Rewriting the script on support

Vicky Bidmead and Sharon Ward, two social workers from Doncaster are involved in the Rescripting team for Doncaster County Council. They share their experiences on the need for rescripting how Social Workers work in Doncaster and the results of their review process.

We started our personalisation journey in 2008. At that time, there was a lot of national guidance from government, and there was a lot of information from TLAP that was coming out about personalisation, making the processes leaner, enabling service users to have starter budgets on an earlier basis. And that was pivotal for Doncaster. It started to reshape the way that we thought about our working processes.

As a result, we undertook a review several years after that to look at the work that we’d already done, and what needed to change in the way that we were working so that we could introduce personalisation. It was clear from that review that actually there were a number of issues that were wrong with our system.

To begin the change process, Doncaster County Council developed a Rescript Project group who were tasked with rewriting the processes that support workers were using daily. We were part of the team from the start.

Our first acknowledgment was that the rescript needed to apply for social workers, assessment officers and rehabilitation officers. We also realised that it needed to be workers from across the different disciplines such as sensory learning disabilities, mental health and older peoples.

So we gathered a core group of people from each discipline for the Rescript Project group and as a team, we set about analysing what we did well and what we didn’t do so well. Importantly, we worked closely with service users and with advocacy agencies to identify the most suitable route to follow.

One of the first things that we looked at was streamlining our processes. However, it became very clear that actually the paperwork that we already had in place didn’t really lend itself to the focus we were going towards. So we decided to create our own bespoke assessments.

To move forward, we worked with other local authorities and we compared our processes against theirs. After a few comparisons we saw that actually our paperwork was the longest in the local authorities. And time-consuming.  Not only for the frontline workers going out, but also time-consuming for the back office processors, which put more time onto that service user getting their budget up front.

We also received information from service users that highlighted that the process that we were undertaking was solely based on their deficits. The assessments foremost looked at the negative side i.e., what a person couldn’t do rather than the positive things that they could do. The process did not acknowledge the positive attributes of a person.

So it was very much agreed from both service providers and users that the assessment forms that we were working with really were inappropriate, and we needed to move away from that.

We started with a blank piece of paper, and together the Rescript team developed a new assessment process. We moved away from a tick box assessment to a conversation-led assessment; an outcome-focussed assessment which actually underpins the principles of a person-centred approach, which for us as frontline workers is what it’s all about.

We created assessments that mean that workers actually talk to people. The assessments are about having a conversation with a person in their living room, and getting a picture of what their life is all about (their needs, their wants, their life, their circle of friends). We created assessments that looked at the person’s story and it captured a day in their life; a week in their life; what’s important, and who is important to them. We think of it as a holistic approach, which it should be.

A benefit of the Rescript group being so multidisciplinary was that we were able to have really insightful discussions. If we didn’t agree with what somebody was saying, then we would question and discuss why: “Talk to me about it. Tell me why you think that works for you. Tell me why that’s going to work for that service user out there in the community.” We were able to challenge each other respectfully and take on each other’s views. Because we had so many different characters within that Rescript group, we were able to come up with a great tool; a good assessment process that works.

Once we had devised the assessment, and we had the bones of how we wanted it to look, we then had to look at our resource allocation system (RAS) and how that could fit. Unfortunately that was still driven by tick box information. In fact, it didn’t lend itself to the assessment that we’d created at all, so we thought, ‘Okay, how do we go about this? The answer was that we were going to have to make changes to the RAS. That was probably the biggest and bravest step that we took, deciding to create our own bespoke RAS. We don’t believe that any other local authority had done that at that point and we are quite proud to say that we’ve actually taken it on board.

One of the big changes to the RAS came about from the fact we thought it should be around professional judgment. So we came to the conclusion that it needed to be based on eligible and unmet needs, which is similar to what Fair Access to Care Services (FACS) looks at now but it also needs to be based on a level of risk.

The level of risk is not something that our assessment processes and assessment tools lend themselves to well but we managed to formulate the level of risk that was involved in the RAS. However, it took some time to perfect! But again, because of different characters in the group, we came up with a really good robust way of identifying that person’s needs through our RAS grid.

