At the earliest opportunity, the City Council must make clear statements (or repeat
previous statements) publicly and to its staff of its strategic direction for the five care
groups to whom Social Services provides a services, namely: Children and Families;
Mental Health; Learning Disabilities; Older People; and Disabled Adults (people with
physical and sensory disabilities). These may include, for example:

 A clear strategy for the prevention of children becoming “looked after”


 A clear strategy for the “balance of care” in availability of different types of services
for older people
 A clear strategy for day activities / day services for people with learning disabilities
 A clear strategy for Individual Budgets (direct payments)

1.10 You need to be clear about:

 What the City Council does


 What the City Council doesn’t do
 What the City Council advises about how people can do it (i.e. organise services) for
themselves

1.11 These must be short unambiguous statements, expressed verbally and in writing - not in
lengthy documents. They must answer the simple question, “What difference are you
trying to make to the lives of children / older people etc. in Bristol”?

1.12 You need to be equally clear what you are not attempting to do, or cannot do, or
positively won’t do – even though some of these things may be desirable or wanted.
There are some materials which have been made available to me from another Local

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Authority which may be helpful to Social Services in Bristol. These include a letter from
the Director of Social Services to prospective service users to be sent on the basis of
individual judgements where some services are no longer available because of a stricter
financial climate.

1.13 Be brief, be straight, be realistic with the people of Bristol and with partners.
Expectations need to be changed. Both “waiting list” and “dependency” cultures must
be eradicated.

1.14 Strategies must be developed (or “dusted off” and updated) and joint strategies agreed
with key partners – with NHS Trusts, around the implementation of “Every Child
Matters”, with independent care providers, and others, to drive the remodelling of
services towards clear outcome objectives. It means embedding a culture of strategic
planning and joint strategic planning which is outcome focussed, soundly financially
underpinned and, most of all, which all are resolved to deliver.

2 Commissioning

2.1 You must establish, as a matter of urgency, robust commissioning arrangements for all
services. This is the single most important recommendation I am making to you
anywhere in this report.

2.2 Whatever the scale of current financial problems, the route to restoring spending in line
with budget is not any instantly available policy option which somehow the City Council
has “missed” and others have found in recent years. Rather, it is three things, which
span this section and the next:

 Robust Commissioning and Contracting for services


 Effective Performance Management
 Disciplined Financial Management

2.3 In 1999, the Audit Commission / Department of Health Social Services Inspectorate
report of the Joint Review of Social Services in Bristol City Council, in the second point
of its “Forward Agenda for Bristol Social Services” said:

“[There is a need to] Create Comprehensive Systems for Commissioning and


Monitoring Services

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The Authority needs to clarify which services it can directly provide most cost effectively
itself, and which services it should more appropriately commission from other sectors. It
should then develop commissioning strategies, which both make best use of its
purchasing power and help build strong partnerships with quality providers in the
independent sector. In order to do that, the Authority needs to have more effective ways
of costing services and linking that costing to the evaluation of quality, especially as
measured in the achievement of desired outcomes for users and carers.”

2.4 Commissioning ideas and approaches have moved on since 1999, not just in Social
Services but in other parts of local government and the NHS. However, it is arguable
that the failure to implement what was recommended in 1999 lies at the basis at what
has caught up with Bristol City Council in subsequent years. Given the
recommendations of the Joint Review in 1999 in relation to both strategic direction and
commissioning, the question has to be asked, “Why was there this failure to implement
them?” It is imperative that you learn from your own history and do not repeat your
mistakes. My recommendations to you are that you now need a mix of 1999 and 2005.

2.5 Robust commissioning arrangements mean:

 Eligibility Criteria
 Assessment of Needs
 Affordability

These elements are explored further in the sections that follow.

2.6 Eligibility Criteria: These need to be consistent with Fair Access to Care Services
statutory requirement, with thresholds capable of being varied up and down according
to the City Council’s available financial resources. You have these in place. In relation
to adult services, they state that: “Social Services intervention should be a “last resort””,
and that:

“A person is only eligible for help from Social Services where: -


 they have needs that are judged to pose Critical or Substantial risk to their
independence
 they are not able or willing to arrange their own care and support
 there is no-one else willing, able or appropriate to help

2.7 Evidence suggests these are very variably interpreted across the city, with enormous
cost implications. This cannot continue. Members and managers must demand
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compliance with established criteria and consistency of practice. This needs to be
backed up in staff supervision, through PMDS (Performance Management and
Development Scheme), team planning and performance management at all levels.

2.8 Assessment of Needs: Where there are “eligible needs”, there should be
individualised assessments of needs and risks, including self-assessment where
possible, based on a person’s wishes for the sort of service they want, with their
circumstances regularly reviewed and service responses adjusted accordingly. These
principles apply to both children’s and adult services. Evidence suggests that these care
planning and care management approaches are of variable consistency, with
substantial assessment delays, and reviews often not undertaken. Again, the financial
implications of continued overprovision of high cost services are considerable. As with
commissioning in general, the concept of care management has been underdeveloped
in Bristol over the last decade. It is not too late to implement this, alongside the new
concepts of “care navigators” and “care brokers”.

