Most of the Mental Capacity Act (MCA) related e-bulletins and newsletters that I have received lately focus on the major overhaul to The Deprivation of Liberty Safeguards (DoLS) – and the new Liberty Protection Safeguards (LPS). This is due to be implemented later this year. This is great as it ensures that we are all prepared for when the changes come into effect. However, we know DoLS, and LPS when it’s in force, are part of the MCA, the principles of which must be applied in all cases. Many of us know from practice that where the MCA is applied correctly, DoLS can even be avoided in some cases. Therefore, the MCA is a crucial obligatory foundation to DoLS / LPS but also to health, social care and beyond, so I am wishing to raise awareness of the other work that is happening alongside the LPS work. This is the review of the existing MCA Code of Practice.

  • Hopefully, you would have seen the call for evidence issued by the Ministry of Justice last year asking for people’s opinions on the code. I have had the honour of sitting on the working group that has been leading on the review. The group consists of members from a variety of backgrounds, including law, health, social care, the third sector, academics as well as government, all experts in the MCA and personally I have learnt a lot from.

I have seen first-hand that the review is no easy task; the group have literally looked through the code line-by-line and scrutinised the smallest of details; and often had constructive debate amongst members. The code is not the shortest of documents, so as you can imagine it has taken a while to get through the code in this level of detail. I can also assure people that as we have gone through each chapter, section, and line we have looked through the information people submitted through the call for evidence.

Helpful, accurate and up-to-date

Information from the call for evidence has been a key to the review. The code was written before the MCA came into force, and so was looking ahead at how it was thought the new law would work in practice. This review provides an opportunity to make changes to reflect how the law does and should work on a day-to-day basis, and so the call for evidence has helped with that.

The review cannot change the MCA itself. Many times as a group we have had to look back at the MCA and ensure that the code continues to reflect the law. But the review does enable us to ensure that the code is helpful, accurate and up-to-date with case law and best practice. I know that the Ministry of Justice have been looking for real life scenarios to include in the Code, as many of the current ones are out of date and all were written before the MCA came into force.

The working group have just had our last meeting and all the many months of work and recommendations are being looked over by the Ministry of Justice. They are now pulling together the final draft. Don’t panic though – this won’t suddenly land in your inbox; there will be a consultation on the MCA Code update alongside the new LPS guidance. I urge you to submit your thoughts. As we know the MCA is a fundamental backbone to health and social care; and to wider society as it effects so much more, from banking, to shopping and to someone’s everyday activities (really the list is endless). Therefore, we all need to ensure that the code, which is statutory guidance for how the law should work in practice, is right and fit for purpose, so look out for the consultation that will be out soon – and do please respond.

As a registered social worker with 30 years’ experience, I have worked in various roles in mental health social work, including Operational Director for Mental Health in Milton Keynes. I have been in my current role since 2009, including a part-time secondment to the National Development Team for Inclusion (NDTi), where I worked with other local authorities developing and delivering community led support (CLS)/strengths based social care (SBSC).

The journey in Leeds

In April 2015 a new DASS and Deputy Director started in Leeds, and these appointments, plus the introduction of the Care Act, enabled us to look at how we delivered social work in Leeds. Cath Roff, the new DASS, announced her desire to ‘liberate social work’ (a wonderful thing to hear!).and told us her mantra for change:

  • Do no harm
  • Don’t break the law
  • Don’t break the budget

The order of these messages was key.

Innovation

In order to avoid the Leeds habit of ‘pilotitis’, a programme board was established and an innovation site – one of the more established co-located neighbourhood teams in a deprived area of Leeds – was selected. We wanted the innovation to be owned by front-line workers, so we also set up a ‘Making it happen’ group and invited interested frontline workers to join.

Achievements

  • Replacing huge, overly complex assessment documentation with a ‘blank sheet of paper’ conversation record and changing the way we talk to people – focussing on what’s strong not what’s wrong
  • Changing where we talk to people – we have Talking Points in each neighbourhood team locality and no longer default to seeing people in their own homes
  • Ensuring we listen to people and hear what they are saying (and sometimes what they are not)
  • Linking people into the wealth of 3rd sector support Leeds is privileged to have
  • Ongoing evaluation in partnership with the NDTi and associated LAs

Next steps

There is no end point to this journey – whenever you think you have got ‘there’, ‘there’ changes! SBSC and CLS are a return to the roots of social work and without a doubt there is a massive culture change for people who have grown up with the ‘care management’ approach to social work. We need to properly engage with the population of Leeds. Under the old model, we rationed and rationed until people had exhausted themselves. Now we are wanting people to come to us earlier, before everything gets broken, but we do need to make sure they understand that!

