Delivering better outcomes, better lives in Manchester

Working with Manchester City Council and Manchester Local Care Organisation to deliver sustainable transformation for the citizens of Manchester

January – September 2021

89%

of hospital admissions and bed days avoided through interventions of Care Navigators

c.40%

reduction in delayed discharges

Reframing the problem

Task

Impact

What new opportunities to improve outcomes and save money did we identify?

Manchester is no stranger to pushing the boundaries with innovation in . Adult social care in Manchester is pioneering, but the challenges are stark. The city has some of the most challenging population health outcomes and inequalities in the country, and is operating against a backdrop of needing to reduce costs by c.20% (£18m) over the next three years. These challenges have been impacted by the complex effects of Covid, which are continuing to play out both locally and nationally.

IMPOWER was commissioned by Manchester City Council (MCC) and Manchester Local Care Organisation (MLCO) to identify opportunities to prevent, reduce and delay demand for long-term care, focusing on providing the right support for citizens – in the right way, at the right time. We co-designed a whole-system, sustainable transformation plan owned by social care and health colleagues. In January 2021, this work transitioned into an ambitious delivery programme: Better Outcomes, Better Lives (BOBL).

How did we approach the task and what did we do?

IMPOWER worked as a blended consultancy and client team, using our health and social care ‘5 Fast Forwards’ to mobilise key workstreams. Our focus is on delivery execution and delivering change through prototyped interventions – start small, iterate and scale – driven by a vision. Priority areas for year one were:

Working with frontline teams to embed strengths-based practice using behavioural change techniques – supporting frontline practitioners through the change process, and developing ‘Communities Practice’ to support self-reflection – an opportunity for groups of practitioners to meet and reflect on their practice using individual cases they have been involved in.
Developing a commissioning plan and managing the interface between commissioning and operational staff to build relationships, capture learning and feedback, and resolve any commissioning challenges.
Developing a primed performance framework throughout the organisation that enables Adult Social Care to have a clear evidence base for decision making, to interpret and act on the evidence to improve services.
Developing a vision with frontline practitioners within reablement and Technology Enabled Care (TEC) services, identifying and delivering a range of prototyping opportunities to test, evaluate and scale key areas of change in delivering the vision.
Supporting the wider communication of the programme to build momentum for change.
Developing governance infrastructure to ongoing decision making and prioritisation processes, including a regular assessment of the conditions for successful change, with mitigating actions to improve those conditions.

What impact did our work have?

Nine months into a three-year change programme, the programme is already delivering sustainable change, receiving positive impact from frontline teams and having a positive impact on improving people’s lives. Key highlights include:

A 4% decrease in commissioned homecare hours in the South Manchester locality (April – July 2021), which has been pioneering the BOBL programme since February, bucking national trends of increasing challenges with homecare demand.
Residential and nursing care admissions remaining low, with a less than 1% increase since April – evidencing that people’s independence is being supported in less restrictive settings.
Monthly TEC applications steadily increasing from c.15% in March 2021 to over 25% by August 2021 in the South Integrated Neighbourhood Teams – demonstrating that alternative support options are being utilised.
A 21% increase in referrals into reablement from a community setting (April – July 2021), indicating a more proactive and preventative approach to support citizens to live safely in their homes for as long as possible.
In July 2021, the number of completed carers assessments exceeded the three-year average by 14%, indicating that carers are being better supported to have sustainable and fulfilling caring roles.
A cultural shift towards strengths-based working. Between 31 May and 3 September, 97% of social workers reported that taking part in the BOBL programme’s ‘Communities of Practice’ had helped, or partly helped, to develop their strengths-based practice.

Core to embedding change at the front line has been an absolute alignment between a confident Senior Leadership Team, Heads of Service and frontline teams, working together to deliver integrated health and social care to improve outcomes for Manchester citizens.