2.9 Affordability: The third building block of a commissioning approach is what is


affordable by the City Council (and indeed by other partners where there are joint
commissioning approaches). The presumption in a commissioning-led approach is that
it will drive down / drive out unnecessary costs. The City Council must project one year,
three years, five years and beyond in terms of financial implications if service
modernisation and fundamental change is to be made to services which require
significant “lead in” times.

2.10 From these three starting points, the City Council needs to:

(a) Aggregate upwards what quantities of services are needed, at what quality
levels, and at what cost, into service specifications which existing providers or
prospective providers can plan to meet, whether they be within the City Council
or outside.

(b) Define openly and consistently implement policies on acceptable unit costs; cost
ceilings for individual care packages; fee level enhancements; the way direct
payments are funded; and the mix of contracting, including “spot”, “block” and
“call off”.

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(c) Have a clear and widely owned plan for how many people will receive a service,
at what level, at what unit cost, and what total aggregate cost, with defined risks
and contingencies, in the context of the five cash limited care group budgets.

(d) Establish robust contracting and procurement mechanisms, informed by the best
generic public and private sector approaches, resulting in tough negotiations but
sensitive to the needs of users of Social Services. Decisions can then be made
between potential providers, internal or external, on the basis of lowest possible
cost consistent with the delivery of the service specification and allowing for any
other considerations the City Council decides.

(e) Ensure compliance, quality control, performance monitoring, performance review,


financial management, and redress mechanisms consistently and thoroughly.

2.11 These changes to a rigorous commissioning-led approach (based on eligibility,


assessment and self-assessment of need and affordability) represent a fundamental
cultural shift from Bristol City Council’s historic approach to Social Services. They are
critical to the way forward. They create a framework for the choices and decisions
which must be addressed by professional staff, managers and politicians.

3 Where This Approach May Lead

3.1 Several elements of this approach to strategic direction and commissioning exist within
Social Services currently. However, they frequently exist without a clear legitimacy from
Social Services Senior Management and the endorsement of Members. It is desirable
that there is agreement first on such a commissioning framework, and a joint framework
with others (NHS especially) where appropriate, which then enables Senior Managers
and Elected Members to consider difficult decisions and choices which “fall-out” from
such an approach.

3.2 I have interpreted my brief as being asked by you to make recommendations on


decisions which will almost certainly need consideration. What follows is not
comprehensive; it is illustrative and selective. It has variable features across the care
groups, and requires sensitivity in relation to people who should no longer receive
services or receive a changed nature of service, and in relation to the staff currently
involved in providing them.

3.3 There are subject areas which I have not considered, such as transport, where the
same commissioning and contracting principles apply. Several proposals will require
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consultation – with the public, with users and with other organisations. Several
proposals are joint proposals, most especially with NHS Trusts.

3.4 What is important is not whether you agree or not to do what I am indicating, rather that
you:

(a) Establish a strategic direction and a commissioning framework which allow you
to consider these difficult issues properly

(b) Ensure real will on the part of managers in Social Services and corporately,
politicians and partners, to address these issues

(c) Delegate authority to managers to make the necessary changes and support
them in the tough decisions involved.

4 Action Required

4.1 The following section considers the following key outputs:

 The Independent Sector


 Integration
 Modernising and Transforming Services
 Managing Workforce costs

4.2 The Independent Sector: Where there are inherently higher comparative costs
involved in the direct provision of a standardised care service by the City Council, as
compared with a not-for-profit or for-profit contractor, the City Council should transfer to
a reputable quality assured independent sector provider(s) in a planned and ordered
way. This applies across all care groups, particularly (but not exclusively) where the
services are non-specialist, lower risk and likely to need assured supply into the
medium term. There should be exceptions where there are significant quality risks to
services needed by the most vulnerable people. One example, currently, might be older
people with severe dementia.

4.3 This approach should be combined with a new policy towards market development and
market management. As independent sector care providers said to me, “If we can see a
vision of where Bristol City Council want services to be in five years, we can develop or
change our services accordingly”. In principle, it would be hoped that in-house services
(such as home care and foster care) could be as capable of responding to the same
challenge.

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4.4 Although I am expressing this in such a direct way realising it may provoke some
discomfort for City Council staff, politicians and trade unions, it is a direction of
approach consistent with current central government policy, has been pursued in other
local authorities of all political compositions, and is consistent with the principles of
fairness and value for money for Bristol City Council taxpayers. It does not imply a
planned reduction of expenditure on services: It could imply more service to more
people for the same sum of money. It should also lead directly to significant
improvements in published performance indicators on unit costs for services.

4.5 Integration: In many aspects of both commissioning and provision of services, there
are shared interests and shared users with other services, most especially with
education, health and housing. Integration of thinking, planning, service delivery and
sharing of financial risks (as opposed to seeking to transfer them) is vital for the people
of Bristol – for example, for the education of children “looked after”; for care upon
discharge from hospital; for support if you are disabled to be able to live in your own
home.

