Maximising independence in adult social care

Maximising independence in adult social care: London Borough of Ealing

April 2018 onwards

£4m

directly saved (plus £6m indirectly saved) through the Better Lives programme

54%

reduction in referrals from the contact centre to specialist services

13%

increase in service user reviews, meaning that more people are receiving support relevant to their current needs

“As a result of IMPOWER’s work, we have seen change across the service. Spend has stabilised, we have improved understanding and grip on activity, and a consistent way of delivering social care. My high expectations have been met, and my directorate is in a far stronger position than 18 months ago.”

Judith Finlay, Executive Director for Children, Adults & Public Health, Ealing Council

“The difference when working with IMPOWER is that they genuinely work with you, seeking solutions that work with current systems and using the skills of the staff delivering the business. They don’t set themselves up as experts, but encourage others to develop solutions. If they spot something wrong, they challenge in a constructive way. Their inheritance will live on, and I have really enjoyed my time working with them to deliver real and sustainable change.”

Kim Carey, Interim Director of Adult Services, Ealing Council

Task

Reframing the problem

Key insights

Change at the frontline

Managing interfaces

Managing trajectory

Impact

What was IMPOWER tasked to do?

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.

How did we help the client to reframe the original problem?

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.

Were there any key pieces of information, analysis or insights that changed the course of the project or which our recommendations relied upon?

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:

65% of cases in Older Adults could have been prevented
64% of packages in Learning Disabilities could have been reduced
55% of cases in Physical Disabilities could have been delayed

This clearly evidenced that there was avoidable demand within adult social care.

How did we help the client to deliver change at the frontline?

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.

How did we help the client to manage interfaces? (boundaries between organisations, people or processes)?

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.

How did we help the client to manage trajectory?

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.

What impact did our work have?

As of November 2018, there has been a significant shift across several key performance indicators:

The Better Lives programme has directly saved £4 million through review programmes and reducing placement spend, and indirectly helped to save a further £6 million, through management actions such as securing funding from partners, increasing income from service users eligible to pay and reclaiming payments that had not been used.
40% reduction in contacts to the front door over the last 12 months through more effective contact routes
54% reduction in referrals from the contact centre to the service over the last 12 months because of more effective signposting and use of strength-based conversations
13% increase in service user reviews, meaning that more people are receiving support relevant to their current needs. On average there were 349 such reviews per month in 2017/18, and this increased by 12% in the first four months of 2018/19 (to an average of 392 per month).