Dedicated DHA
programme roles
Our research highlights the pivotal importance of two roles in effective operation of DHA programmes, those of DHA Programme Leads and, in one borough, an ASC lead commissioner. They supported successful DHA implementation and it is important to consider establishing these, or similar roles and to identify the required resource.
The DHA Programme Lead role was universally acknowledged as vital for a successful DHA programme; without it, district nurses would not have had the required resource to roll-out DHA and engagement with stakeholders would have been much more difficult. Someone with time, focus and enthusiasm to lead the programme was vital:
‘You really need someone who brings the experience, but also brings the energy… the passion to do it.’
Our evidence indicates considering these issues:
- The DHA Programme Lead is a highly skilled and specialist role, which needs to be held by someone with a nursing/ clinical background and should be NHS-based due to the clinical oversight/ governance required
- The role requires more than nursing/ technical specialist knowledge. Important skills include strong communication; high levels of motivation, drive and initiative; well-developed relationship building skills, and strengths in training and imparting knowledge/developing other. DHA Programme Leads should also have experience of working with commissioners, district nurses, care providers and care workers.
The three GM boroughs that had been successful in establishing DHA programmes had all had a dedicated DHA Programme Lead. Where boroughs had not succeeded in their attempts to launch DHA programmes, they identified lack of such a role as a key factor.
A degree of realism is needed, however, about the capacity of one DHA Programme Lead to bring about significant change.
They speak about it like it’s going to change the world, and I don’t know if that expectation is realistic. What they think [new DHA Programme Lead] is going to achieve, it’s like ‘whoa, there’s just one person’, and it’s a massive task, you know?..
A key question is how to fund these roles. Three GM boroughs had pump-primed a DHA Programme Lead using adult social care transformation or Better Care Fund monies. In two boroughs, savings in district nurse costs had enabled these posts to be made permanent and NHS-funded. Innovation funds are perhaps now more restricted than when GM’s programmes were established, and it is important to identify what funding will be available to support DHA programme roles.
If resources permit, our evidence suggests that a dedicated DHA team will support more rapid scale up of DHA activity. As one DHA Programme Lead noted:
Ideally, I would have a team with me, managing care homes and providers, and soon LD homes, and assisted living. It’s quite a lot… I know money is a really big problem at the moment… Even if I had one Band 5, that would be really beneficial, because they could do the final sign-off for the competency booklet.
Consider also how adult social care will be resourced to support DHA. A dedicated adult social care commissioner role was central to success in the borough with the most fully established DHA programme. This role enabled strong, trust-based relationships with both health colleagues and adult social care providers, which was invaluable to both recruiting providers and building and maintaining relationships. The importance of this was reflected in concerns that emerged as this role was removed:
I have got a few providers who are like, “Oh, no, I don’t really want to do it” . Now all I had to do was cc [commissioner], and they’d do a U-turn and be like, “Actually, do you know what? We’ll do it now, do you want to come in?” Whereas, now, I don’t have that… I’ve not been in touch with the providers as much as I used to.
Some boroughs that had not launched DHA programmes identified lack of commissioning capacity as a constraint.
The lead commissioner role brought other benefits. For example, they were able to drive innovative contracting arrangements that supported DHA. A developmental contract which contained a clause which allowed for change in practice under contract duration was used. DHA were included as a broad vision as opposed to a detailed specification which allowed for flexibility as the programme developed.
[The contract] had a section that basically said, ‘We want to change homecare, and we know broadly some of the things we want to do, but we don’t really know how to do them, and what we want to do is work with you as a provider, as one of the contracted zone providers, to develop some of those ideas in practice during the lifetime of the contract’.
Zone provision was also adopted, whereby all adult social care provision in a particular zone was guaranteed to a particular provider. Providers didn’t then have to repeatedly tender for contracts, removing competition which built relationships both between commissioners and providers and across providers. Providers where then willing to work collaboratively and share good practice, being part of a forum that promoted sharing ideas and good practices with the commissioner and DHA Programme Lead.
They tender for to be the zone provider. But once they’re that, they don’t package by package have to tender for it. They’ve got the security of knowing if it comes up, it’s theirs. [This] meant that they weren’t competing against each other for work, and that was important, because it meant that I was able to have a forum, a working group if you like, of the six providers who’d meet regularly… I would routinely be able to sit in a room with all the providers, and they would work happily together. They would share good practice together, you know. So, for me, as a commissioner working in a transformational way, that was absolutely key. I’d often sit and think, “How on earth would we have achieved anything if we’d not done it like that?”
While all local authorities will need to develop their own approaches, and this is not meant to be prescriptive, it is worth noting that these experimental, developmental approaches were effective in the establishment of successful DHA programmes.
