3. Systems leadership, governance and management arrangements

3.1 Introduction

Councils have a key role in the leadership and governance of the “Whole System” of care, support, health, and housing for adults with learning disability. This includes initiating actions that help to reduce the inequalities that adults with learning disability all too often experience. They also need to have management arrangements in place that quality assure their own contributions to the “Whole System” of care and support and ensure support is strengths based, personalised and maximises individual choice and control.

3.2 What good looks like

The best councils provide “Whole System” leadership to the care, support, health and housing system for adults with learning disability  to help develop and agree a shared vision of how they can be best supported to live the lives they want. Councils will agree a joint strategy with partners to deliver that vision. In many respects the director of adult social services’ role is akin to being a cultural change agent, hence it is crucially important for the director of adult social services to engage with politicians along on this journey, as political ownership of the vision will help build support across departmental boundaries and commitment to implementation.

The best councils collaborate with adults with learning disability, their carers, and with partners from across the care, support, health, and housing system to co-produce new approaches to improve the lives of adults with learning disability . They encourage and enable all parts of the system to make reasonable adjustments so support can be made accessible to adults with learning disability.

They establish, support and operate governance arrangements co-ordinated by the Health and Wellbeing Board to ensure the care, support, health and housing system consistently supports adults with learning disability to live the lives they want to, provides value for money and is transparent and accountable.

They establish, support, and operate management arrangements that monitor performance on an ongoing basis to ensure. Individuals are supported appropriately, individual outcomes are being achieved, value for money is being achieved, organisational learning takes place and improvement is continuous. (Go to Quick self evaluation, part 6, on efficient structures, systems, and processes for more information)

They encourage and support personalisation of support and facilitate innovation and promote the use of direct payments, individual service funds, managed accounts and individual health budgets and the systems that support these.

They expect, empower and support managers, in the council, and in commissioned provider services to:

• Lead by example and communicate expectations to their staff, key partners etc.
• Do whatever is necessary to support adults with learning disability in line with the vision within broad boundaries, for example the directive, “don’t break the law and don’t break the budget” encourages/permits innovation.
• Manage and monitor performance to ensure transparency and accountability for the delivery of the desired costs and outcomes from the “Whole System”.
• Be outward looking and open to constructive external challenge to continuously improve and learn from the experiences of others.
• Share their own learning with others.

Who is good at this?

Case study: Hammersmith and Fulham

In the London Borough of Hammersmith and Fulham, the Health, Adult Social Care & Social Inclusion Policy and Accountability Committee formed a member-led task group to consider how the council could improve the experience for young people transitioning from Children’s Services to Adult Services.

This transition improvement process was co-produced with stakeholders. The task group comprised councillors and parents. Throughout the inquiry, the task group met with parental advocacy groups, council officers in Children’s Services, Adult Services, Health, and Housing, Education and with medical professionals, and third sector representatives.

The task group set itself the following three objectives:

• Understand the current model and its shortcomings and challenges
• Consider what a ‘good’ transition experience would be
• Make improvement recommendations.

Whole system leadership was essential to the project as it involved education, children’s and adult social services, health, and housing services.

3.3 Expected outcomes

In terms of outcomes, councils that are implementing good practice should find that the:

• Elected Members, care and support providers, people who are supported and their carers all feel actively involved in quality assurance, quality improvement and governance processes.
• Decisions (within the council or with partners) are based on a clear vision and a shared set of values.
• Strategic and operational planning processes are informed by learning from other councils and from participation in national, regional, or sub-regional research/development or pilot projects.
• Inequalities (health and other) experienced by adults with learning disability reduce over time.
• Autism self-evaluation, every two years, shows progress in implementing the Adult Autism Strategy. 
• Quality of life, as reported by adults with learning disability, improves over time.
• Quality of care and support services, as rated by the Care Quality Commission, for adults with learning disability improves over time.
• Percentage of adults with learning disability and/or their carers who feel their support from adult social care meets or exceeds their expectations. Increases over time.
• Value for money from expenditure on support for adults with learning disability improves over time.
• Expenditure on support for adults with learning disability is being contained within the annual budget
• Share of resources allocated to support for adults with learning disability is considered equitable.
• Positive media coverage of the council’s support for adults with learning disability increases over time.

Guidance

• To take a co-productive approach to local systems leadership: Getting under the skin of it: Social Care Innovation Network 2019
• To learn about existing well performing Health and Wellbeing Boards (HWB) and the LGA HWB support offer: What a difference a place makes: The growing impact of HWBs: LGA 2019
• To learn how to enable an effective autism partnership board: It involves us: Enabling meaningful inclusion of adults with autism in the development of local autism: NAS 2014.

Good system leadership encourages and gives permission for innovation within broad boundaries: don't break the law and don't break the budget".

Stephen Chandler former Director of Adult Social Care at Shropshire County Council

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3.4 Systems leadership, governance, and management arrangement outcome indicators

Outcome Indicators	Aim	National/Local
ASCOF (1A) Social care-related quality of life for - split out adults with learning disability.	Increasing rating	National data
Life expectancy for adults with learning disability compared to life expectancy for the whole population.	Lowering the gap	National data
Proportion of key partners organisations in the care, support, health, and housing system formally committed to the local vision, shared statement of values and joint strategy to support adults with learning disability.	Increasing percentage	Local data
Analyse Care Quality Commission ratings of local services in detail and monitor the percentage of providers rated “Outstanding” or “Good” for the key line of enquiry on “Are they well-led?”	Increasing percentage	National Data
Balance of positive to negative feedback about support for adults with learning disability from the most recent peer or similar external review.	Improving balance	Local data
Proportion of key partner organisations that publicly report the effectiveness of processes to ensure they make reasonable adjustments so people with learning disability (and other disabilities) can access their services.	Increasing percentage	Local data
Proportion of adults with learning disability accessing annual health checks and % leading to health action plans	Increasing percentage	Local data

3.5 Self evaluation questions

How to rate yourselves against the self evaluation questions:

For each chosen section the director of adult social services should consider each statement about good practice that follows and work with their senior management team, representatives of key partner organisations and local experts by experience to rate the council’s practice described using the following five-point scale.

The scale to be used is as follows:

Leadership, governance and management arrangements