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?
A Happy Christmas and New Year to all our clients and website visitors
December 13, 2010
CHS would like to wish all our clients, partner agencies, and readers of our website a happy Christmas and New Year.
2011 will be a challenging and interesting year in the delivery of health and social care services and we look forward to working with you in finding solutions to meet your local community needs.
From the Directors of Care and Health Solutions Limited.
Adult Social Care to be ‘social enterprised’ Ministers announce
November 20, 2010
Community Care report (18th November 2010) that Ministers have told Councils to boost efficiencies of in-house care to protect front line services. In-house provision should become the exception to the rule raher that the norm, with services provided by social enterprise and mutual bodies improving competition and quality in the social care market. Emphasis is also on preventive services including telecare and reablement models. This ties in with a move towards personal budgets for all.
Reablement the key but are we heading for unification?
November 13, 2010
Reablement services across the country have been successful in altering the delivery of traditional domiciliary care.
Through commissioned social care arrangements Department of Health data confirms the evidence of substantial efficiencies being achieved over the past two years by the model which essential offers an intensive ‘free’ six-week programme of support to enable service users to become independent post hospital discharge. This is a marked change and improvement from the previous on-going traditional provision of open ended domiciliary care.
Andrew Lansley has released £70 million new monies for health to develop reablement services withfurther funding expected over the next two years. However responsibility has transferred away from local authorities to health to take on the responsibilities for the first 30 day discharge period. This runs the risk of undermining many of the developing social care reablement services and added more bricks to the often quoted ‘berlin wall’ which still exists and is well patrolled by commissioners from health and social care.
The NHS White Paper is welcomed in placing greater control for commissioning with GP Consortia and it will be interesting to see what the Social Care White Paper in 2011 contributes to creating the notion of single pathways through or under this funding battle ground symbolised by the ‘berlin wall’ .
At the LCS 11th Annual Healthcare Conference in London on the 12th November 2010 it was interesting to note how many speakers referred to the notional ’berlin wall’ including Stephen Dorrell MP and Lord Warner. It is also interesting to note the potential of NICE taking on regulation across health and social care. White Papers come and go and everyone knows about the billion efficiencies which mist be achieved during the life of this contract. These White Papers will stand a good chance of success given they are to be enacted early in the Parliament and therefore professionals need to embrace the changes that are coming.
The question which no one answers is simple – until you address the current fundamental different cultures and values between health and social care the ‘berlin wall’ will remain in place.
We all know the outcome of the real berlin wall – Unification.
Is this the pathway we are going down?
Radicalism and exciting times in delivering services as an LATC
October 27, 2010
The Essex Cares LATC model as many Councils are looking to follow focuses on reducing ‘back room’ costs and making other efficiencies. The exciting aspect of the LATC model as with the new Social Enterprises is the freedom to trade and act quickly in responding to the fast changing social and health care markets and create service models which deliver income generation opportunities to add to the required efficiencies.
Nearly 18 months on since going live Essex Cares is looking at how to redesign service delivery in order to forge partnerships with health providers and consider how the lay of the land will be post the Coalition Government announcements on health and social care. Creating preventive models and offering solution based service models will be interesting to see in terms of ‘middle england’ deciding to buy services as well as go through traditional social service routes.
What is evident is that the demographics of local communities will see many self funders as well as those formally financially assessed by Councils looking for services that are quickly accessible and delivering a complete range of services through as few ‘assessors’ or ‘providers’ as possible. Put simply the advent of call centres, life lines with quick and easy reach to telecare, equipment, and reablement will be key. How many people in their 303, 40s. or 50s have the same experience relating to their parents? All they want is someone to provide a quick and easy package into their parents home with the family retaining a level of control and choice. Yes, you can go through formal the local authority FACS criteria but how many people would pay for a fast effective service covering all your needs?
These are the sort of questions that Essex Cares as a commercial trading company is free to pursue – exciting times for progressive providers exist if they can understand their local markets, identify the right partnerships,investors and products.
(Mark is Managing Director of Essex Cares – www.essexcares.org )
Generation of Political avoidance as ‘baby-boomers’ big bang is now!
October 21, 2010
On average around 100,ooo people a year reach the age of 65. In 2012 Olympic year a spike will see 850,000 people reach this landmark. The reality of an ageing population is now here which politicians over the past 30 years have failed to prepare for and even today fail to acknowledge. Forget credit crunch and spending reviews the tidal wave of demand for health and social care will place extreme challenges on our public sector services at precisely the wrong time in terms of funding availability. The Coalition Government have tacitly acknowledged this time bomb of need by transferring £2 billion from the health to social care budgets for old age but this will be drop in the ocean as the older population place increasingly demands on services.