4.6 What is important in the coming reconfiguration of the Social Services and Health
Department, as it has been known, when it ceases to exist in 2006 or 2007, is not “what
goes where”, but how your new arrangements herald cultural change in all
organisations to work better with each other across universal, preventative and targeted
responsibilities. The focus must be on integration of those things which it is important to
do together (not everything) from the point of view of the optimum benefit to people in
Bristol.

4.7 It is vital that continued planning for “Every Child Matters” and “Independence, Well-
being and Choice” is based on a shared view of desirable outcomes for people if there
is to be real transformational change in Bristol in the way organisations together meet
the needs of individual users, patients, children, tenants and residents.

4.8 It means using the mechanisms of joint strategic direction, joint commissioning, pooled
budgets, management devolved to one or other as lead agency, integrated services,
generic workers and new governance arrangements. “Partnership Boards” which are
“Boards” – setting direction, determining resources, reviewing performance – not
repetitious discussion and no decisions. Boards which have effective political and non-
executive NHS leadership, working well together, as well as attendance of Chief
Executives, Directors and Senior Staff.

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4.9 Modernising and Transforming Services: Historically, people have been admitted in
crisis, often at high cost, to nursing care, adult residential care, day centres, children’s
residential care and independent foster carers. Large sums of City Council spending,
and that of other organisations, is currently “locked up” in inappropriate services. Some
are them are fundamentally at odds with the thrust of preferred strategic direction.

4.10 How do you get out of this?

 Stop admitting people – children “looked after”, residential and nursing care. Taking
tough decisions requires staff to be backed up by managers and Members and the
application of sound criteria and good processes

 Review and “move on” Children/Adults who no longer need to be there

 Encourage the planning and development of alternatives and more appropriate


services. Make use of currently invested financial resources. Pool the capacities of
different organisations’ funding. Learn from the experiences of Bristol Collaborative
Service, intermediate care and direct payments

 Be willing to invest upfront in “invest to save” strategies, especially where change is


more difficult because of slow “turnover” services – for example, learning disabilities

 Close no longer needed, or no longer appropriate, services

4.11 All of these points are about leadership and management. They are not about “more
money” at all, or only at the margins. Indeed, there are significant savings to be
achieved.

4.12 Managing Workforce Costs: Bristol is not unusual among local authorities,
particularly those with high levels of in-house services, in experiencing recruitment and
retention challenges with a wide range of staff, significant levels of sickness absence
and escalating agency costs.

4.13 The first requires clear criteria for filling posts and sensitivity as to the way “freezes”
operate such that they do not have unintended perverse additional costs to Social
Services as a whole. The second and third require very focussed management
approaches. No appointment or extension of agency staffing should be agreed unless
six questions can be satisfactorily answered to a responsible Senior Manager:

 What efforts have been made to obtain non-agency staff?


 What proposals have you to avoid using agency staff in future?

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 How long do you propose to use agency staff for?
 How much will it cost for the period you are requesting?
 How will you pay for the cost?
 How much is allocated in your budget for agency staff?

4.14 There is much to learn from successful strategies in relation to the management of
sickness and agency costs in other local authorities.

C Specific Services

5 Overview

5.1 If making better use of independent sector providers, integrating services with others,
modernising and transforming services and managing workforce costs are the keys,
what are some of the practical implications? What follows is in brief form only. What I
say can be developed in discussion and through further work.

6 Older People and Disabled Adults

6.1 This is the care group most in need of a clear strategic direction and robust
commissioning framework, especially jointly with the NHS. Both the strategic direction
and commissioning framework need to be positively, publicly and formally agreed by
Bristol City Council Members and NHS Trust Boards

6.2 Residential Care: There is little case for Bristol City Council continuing to directly
manage more than a very small number (if any) of its existing 17 residential homes.
Indeed, many should be closed without re-provision within the next 3-5 years.
Experience suggests that a well consulted upon and well managed (from the resident’s
perspective) closure of an individual home can take place within three years. Given the
following preconditions, very substantial financial savings are achievable or available for
better investment:

 Successful development of joint Health/Social Services Intermediate Care Services


 Good integrated hospital discharge planning and preparation
 Cultural change to current notions of dependency, ‘gate keeping’ and good assessment
and review
 Substantial increase in intensive homecare and support to living in your own home
 Planned reductions of nursing and residential care placements

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 Good availability of private sector residential care – existing or potential to develop
 Effective commissioning of services which ensures prices paid are enough to secure a
good quality service
 Rigorous monitoring of service quality and effective contract management
 Extra care housing provision

6.3 On this last point, planning for more extra care housing should be undertaken cautiously
and with regard for what ‘the next generation’ of older people want in terms of extra care
support to their independent living, and whether more of this can be provided in their
own homes. Extra care housing provision should not be viewed simply as a
straightforward replacement for the closure of Council residential care homes.

6.4 If existing residential homes have significant staff vacancies resulting in expensive
agency staff cover, the closure programme for individual homes might need to be
advanced more quickly.