I often tell new recruits that ‘if you can do social work in Bradford, you can do it anywhere’. Bradford is the 4th largest Metropolitan Council with a population in excess of 530,000. The diversity of this population is staggering. Like most other areas we are experiencing rises in demand, and the complexities of families but somehow we have managed to keep the number of children who need to be looked after – or who are on Child Protection Plans – lower than many of our statistical neighbours. When Ofsted reported on our joint targeted area inspection last year, they described social work in Bradford as flourishing.

One of the reasons for this is our strength based approach. Bradford Children’s Services have worked with our Safeguarding Children Board and all partners to introduce and sustain Signs of Safety. To date we have trained more than 2000 people who impact on the lives of children in Bradford in Signs of Safety. This includes not just Early Help Workers and Social Workers, but also Health, Education, Police, Probation, Voluntary Sector and beyond. Critically, we have run events for Senior Leaders and Elected Members. We can confidently say that Signs of Safety is becoming embedded in Bradford.

For the last 18 months all Initial Child Protection Conferences have followed the Signs of Safety methodology. Using simple, clear, jargon free language to engage children and families in conversations detailing what is working well, what we are worried about and what needs to happen next is impactful. Families have constructed their own danger statement and families have told us ‘I now get why you are worried.’

This strength-based approach has freed up our staff to be more courageous (and less risk adverse) in their decision making and solutions.

Over the past six months, Bradford has extended the Signs of Safety model into the West Yorkshire Problem Solving Courts pilot. In addition to a Social Worker focusing relentlessly on needs of the child, we appointed a separate worker to focus on the needs of the adults. It’s early days, but there is already clear anecdotal evidence (which we hope will translate to hard evidence) that this approach is enabling children to safely and appropriately remain with their birth parents. The emerging case studies not only represent a win for the public purse, but also a win for children and for families – and that is why we came into social work in the first place.

We have all heard a lot about how we need to get to strengths- based approaches – building on what people are good at, the assets they have, and what they already do that works. Since I started my role in March of this year, I have concluded that this applies to refining our strategy too. National Voices needs to change. Our influencing environment is different: Person-centred care is largely reflected in all relevant policy documents now, but it has clearly not arrived in the lived reality of how most people experience their care. And our funding environment has changed too – the time of core grants, where a government body sees the value in a voluntary sector infrastructure organisation and funds it, seems to be over for now.

This all means we need to find a way of addressing the gap between rhetoric and reality on person-centred care, and we need to do so in a way that helps us to fund our ongoing work.

In thinking through this challenge, it became clear to me that we need to take a strengths-based approach: we haven’t got much money or many people, and if we think of ourselves as a stand-alone organisation, this lack of resource will severely limit our impact. But we are part of a massive network of assets. We have 160 members, who have great people working for them, across policy and influencing, service delivery and innovation, research and advocacy. They work with thousands and thousands of volunteers, and draw on the resilience and energy of even more people we are here to support: people living with ongoing health problems, and many of the other issues that are associated, if not caused by ill health: poverty, loneliness, inequality.

Connection is our strength

We need to think of this network as our asset. Focus on the connections we need to build, and strengthen our insight and analysis of what our members know and do. We can then engage so much more effectively with the many opportunities for change that arise out of the national push for primary care reform, the local drive to implement social prescribing, or the regional ambition to integrate services.

This means we need to learn some different skills too; for instance, listening to our partners’ experiences; facilitating collective action; and supporting people to advocate for themselves and others. It might sound a bit trite, but it is still true that our connection is our strength.

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To us in Walsall, Restorative Practice means strengthening relationships between people as well as strengthening social connections within communities. It focuses on building relationship with children, young people and their families and connecting with the communities in which they live. We think this will help us to better understand their needs, ensure we are empowering them to make positive changes and enable them to secure sustainable outcomes. So we are committed to embed restorative practice as a fundamental part of our transformation programme. It is a common-sense approach.

To ensure we will stay on course we have set out a number of principles:

Taking a system-wide, asset-based approach

Our transformation programme is not just social care-focused but works across all of children’s services in Walsall.

