Case studies for transforming social care

The Social Care Innovation Network (SCIN) is a partnership between SCIE, TLAP and Shared Lives Plus, funded by the Department of Health and Social Care.

Its purpose is to examine and promote ways in which innovative approaches to social care can flourish and develop. The network has brought together councils and organisations which provide care and support to people, citizens and national bodies to work collaboratively and creatively, in order to push the boundaries of what is possible.

The network aims to identify solutions to developing asset-based approaches and deliver two core aims:

• to make visible and value the skills, knowledge, connections and potential in the community
• to redress the balance between meeting needs and nurturing the strengths and resources of people.

In helping local areas find ways to scale innovation, the Network was asked to consider three areas:

• Developing the asset-based areas model in more depth.
• Re-designing commissioning so that it supports innovation by becoming more citizen led.
• Taking self-directed support back to its roots so it affords authentic choice and control and enables people to connect and contribute.

The Network has produced a range of tools to support commissioners to deliver better commissioning, with a ten point action plan for local areas.

Find out more: Social Care Innovation Network

The London Borough of Brent faces rising demand for adult social care from older adults and adults with learning disabilities. The authority has faced large cuts in funding over recent years, which have led to pressure on local voluntary sector and community services.

Whilst there is a strong commitment to improved outcomes, practice is often inconsistent and the systems, forms and processes often prevent efficient and productive practice.

SCIE were really critical in helping us to guide us through workshops towards developing an evidence based practice framework that staff actually believed in.

Georgina Diba, Head of Transformation and Principle Social Worker

SCIE worked with the leadership and front line staff for over 12 months to design and implement a new approach to practice for Brent.

• Analysing the barriers to successful practice, including the processes, IT, care management system and approach to supervision.
• Workshops with staff to co-produce a new vision and framework for practice that would lead to the creation of productive and well supported workers, freed up to deliver strengths based practice.
• Provision of advice.
• Tailored three-day training programme with all managers and frontline.

Brent has implemented the framework across all staff groups, and with partners in the wider community. The framework is being used to guide all training, policies and procedures.

Over a year’s period we provided flexible challenge and support as the council embarked on its ambitious transformation programme, with members and officers working to a clear person-centred direction, engaging voluntary and community groups in a range of ways including the transfer of some assessment activities and funding.  

We assisted by:

• Specific best practice research, reviews and recommendations.
• Workshops with senior and middle managers reviewing progress and helping identify next steps.
• Support/challenge in meetings with members, community groups.
• Critical friend in the development of some key reports.

The council was clear that real change and improvement was no quick tick box and that generating sustainable momentum behind the vision and way forward was in itself an important outcome. However they identified a number of individuals and families who felt that the emerging approach had made them feel more in control of their lives, with more options and choices regarding the type of support to best meet their needs.

The Council has transferred its front door and initial assessment functions to the voluntary and community sector. In the first year, this has reduced the spend on agency staff and freed up to £500,000. 

Since 2010 Surrey County Council has faced a reduction of more than £200 million in its core funding from central government. During the same period the council has seen significant increases in demand, not least for adult social care. The number of adults with a learning disability supported by the council increased from 2,573 to 3,760 (46 per cent) and the number of older people supported increased from 8,981 to 9,822 (9 per cent). This growth in social care packages is well above the average for councils in the South East.

The practice culture of the service did not place enough emphasis on recovery and independence and using personal and community assets. 

Surrey County Council has been pleased to engage SCIE as our improvement partner aiming at adding capacity, challenge, support, knowledge and expertise to our adults social care improvement journey. The partnership is shaping well and we all benefit from the open and engaging style SCIE is bringing, helping us build on areas of strength as well as known challenges.

Simon White, Executive Director Adult Social Care, Surrey County Council

SCIE worked with the leadership and front line staff for over 12 months to design and implement a new approach to practice

• Analysing the barriers to successful practice, including the processes, IT, care management system and approach to supervision.
• Workshops with staff to co-produce a new vision and framework for practice that would lead to the creation of productive and well supported workers, freed up to deliver strengths based practice.
• Action learning sets to test and embed new ways of working, such as new first contact and assessment forms.
• Training over 250 team managers and front line workers in strengths based practice.
• Developing a codified workbook to support consistent and effective practice across the organisation.

Surrey County Council has developed an ambitious, and widely owned, improvement plan. Although this is a plan for the longer term, Surrey is already seeing benefits in terms of improved outcomes and reduced costs. For instance, it has seen more people who contact social care, receive the support they need in the community whilst demand for care packages and use of residential care have fallen.

Staffordshire County Council and Clinical Commissioning Groups commissioned SCIE to develop an evidence-based joint strategy for the market management of residential and nursing care homes in Staffordshire.

It was crucial that the strategy was based on a good understanding of current strengths, opportunities and areas for improvement in Staffordshire, as well as the national evidence base and best practice examples, and was developed in a way that generated buy-in from a range of stakeholders.

The strategy and an associated action plan were therefore developed through:

• Analysis of local, regional and national data to understand the current circumstances and future needs of the care home market in Staffordshire.
• Engagement with nearly 60 local stakeholders including both local authority and CCG commissioners, provider organisations and carers.
• A desk top review of best practice in care home commissioning, including in five comparator areas to identify areas of good practice and innovation that could be considered by Staffordshire.
• Two system-wide workshops to develop and test the strategy.

The completed strategy identifies a number of strategic objectives for further developing joint market management of care homes.

We led business case and benefits case management for the implementation of a digital front door platform to enable better demand management, better targeted assessment and care management and identify the investment and service benefits.

Alongside this, we helped shape the business for a NHS Digital grant to create a common data sharing platform around NHS, GPs and social care, working alongside Patients Know Best.

Our work helped shape and make the case for change to enable the Bi-boroughs adult social care to fully embrace digital technology through the digital front door to the future establishment of a Care eMarketplace.

Our benefits assessment and support to the bi-Boroughs unlocked £500,000 of investment in a new data sharing capability from NHS Digital and we supported the ongoing evaluation of this project. Already this platform has proved effective in meeting many information sharing challenges relating to COVID such as safe hospital discharge.

SCIE led a project with the British Association of Social Workers to explore in depth the digital capabilities of social workers and develop a national capabilities framework. The work involved a large scale survey, in depth case study work, online engagement with social workers and engagement with a national panel.

In March 2020 we published a national knowledge, skills and values framework setting out what social workers need to develop their use of digital technology in practice. It supports social workers to meet and adhere to the regulatory standards - The Professional Standards – developed by Social Work England, and sector-wide agreed levels of ethics and the Professional Capabilities Framework

This project demonstrates the immediate value of the work we are doing together on transforming health and care through making sure our staff have the digital capabilities and literacy, and it shows the way to a digital future for the health and care workforce, through education and training.

Patrick Mitchell, Director of Innovation and Transformation at Health Education England

Buckinghamshire Council is on a journey to implement strengths-based practice. Driven by its Better Lives transformation strategy, Buckinghamshire seeks to embed strengths-based approaches across the service which involves practitioners having different conversations with people based on their strengths rather than their deficits, and more people being supported to live independently. It has involved establishing a service based on three key parts:

• Living independently, which is about supporting people to draw on their own strengths, social networks and community resources
• Regaining independence, which focuses on providing short–term support to help people to regain their confidence and independence
• Living with support, to support people with longer–term care and support needs

As part of its transformation programme, SCIE has been asked to support Buckinghamshire Council to test, refine, develop and implement a named worker model across long-term and review services within adult social care. Reflecting the national Named Social Worker model - which the Department of Health and Social Care funded SCIE to pilot - the aim of the Named Worker approach in Buckinghamshire is to provide more seamless, strengths-based and preventative support to people who draw on support.

The new approach will:

• Enable people who draw on care to have a Named Worker they contact who understands their needs and strengths
• Reduce waits as people are no longer passed from pillar to post
• Increase staff satisfaction and sense of professional autonomy
• Increase focus on people’s strengths and assets

The work has entailed:

• Design workshops with a mixture of social care staff
• Review of best practices from elsewhere
• Ensuring the Named Worker model is tailored to the local context for Buckinghamshire through staff engagement events

The London Borough of Hounslow Adult Social Care Service like many others across the sector, is seeking to implement and embed a strengths-based care philosophy into everything it does. This philosophy should change the relationship between ASC and the people it supports and cares for. As strengths-based practice matures, it should enable people to achieve better and more sustainable outcomes and to live more fulfilling lives.