6.5 Home Care: Following intense negotiations, there is a prospect of a positive agreement
with staff and the trade unions for the home care business unit. There needs to be
clarity about what is wanted from home care generally and the remodelled in-house
service in this light. The service needs to change radically in who gets the service,
when they get it, what sort of service they receive and the cost of the service. The in-
house service should cease doing many of the things it has been doing for a long time.
Much of the traditional Bristol City Council model of home care service, which includes
lower level packages, needs to be fundamentally changed.

6.6 The outline agreement implies that the service should become the service of first choice
to very frail and vulnerable people needing intensive care, much of it being morning and
evening work. Unless the home care business unit can offer this flexibility and staff are
willing to work at these times and develop the necessary skills, the argument cannot be
sustained for a higher cost in-house service when an equivalent service is available, or
could be developed, at lower cost in the independent sector. There will need to be early
review of progress in relation to the changes required to be implemented.

6.7 Adequate diet and the enjoyment of meals is a vital part of sustaining the well being and
independence of a frail older person. Recognising this should not, however, lead Bristol
City Council to continue to provide a subsidised meals service, whether directly
managed, or independently contracted. There are other ways in which older people can

23
purchase meal delivery services without the intervention of the City Council. If there is
proven need for the Council to contract for a service for a small number of people, it
should be done on a cost neutral basis to the Council.

6.8 The loss of public understanding of the Council’s position in relation to day activities /
day services is illustrated in:

 The way well-managed changes in day services to people with learning disabilities have
merged in the public eye with issues relating to older people and adults with physical
disabilities.

 The way older people and adults with physical disabilities with very divergent needs
have been met in a very old style, undifferentiated day centre service, with no up-to-
date review of eligibility or needs. This pattern of service provision is not sustainable.

6.9 Many of the currently high profile public debates in relation to older people are
contentious precisely because there is no link to a clear and agreed overall strategy.
Such a strategy must be forthcoming urgently.

6.10 One possibility in this strategy is that the City Council should state publicly that (for
example) 95% of its financial resources for older people will be focussed exclusively on
those people at greatest need or risk according to up to date reviewed eligibility of
needs.

6.11 Perhaps 5% should be identified as Social Services contribution to preventative or lower


level support needs of a much larger number of older people in Bristol. This resource
should be applied through close working, agreement and partnership with voluntary or
other independent sector organisations, and without the same eligibility entitlements.
Such an approach would make access to lower level forms of support more sustainable,
and ensure targeting occurs in consultation with other partners.

7 Learning Disabilities and Mental Health

7.1 The increasing number of people with learning disabilities of all ages, many with
complex needs, has become a marked feature for Bristol City Council and most other
local authorities in recent years. Much of the service response has become crisis
dictated, making use of high cost nursing and residential care provision. Until recently,
there was also insufficient senior management capacity within the department in this

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area. The appointment of an interim divisional director is already making a discernable
difference.

7.2 It is recognised that development of modern supported living, more appropriate day
activities and services which value people and give choice can make a real difference to
the quality of the lives of very disabled people with learning disabilities. Working with
Housing in its enabling, providing and supporting people roles is at the core of making
real changes in learning disabilities.

7.3 The fundamental strategic direction of learning disability services needs to be rethought
and reformulated jointly with the NHS, who are in effect providers of parallel services
locally. Neither the NHS, nor Bristol City Council, can afford wasteful debate about
respective responsibilities for people, or about continuing health care. The focus must
be on pooling of all resources which are available, with a shared vision, clear joint
strategic direction, shared management of financial risk and truly integrated services -
regardless of who takes responsibility for the lead commissioning role and direct
management of services and staff. It is possible that this could be Bristol City Council,
backed by robust joint governance arrangements.

7.4 Mental Health (like Children’s Services) is more directly influenced in its service
priorities by statutory requirements. Already many of the City Council’s responsibilities
are devolved to the NHS, with just a City Council strategic planning capability. This
service direction is right and the City Council, Elected Members as well as Officers,
need to be influential in the governance of joint commissioning and financial decision
making. It is important that expenditure on older people with mental health problems is
properly and consistently apportioned. What joint commissioners expect from the
performance of the Mental Health NHS Trust must be clear and funded appropriately,
with current continuing health care issues resolved.

8 Children’s Services

8.1 The three challenges for Bristol’s Children’s Services have been caricatured as
“placements, placements, placements”. If this is indeed the case, then three of the rules in
modernising and transforming services (above) apply: stop admitting; review and move
on; and encourage alternatives.

8.2 Bristol has a high number of children in out of city residential care and very high
numbers in independent foster care, with higher costs externally than for those services
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provided by the City Council’s residential or foster care. In part, the pressures overall
are the product of the very complex needs of severely emotionally damaged and
disabled children, as well as the product of higher risks to children in big cities like
Bristol. It is a pattern repeated in other parts of England.

8.3 The principles of devolved financial management are at the heart of Social Services
finance for the future. However, to achieve the immediate impact needed on reducing
placement numbers it is appropriate that there should be tough minded, centralised
scrutiny and control of all placement admissions and costs for the foreseeable future.
These new arrangements need to be fully in place very quickly. The application of
consistent thresholds for decision making should be combined with a clear message to
parents, local communities, schools and other organisations - and, where necessary, to
Social Services own staff - that becoming “looked after” is rarely in the best interests of
a child in the short, medium or long-term. There should be clearer and tougher
thresholds for admission to care of all children. Alternative strategies must be deployed.

8.4 With Education, there must be greater willingness to “hang on” to children who are
challenging in both day schools and residential special schools. There must be more
appropriate educational alternatives, or other support, for young people not in schools,
at risk of being looked after, or at risk of being moved on from a lower cost Bristol
residential or foster care placement to a higher cost one elsewhere mainly for
educational reasons.

8.5 Social Services need to strengthen their investment in intervention and support at the
time crises risk escalating. Resources may need to be redeployed alongside Education
and the Children and Adolescent Mental Health Services. Similarly to the 95%/5%
notion in relation to older people, there should be some rethinking of the withdrawal
from preventative services in recent years. These should be focussed with Education,
Health, Connexions and others on children at known higher risk of home or placement
breakdown. This approach should be integral to implementing “Every Child Matters”.

8.6 The department currently buys a large number of high cost, independent sector foster
care placements on a “spot” basis, often in a reactive way. A start has been made in
establishing a block contracting approach. However, more needs to be done to develop
a more proactive and strategic approach to investment in both “in-house” and
independent sector foster care.

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8.7 As with older people and homecare, there are strategic choices to be made, not
avoided, about what is appropriately in-house, and what is externally purchased for the
future anticipated patterns of demand for foster care. There may be new types of foster
care which should be developed. All independent foster care placements, unless part of
a specific contract, should be viewed as short term in the first instance. There should be
a presumption against long term placements.

8.8 Social Services and the City Council’s Legal Services should reconsider whether earlier
use of legal advice and support might avoid, not add to, costs currently associated with
legal proceedings.

C Leadership, Management and Partnerships – Fit for the Future

9 Overview within the City Council:

9.1 Leadership in local authorities, particularly a prestigious City Council like Bristol, is a
subtle mix of the political, the corporate and the departmental and service specific.

9.2 For Social Services to move forward in Bristol to a more promising future requires some
learning from the recent past: how things happened, why and what needs to be different
in the future. These are subjects I have explored at length with people over recent
weeks, with a striking consensus of common understanding among Senior Elected
Members of all political parties, the Chief Executive and Corporate Directors/Heads of
Service and Senior Managers in Social Services.

9.3 The distance of Social Services from the political and corporate mainstream in recent
years, with few Members and Officers corporately having close familiarity and
awareness of the underlying issues and the external challenges faced by Social
Services, cannot be continued. Different views exist as to why it evolved like this.
Equally, however, the relationship for the future must not be one of corporate control
and insensitivity to the diverse range of services which cluster within “Social Services “.
A new, properly balanced relationship needs to be established.

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9.4 I have been struck by the high degree of mistrust and low confidence on the part of
many Elected Members in the leadership of Social Services, including knowledgeable
Members with past Executive or Social Services Committee responsibilities. Equally, I
have been struck by the goodwill, understanding when explained, and personal
commitment to the things Social Services has to do. In reverse, I have been struck by
some of the perceptions of Members by Senior Officers and staff in Social Services. In
particular, the lack of confidence as to whether they will be supported privately and
publicly in implementing difficult decisions which the Council, Cabinet, Executive
Member or Director have decided in the face of individual complaint or public challenge.

9.5 A more healthy way forward, perhaps immediately post election in May and regardless
of outcome, would be for the “Top Member Team” (one political party or cross party)
and the “Top Officer Team” (corporate and departmental) to work together to redefine
what they want and expect from each other. There is a need to redefine the intended
style of leadership they wish to give to Bristol and to the City Council.

9.6 Members and Social Services Senior Managers, at the various interfaces of their
working together, should stay focussed on the key strategic challenges and on the
priority agendas which have been agreed, and the performance review of these.
Valuable time must not be diverted into escalated matters which should have been
devolved to others, nor into inappropriate operational detail or individual agendas.
Clearer “ground rules” need to be established for the way Members and Officers should
work together in many different shared settings.

9.7 Many relationships between individual Members, Officers in both Social Services and
corporately, have been good. They have just not been substantial enough and fit for the
purpose of managing a multi-million pound public service with very volatile demand and
supply. I am not convinced that establishing relationships on a better basis for the
future can be left to individual negotiations between the relevant parties, however well
intentioned, without some agreed framework.

9.8 I am very willing to explore these ideas further. To illustrate, two issues which merit
some reflection are:

 Proposed revised arrangements for Scrutiny as they affect Social Services and its
Children’s and Adult Social Care component parts: How should these link to Member
monitoring of 2005/06 budget and performance and also the way in which there can be

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a small group of Members, not just one Executive Member, who have real current
knowledge of the issues facing Social Services, locally and nationally? There should be
a clearer approach to the role of Elected Members – what is/is not appropriate for them
around operational issues?

 The Council’s Corporate Plan: The Plan gives a low profile to Social Services (both
Children’s Social Services and Adult Social Care). It invites questions about the City
Council’s “ownership” (politically and corporately) of the Social Services agenda and the
importance of the relationships with external partners. Perhaps too much has been “left
to” or been “kept private” by Social Services in the past?

10 Issues for the City Council:

10.1 Beyond this general overview of some of the context in which Social Services operate,
the points which follow touch on a range of specific points for further work or
consideration.

10.2 Local Elections every year and the inevitable uncertainties and avoidance of risk taking
at critical times means it is difficult to make fundamental and sometimes contentious
strategic changes. Is there a way this can be changed?

10.3 It is important that the leader of the political administration, Executive Member for Social
Services, Head of Legal Services and Director of Social Services ensure that all of
them, and all working with them, have a clear common understanding of the City
Council’s processes for formal consultation, decision making and scrutiny AND that
there can be no confusion about the status, proper place and timing for all decisions to
be made.

10.4 The City Council needs to be prepared to take more tough decisions about Social
Services in Bristol and to fully implement decisions it has taken previously. Complaints
about intentions, processes and outcomes are inevitable. The Council must have proper
mechanisms for dealing with these but not allow, from within the Council or outside, fear
of complaints to prevent proper decisions being taken and implemented, including by
Social Services frontline staff who can feel very exposed.

10.5 Everywhere, there are critical relationships between Social Services and the “corporate
centre” which need to be reviewed and improved jointly. The starting point needs to be

29
recognition of proper difference of role and function, but within a common City Council
corporate framework. These need to include:

 The relationship which has been significantly developed recently (out of adversity) with
Corporate Finance

 Opportunities to strengthen the important relationship with Legal Services

 The underdeveloped relationship with Performance and Improvement

 The currently problematic relationships around Human Resources. This is such an


important area affecting the Council’s workforce, staff recruitment and retention,
changes in job requirements, trade union relationships and service changes which
impact on their members. A very positive workshop was facilitated recently with GMB,
T&G and Unison officers together with the Acting Director of Social Services and two
colleagues. This should be built upon quickly.

10.6 It is imperative that the Finance Manager (Social Services) and Human Resources
Manager (Social Services) and the functions they manage must be fully on the “inside”
of all Social Services Management processes and at all levels. They must be fully
involved in consultation and decision making about new, changed policy proposals from
the earliest stages. From where they are managed is not the issue. It is a matter of
function and appropriateness.

11 External Partners

11.1 Relationships with external partners are also not good enough currently; perhaps for a
number of reasons – the consistent budgetary pressures (whatever the actual end of
year outturn), the lack of confidence between leading Members and leading Officers
and the nature of leadership styles. There is now an urgent need for a substantial
investment of time by the new Social Services Senior Management Team, most
importantly with the inclusion of senior Elected Members, to work on improving a
number of external relationships.

11.2 The relationship with the NHS is the most important. Relationships with NHS Trusts
and their staff impact on almost every aspect of Social Services, both Children and
Adults. The financial and performance imperatives are equally challenging for the City
Council and NHS locally.

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11.3 Standing off, keeping a distance, keeping finances separate, trying to avoid risks with
each other is not a sustainable strategy. There are huge financial risks for the City
Council if you do not work proactively and effectively with the NHS in Bristol.

11.4 The NHS PCT Chief Executives I have met with are looking for a new relationship with
Social Services. It is a relationship Social Services Senior Managers should seek to
reciprocate on the basis of equality, understanding of each other’s pressures, and with a
joint commissioning or joint problem solving approach to current challenges, including:

 Older People’s strategy


 Every Child Matters
 Transformation of Learning Disability Services and use of Section 28A Funding
 Agreed funding for Mental Health Services
 Continuing Health Care;
 Impact on Social Services of reduced hospital beds
 Impact on Health of reducing nursing and residential care placements
 Future arrangements for Adult Social Care.

11.5 In more limited ways, I have explored some of the issues which need to be pursued
further with others - independent sector care providers (mainly nursing and residential
care for older people and people with learning disabilities and home care); with the
voluntary sector (what relationship do Social Services really wish to have?); and with
housing (the future of supporting people funding).

12 Within Social Services:

12.1 The critical features that are at the core of the huge challenge facing the Social Services
Senior Management Team can be summarised as:

 Managing the immediate financial challenges and implementing the new


financial management regime

 Pursuing policy options which may be unwelcome to some and involve


significant service change

 Establishing new working relationships with Elected Members, the corporate


centre and External Partners.

31
They will need support personally and organisationally. At the core of their new
approach must be some fundamental changes to the culture which has been perceived
previously, whether or not it has been a feature only of Social Services or other parts of
the City Council as well.

12.2 It is not acceptable, as some have commented to me, that “people only do things in
Bristol City Council when they are told to”; that some “expectations and requirements don’t
really matter” or “are of no consequence”. An “optional culture” where people “pay lip
service” will not deliver on the challenges which lie ahead.

