Social care faces unparalleled change

Sandie Keene, President of ADASS (Association of Directors of Adult Social Services) writing in the Guardian:

During a previous change in the social care sector, the current chief executive of the Care Quality Commission, David Behan, likened what was happening to the movement of underground tectonic plates: different pieces of the social care architecture slowly shifting into place.

And so it is again. As the adult social care sector prepares for its annual showpiece conference, we face change and development which - not wishing to belittle the task David faced at the time - are without parallel in the lived experience of anyone in this sector.

The underlying leitmotifs are closely linked and devilishly complicated. The twin challenges of driving forward ever-closer integration with the health service while making sure that the right financial incentives are put in the right places at the right time to ensure that investment in integration optimises our success.

Meanwhile, and running parallel to that exercise, local authorities are robustly tackling the issues thrown up by the care bill. Not least the problems and challenges faced by trying to establish a model through which the Dilnot funding reforms can be successfully integrated into our financial mechanisms.

It is not simply an arithmetical problem, though it would be hard enough even if it were. There remain still urgent issues about the means by which we monitor against declared objectives. And there are continuing professional and management concerns about the loss of finance on the one hand, and the loss of independence on the other. While academic debate continues about the nature of prevention and how it can be measured.

It would be misleading and distorting to examine too closely here the problems posed by the so-called "metrics" of the £3.8bn integration transformation fund. Suffice to say that no: these are not tectonic plates grinding into position. The sound we are hearing is more like a number of combine harvesters, which were all travelling at different speeds in different directions, but have suddenly been ordered to go in the same direction at the same speed. The air is filled with the noise of clashing gears. But clarity will come.

The sector is excitedly awaiting the names of the 15 or so pioneers who will be selected to trial the best in integration over the coming months and work out some of the potential legal, management, structural and professional issues that will be thrown up. As minister Norman Lamb has put it, the challenge is to remove the barriers, and the pioneers will help us become much more focused on the known barriers in the first place, as well as discovering new ones.

Read the full article on the Guardian website