This vision for a more community-orientated, strengths-based care and support offer, aligns strongly with the One Hounslow vision, a new reform programme being implemented across the Council. This programme calls for:

• Partnerships by default – with VCSE organisations and local public service partners working with ASC in local communities and playing a strong role in supporting people
• Person-centred care – with people more involved in the co-production of service design and delivery
• Preventative – with earlier intervention and seeking to increasingly understand and tackle the causes of demand
• Clear and transparent processes – which are streamlined and align to people’s needs and strengths-based practice.

The London Borough of Hounslow commissioned SCIE to review progress on this journey and recommend opportunities to further embed and accelerate strengths-based practice – particularly in the context of the experience of COVID.

The project was delivered through four distinct phases of work:

Stage 1: Setting the objectives and building the team

This early engagement, team building and understanding of the local context framed the future project focus and later recommendations. From the project outset, a group of practitioners and staff from across the service and support teams were drawn together to form a practice forum. SCIE met with this group at several critical points during the project to feedback and gather reflections on the emerging findings, to ensure these reflected frontline staff’s perspectives.

Stage 2: Practice study

This in-depth practice study incorporated a range of diagnostic activities as outlined below, providing a multi-lensed view of the service, which identified opportunities for next-step improvements to practice. This include administering and analysing SCIE’s Practice Insight Tool (PIT) which has been designed by social work experts and is underpinned by strengths-based legislation and guidance and provides a co-produced, strategic, and appreciative view of how practitioner teams spend time on key practice activities and helps to identify opportunities for improving the impact; day in the life of workshops and interviews with people who draw on support.

Stage 3: Developing the findings and action plan

Following the practice study, we drew together the range of scoping and diagnostic findings to begin developing a case for change and outlining a series of next-step recommendations to be agreed with senior leadership

Stage 4: Action plan

Following agreement, SCIE developed a report of findings and recommendations supporting the practical application of these areas of improvement to support ASC’s ongoing transformation.

We want every person in Doncaster to live in the place they call home with the people and things that they love, in communities where they look out for one another, doing things that matter to them.

As part of work towards achieving this vision, Doncaster Council have commissioned SCIE to help them improve access to care and support in Doncaster.

Our work to date has involved:

• Conducting interviews with a broad range of partners and stakeholders across health and social care
• Designing and facilitating a series of workshops for staff and people with experience of seeking and drawing support, to map current and desired experiences and outcomes
• Reviewing and analysing service data
• Running workshops with people who draw on support to design co-design a new operating model for access.

SCIE was commissioned by the London Borough of Barking and Dagenham to support it to develop a high-level Target Operating Model (TOM) for early help services across the borough. As part of this work, SCIE was also asked to develop a new practice model to support effective early help practice.

Children, young people and families in the borough face a number of significant challenges including poverty, domestic abuse, mental ill-health and low-quality housing, and the aim of the early help service is to support families in remaining resilient and avoid their circumstances becoming more difficult.

SCIE was asked to engage with practitioners, families and national good practice to develop a target operating model which sets out how the service will operate in the future so that it can deliver the best outcomes possible for children and families within available resources.

The TOM was developed through extensive engagement with staff and through review of local documents and data, including a review of performance and service demand data; and workshops with targeted early help staff.

• Over 50 interviews with stakeholders working in LBBD’s children’s services
• Pathway workshops with practitioners from across the early help system to consider specific care pathways
• School visits and an observation of a vulnerable pupil clinics
• Review of performance, financial and demand data
• Interviews with representatives of national good practice sites (Camden, Doncaster, Kensington and Chelsea).

The aim of the TOM is to better integrate partnership-wide structures in to one, so to strengthen our Early Help offer to children and families, enabling much earlier identification and targeted intervention to be delivered and reduce the escalation of need into statutory services and maximise our resources and capabilities to deliver a more joined-up service offer.

