CASE STUDY
Delivering sustainable discharge and flow improvements across East Surrey
Delivering sustainable discharge and flow improvements…
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Changing the conversation about adult social care
A new way of managing demand with a genuine focus on outcomes with Cambridgeshire County Council and Peterborough City Council
June 2018 – September 2020
Identifying new opportunities to improve outcomes and save money
IMPOWER worked with Cambridgeshire County Council and Peterborough City Council’s adult social care service to support the development and delivery of their transformation programme, the Adults Positive Challenge Programme, to help people remain as independent as possible in their communities (and with support from them).
This work included the design, testing and rollout of a number of demand management interventions focused on early intervention and prevention, and linking people into their communities to improve people’s outcomes by maximising independence at every interaction.
Through building a clear picture of demand flow and activity and an avoidable demand analysis, the initial diagnostic uncovered a range of opportunities to better manage demand and improve outcomes – helping start a conversation about ambition.
Creating confidence in seizing these opportunities
Applying a test and learn approach, we worked alongside frontline teams to shape initial trials within priority opportunity areas. Early trials included:
- Reconfigure to signpost for self-help rather than default to request for an assessment (Staying independent and well is the first page you see on arrival) and enhanced the content around early help and intervention
- Reshaping and rewording of the council’s adult social care webpages through a behavioural science lens and more effectively signpost to community support
- Working with Older People Locality teams and Physical Disability team to design and test the ‘Changing the Conversation’ approach (applying a strengths-based approach and behavioural science techniques in assessments and reviews)
- Trialling a Technology Enabled Care (TEC) -first approach and promoting TEC at every opportunity
The early proof of concept work enabled us to test the potential scale of impact quickly and capture learning, so we could adjust as needed before rolling out the approach more widely. At the same time, we worked with the leadership team, Transformation, Finance & Business Intelligence colleagues to refresh governance arrangements and agree and set trajectories to understand the impact of interventions.
Impact
Building on learning from initial trials, our team worked alongside the service, transformation team and dedicated Change Champions to further develop and roll out the Changing the Conversation approach and build skills in strengths-based practice and applied behavioural science. This was supported by a model of peer support and challenge which introduced ‘huddles’ to create space for reflection, sharing of good practice and ideas.
As the Adults Positive Challenge Programme developed, new workstreams in opportunity areas (including reablement, carers, and preparing for adulthood) were established. We also introduced our Trajectory Management approach to demonstrate the impact of demand-led interventions across the customer journey, at both workstream and programme level.
Programme impact:
- By the end of the first full year of the programme, Cambridgeshire had seen a reduction in the number of community contacts received due to improvements in public facing advice and information
- £5.81m of cost avoidance and savings across adult social care in Cambridgeshire
- Contacts for new clients per 100,000 of the population increased by 37% between 18/19 and 19/20, yet the numbers receiving long term care and support funded by the Council per 100,000 only rose by 1.2%.
- In 19/20 395 people received TEC which would avoid or delay an admission into residential care
- In the CCC Older Persons and Physical Disabilities teams Changing the Conversation has had an impact in 60% of the assessments and reviews they are undertaking
- Where Changing the Conversation has had an impact during a review, it is 4.5-7.5 X’s more likely the review will end in a decrease or avoided increase (rather than no change or an increase)
Creating a more resilient client organisation
The Adults Positive Challenge Programme has changed the way transformation is delivered in Cambridgeshire. This has included improving how intelligence (data and insight) is accessed and used to track change delivered and impact achieved, as well as how the workforce is engaged in change and equipped with the skills and tools to improve outcomes for people.
The practice and approach developed and embedded through the Adults Positive Challenge Programme also provided a strong foundation for the council’s Covid response – from governance arrangements to support rapid decision-making, to combining data with community intelligence and the lived experience of residents – going where the need is in ways that make most sense to people, to embedding the peer support and reflective practice that enabled teams to connect and problem solve.
The core approach, changing the conversation, went on to be used as a key framing for discussions across the council and beyond of how complex services could be improved. It was adopted to reframe the ambition and then drive improvement in SEND/high needs and also was instrumental in influencing relationships with health partners across the system.
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