How Essex Cares is responding to the ‘Big Society; and localism agenda
January 14, 2011
Essex Cares Limited is the Country’s first Local Authority Trading Company (LATC) involving the direct transfer of Adult Social Care Services. The Company began trading on the 1st July 2009 with Essex County Council’s former in-house provider services and workforce given the opportunity to create a new future in meeting the health and social care needs of Essex Citizens. This account describes the success of Essex Cares during its first 18 months against the backdrop of the profound political and economic changes as driven by the Big Society agenda.
Essex Cares Limited (ECL) is well known across the public sector for what it is rather than what it has achieved. This is the legal framework and concept of an LATC model which has seen former in-house public sector services externalised with the creation of the new independent company but with the Council remaining the shareholder. Numerous Councils are looking to adopt a similar approach to their in-house Adult Social Care Services to both make dramatic efficiencies and introduce commercial principles to service delivery in 2011.
What is less well known and yet to be proven is what Essex Cares will do in response to the Government Agenda on health and social care and the rapid withdrawal of the State from people’s lives as local communities are encouraged to do more for themselves (Localism Bill) and embrace the ‘Big Society’ ethos of individuals and communities finding their way and own solutions.
On 1st July 2009 850 former Essex Council employees and services covering the Countywide Equipment Service, Reablement, and a raft of Day and Community Centres for older people and people with learning disabilities, with an annual turnover of £35 million, delivering services to some 100,000 people annually, transferred from the Council. Despite significant media interest in the LATC model the focus of the Essex Cares strategy has revolved around service redesign, a more towards preventive services, and with the freedom to trade opportunities to build links with health partners and the large untapped self-funder market. In short a complete rethink has taken place to instigate the delivery of services direct to customers.
Mark Lloyd the Managing Director of ECL comments, “we have all been on a learning curve in understanding how you combine the best practice principles of the public sector with the entrepreneurial benefits of the commercial sector – in doing so we are in an exciting place in terms of what we can do particularly in responding to the wider self funder market as well as those people assessed and receiving financial support from Essex County Council.”
To do this ECL has had to review how it delivers what were traditional provider services and focus on the future markets for business growth. Three distinct business streams transferred out within the ECL framework being Essex Community Support covering a range of older and sensory services, the Equipment Services, and Employment and Inclusion Services covering both employment and day care services for adults with a learning disability. To position the business in the new world ECL has restructured.
In 2011 ECL will have two new operating arms being Essex Home Support and Essex Community Support, with a third arm focused on marketing and business development. Essex Home Support will provide a range of preventive services into people’s homes including reablement and equipment with Essex Community Support providing a range of community based buildings and services across the County. The traditional division between old age and disability is removed with a focus on the home and community settings. The key driver for Essex Home Support will be the wishes of customers and their families in supporting loved ones at home with the key driver for the Essex Community Support services getting in touch with the new localism agenda and designing services as driven by local people.
Central to this overall model is a repackaging of services. ECL is fortune to be in a strong position as a business with the countywide equipment service and a highly successful reablement service which continues to operate in the upper quartile of Department of Health statistics on independence outcomes for people receiving the extensive six week programme. What is central to the ECL model of delivery is a commonsense approach to recognising the wishes and needs of the baby boom generation and their often articulate and vocal grown up children who want choice, control, and options for their parent’s health and care needs.
Any conversation on care and support needs with a group of middle aged people will quickly highlight anxieties and concerns for their parents or relatives and the gauntlet of accessing a well defended health and social care system which is not always consistent in information and a co-ordinated approach to giving options. Moreover the need to talk to countless health and social care professionals overwhelms.
ECL will deliver a complete package of services into a person’s home including a sensible assessment with family members backed up by immediate delivery of equipment, reablement, dementia technologies and telecare. Security checks and life line options complete a simple process of providing the needed environment and support to help retain people in their own homes.
Key to this re-design is the need for ease of access through a call-centre, speed, and assessment and provision of services through no more than two trained workers. As a model Essex Cares recognises that the first crisis point is often concerns raised by the family GP. Leaflets will be placed in GP surgeries offering patients and families a free assessment for this new service.
The territory Essex Cares is entering is that which has been seen for years in the NHS. Everyone knows the NHS is free at point of delivery but the public have choice in accessing private healthcare as an alternative. Essex Cares will continue to provide social care services that are ‘free’ or financially assessed under Local Authority assessment criteria, but the option remains for an increasingly large section of the community to buy direct.
