“I feel quite a sense of pressure.”
Phil Holmes has been asked how, as Sheffield Council’s director of adult services, he responds when reminded the authority is facing a £20 million overspend – largely as a result of the spiralling cost of social care. But while the figures might add tension, he won’t be defeated.
“I suppose what I don’t feel is paralysed. That’s often an easy reaction. How we’ve tried to respond to the budget situation, and it sounds a bit glib, is to think about doing the right thing.”
Phil is sitting in his small office in the Town Hall – “It’s a little bit of a bolthole” – having declined to be photographed on the building’s main, grand staircase as he wasn’t sure it projected the right image. Instead he’s happier outside on Pinstone Street.
He exudes calm, despite any stress beneath the surface – a good attribute when the country is repeatedly warned of a growing social care crisis. Less than two weeks ago the King’s Fund pointed to a rise in demand that will only increase as the nation’s population ages. There will be half a million more people aged over 85 in the UK by the year 2025, the think tank said, with the proportion of those needing nursing home places increasing by up to a third.
Does Phil believe he’s grappling with the council’s biggest issue?
“Erm... I don’t think so. Some people want to associate social care with some very heavy-end NHS-type things, but it’s ultimately about people having a good life - whether people get out and about, whether they live where they want to live and do the things they want to do, with the people they want to spend time with. It’s woven throughout what the council does. The way that will best help social care is by working very collegiately in the council, and with other people in the city engaged in the same area. There are challenges in the public sector in general.”
Phil is in charge of around 800 staff, who perform a variety of roles, from social workers and commissioning staff to frontline workers visiting people’s homes.
“Honestly, having been round them they all do an amazing job. I’m always completely blown away. I don’t think they’re putting on a show, either. It’s a privileged position for me to be in to try and help that all fit together.”
Sheffield, he says, faces similar challenges to other places, but has a particular need to begin supporting people ‘in a more preventative way’. He talks of giving individuals ‘choice and control for longer’, and not intervening ‘a bit too late’.
Money for social care has been protected as much as possible locally, but even good outcomes have a knock-on effect – if young adults with disabilities are living longer, they will need support for a greater amount of time. So the council, the NHS and other organisations are ‘trying to be part of the same team’.
“A lot of our conversations are about the Sheffield pound, and trying to avoid a parochial ‘This is my bit, that’s your bit’ approach. We need to make sure we’re all spending money in the right way. It’s quite a big tanker to turn round, with not a lot of financial margins so we don’t spend money twice.”
Phil finds it reassuring his budget has been largely shielded from cuts, but argues that people need to have ‘rounded lives’.
“They need access to good, green spaces, they need to be able to have a transport network that gets them out and about and good quality housing. Younger disabled people need job opportunities. I have to think about the broader picture. If I hoover up all the resource into adult social care, then we won’t be able to support as many people preventatively, and that creates a vicious cycle.”
There has been a push, he says, to deal with inequality and the division in Sheffield between the affluent and those struggling to get by.
“In adult social care we’ve just reorganised, so we’ve focused on neighbourhoods rather than being a central function. We spent a period of time taking something of a centralised approach, which meant there’s more we can do to have connections with people in their communities.”
Social care is often spoken about in the context of looking after the elderly, but ‘one can’t afford to focus on any particular group’, Phil cautions.
“In the press there’s lots of talk about care for the elderly and hospitals, and that’s a big deal. Equally importantly there’s a really strong agenda around adults of working age, and thinking about people from birth as well. We’re working now in the same area as children’s colleagues, so that younger people with disabilities feel they’re the same as people that don’t. We all want Sheffield to be a city where, regardless of your background or your age, you’re able to thrive.”
The predicament facing today’s younger generations in their old age is a potentially worrying one. Are there any models of support that could work? “I don’t know whether we can predict,” Phil says carefully. “I suspect people reading this interview will know many people in Sheffield and elsewhere in the country just thrive into older age because of their own efforts, because of their families around them and how they’re supporting each other. It would be wrong to think that growing older happily and successfully in Sheffield is all about what the council or social care do.”
One strategy is to be more watchful for people needing help at key times in their lives, such as bereavement or illness.
“A lot of it is quite soft. If we just think about how many care homes we’d need if we carried on as we were, or how many hospital beds we’d need, we’d all get fairly frightened quite quickly.”
He praises charities and the NHS. “There’s a lot of things that give me a lot of cause for optimism.”
Phil’s boss, executive director Jayne Ludlam, has ‘three obsessions’: prevention, workforce – keeping people focused on their jobs, rather than fretting about spending – and quality.
“If we take an approach around money that reduces quality, we’re likely to spend more.”
The short-term intervention team has become ‘more efficient’ so staff can spend more time directly with people, and ‘significant progress’ was made last year in reducing the number of people waiting in hospital for home care. “We’ve had a challenging winter, we’ve still got some delays we’re working through, but we had a much better year in 2017 than 2016. We’re far from helpless.”
The Government is giving councils across the country an extra £150m for social care over the next financial year, but generally the policy seems to be that councils should put up tax and risk unpopularity rather than expecting grants.
In an attempt to balance the books, Sheffield is poised to raise bills by 5.99 per cent, the maximum amount permitted. Other councils have exhausted their options; in Northamptonshire, leaders have effectively declared bankruptcy.
Is Sheffield entitled to more funding from Whitehall?
He lets out a big sigh. “It doesn’t feel massively helpful to get into that kind of speculation. As and when we get to the point where absolutely nothing else is possible, I will be engaging in this conversation in a different way.”
Phil, 45, grew up near Surrey. He went to Cambridge University, and while in his second year did rehabilitation work with young adults. “Seeing people happy... it sounds a bit rose-tinted but that was genuinely the buzz I got.”
After qualifying as a social worker he spent time in London, including spells in Hackney and Camden, then went into management. Later Phil moved to Derby, where he spent a decade with the city’s council before coming to Sheffield in 2015. He still lives in Derby with wife Claire, an occupational therapist, and their son, 14, and daughter, 10.
Travelling to Derby is a ‘very easy commute’ – he tries to incorporate a run into the journey, he says, nodding to a jumble of clothes hanging on the back of his office door.
“Sheffield is the kind of place where you feel like if you can’t help good things happen here you can’t do it anywhere, there’s a lot of potential. There’s a lot of national doom and gloom but it’s quite an exciting time to be here.”
‘We don’t need a loneliness industry’
Loneliness is a huge problem - but one single organisation cannot be responsible for fixing it, says Phil Holmes.
“I’d describe it as a problem for society. We can all relate to some extent, though I can’t possibly relate to the degree of isolation some people are going through.”
Bodies such as the council need to form a ‘broad coalition’, he thinks, spotting common triggers like bereavement.
“What I suspect people don’t need is a loneliness industry coming out of the council or other statutory organisations – a kind of ‘do unto people’ in the name of loneliness.”
Sheffield is very community-spirited anyway, he says, an attitude to be encouraged ‘rather than unwittingly doing anything that fetters that’.
“The council’s got a key role, I’m not trying to duck that, but we don’t want to turn loneliness into some interventions from the council that many people probably won’t appreciate. You can get into that: ‘Here’s the top 10 tips for not being lonely’, or you could set up a befriending service, and think you’ve ticked the box. For the myriad reasons people in Sheffield feel lonely, we’ve not addressed that if we’re doing it in an unsophisticated way.”