CASE STUDY
Delivering sustainable discharge and flow improvements across East Surrey
Delivering sustainable discharge and flow improvements…
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Maximising independence for adults in Lincolnshire
Changing culture, behaviour and practice in Adult Social Care to deliver better outcomes
August 2020 - present
Identifying new opportunities to improve outcomes and save money
Lincolnshire County Council (LCC) began working with IMPOWER in mid-2020 to identify opportunities to improve outcomes and maximise independence for individuals across the care pathway, through delivery of the right interventions and approaches.
The potential impact of the pandemic on demand and costs, combined with a lack of clarity over future funding, created an uncertain picture for the future. Adult Care in Lincolnshire had been recognised as a strong performer across some areas, but they recognised the need to prepare for future challenges – and had an ambition of moving from ‘good to great’.
IMPOWER completed analysis of demand across the adult care journey:
- Analysis using the IMPOWER Index suggested that Lincolnshire is delivering better than average outcomes at lower than average spend in adult care, compared to other local authorities.
- However, the Adult Social Care Financial Return (ASC-FR) showed that LCC received 7% more contacts and signposted 16% fewer contacts at the front door than statistical neighbours (19/20).
- The SALT team also received 76% more contacts from hospital per 100,000 than the national average (19/20).
- Around half of staff did not feel confident in applying strengths-based approaches in their conversations (Lincolnshire Staff Survey).
- Case reviews completed by LCC practitioners identified an opportunity to prevent, reduce or delay the requirement for long term support in 21% of cases. (73 cases reviewed by 10 practitioners)
- LCC was one of the highest performing in terms of number of reviews completed (SALT team 19/20), but 89% of these result in no change.
This work demonstrated the opportunity to change culture and behaviour across the service – within operational teams and among partners, and to establish a system-wide focus on supporting individuals to maximise their independence.
Creating confidence in seizing these opportunities
IMPOWER supported Adult Care to develop a new vision and ambition with a focus on supporting people to ‘stay as healthy, safe and independent as possible during all stages of their life’. To deliver on this ambition, using IMPOWER’s EDGEWORK® approach, a programme of work was launched with a focus on changing culture, practice and ways of working. This ranged from reframing digital information, advice and guidance to promote independence, through to embedding strengths-based approaches in practice by empowering practitioners to work differently.
The work began in September 2020 with a trial intervention in the ‘front door’ to Adult Social Care – the customer service centre (CSC) delivered by a commissioned partner (Serco). IMPOWER worked with the service’s staff to shift the focus of their conversations towards recognition of an individual’s strengths, and the opportunity to resolve issues at the first point of contact through a strengths-based approach and using applied behavioural science techniques.
In this initial phase IMPOWER also worked with a mixed team of Learning Disability and Mental Health practitioners to develop and apply strengths-based approaches to annual review conservations, supporting teams to co-design approaches and tools. The teams involved in this work supported each other to embed a shift in practice through regular peer support and challenge in ‘huddles’ – now incorporated into the way teams operate.
Following the success of these trials IMPOWER and LCC worked with a wide range of frontline teams across the care pathway to embed strengths-based approaches in practice and ways of working, aiming to maximise independence and improve outcomes for individuals. This work also included:
- Making Technology Enabled Care (TEC) part of a strengths-based approach to practice: Initial trials of a ‘TEC first’ approach supported staff to consider the range of TEC available from providers and within many individual’s homes, and how this can be used to maximise independence and strengths. These trials demonstrated the potential impact of TEC to a strengths-based approach, and the approach and model used has been scaled up and rolled out across teams.
- Developing a ‘Primed Performance’ approach: IMPOWER supported Adult Care to develop a new performance approach and metrics at a team, service and departmental level – focused on understanding performance against the overall ambition of maximising independence and improving outcomes. This has also involved work with different teams and senior managers to set, track and manage future trajectories for cost and demand, and to embed a different way of using and acting on performance data and intelligence.
Impact
Through scaling successful approaches and interventions across the Adult Care and Community Wellbeing (ACCW) service and care pathway, this programme has delivered demonstrable impact on outcomes, demand, practice and behaviour at a system level:
- The overall number of people in receipt of long-term support is decreasing each quarter – more than 400 fewer people are receiving long-term support than at the start of 2021-22.
- Previously, 1 in 5 people were referred to ASC operational teams at the front door. Through improved conversations at the front door in 2021-22 this has reduced to 1 in 10.
- Care Act Assessments which lead to long-term support have also fallen from an average of 39% during 2020-21 to 12% in Q3 of 2021-22.
- As a result of the Improvement and Development Programme, ACCW are on track to deliver targeted savings in excess of £1.8m between 2022-25.
These system-level achievements built upon impact demonstrated through a range of interventions trialled and evaluated in the initial phase of the programme:
- A 68% overall reduction in customer service centre (CSC) Front Door conversations leading to a referral to ASC teams (53% of conversations initial trial baseline, ongoing reduction to 17% of conversations by six weeks after roll out complete). (Trial was held Sept – Nov 2020)
- A 100% increase in Wellbeing Service conversations resulting in information, advice and no further action during the initial six-week trial (from 17% of conversations in week 1 to 34% of conversations in week 6, recorded through impact logs). (Trial was held Feb – Apr 2021)
- Signposting was increased by 142% following initial conversations/assessments in the Louth Adult Frailty and Long-Term Conditions team (33% of conversations in week 1 to 80% of conversations in week 6).
- 22% of Adult Frailty reviews resulted in decrease in support needed or avoided an increase in support in West Review team. (Jan – Feb 2021)
- And an average of 10% Learning Disability reviews resulted in a decrease in support needed or avoided an increase in support. (Data taken from two trials and rollout, Sept 2020 – July 2021)
- Staff involved in strengths-based approaches workshops and huddles report feeling more empowered and more valued in their roles. 95%+ of practitioners have reported finding strengths-based approaches and tools useful for their conversations.
Creating a more resilient client organisation
In addition to delivering impact for individuals, IMPOWER have supported LCC to create a more resilient system, that is responsive to changes in demand across the care pathway. Key to this has been IMPOWER working in partnership with teams in Adult Care to build the knowledge, skills and capability to deliver and scale successful interventions and approaches, and to deliver continuous improvement in Lincolnshire. This has included:
- Supporting, developing and training an integrated LCC delivery team with staff seconded from the workforce development team and social work teams. Initially this team worked alongside IMPOWER to support the roll out of interventions and approaches, before fully handing over responsibility for this to the team, with continued coaching and support from IMPOWER.
- A group of staff focused on managing digital information and guidance have been upskilled in applying behavioural science and a focus on maximising independence across key adult care digital content. The group has continued to make further changes to online support and guidance, to support the new vision and focus on maximising independence.
- A new performance and intelligence approach has been developed with frontline teams. This framework allows LCC to understand the impact the programme is having at a strategic level, and is supporting teams and managers to understand the day-to-day contribution of their work towards the new ambition.
In Autumn 2021, LCC and its key partners recognised the opportunity for applying the learning from this programme to support a system-wide focus on maximising independence across the health and care system. IMPOWER are now supporting multi-disciplinary teams in acute hospital settings to trial interventions using a strengths-based approach and applied behavioural science – to improve outcomes and support more individuals to return home with the right support, and to prevent admission to hospital.
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