At the same like many providers Essex Cares operates on that well reported ground between health and social care commissioners which is sometimes describe by commentators and politicians as the increasingly well defended Berlin wall. As a provider this wall feels more complex and well defended than in many a year with changes responsibilities between health and social care for public health and hospital discharge arrangements.
Again the freedom to trade as a commercial company opens the door to an LATC like Essex Cares to forge new partnerships with health commissioners, GP’s, and the emerging Social Enterprise NHS provider arms to find solutions for local communities. Essex Cares has the ability to ‘sell’ proposals to hospitals for hospital discharge processes in a way which would never have happened as a traditional in-house provider arm of a local council.
Whilst some Coalition Politicians have indiscreetly talked about the Maoist intensions of the Government Essex Cares recognises it needs to embrace a well-planned revolution to take opportunity of the seismic movement of the health and social care agendas. Whether Essex Cares succeeds and becomes known for what it does as a front line provider only time will tell.
So is it an end to the baby boom ‘gravy train’?
January 1, 2011
So shock horror the tabloids are reporting this week that 1 in 6 of us will reach the age of 100. This also coincides with the indiscreet comments by one Liberal Government Minister pre-Christmas as reported in the press that the health and social care reforms are Maoist in their intentions. Neither of these separate statements should be seen as a surprise. We have known for a generation about the rise in life expectancy coupled to the ‘tidal wave’ of baby-boomers reaching retirement over the next few years. Perhaps the most alarming statistic which highlights this is confirmation that in 2012 850,000 people will reach the age of 65 as confirmed to only 100,000 in 2011. Comments on a Maoist experiment will be interesting to see – yes, we are probably going through a revolution in health and social care reform which will lead to us all falling back on the new values of the Big Society and localism meaning we do more for ourselves as opposed to finding support from the welfare state. There is an interesting view that the original welfare state of the 1950s only provided the safety net for the few as opposed to the many seen in 2011 – in other words the parameters of the safety net have grown over the last 50 years as we have become more dependent on the State. Whether or not this is true the baby boomers experienced unprecedented economic growth. It is only now with the austerity measures that we are perhaps going back to a pre-war view of the community, family, and individuals looking after themselves.
It is certainly interesting over Christmas to see the comments and discussions on the News relating to the lucky or privilege generation now known as the post war baby boomers. Access to the new Bevan Welfare State, free higher education, home ownership, and the liberational social attitudes as seen exploding in the 1960s are all seen in the stark light of 2011 as a time of privilege and prosperity. What should not be forgotten is the reconstruction of our Country post the War with major investment and a time of economic growth in the 1960s which was probably not seen again until the early days of the Blairite Government. Extreme wealth of the few was also matched by extreme deprivation and poverty for large sections of the population but with the growth of the Middle Classes many of whom now require health and care support in their retirement.
The end of the ‘gravy train’ for the baby-boomers in 2011 can be seen on a number of fronts. The unfortunate phrases used by Social Service Departments to describe older people in need include ‘wealth depleters’ and ‘asset rich cash poor’. Such phrases typifies the view of the state for people entering the registered care world. ‘Wealth depleters’ are people placed by families independent of the state whose income is whittled down through fees until they hit their final allowed £23,000 allocation at which point the State has to take on responsibility. ‘Asset rich cash poor’ typifies large sections of the baby boomers who have seen their families leave home and have entered retirement still living in their large and now empty houses but with little or no income to fund their lives – this situation is now made worse with the current housing slump with people unable to ‘cash in’ their property sale to fund their retirements. Worse still this causes a problem within care homes where perspective clients are unable to fund their care until their house sells.
The baby boomers have grown up and had families who now in turn aspire and hold expectations far greater than seen by their parents. We live in a society of instant access, what was easy credit pre the credit crunch, and expectations on having freedoms not even our parents had post the second world war. At some point the current austerity measures will impact us all with the squeeze in the property market, unemployment, and the continued recession.
So in summary the action of our bankers in generating the credit crunch and crash has hit the baby boomers hard. Deduced Pension funds, properties that cannot be sold, and the biggest threat of living longer meaning a greater likelihood of nursing or registered care now means all of approach our latter years will not be able to take for granted what we had expected in our younger days namely a well funded welfare state.
We wait to see what the the so called Maoist revolution in health and social care delivers?