Another great, and insightful Q&A session with Mr Martin Farran of Liverpool City Council. Thanks again Martin for providing such detailed responses to my questions. I hope everyone enjoys reading it as much as I enjoyed asking the questions!

1. Interview with
I had the absolute pleasure of a conversation with Martin Farran, Director of
Adult Services & Health at Liverpool Council. With the release of the NHS long
term plan and key areas of investment focusing on community care/mental
health…I was keen to gather his thoughts on the subject.
I also wanted his opinion on the use of technology…not only in elderly care, but a broader use in a
healthcare environment.
1) Firstly, what are your thoughts on the NHS long term plan…positives/negatives in terms of the
investment in community care etc?
We currently have a reactive system; people often talk about the system being broken. However, it
was built in the 1950s and it’s a case of being redesigned as things have changed a lot since then. It’s
more about a person-centred equality approach. The lead model is now a social model as opposed to
the “traditional” medical model which still predominates.
I visited Trieste in Italy in 2018, to see what they have achieved by a radical change to their mental
health services - between 1975 and 1978 they reduced their inpatient beds by 87%. Money was
transferred from healthcare into housing, and the voluntary and community sector to provide
community-based services. In 1978 the Legislation was changed to reinforce the shift already
experience – Law 180s was introduced and meant that someone with mental health issues could only
be detained for up to a week. They view mental health on the same lines as general physical health,
with in-patient assessment based in the local District general Hospital; plus, four local community units
with up to 6 beds each, covering a population of 250,000 – and when I visited only one person was an
in-patient.
CCG (Clinical Commissioning Group) are understandably driven to deliver to budget, and this is often
used to differentiate those seen as performing rather than the morbidity gap – which may be getting
bigger – surely this should be the key measure. Similar issues also exist in local government.
It’s important to note the biggest employer in Liverpool is Health and Social care, (and that social care
employs more people than the NHS) but wages for the majority are either at or just above national
minimum wage. Therefore, there is an argument that we should be seeking to secure better pay for
community-based health and social care staff, as this makes sector, and the city more appealing, and
given that the majority of staff live locally provides inward investment. But perhaps the key point is
how can we say we value people and pay so little, surely vulnerable people deserve better – staff that
receive a decent wage. A much more radical approach / step change in the system is required.
2) Within Liverpool, where do you feel the pressure points are surrounding elderly care?
We have a growing population. An important factor is whether we’re getting people with the right
skills in our area, developing local talent and solutions…. are we actually doing enough to get skilled
workers in? (work placements for school, students, mentorships, apprenticeships, developing career
pathways etc).

2. More has to be done to engage with the community to agree their priorities and how they want to be
engaged as part of the solution / addressing their own needs etc – what is our vision for the future
and what would good look like; what would the impact have been if the £20b that went to maintain
the current system was invested in the voluntary and community sector………..
How do we also engage with developing the right type of housing and support? If the money spent on
costly institutional building-based services was spent in the community (as in Trieste), over time we’d
deliver more, see better outcomes, and more than likely reduce the overall costs. We need to put the
right support in the right place at the right time to prevent institutional care.
In a similar vein Homelessness is a massive national issue. In Liverpool it’s great that we have made
significant historic investment which means we can house everyone in temporary accommodation, and
no one needs to sleep rough. But it’s temporary accommodation, doesn’t deliver good outcomes and
is at a cost of over £12m per year, funding 750 temporary beds every night.…we need to create more
permanent accommodation. We one of the three national pilot schemes for ‘housing first’ and by
autumn hope to be offering wrap around support for vulnerable people to move directly into their own
home and reduce the use of temporary accommodation. It’s a case of identifying appropriate
accommodation, and building the support around the individual. This isn’t a short-term solution.
Ok, given what you’ve just said …how do you think technology could help?
We need to embrace the broad range of technology that is available which can support people to
maintain living independently, from telemedicine / telehealth / telecare reducing pressures on
institutional care e.g. admissions to acute care, residential care etc, to a much greater use of aides,
adaptations, equipment e.g. a local building company has developed with John Moores University a
modular built pod that can be put on the back of terraced houses to provide a toilet, walk-in shower
etc. It can be easily and quickly installed, and re-useable so relatively low cost - which means people
can be supported to remain living in their own home, including those diagnosed as End of Life care.
Thanks again to Martin for taking the time to discuss what is, a very pertinent and important topic.
I hope to speak to more Local Authorities over the coming weeks to ask the same questions. Are they
all singing off the same hymn sheet…or at their paint points and opinions different?
Scott Walker – 07720 966 300
s.walker@grandcare.co.uk