The Department of Health’s director general for social care, local government and care partnerships tells Winnie Agbonlahor about a career spent working across boundaries
Jon Rouse was one of the first senior civil servants hired on a fixed-term contract. “Some people don’t like it, but I have to say it doesn’t half focus the mind,” the Department of Health’s director general for social care, local government and care partnerships tells me over lunch. “Whatever I want to achieve, I have to achieve in that period.” His four-year contract ends in March 2017 and, while he says he hasn’t thought about what he’ll do next, he has one principle when it comes to his career: “I choose jobs that I think I will find interesting and where I can make a worthwhile difference.”
Rouse hasn’t always been this focused. He studied law at Manchester University, but says he had no intention of practicing it – a decision that he found “very liberating”. There was just one problem: “I didn’t have a clue of what I wanted to do.” After graduating, he spent a year volunteering as a youth worker on the South Kilburn Estate in London. His motivation? “I was brought up to care about people who are maybe not in as fortunate circumstances as we are, and I’m also a committed Christian.”
When he applied to the Civil Service Fast Stream, he asked to be placed in the Foreign Office: “I was a naïve 22-year-old. I would have been the worst diplomat ever!” Instead, he was deployed to the Department of the Environment, which back then had responsibility for housing and regeneration and was, he says, “a much better fit” for his skills and interests. After discovering his “true passion, namely regeneration and housing”, he went on to work on various arm’s-length bodies delivering urban regeneration projects for 12 years, before becoming chief executive at the London Borough of Croydon.
A love for public service runs in the Rouse family, he says: “My dad was a child protection social worker, my mum worked with 0-5-year-olds, my brother is a probation officer and my sister is a teacher – so you can spot a pattern,” he says jokingly. Perhaps the tradition will continue with his kids? “I don’t know, because I’ve adopted so they may not follow the same genetic code,” he says, opening up about his personal life: “My wife and I couldn’t have kids of our own, felt we had a lot of love to give, and wanted to offer some kids who had a broken situation a second chance.”
Wanting to help, however, wasn’t enough. Rouse describes the adoption process as “long and arduous,” and adds that “we had some very bad experiences, some terrible experiences.” But his face lights up when he tells me the happy ending of the story. “We have two lovely girls, who have been with us now for over six years.” Aged seven and eight, the two are blood-sisters. Rouse proudly shows me a picture of his daughters on his smartphone.
“You’re dealing with organisations that have completely different histories, different cultures, and we’re asking them to work in a completely seamless and coordinated way – it’s not easy.”
He says that adopting “is a tough journey”, but quickly moves on to the more positive subject of the government’s recently announced adoption fund. From 2015, adoptive parents in England will have access to the £19.3m pot, to pay for therapeutic services and intensive family support. “It’s those small interventions you need [as adoptive parents], and you often need quickly,” he says.
Another central government funding pot to be released next year is the Better Care Fund – one of Rouse’s many projects. The Department of Health and the Department for Communities and Local Government developed the £5.3bn fund’s policy, with NHS England and the Local Government Association responsible for its delivery and implementation.
A total of 152 county or city-wide local authorities will use the fund to join up health and social care. So far all but five of the plans, which are written by local health and wellbeing boards, have been approved by Rouse’s team. “We’re in pretty good shape,” he says: “We got 97% of the plans approved and we’ve still got five months.”
Joining up health and social care has been the goal of many a previous government – so far with limited success. One of the big challenges is to encourage organisations to work together, focusing on collective benefits rather than each organisation’s own aims. “It’s incredibly hard,” he says. “You’re dealing with organisations that have completely different histories, different cultures, and we’re asking them to work in a completely seamless and coordinated way – it’s not easy.”
Would it help to change structures to achieve true integration of health and social care? “I think anybody who thinks the answer is structural reform should think again about what the question is. For me, culture trumps structure every day of the week: get the local culture working; get people aligned; start conversations; put the user at the heart of those conversations. You’ll make a lot more progress,” he says, adding that in the NHS “we’ve just been through one big structural reform – we’ve done that. Now going forward we really need to focus on culture.”
Rouse is optimistic, for he argues that “people generally go into public service to do the right thing, and I think we all know that integrated care leads to better quality of care, less joining up for the individual to do, more support for carers, and hopefully less pressure on hospitals.” What’s more, he says, “we’re not starting from scratch: a lot of areas have been working away at this for up to ten years, with lesser or greater degrees of success.”
The “trick” for Rouse’s team has been “trying to find the right balance between being facilitative and supportive, and when to be more demanding and exacting.” These reforms to health and social care were never meant to be a “top-down, centrally-driven, cookie-cutter programme,” he says.
“I think there’s more distance to go and I hope we go that distance. Obviously it’s a decision for politicians to make, not me, but I can’t change who I am. I am a localist and that’s what you get.”
During his time in regeneration and council bodies, Rouse begrudged this centrally-led and domineering approach. The government is increasingly seeing councils as partners rather than “subjugated actors”, he says – but in the past central government teams were more prescriptive: “A lot of what was there before were top-down programme teams that used to go round the country telling people what to do, and when I was in local government I resented some of that activity because it felt like they were trying to dictate that everywhere should be the same.”
Now, he says, “our model is different: more strategic and more aimed at localism.” A self-declared “arch-localist”, Rouse says he’s “more optimistic at the moment around the move towards a more localist agenda than I have been at any point in my career”. Growing numbers of local authorities are working in partnerships, he says, and “it seems like it’s got momentum that may this time be almost unstoppable.” He adds: “I think there’s more distance to go and I hope we go that distance. Obviously it’s a decision for politicians to make, not me, but I can’t change who I am. I am a localist and that’s what you get.”
Other changes he’s noticed in central government – since his short stint as private secretary to the housing minister, from 1994-95 – include a willingness among departments to work together more. He himself, for instance, has “programmes with DfE, MoJ, the Home Office, DCLG, MoD, and I find none of these relationships obstructive or difficult; I find them enjoyable.”
Rouse has also noticed that the civil service has become “much more professionalised”, and that “there’s much more of an emphasis on delivery than there was when I first arrived; I think there is a better balance between policy and delivery.” The two, however, “could still be better integrated”, as “people still tend to put themselves in either a policy box or a delivery box.” Asked whether he believes the policy-delivery split makes sense, he says: “No. My personal view is that you’ve got to see the whole thing as a continuum.”
Rouse is a strong believer in connecting with the frontline. During his time at Croydon council, he performed frontline duties once a month – spending days working as a bin man, a caterer and a caretaker. Now based at DH, he enthusiastically participates in the ‘Connecting’ initiative, which involves 20 days a year on the frontline.
The programme has been ridiculed in the press, but Rouse is certain of its benefits: “It completely changes the conversation. Of course, you’ve got to be careful that you don’t tend to policy by anecdote, because you still need the evidence base, but it does lead to a much better-balanced discussion. It becomes far less theoretical; and I think it’s very healthy.”
We’ve long finished our mains – my delicious fillet steak and Rouse’s traditional shepherd’s pie. But Rouse can’t stay for dessert. He’s off to chair a meeting. “We’re trying to put together a public-private financial vehicle for dementia research,” he explains. These partnerships, he says, “are always difficult because you run into all sorts of legal issues trying to combine two very different types of money.” Despite his appointment, he seems relaxed and makes no attempt to leave. “Have you got enough?”, he asks. “More than I can fit in!,” I reply. And he goes on his way: off to make some more connections between the public and the private; the national and the local; and the strategic and the frontline.