Moving away from over-reliance on processes and compliance

That means moving from a culture focused on the problematic (ie assessing need). Instead we are investing to create a stable confident workforce who are able to effectively manage uncertainty and risk and identify people’s strengths and build on them to secure change and build resilience.

Creating locality based teams

This isn’t just about moving the furniture, but a relentless focus on connecting practitioners, where it makes sense to do so, with communities and local resources.

Co-producing the transformation journey

This means co-production with our key stakeholders including children, young people and families. To achieve this we having to reshape our relationship with them to ensure that it is based on high support, high challenge.

Learning from asset-based innovations and transformations elsewhere

We want to develop a whole-system approach that has a strong evidence base. In particular the importance of whole family/community based support, focusing on relationships, and striving towards evidence based decision making across the organisation.

So, we have concluded an asset-based approach is common sense, but not always common. We acknowledge that this will require lots of energy and courage, but is absolutely the most important change needed to get it right for our children.

This is the story of how a profound re-imagining of the relationship between citizen and state came to give birth to a new approach to children’s social care.

The Wigan Deal

The Wigan Deal is a response to austerity with roots in the values and society of ex mining communities. At its heart is an approach that builds on assets and through conversations.

In the five years since its inception Wigan enjoys healthy local public approval ratings, a relatively stable financial environment and improving outcomes.

Aligning children’s social care

Professor Eileen Munroe’s 2012 report on the future of Children’s Social Care focused on how might re-empower social work professionals & more local flexibility. The Children’s Social Care Innovation Fund in 2014 was the catalyst for new ideas and thinking and Wigan saw the opportunity to test its Deal thinking in Children’s Social Care focusing on CSE and adolescent mental health. The evaluations pointed to a strong alignment.

Wigan was rated ‘Good’ by Ofsted in March 2017, recognising its ability to maintain a safe (but traditional) system while exploring new approaches though innovation. Wigan was then faced with a choice – put its faith in a traditional system that had served it well or invest further in innovation. It chose innovation.

A dynamic network of national innovators

By 2016 Children Social Care innovators from across the country were starting to talk. Enabled by the Spring Consortium, and with access to better evidence, Wigan opted in 2017 to import 3 innovation projects tested elsewhere – PAUSE, Mockingbird Project and No Wrong Door project – as they were asset based in their approach and Wigan Deal consistent.

Increasingly we are convinced that innovation is the ‘join’ between areas of national policy and strong localist visions.

The Greater Manchester dynamic

Recently the Department for Education awarded Greater Manchester £5.7m to scale and spread children’s social care innovation across its 10 Councils building on initial work by Rochdale, Stockport, Salford and Wigan. Aligned to Greater Manchester public service reform, this will see the emergence of the next step – system level change driven by innovation ecosystems.

The Impact of the Wigan Deal

The Deal is more than reform, it’s a movement and a new model of sustainable public services. We’ve lost £160m in government grants but we haven’t cut services – how they are delivered and where they are delivered has been transformed. This approach is improving outcomes and saving money, doing better with less, and we are confident this will continue.

In East Sussex we’re looking to have meaningful and helpful relationships with children and families. We call it Connected Practice. Other local authorities have chosen to practice systems such as Signs of Safety or the Reclaim Model of child protection casework. For us though, Connected Practice is how practitioners develop transformative relationships with the most vulnerable families in the community. This can be achieved by having a good understanding of trauma, attachment and risk, underpinned by evidence-based approaches.

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We believe that families have strengths, networks and skills that they can bring to bear to foster positive change; and this underpins Connected Practice. So as part of developing each child’s plan, practitioners ask the question: What are the strengths that we can harness within this family/ carer and extended family to create change?

In addition to supporting families, East Sussex has continued to invest in wider preventative and community services which help maintain families’ independence, such as early help and community-based support.

Ofsted report

We’re delighted that our recent Ofsted inspection of children’s services said: ‘The East Sussex model of “connected practice” has been comprehensively rolled out and is fully embedded, resulting in helpful, enduring and trusting relationships between practitioners, children and their families, sometimes over many years’.

Supportive relationships

From Director of Children’s Services to frontline workers, it’s vital to prioritise supportive relationships with each other. In this way, connections have a cascading effect; if practitioners feel supported then they can have helpful relationships with the child and family with whom they work. Therefore the model promotes connections throughout the organisation, including through high quality supervision, group supervision, and practice development.

