IMPOWER is working with the London Borough of Ealing to transform Adult Social Care. This involves reducing spend and improving outcomes for the people of Ealing by using a strength-based approach to maximise the independence of service users.
Three stages of activity have taken place since April 2017: an Avoidable Demand Analysis to understand how demand could be reduced and establish the impact on spend; a short Programme Development stage that included trialling new approaches with teams; and, since September 2017, delivery of the council’s Better Lives transformation programme.
When IMPOWER started this work with the council, they had exhausted traditional supply-side cost reduction approaches. We enabled them to refocus on managing demand, in large part by reframing their approach to social work by adopting a strength-based approach. Our working hypothesis was that we could reduce cost and improve outcomes by changing the behaviours of staff and service users, and this has proven to be correct.
The first stage of activity was focused on analysing avoidable demand through a combination of case reviews, data analysis, benchmarking and observations.
The case reviews were critical. Ealing’s social workers looked at a sample of cases from across the service, focusing on whether care packages could have been reduced, delayed or even prevented from entering social care. Key findings included:
This clearly evidenced that there was avoidable demand within adult social care.
We used a strength-based practice approach with three teams (an older adults locality team, the Independent Living Team and the Contact Centre) to trial a new practice approach. We provided materials, training and coaching to change the behaviours of both staff and service users, in order to maximise the independence of service users. Care was taken to refine an approach that worked for Ealing – a distinct ‘Ealing Way’.
To embed the approach with other teams, we involved team managers and senior social workers using a ‘train the trainer’ model. We ran sessions with them so they understood both the approach and how to manage change in their teams, then supported them to roll this out. We supported the approach in various ways, including by developing a new set of forms for social workers that have radically changed the way they operate. The forms promote strength-based working and are significantly shorter than previous versions.
One of the programme’s workstreams focussed on the interface between the adult social care service and its health partners. We undertook a project to understand how demand was driven across health and social care – from people entering Accident & Emergency all the way through to requiring a social care package. This helped create a shared view of the challenges and opportunities.
The success of a programme like Better Lives is dependent on (as one of the Ealing management team put it) making sure the front-line staff understand ‘the small decisions that will affect the big numbers.’
Trajectory Management is key to this, and helped the client in two ways. First, it put in place a management-level finance and performance reporting cycle that enabled key decisions to be made based on information about Ealing’s adult social care system as a whole. Second, we through the use of a Primed Performance Management system it enabled the council to drill right down to understand how teams and team members are performing, what is working and what needs to change.
Developing these systems was the (relatively) easy part. The critical activity has been working with people across the service to analyse, communicate and act upon the data.
As of November 2018, there has been a significant shift across several key performance indicators: