Transforming adult social care in Suffolk

Our work enabled the council to identify that 41% of demand was avoidable, with potential savings of £11 million

May 2018 - April 2019

41%

of demand identified as avoidable

£11m

Potential savings identified

“IMPOWER were able to engage with our workforce in a way in which we could not, providing an objective view and engaging with staff positively following an organisational restructure.”

Tracy Lindeman, Assistant Director, Suffolk County Council

“Our work with IMPOWER identified a greater level of opportunity than we had expected and IMPOWER provided us not only with a summary of the opportunity, but a list of activity to contribute towards realising this.”

Phil Quickenden, Senior Manager Lead – Demand Management Programme, Suffolk County Council

Task

Reframing the problem

Key insights

Change at the frontline

What was IMPOWER tasked to do?

Like many local authorities, Suffolk County Council was facing significant challenges in relation to its Adult and Community Service (ACS). IMPOWER was initially tasked with helping Suffolk to identify a series of potential target demand scenarios in ACS. This work demonstrated there was significant potential to reduce demand volumes and in doing so make savings of up to £11 million. In the second phase of work, IMPOWER provided targeted support around culture and behaviour change in order to ensure the right conditions were in place to sustain change over the longer term.

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

The council felt they had introduced traditional demand management approaches but were still not seeing the benefits in either improved outcomes for people or financial savings. We reframed the problem by enabling them to understand why strengths-based practice was not being applied by frontline staff, and how more effective demand management (at the pre-front door and front door) could free up capacity at all stages of the customer journey. This allowed staff to have longer and more effective conversations with customers, with the explicit aim of maximising their independence. An additional benefit of the work was that it helped re-shape and reframe the entire ACS demand management programme, with the client ulimately deciding that all projects should work towards the same goal of improving outcomes and reducing cost, rather than demand management being one project operating in isolation.

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

41% of demand was avoidable – case reviews showed 41% of people dependent on ACS could definitely or probably have had their needs prevented, delayed or reduced had an optimal early intervention and prevention system been in place.
30% of staff thought they did not work well with health partners, and improving community resources and information about ACS and other services was identified as being a way of preventing demand.
39% of staff viewed the role of ACS as ‘providing services that people ask for’, with issues including the website driving people towards council services, the language used during conversations enhancing dependency, and reviews not identifying opportunities to reduce care packages.
Key messages about the focus on maximising independence had not filtered down from the leadership team, and as a result there was a lot of resistance to the work we were doing. Planned activities were therefore flexed to focus on engagement and sharing the thinking around why demand management is important. This resulted in some really rich and honest conversations with frontline teams and helped enabled the work to progress as originally planned.

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

IMPOWER consultants were embedded within the council’s demand management team, allowing them to work closely together. This enabled genuine collaboration on both project deliverables and on other relevant activities, such as drafting communications to staff about the programme, shaping the programme governance, and introducing more considered language in AF1 letters being sent to customers. Frontline staff were engaged by facilitating demand management workshops with staff from across the service to share insights, identify opportunities and change behaviours in order to prevent, reduce or delay demand.

How did we help the client to manage trajectory?

Trajectory Management Our approach to benefits realisation in a complex system – enabling primed metrics to be tracked over time and providing an overview of system improvement. was pivotal to:

Enabling the leadership team to track the impact of the demand management programme. This approach uses Primed Metrics to give a clear line of sight between delivery and financial savings, moving away from retrospectively monitoring savings lines in a spreadsheet to proactively seeing problems as they occur.
Co-designing a performance dashboard for team managers to help them support their teams in terms of strength-based practice and workload management. Enabling team managers to use data to identify pressure points within their teams and to guide supervision resulted in increased understanding of an outcomes focus and the wider demand management programme.

“The concept of Trajectory Management has allowed us to monitor the impact of a huge volume of activity with much greater confidence, in particular where different pieces of work had differing effects on the same budget.“

Phil Quickenden, Senior Manager Lead – Demand Management Programme, Suffolk County Council)

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

Behavioural science was central to the success of the project. For example, a behavioural lens was applied to the existing AF1 template letter This letter is sent out to customers to request an update on their financial situation. in order to improve the response rate. Historically, the response to these AF1 requests was poor and the letter was therefore rewritten using a MINDSPACE approach:

MESSENGER: Changing who the letter comes from, so it is signed by the client’s social worker rather than the general ‘Fairer Payments Team’.
INCENTIVES: Describing the consequences of the recipient not responding to the request to complete an AF1 form.
NORMS: Normalising the response required by saying that most social care applicants in Suffolk complete this letter easily and on time.
SALIENCE: Formatting the letter to make it completely clear what the recipient needs to do in response to it.
PRIMING: Reminding the individual what the council has promised to do for them.
COMMITMENT: Reminding the individual that they committed to fill in the form when they became a recipient of social care support.
EGO: Telling the person they are a trusted and valued local citizen and by completing this form they are helping keep their community services running.

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

IMPOWER facilitated conversations between the council and health partners across the 3 regions in Suffolk, to help build appetite and momentum for taking a demand management approach through the health pathway. These discussions have led to the council and health partners actively taking forward initiatives to better understand and influence demand flowing into and through the acute hospitals in Suffolk, which will ultimately lead to wider system benefits and improved outcomes for patients and service users.

What impacts did our work have?

Supported the leadership team and frontline teams to establish the level of avoidable demand, and the resulting scale of opportunity to achieve better outcomes.
Identified £11 million of potential savings from better demand management.
Supported the establishment of an overarching demand management programme for ACS in Suffolk.
Instilled understanding and ownership about demand management amongst frontline staff, and supported them in realising their own role in the process.
Introduced the use of Trajectory Management Our approach to benefits realisation in a complex system – enabling primed metrics to be tracked over time and providing an overview of system improvement. in order to set an inclusive ambition and provide a clear link between the programme of work, daily decision making and savings.
Developed a Team Manager Dashboard that allows teams to more effectively manage demand at a local level.

What was key to the success of this project?

“Our collaboration with IMPOWER gave credibility to the plans we co-produced, giving confidence to our stakeholders. Adopting a Trajectory Management approach gave us the evidence we needed to obtain executive and political confidence in this activity, along with a framework around which we could monitor performance across the county.”

Tracy Lindeman, Assistant Director, Suffolk County Council

“Our work with IMPOWER has been truly collaborative – we have been able to utilise the team’s experience, enthusiasm and skills to truly complement our work. IMPOWER have enabled us to transform our staff communications and engagement, by hosting workshops and providing a safe environment for our staff to share their ideas and concerns which have then been interpreted and fed back constructively.

“Translating and interpreting complex data is challenging and IMPOWER have been key in enabling us to do this. As a result, we have extremely high confidence in what this data is telling us and in how best to proceed based on the opportunities identified.”

Phil Quickenden, Senior Manager Lead – Demand Management Programme, Suffolk County Council