We know that through these supportive relationships more children and young people are supported to stay at home with their families – leading lives that are safe, stable and fulfilling.

Stuart Gallimore is President of the Association of Directors of Children’s Services (ADCS)

Stockport has transformed our children’s services over recent years to create ‘Stockport Family’ which is an integrated and agile early help and social care system that challenges the concept of referrals, thresholds and agency boundaries. Stockport Family works closely with universal services, particularly health, schools and police, to ensure that services can identify needs early and provide timely support and intervention. The integrated structure has strengthened links with midwifery, school nursing, health visitors and early year’s services. We have created a simplified structure to allow professionals and families to “call in” the right intervention, specialist knowledge and skills at the right time.

Stockport has a well-developed ‘Team around the School’ model, which places skilled and motivated early help practitioners alongside link social workers, school nurses, and other local partners within the community, to work with whole families as need arises.

All work with families is underpinned by Restorative Practice, promoting behaviour and practice which helps to build and maintain healthy relationships; resolve difficulties and repair harm where there has been conflict. The concept of ‘working with’ is embedded in our values and has positively impacted on our culture to deliver strengths based practice and whole system change.

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In the past few days, Lyn Romeo, Chief Social Worker for Adults, has talked in her blog about social work now being given the ‘recognition it deserves’. She argues that it is the way in which social workers engage with families, and the relationships they build, which are now being more highly valued. “This recognition is built on our understanding of people, their families and the environments within which they live, our values and human rights, strengths based practice, working alongside people to enable them to have better lives.” Lyn Romeo, Chief Social Worker for Adults.

We all know that relationships matter – we are social beings. Our quality of life, indeed our happiness, is directly related to the degree to which we feel connected to others, we share experiences and can rely on people who care about us for support.

If you needed convincing by hard evidence, then it’s available in abundance. The research on the importance of relationships is clear: healthy relationships are a vital component of health and wellbeing. There is a good deal of compelling evidence that strong relationships contribute to a long, healthy, and happy life and that, conversely, the health risks from being alone or isolated are comparable to the risks associated with cigarette smoking, blood pressure, and obesity. The Grant Study, undertaken by Harvard researchers, followed the lives of a cohort of men over 75 years. When it concluded, the researchers declared an overwhelming and important, but simple, finding: relationships are key to a happy life. Those men who were satisfied in their relationships were all round happier and healthier human beings.

Lyn also used her blog, which was published as the sector prepares for the NCAS conference later this week, to announce the Named Social Worker pilot, which Innovation Unit, in partnership with the Social Care Institute for Excellence, is helping to deliver. The pilot gives six local authorities funding and support to allocate a named social worker for adults with autism, learning disabilities and mental health issues.

Ultimately, Named Social Worker is about creating the space for purposeful and empowering relationship building, built on a deep understanding of individual need and capacity.

Providing a dedicated caseworker who has an ongoing responsibility for an individual’s support means they can be the primary point of contact for care and treatment, and can use their professional voice to challenge across the system and advocate on the individual’s behalf, linking with a range of services, professionals and organisations. Whilst the pilot does not sanction any new powers for social workers, it gives us a chance to understanding how to change the experiences and outcomes for people with autism, learning disabilities and mental health issues by introducing a new set of relationships.

Our involvement in this programme, in partnership with the Social Care Institute for Excellence, provides us with an opportunity to learn more about how to change practice in public policy. We look forward to working with the pilot areas as they pilot different approaches to the Named Social Worker model over the next six months, supporting them to articulate and assess the impact of their approach on outcomes for individuals, and bringing them together to share their experiences and learn from one another. As ever, we’ll be sharing insights and evidence along the way.

At Innovation Unit we create new solutions for thriving communities: solutions which build, support and recognise human potential and the critical importance of thriving relationships – within families, between individuals, and across personal and professional boundaries.

And when it comes to creating thriving families, we know that it’s not just relationships within those families that matter. Where families need support, the quality of the relationships they have with public service professionals, like social workers, is also a deal breaker. Research from the Harvard Centre for Developing Child has found that the single most important factor in the success of any intervention is the quality of the relationship between a professional and a family.

Innovation Unit related work:

We are working as part of the Spring Consortium on the Children’s Social Care Innovation Fund. 53 projects are identifying enablers and barriers to innovation which raise questions for the sector about how new approaches in children’s social care can be best developed and supported.

SCIE’s related work: