Guest blogpost on Ealing's adult social care transformation programme and their incredible 'spend per day' reduction.
A few weeks back, IMPOWER brought together representatives from 13 different local authorities for a Shared Learning Event on transitions between children’s and adult services, to share their experiences on this issue and to think collaboratively about solutions to the challenges they face day-to-day.
The event was made all the more valuable by the range of experiences and perspectives in the room, and discussion on the day generated some important insights relating not only to the specific challenges identified but also to the subject of transitions more broadly.
- There is a need to build trust and understanding across service and organisational boundaries through agreeing shared vision and accountability for young people’s outcomes;
- This must be supported by a change in the behaviours of frontline staff, through enabling them to focus on outcomes and to work with partners outside of their service;
- Work is also needed to understand the expectations of families, who often feel they have been fighting the system every step of the way, and to begin having different conversations that are more collaborative and outcomes-focussed;
- There is also a need to acknowledge that outcomes and costs cannot be understood from a service perspective, but must be measured across a lifetime, to enable more effective joint working and meaningful performance management.
The 5 Fast-Forwards for Social Care
Discussion on the day was structured around an approach we set out in our recent report 5 Fast-Forwards for Social Care. In the report we argue that there are 5 fundamental shifts that leaders in adult social care need to make to change their systems for the better and create a sustainable model. These are:
- Reframing ambition by widening our understanding of the problem, building trust, relationships and inclusive ambition across traditional service and organisational boundaries
- Delivering at the frontline by empowering the workforce to focus on outcomes and enabling them to make choices on the basis of both social purpose and system performance
- Understanding and changing behaviours of staff and those we work with to embed new ways of working
- Managing interfaces by developing solutions that bridge boundaries between organisations, people and processes
- Managing trajectories by shifting to a different type of performance management and governance that supports proactive decision-making that is outcomes focussed and evidence based
These 5 shifts reflect the fact that adult social care is a ‘complex’ system, not a ‘complicated’ one, and are based on our EDGEWORK approach. Bringing about sustainable change in a complex system requires recognising and managing that complexity, and co-producing solutions across organisational boundaries.
We worked with those in the room to apply this approach to some of the most urgent issues public sector organisations face each day around transitions.
What are the challenges facing professionals working on transitions?
We began by asking participants to give us a long list of challenges, most of which will come as no surprise to anyone working in this field, and none of which are straightforward to resolve:
|Lack of joint working||Culture of ‘caring for’|
|Information sharing with families in schools (and managing expectations)
|Transition is not ‘young people-led’||Siloed working between children’s and adult services – no lifelong service|
|Transition planning happening too late
|Commissioning model is hours-led rather than outcomes-led||Lack of opportunities to build key life skills|
|Sufficiency and diversity of the market
|Lack of supported employment options||Councils and staff wrapped up in ‘the day job’|
|Different legislation for different agencies and teams can lead to conflict and barriers
|Gap in transition support for young people with lower-level needs but who still need help||Lack of preventative support and funding for this|
|TEC not used enough within children’s services
|High staff turnover leads to inconsistent support||Lack of clarity around roles and responsibilities – need for shared ownership|
Three of these challenges were then identified as priority issues, and teams applied the 5 Fast Forwards approach to identify ways to address them. The priority issues were:
- Siloed working between Children’s and Adult Services
- Commissioning – shifting from a focus on hours to a focus on outcomes
- Lack of options for supported employment
Applying the 5 Fast Forwards: lack of options for supported employment
In three groups, we worked to apply the 5 Fast-Forwards to each of the priority issues. The table below presents the ideas and solutions from one of the groups, which discussed tackling the lack of supported employment options.
This was seen as an urgent issue for attendees, who saw low levels of ambition and limited supported employment options locally limiting young people’s progress and leaving them more dependent on social care in adulthood as a result.
|Lack of options for supported employment:
|Delivering at the frontline||
|Understanding and changing behaviours||
This table illustrates the breadth of potential solutions that can be developed and explored when those working in the sector have the opportunity to come together and discuss some of the biggest issues. We look forward to the next Shared Learning Event in March 2020; do let us know if you’d like to be involved.