12.3 The new Acting Director of Social Services and Senior Management Team must
engage with managers and staff in Social Services in new ways, win understanding,
trust, will, compliance and encourage individual and team ideas and initiatives. It
means new modes of communication and engagement. It means setting priorities and
specifying outcomes. It means service delivery plans grounded in both resolve to
change services and financial realities. It means a performance management culture in
which PMDS is for real, not a ritual.

12.4 It means being honest, being straight, holding people to account and tackling under
performance. It means empowering Service Managers, engaging Team and Unit
Managers and connecting with workers at the front line. Importantly for everyone in
Social Services, it means feeling pride in what they are doing for people in Bristol,
feeling valued for their contribution and “owning” a collective commitment to work with
colleagues - upwards, downwards and as peers to achieve what is required.

13 Financial Management and Cash Limited Budgets

13.1 The paragraphs above describe the way challenges should be approached. The
biggest test will be in relation to finance. The review of financial management 2004/05
and the action plan arising from it document very clearly what must be done. They are
founded on the twin features of “devolved financial responsibility” and “effective control
mechanisms”. These are utterly compatible. The project management approach to
implementation must be unremitting.

13.2 There needs to be an instant “step change” from the beginning of 2005/06 which is real,
as well as symbolic, if confidence is to be clawed back. It requires a business plan
approach and performance management culture – linking of finance, activity and
performance review at every level.
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13.3 The Social Services budget for 2005/06 has been clearly separated out with finite cash
sums identified in relation to the five care groups. Working allocations have been
announced which make allowance for the risk areas identified in the text of all the
budget reports to Members. All Divisional Directors are clear about their cash allocation.
Most budgets are being devolved to Service Managers and sometimes Team Managers
where Service Managers are satisfied that it is realistic for 2005-06 and the individuals
involved are competent to the task.

13.4 Service Managers (and Team Managers, where appropriate) must be responsible in
2005/06 for:

 Ensuring targets are clear


 Defining their information and monitoring needs and ensuring that adequate
basic systems are in place, not withstanding the need for improved
performance information systems in the department generally
 Obtaining finance staff help in relation to profiling and forecasting
 Knowing precisely (for example in relation to older people, whether in the
community or on discharge from hospital), how many placements can be
made each month and at what cost.
 Delivering on their cash limited bottom line
 Being held personally accountable for all of the above

13.5 There should be no ambiguity anywhere about who is responsible for every part of
Social Services spend – not just what is newly committed but also the continuation of all
past commitments to ensure that they are appropriate, reviewed and funded at the
lowest possible cost.

13.6 In selected areas of high cost placements and volatile demand, it is appropriate that
there should be more centralised spending control panel processes for a time limited
period to ensure rigour, consistency and fairness (to users, carers and staff) about
spending priorities. These processes need to be tough minded. They must not
undermine confidence in devolved financial management which is the end objective.
Neither must they encourage staff to exaggerate care plans and needs statements in
the hope of securing resources when the focus should be on maximising independence,
living at home and taking some greater risks with good judgement and management
support.

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13.7 Inevitably some features of the department getting to grips with financial management in
ways which have not been done in recent years may prove unwelcome in some of their
implications. The underlying intent is to delegate responsibility for activity and financial
management to as close to service users as possible and where local flexibility can be
exercised according to local need within a clear policy framework and cash allocation.
Until all the mechanisms for this are in place and local managers can be effectively
supported in what is required of them it will be necessary to retain a number of
centralised controls – with responsibility residing with Service Managers to balance
purchasing spend, in-house provider costs and workforce expenditure.

C Conclusion

1 Sustaining Change – How to Ensure It Happens

1.1 “ How can we be sure things will really change?” “How can we be sure things will not revert to
the way they have been in the past once the current interest passes?” Increasingly over my
weeks in Bristol these are the questions which have been asked of me – by staff in
Social Services, by those inside and outside the City Council and indeed by some
Members.

1.2 What they have meant though has varied:

 Some have meant effective financial systems and accurate reporting of


financial information to Members

 Some have meant a culture in Social Services which enables managers and
staff to ask difficult questions, to share unwelcome information and to
challenge proposals which they do not feel will deliver the outcomes intended

 Others have meant a willingness of Social Services to work with the voluntary
sector, independent sector care providers and the NHS, in a more open and
partnership-oriented way

 Others have meant a political willingness on the part of the political


administration of the day to accept policy ideas or change proposals which
are not in keeping with perceived past orthodoxies

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1.3 All of these perspectives exist and need to be addressed. Unless reassured through
evidence of changes in behaviour, lingering doubts will, at best, be a constraint and, at
worst, be a block on the changes required if Bristol City Council’s Social Services’
underlying financial problems are to be turned round. The public, political and media
spotlight – including items in “The Guardian” nationally on three successive
Wednesdays this month (which have not been all negative) - gives you little choice.
Clearly, Bristol City Council is being watched.

1.4 The ingredients for a better future for Social Services in Bristol certainly exist, including
the wish of so many people; political commitment; the stature and leadership of a big
city; the new approach to financial management; the new Social Services Senior
Management Team; and the enduring catalytic effect (I hope) of Neil Haddock and
myself.