Pre the Public Sector Spending Review the 2020 Public Service Trust in their excellent Vision of Public Services confirm that we need to increase GDP by 4-6% to meet demand for an ageing society and tackling child poverty. The gap between demand and resources is set to grow dramatically requiring a new model and deal for health and social care which recognises a two-tier system between the ‘have and have nots’.
The failure of our five year term parliaments is that Governments for all to long have focused on the short term and not the long term issues. Royal Commissions on old age have come and gone but no Government has been brave enough to grasp the nettle on how to address the old age bulge which is now upon us. The excellent Wanless Report published by the King’s Fund in 2006 warned us of this crisis which politicians of the day need to address. We can talk about budget reductions and cuts but when will we take responsibility as a Society for providing the service base which the older population of this country is now going to place pressures never seen before?
This should not be a political issue rather an all party approach to finding extremely challenging solutions at a time of scarcity. Do we not owe this to the ‘baby boomer’ generation?
Lloyd delivers key note presentation at the National Home Care Conference
October 10, 2010
On Monday 11th October Mark Lloyd was a key note speaker at the 2010 National Home Care Annual Conference in London. Mark presented on the benefits of the LATC Model – the experience of Essex Cares. Later on the same programme an Essex Cares colleague Jon Manzoni presented on the Reablement service within Essex Cares. Some 60 Council in-house provider services were represented at the event which also heard from Richard Jones, President of ADASS in 2010.
Key themes raised by Lloyd were the urgent need for in-house providers to review their business base and consider one of the externalisation routes including social enterprise or LATC with an urgent need to diversify to respond both to the Government White Paper but also the demographic ‘time-bomb’ of old age which is now a reality with the baby-boom generation reaching retirement age.
Lloyd made clear the benefits of an LATC with the freedom to trade and ability to respond to the fast changing market place.
BBC Politics Show reports on success of the LATC model
September 30, 2010
The BBC Politics Show has interviewed Mark Lloyd – CHS Director and Managing Director of Essex Cares on the success of the LATC model. This links in with the current spate of interest in such models including Social Enterprises and Mutual Societies. Most recent publicity this week relates to the intentions of Suffolk County Council to commission nearly all its social care services from external providers prompting speculation of the potential tidal wave of transfers to the independent sector.
Mark told the BBC that the Essex Cares LATC experience had been extremely positive with significant back room savings made, front line staff protected, and the freedom to trade giving a real future to the organisation and workforce to respond quickly to the changing health and social care market. Essex Cares has just published extremely positive first year performance results including a dramatic drop in sickness rates reflecting the high morale of a galvanised workforce. For more information visit the Essex Cares website – www.essexcares.org to read the first year Impact Report.
The programme was aired on BBC 1 on Sunday 3rd October. You can catch a repeat of the show on the BBC iPlayer using the link below, which will be available until Sunday 10th October.
http://www.bbc.co.uk/iplayer/episode/b00v2437/The_Politics_Show_East_03_10_2010/
Social Enterprise the right answer for public sector workers
September 21, 2010
Much is being made in the media at the present time concerning the pros and cons of social enterprise models for public sector workers. Indeed one of the Coalition Government’s commitments is to see greater opportunity and ownership by public sector workers in the management and control of front line services. Various models are mentioned in the press and by politicians including cooperatives, mutual societies on the John Lewis model of share ownership, and Trading Companies. All models achieve the same outcome namely the externalisation of current in-house services into the commercial market place but with the crucial freedom to chart their own direction and freedom to trade. In other words entrepreneurialism will be awarded.
A spate of articles are now appearing in the media pre the 20th October 2010 Government announcement on Public Sector Cuts. On the 22nd September Craig Dearden-Phillips has written an excellent article in the Guardian Society on ‘how to solve the third sector pensions headacre’ with the externalisation of services into Social Enterprise models. He highlights the pension deficit gaps and the continued legal obligations of NHS and Local Government to meet this shortfall. Much will depend on the impending Hutton Report in terms of addressing Public Sector Pensions.
John Burchill’s article in the Guardian on the 16th September 2010 ‘Switch to Social Enterprise’ raises the question of how do public sector workers gain the necessary savvy to operate in a commercial environment. The answer is very simple all of the above models give freedom to trade to former traditional in-house services. The opportunity for a workforce to take ownership and control of there services for most represents a wonderful opportunity which most people will respond well. There is nothing like responsibility and freedom to manage a business without the ‘bureaucracy’ and slow decision making processes of the public sector.
Any service transfer requires a full and detailed analysis of running costs through a business case which documents and confirms actual needs for the new business versus year on year allocation of corporate costs. The culture change of any new organisation will be profound. So give public sector workers the opportunity to prove their abilities to run their businesses in the interest of the communities they serve.