Happy, Healthy and at Home in Bradford

Empowering staff on the frontline to work with greater freedom and empower vulnerable citizens

June 2018 - June 2020

32%

increase in contacts diverted to information and guidance by front door

£3.2m

reduction in overall spend

15%

reduction in residential care placements delivered across all services

“It is clear that all the main agencies have bought in to the partnership, with some positive results to show for it… a lot of work has gone in to forming and developing relationships which is already producing better outcomes.”

Professor Steve Field, Chief Inspector of Primary Care Services, Care Quality Commission

“…. there was a clear shared and agreed purpose, vision and strategy described in the Happy, Healthy [and] at Home plan…CQC found that most staff were committed to the vision – whether working in adult social care, primary and secondary care sectors, or in the voluntary sector.”

Care Quality Commission press release on a local system review of Bradford

Task

Reframing the problem

Key insights

Change at the frontline

What was IMPOWER tasked to do?

Faced with the twin challenges of rising demand and dwindling resources, Bradford embarked on a bold new approach. The Happy, Healthy and at Home programme was launched as a new vision for wellbeing – one that empowers staff on the frontline to work with greater freedom and, in turn, empowers vulnerable citizens.

IMPOWER was initially brought in to work in partnership with the council to help support this vision and facilitate the changes required across the health and care system. As the impact and early benefits of the work became apparent, IMPOWER extended support to a cross-council programme tasked with understanding parts of the broader system driving demand for services. This programme also identified wider opportunities to deliver better outcomes for the District and helped reset transformation priorities.

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

Building on the success of new council initiatives (introducing strengths-based practice, delivering community led social work and an early help and prevention pilot), IMPOWER helped the council uncover the scale of opportunity to drive greater independence for people accessing services and deliver sustainable care and support services in Bradford.

Creating a picture of demand, understanding what is avoidable, and engaging staff across the department to identify opportunities for greater independence helped reframe the ambitions of adult social care so that the focus is now on maximising independence across the service (including the front door, enablement and long-term care).

The approach focuses on helping people to make more informed decisions about their support needs, embedding early intervention that builds on people’s natural networks of support, and putting people with long-term support needs at the heart of decision making. This strategy has resulted in fewer long-term care packages, supporting a reduction in spend on higher cost support.

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

At the start of the programme:

35% of demand was avoidable
Too many people were being placed in care setting when remaining in their own home would deliver better outcomes
90% of reviews resulted in no change
Staff were well engaged and open to change with 90% stating they want to promote independence

Early impact of the new approach was seen during the programme:

An increase in calls resolved at first point of contact. The Independent Advice Hub introduced a three-week call back to clients, which showed 90% don’t need any further help – but it catches the 10% that would otherwise slip through the net and enables them to give them further advice/support.
More than 500 strengths-based reviews were carried out:
- 27% of home support reviews agreed a decrease or ending of packages and resulted in improved outcomes.
- 32% of learning disability reviews resulted in reduced packages, greater independence, and improved outcomes.

Learning from the approach in Health & Wellbeing was applied to a cross-council project to identify wider opportunities to deliver better outcomes.

A series of workshops conducted across the council resulted in the generation of over 300 ideas (and a clear set of cross-cutting themes) to shape a council-wide transformation programme.

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

From the very start of the work, council staff and the IMPOWER team worked side-by-side to design, test and embed new approaches. This included working closely with frontline teams at the front door and in localities.

Using a range of tools and techniques, conversations were transformed to focus on outcomes and maximise independence in listening and building on individuals’ strengths across the journey in adult social care from initial contact to review – from when people first got in touch with the council to talk about social care through to a review conversation of current care and support package.

The approach was enhanced through embedding peer support and review. Social work teams come together on a regular basis to share ideas, experiences, and knowledge to improve the outcomes for people, highlight any challenges to enable quick resolution, and unlock best practice.

How did we help the client to apply behavioural science, and what did this achieve?

Applying our EDGEWORK methods, unique insights to behavioural science and understanding of the complex nature of adult social care, IMPOWER worked with frontline practitioners to help change the way citizens engage with services, with a focus on prevention and early intervention.

The team worked with staff to explore strengths-based language and behavioural science techniques, design new tools to support participation, and identify opportunities to draw on community-based support and greater use of technology.

How did we help the client to manage trajectory?

IMPOWER introduced Trajectory Management, working with council colleagues in Business Intelligence and Finance and engaging managers and teams. This involved developing and setting clear trajectories across the department and rolling out a performance management approach to embed regular conversations about performance and data in ensuring a clear understanding of performance at team, service and department level and insight-led decision-making. This was supported by the development a performance dashboard, led by the council’s Business Intelligence Team, to provide practitioners, team managers and senior leaders with a real-time view of service demand, costs and outcomes.

What impact did IMPOWER’s work have?

From being the default option, long-term care is now regarded as the last resort and the Happy, Healthy and at Home Programme is helping more citizens get the support they need, remain independent and improve outcomes.

The impact of the programme has seen improvements in outcomes for local citizens and direct impact on services delivery:

87% of contacts diverted to information and guidance by the Independence Advice Hub (from a baseline of 55%)
15% reduction in residential care placements delivered across all services
Home support hours have reduced by 7,000 or 7% between October 2019 and February 2020
An overall spend reduction of £3.2m

What was good about this project? What was the key to its success?

Delivering sustainable change at the frontline and empowering staff to work in new ways was dependent on engaging staff from the outset – in identifying the scale of opportunity, shaping priorities, and designing initiatives.

This has been a true delivery partnership. The programme is led by the council, was co-designed with and delivered by staff and has people at the heart of it – all of which has been fundamental to its success.