This TOM proposes an ‘invest to save’ plan for transforming Early Help in the Borough. The TOM will drive a preventative approach, focusing on building the resilience and independence of families, leading to reductions in demand for high-intensity support over the medium term.

The high level TOM was presented to senior leaders from across the partnership in October and is now being implemented.

The Council’s adult social care service is on a journey towards becoming more strengths based in how it works with local people, as underpinned by its vision – Promoting independence: supporting people to be independent, enabled and well which ‘sees social care needs in the context of people’s lives within their families and communities’.

This journey started in 2018 with the development of people’s stories and what this means for their social care and support. Adult social care’s vision for strengths-based practice has been set out in a Practice Framework and Delivery Model, which was launched in the summer of 2020.

Last winter, Barking and Dagenham commissioned SCIE to undertake a review of progress in embedding strengths-based practice and to identify opportunities to accelerate its implementation and effectiveness.

This diagnostic was carried out across four stages

Stage 1: Understanding the local context and its challenges

Rapid engagement with senior leaders and identifying key project stakeholders to define the project scope. Conducted a series of one-to-one key stakeholder interviews across the Council and a desk-based review of local key documents and data.

Stage 2: A multi-lens study of strengths-based practice

A broad range of diagnostic activities to surface and explore the realities of strengths-based practice on the ground, including:

• A quantitative data study on how practitioner teams spend time on key practice activities – identifying opportunities for improving the impact and value of strengths-based practice
• A series of workshops to explore practitioners and team managers’ operational experience and insights against a number of key challenge areas identified
• Conversations with local people who draw on adult social care services, to garner their perspective and experience of this service
• A number of reflective workshops to explore the ‘what good looks like’ vision and the changes needed to achieve this

Stage 3: Developing a case for change

Drawing together the scoping and diagnostic findings, to develop a case for change and outlining a series of next-step recommendations.

Stage 4: Next transformation steps

Enriching the findings and recommendations into a complete report and worked closely with the adult social care leadership team to take forward the project recommendations, supporting the practical application of these areas of improvement including a roadmap to support its ongoing transformation.

Gateshead adult social care is on a rapid transformation journey to embed a strengths-based approach across its provision of care and support to residents and communities. This ambition is supported by the Council’s Thrive agenda, Making Gateshead A Place Where Everyone Thrives, which seeks to tackle the area’s local inequalities and to invest in nurturing the potential of its communities and assets.

The strategy has five key pledges:

• Put people and families at the heart of everything we do
• Tackle inequality so people have a fair chance
• Support communities to support themselves and each other
• Invest in our economy to provide opportunities for employment, innovation and growth
• Work together and fight for a better future for Gateshead

Gateshead Council commissioned SCIE this year to conduct a diagnostic of its approach to strengths-based practice and to assess where critical barriers and opportunities exist in relation to further embedding this approach.

The aims of the diagnostic were to:

• explore the barriers and opportunities to embedding impactful strengths-based practice across adult social care
• support adult social care with the development and implementation of a new case management system
• work appreciatively with practitioners to develop a strategic action plan

This diagnostic involved a number of exploratory activities:

• Gathered understanding of the local context through a series of interviews with key stakeholders across the service and local system partners, as well as a desk-based review of key documentation and performance data
• Developing a cross-service forum of practitioners to engage with throughout the project, to feedback and gather reflections on the emerging findings, to ensure these reflected frontline staff’s perspectives and aim to galvanise practitioners to support improvement priorities
• Designed and delivered a series of workshops with frontline teams, to explore in-depth and appreciatively with practitioners a number of emergent improvement themes, to surface the ‘on the ground’ barriers and opportunities to embedding strengths-based practice across the service
• Deployed SCIE’s critical review tool, asking managers across adult social care to reflect and score their service against nine domains critical to developing a whole-place approach to strengths-based working

To support adult social care to develop the conditions and enablers to strengths-based working, SCIE produced a detailed report of findings, interwoven with good practice examples to support improvements and an action plan outlining next-step recommendations for Gateshead to take forward.