Adult Social Care Breakfast Briefing: Commissioning, Councils & ICBs

In this Adult Social Care Breakfast Briefing, Kerrie Allward, Executive Director of Adult Social Care at Walsall Council, shares the story of their Place-based Partnership and Integrated Care arrangements.

Integrated Care Boards (ICBs) are one of the latest initiatives aimed at integrating care in the UK, providing joined-up support across the NHS and health and social care to better meet the needs of the population. However, despite the inherent benefits of ICBs, councils and Adult Social Care face a myriad of challenges in navigating this complex integration process. These challenges include coordination among diverse care providers, resource allocation, and the effective implementation of technology.

Kerrie’s talk begins with the recognition that if Walsall Council had started their journey through a commissioning lens they would not have got to where they are today. Kerrie goes on to share how her journey with Walsall began in 2016, when they were in the fortunate position to already have the Healthy Walsall Partnership Board established. This Board brought together all the senior leaders across Walsall, united with a shared ambition.

However, they recognised that they weren’t getting anywhere. They weren’t delivering programmes of activity that were helping them to achieve those ambitions. The Board therefore took the brave step to invest in a Systems Leadership approach. This brought together all the ‘seconds-in-command’ on a weekly basis with the aim to work out how their organisations could work better together.

After around 18 months, Walsall Together was born.

Kerrie’s talk shares more about what Walsall Together looked like and how it has evolved since its conception. This includes an introduction to their ‘Spectrum of Integrated Delivery’ and an in-depth look at their flagship service: ‘Intermediate Care Service’. Kerrie also provides insights into other projects, including: ‘Kindness Rocks’, tackling loneliness and isolation; ‘Work4Health’, supporting people into work, and ‘Diabetes Champions’.

Watch Kerrie’s talk below to discover the evolution of Walsall Together, how it came about, and the difference it has made to the communities of Walsall.

Q&A with Kerrie Allward

Following Kerrie Allward’s insightful talk on Walsall Council’s Place-Based and Integrated Care approach, attendees were able to dive further into the points raised.

Here we provide an overview of the points that were discussed, providing further insights into the successes and challenges of ‘Walsall Together’.

Walsall has had significant success in collaboration as a place-based system. For those that are not so far ahead, where would you suggest to start this journey?

The first very brave step in this journey is commitment. Our Walsall partnership board did this right at the very beginning of their journey, creating an absolute commitment to doing things better as a community.

Start by putting resources into giving time and space to those in senior decision-making positions. It is important to give space to these individuals within the system so they can find opportunities for integration and create for themselves an empowered space to be open, transparent, and not precious around this process.

Start from a blank sheet and ask yourself, what would you like to do and begin aligning all your budgets. Empower the people you are working with, get system commitment and ensure to be open, transparent, and honest about both your financial position, and your barriers, but also your commitment to the job.

Has the dire financial situation affecting all councils, coupled with the post-COVID surge of demand/complexity in Care put any pressure on the Partnership? If so, how is this being managed?

I don’t know if it’s necessarily the financial pressure, but the move to the ICB structure has impacted Care and has made the financial pressures difficult. When we started this plan, we were co-terminus. We had one CCG, one local authority, one acute trust. It was all very neat and very organised, perfect for integration. When we moved to the ICB, what happened was we suddenly couldn’t have that conversation about how we use our money flexibly across the system with just the place-based partners. We suddenly had people who were sat outside of our team thinking about all four areas of our ICB and not just Walsall, and that made it difficult.

We did have to have some difficult conversations. At times those we were speaking with at the ICB lacked the authority to make decisions about some budgets, so instead would have to go and seek authorisation from the system at ICB. So that made it really challenging to move forward with processes swiftly. That being said, we’re still using that foundation of being open and transparent about the money to make the best use of the money.

Having this strong partnership within Walsall Together has absolutely helped our financial position. It gives us the confidence and space to be able to say in conversations ‘It would really help us if we were to do this…’. The conversation is much more open than if I was trying to have those conversations, without Walsall Together there.

