Leading and engaging
across health and social care

Effective leadership of DHA programmes is essential for success, both at the outset and throughout implementation. It is important to carefully consider how DHA will be led and by whom.

Our research suggests that strategic joint leadership from health and social care is vital, even where the impetus may come from one or the other. As one adult social care leader said:

I think one of the challenges is the operational barriers between the understanding of roles and responsibilities and who’s doing this or who’s leading on that; it still is a little bit clunky with health colleagues. But for this to work, that has to be a much smoother approach and much tighter working together. 

Our participants suggested that DHA programmes need to be driven and owned by senior management/ leaders from both health and social care, e.g. the Director of Adult Social Services (DASS) with an equally senior NHS colleague. Where local authorities had tried to implement DHA programmes without this senior NHS support, they had often struggled to secure district nurse buy-in:

It should have probably been owned by somebody, people like [DASS] and the Director of Nursing…. when you want to do something different, you know, it’s for somebody like [DASS] to be joined at the hip with their equivalent in the NHS.  To show that this is important to both of us to get it to work. And if you do it slightly lower down the hierarchy, it just doesn’t work.

Identify at the outset who is best placed to lead DHA programmes at senior level in both health and social care. This will support required buy-in and help tackle issues set out in this toolkit, for example, progressing DHA in the face of other competing priorities and tackling resource constraints. In GM, operational leadership roles were also important for successful delegation, particularly a lead ASC commissioner and, from health, a DHA programme leader (known in GM as a Blended Roles Facilitator):

[DHA] do need a commitment, at the beginning at least, to say, ‘This is the programme of work that we’re going to be doing.’  It can’t be somebody else’s job, just an add-on to somebody else’s job. We’ve got to focus on it, we’ve got to make it work.

It is important to consider how and whether these, or similar, roles will be established. In GM, they were central to ensuring the engagement of all stakeholders not only at a senior level, but also from district nurses, provider organisations, care workers and people who use services and carers.

They also worked to secure engagement from other key groups including NHS Medicines Optimisation Groups (MOGs) and Lead Pharmacists; GPs; the CQC and the Coroners Court. In particular, buy-in from the MOG and Lead Pharmacists was vital for protocol approval and the development of governance. 

Engagement is vital to success, so it is important to put mechanisms in place
to build engagement. In GM, these included:

  • Direct communications with stakeholders: consider a communications strategy to ensure strong, clear and robust communications.
  • DHA Steering Groups, comprising representatives across health and social care, including adult social care providers.
  • Question and answer sessions led by ASC commissioners and DHA Programme leaders with adult social care providers, district nurses and care workers:

So, what we did early days was got the manager or the senior carers, all five of them together in one room, and did a Q&A. And it was really good. So, there was me, [commissioner], and [BRC] led the Q&A. And basically, it just gave them an open arena to say, “Tell us what you’re scared of, tell us what you’re worried about, and we could help hopefully get rid of some of these myths.” And the same question fundamentally comes through for everyone, is about insurance. That’s everybody’s fear. 

  • Adult social care providers were also included in district nurse weekly meetings and daily ‘huddles’

Carefully plan a leadership and engagement strategy, taking into account strategic and operational leadership and a wide range
of stakeholders.

Integration was also important. For example, co-location of the DHA lead commissioner and the DHA programme lead proved beneficial in fostering close ASC commissioner/ district nurse working relationships. This was also important across district nurse and adult social care teams:

We’ve been an integrated organisation for quite a while. So, our community nurses sit with adult social care teams out there in the footprint. So, we have a really good relationship, which I do think is fundamentally one of the absolute benefits to this [DHA] work.

Consider how to promote integration of health and social care strategic and operational leadership teams. 

Implementing DHA programmes: checklist