Reflections on ADASS Summer seminar and the session I co-presented: ‘How to deliver good adult social care - despite Covid’
Guest blogpost written by Adenike Tilleray, Head of Business Management, Adults’ Services, Ealing Council
It is January 2020. A brand-new year and a brand-new decade. As I sit here, during these early days of being back in the office after a relaxing Christmas break, I must admit, I am digging deep. To find that clarity, to set the right goals, and consistently work towards them. I know I am not alone. If you are reading this, Happy New Year, and I am sure you can relate. The end goal is shiny and enticing, although a niggling narrative can often get in the way, one which asks “but is it possible?”
I remember the same challenging dialogue with my colleagues and IMPOWER over 2 years ago, as we embarked on an ambitious transformation programme and launched the Better Lives adult social care programme in Ealing. I remember the diagnostics; the good, the bad and sometimes ugly home truths. I remember the compelling logic of the leveraging all available opportunities.
Better Lives aims to keep people healthy, active and independent for as long as possible. A focus on independence and community connections is better for outcomes. The plan was that we could appropriately prevent, delay and reduce dependence on long term care as we manage growing demands with limited resources, and shift practice and provision to build on support within local communities. Makes a lot of sense, right?
But in those early days, when I looked at the targets on that graph, in all honesty, it felt like an impossible trajectory.
Moving through that apprehension felt just like setting a New Year’s resolution. It took more than a leap of faith too, although that did play a part!
Today, 2 years later I am looking at the downward line on our ‘spend per day’ graph, which shows the art of the possible. In our case, the evidence is clear; Better Lives has been a successful change programme.
Are we spending less? Yes, and by a long mile. There are times when we run the reports and blink at each other in amazement.
But bean counting is not the sole measure of success. If you work in social care the feeling of there not being enough beans to go around, period, may well resonate with you. Instead, I believe the real success has been in a fundamental and sustainable change in practice. IMPOWER helped us to tackle the financial challenge through the lens of culture change. They were right to do so because, to quote Barry Quirk, “culture eats strategy for breakfast”. Recognition of this was the catalyst in the hearts and minds challenge of transformation in Ealing. With IMPOWER’s support, we were able to do what felt impossible by focussing on the all the little things that, over time, have a big impact. You know, the stuff like our values, our strengths and connections, our motivations, conversations, behaviour and reflective practice.
Sure, we have had to do the very essential gritty stuff too. To be honest, at first it was easier for me to commit to measuring stuff than it was to believe our programme would work. I threw myself into the “do, check, review” cycles, reporting, and keeping a firm grip on time, task and performance. But again, it was totally worth the effort. This work enabled me to prove that we have delivered a 40% reduction in demand, over £1m cost avoidance from a 10% improvement in reviews and are now forecasting an underspend for the first time in a probably a decade.
This is a much better place to be in as we look ahead to the challenges of a new financial year. But the real engine of change has been in finding ways to align our response to the financial challenge with the goals, values and behaviours of the people who work here, and their commitment to the people we support. I am proud to say that we have achieved that; user surveys tell us that overall satisfaction has remained above 80%, and that there are increased levels of satisfaction with the amount of control people have over their daily lives. We have received fewer complaints than the year before. And internally, over 80% of the Ealing staff we have surveyed felt that Better Lives has had a positive impact on their work. That’s progress.
Looking back, I am grateful to IMPOWER for their insight and support. Working with them was a valuable lesson in how to engage with change, to do the work and ….trust the trajectory we are aiming for! In fact, even though the IMPOWER team left Ealing a year ago, we still keep in touch and they continue to celebrate our wins and reflections. It is great to know they are still invested in what has become possible. Looking ahead to 2020, my resolution is to keep that magic alive.