1.5 The challenge is to ensure that change is sustained – up to 5 May, after 5 May, beyond,
and for the next five years. Some of my report recommendations are “softer” than those
of Neil Haddock – but they complement his 100%. They are about leadership,
management style, culture and relationships. These are no less integral to the
“transformational change” of management texts, and to achieving sound financial
management and balanced budgets for the future.

1.6 My approach has been about the whole organisation, the whole of Social Services, and
the whole City Council. I have not wanted to personalise. However, the challenge in
the future for the Leader of the Council, Executive Member for Social Services, Chief
Executive and the Director (or Acting Director) of Social Services, is evident. The
leadership of these people together is vital. You have an Acting Director of Social
Services capable of the task. She needs to be part of a “top team” focussed together
on the “what” and “how” of achieving the changes required. The “why” is demonstrably
past.

1.7 The new Social Services Senior Management Team have a number of interim roles
which should be kept under review. Individually and collectively the interim team have
the potential to manage this huge change agenda over coming months, including “Every
Child Matters” and “Independence, Well-being and Choice”. They should be enabled to
“get on with it” without undue distraction.

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1.8 To ensure all of these changes happen and to monitor that they continue to happen,
there need to be sound performance indicators and good performance monitoring.
These need to be about leadership, behaviour and relationships, as well as quantifiable
indicators about service changes and financial performance. The Action Plan which
follows from my report should be a balance of four elements:

 Leadership

 Behaviour and Relationships

 Service Changes

 Finance

1.9 A critical requirement to ensure that change is sustained is that key people are
supported personally and organisationally in what is expected of them. Some of this
should come from roles and functions within the City Council. There are also many
other potential sources locally and nationally.

1.10 The task of managing the core essential requirements of Social Services, protecting and
caring for the most vulnerable people in Bristol and supporting others who care for them
must be the primary focus. Consistent quality of care must be maintained. However, in
the future, fewer people at lower levels of personal need should be served by or funded
directly by Social Services. Many of these people should be helped by the wider
network of multi agency approaches (many supported by Bristol City Council) around
prevention, service provision, regeneration and neighbourhood focus through
partnerships of statutory, voluntary and private sector organisations.

1.11 A number of key words or phrases come up repeatedly either in what I am saying in this
report or people have said to me. These are your words for the future:

“ Honesty in Communication” “It’s okay to say” “Individual Responsibility”


“Strategic Direction” “ Confidence” “Commissioning”
“ Affordability” “ Fairness” “ Eliminate unnecessary costs”
“The proper role of Elected “ Performance “It’s okay to work with people
Members” Management” outside the City Council”
“Integrated Services” “ Cash Limits” “ Engaging with people”
“ Corporate” “Improved “ Partnership Behaviour”
Communications”

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“ Personal Accountability” “Don’t Avoid” “ Enable”

1.12 Perhaps the most important words are:

 Affordability

 Commissioning

 Honesty in Communication

 Personal Accountability

These should be your messages about what Bristol City Council stands for in relation to
Social Services. What will be your focus - and what, by definition, will not; being clear
about your key messages over and over again.

1.13 My report’s recommendations, not just the Summary of Key Recommendations (indeed,
all of the report is recommendations), are a mix of “must”, “should” and “should consider
further”. They offer you a way forward to transformed, modernised Social Services
functions in Bristol, whether in Children’s Services or Adult Social Care, integrated with
other services for the greatest benefit of the people of Bristol. They also offer Bristol
City Council a way to “ maximise service outcomes within the agreed available budget” - the
words used by Nick Gurney, Chief Executive, in an e-mail to Members at the end of
December 2004, advising of my appointment and role over these three months. The
service changes and better financial management required are eminently achievable by
you.

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D References
i Review of Financial Management 2004/05 (Neil Haddock’s report) 2005

ii Bristol City Council Budget Reports to Social Services and Health Scrutiny
Commission, Cabinet and Council 2005

iii Papers made available to me by: Medway Council, Nottingham City Council,
Portsmouth City Council, Salford Council and Suffolk County Council 2005

iv Preliminary findings ADSS / LGA / Treasurers Social Services Budget Survey 2005
(and Report 2004)

v Learning Disability Taskforce (Department of Health) Finance Report 2004

vi Fair Access to Care Services – Establishing the Eligibility of Adults for Help from
Social Services. Bristol City Council 2003

vii Draft Guidelines for Local Authorities when Considering and Implementing the Closure
of a Residential Care Home for Older People 2002

viii Audit Commission/Department of Health Social Services Inspectorate. A Report of the


Review of Social Services in Bristol City Council 1999

ix Eight Steps to Transforming Your Organisation, Harvard Business Review 1995

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Brian Parrott is a Social Care, Health and Local Government Consultant, a Director of Verita
(The Inquiry Consultancy) and an Associate of Solace Enterprises. He has been a Director of
Social Services, Chair of the Association of Directors of Social Services Resources
Committee and Chair of an NHS Primary Care Trust.

He is contactable at brian_parrott@bristol-city.gov.uk or through Bristol City Council


Performance and Improvement Team on 0117 922 3318.

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