What role did commissioners end up playing in the systems leadership journey (enablers? network connectors?)?

When I joined the council, I started this journey as the director of commissioning. As commissioners, we were in meetings discussing from the point of view of commissioners but also outside of that viewpoint to ask questions like ‘What do we want the model of care to look like?’ So we became what we called collaborative commissioners – although I’m sure there’s a definition of collaborative commissioning that isn’t what I recognise!

But ultimately, we broke down the commissioner-provider barrier. We worked as a collective senior management group to identify which model of care we looked like and were transparent about the budgets that we had at our disposal to deliver top services. Once that model of care was developed, we then handed it over to commissioners to do all of the governance, putting that into a specification so we could put it into a schedule within our section 75 agreement. We didn’t commission the services in the end. We ended up, developing that section 75 and developed a partnership. Some elements of it are commissioned, but overall, it’s a partnership arrangement rather than a commission-provider relationship.

How are you squaring the requirement for major cost reductions in ASC with investment in prevention? 

It’s a difficult situation to sort out, and I’m not sure if anyone has yet. We’re constantly having to try and find ways to be creative with what we’re doing to release the money so that we can do that final project. Everyone knows the demands and pressure of complexity, increased need, et cetera, it’s more and more difficult to take that money away from those things and put it into prevention. Where we’ve got the extra money, we cling on to it and we try and make the most out of it. We’re also fortunate to have a great voluntary and community team. Whenever we’re designing anything, our voluntary and community team are part of that process. If there is anything they say that they can assist with, we pass this on to them, as they can deliver this effectively and it is usually much cheaper.

How are you, as a partnership, managing the reductions in staffing in ICB which are required in most systems and its impact?

Unfortunately, it’s not helpful at all, but we’ve been really lucky not to face these troubles. The Healthcare Trust had a major international recruitment campaign. But we didn’t have some of the challenges in attracting those roles as other people have. I’d love to say that that is because they’re coming to Walsall because they’ve heard about all the wonderful things that we offer in Walsall, but I think it’s probably largely because we’re easily accessible, we’ve got good transport links, and it’s cheaper to live in in this area. So because of this, we don’t experience some of the major retention issues that other organisations have.

How did the system support the acute trust to look up and out whilst the platform was burning?

Whether it was luck or whether it was just the approach, I don’t know, but we were very lucky. So once they saw that the Walsall Together partnership was leaning into the acute trust, to put out that burning platform, making sure that we were getting people out of hospital as quickly as we possibly could (and then we shifted into stopping people from going into hospital as quickly as we could), I think they realised that they’re getting what they needed. They’re getting a system that is wrapping around this problem and sorting this problem. So, by 18 months into the partnership, I would happily have let the Deputy Chief Executive of the Acute Trust stand up and talk about adult social care because he was as much convinced about how that partnership works for local people as we were. I think it was that foundational trust, recognising that his problems were my problems, my problems were his problems, and together we had the solutions. This really helped move that relationship on.

Can you say more about how the voluntary sector is represented?  Do you have a formal VCS collaborative?

Yes, we do. It has shifted over time. Right at the outset, we had an infrastructure organisation that was commissioned across Walsall by the CCG and the local authority. Over time, what has happened is we have four flagship community associations within the borough. And more and more, those four flagship community associations have taken on the role of being a lead organisation within the four localities within our borough. So actually, it has shifted now in that we’ve still got the infrastructure organisation Chief Exec that sits on our Partnership as part of our Exec, but we also now have a much stronger relationship with the Chairs of the Community Associate, the four community associations, and there’s a leading Chair of the Chairs. So those four come together regularly, and the Chair of those four also comes and sits on the leadership team as well.

At Panoramic Associates, we’re proud to run a series of Breakfast Briefings that bring people across the sector together, to share their experiences, to help build a stronger public sector.