That it is based on professional judgment also means that what we have is transparent. And it means that actually when we’re out there in somebody’s front room, talking to them about their current circumstances, and what life is like for them, we are undertaking an assessment.

In terms of coming to a conclusion about how we’re going to release a budget to them, and identifying their outcomes, it means that we can explain to them clearly how we’ve identified their areas of unmet need and what their risk is, and that itself drives the RAS.  It’s great to know that we can be very clear and open with service users and carers alike. It’s not based on tick boxes and complicated algorithms; it’s based basically on our conversation, on a person’s needs and risks, and that’s how we’ve come to this resource allocation.

And as workers, we have confidence in it. Before, workers often failed when trying to explain to people why they got this amount or that service because they weren’t confident in saying “the computer says this is your amount”. They could never work it out. We are now able to explain resource allocation to a service user much more clearly and help to support them better alongside their family members.

Where we are at the minute with all of our rescripted processes is that we’ve tested them as much as we’ve can. And we think they’re robust, and we think they are going to work really well, both for service users and for practitioners. We’ve recognised that with the rollout of our new assessment process and RAS, the workers are going to need support to implement it. The training is there; we’ve put that in place now. And management have agreed that they’ll need that ongoing support in order to get the best possible outcomes that they can for those service users that they supported.

We do think it’s important to say that we have had backing from our management behind us. They have let us take lead with this, and they have backed us all the way. They recognised that things were broken in Doncaster. They’ve recognised that things need to change. And they’ve allowed us frontline workers to be able to go with that, taking on board service users’ opinions and experiences in line with the Care Act.

In Doncaster we are changing, and culturally that change is not going happen overnight; it’s going to take a while before that happens. But everybody has recognised that change is needed, and it’s coming in line with the Care Act. And that’s something that we didn’t foresee initially when we started this journey two-and-a-half years ago. The Care Act wasn’t even being mentioned, and certainly the guidance wasn’t around at the point. The journey that we’ve undertaken has enabled us to produce a process and documentation, and a way of working that is Care Act compliant. So currently, that puts us in a very, very strong position.

We believe that there has been a lot of interest around Doncaster’s model of working because we have created something very unique, but something is very much in tune with personalisation. And think that’s something as a Local Authority and as a project team that we are very, very proud of.

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The Importance of the Care Act

Blog from Tim Gollins: Lead for Self-directed Support and Personal Budgets & Regional Co-ordinator for for Yorkshire and Humber Association of Directors of Adult Social Services (ADASS) 

In my professional life I have two roles:  The first one is working for ADASS in Yorkshire and Humber. And the second one is working with Think Local Act Personal (TLAP) on their self-directed support work stream.

ADASS in Yorkshire and Humber recently sponsored the Doncaster Bringing The Care Act to Life event with support from TLAP and that’s because we knew the event hit a number of key priorities for the region as well as nationally. There was lots of relevant information on commissioning personalisation and developing the market so it was a really key event for us in the region.

For me, there was a number of really important things that were addressed on the day. There was information about how we do assessments; how we do reviews; how we do care and support planning and how resource allocation is important. Also people explored how we develop new conversations between freelance social workers, people that they’re working with, social workers and families, and friendship networks as well as new conversation between social workers and commissioners. I think it’s important to do this because we don’t often have the quality of conversation about communities that we need between those two bodies. Good conversations can highlight what there is in communities that people are able to use, what is not within the community’s power and what’s not available? And eventually, how we can reconcile those differences.

I think there’s a number of clauses in the Care Act that mean we have to address those areas. Clauses about well-being, about prevention, about providing information advice, and about involving key people in the social care process. All of those things came together brilliantly at the Doncaster event.

I was really impressed while I was there with the willingness of people to share their good practice and communicate with each other; experiment and move forward collectively. We also had a number of really good questions and challenges which I know that we won’t be able to resolve immediately; but we will over the course of the next few months as the Care Act goes live.

Actually, some of the key highlights of the event were the questions that people asked that were really poignant. Questions around how, when social workers are having key conversations with people, do you get over that difference between the amount of money that’s available to help them with their needs, and the well-being that they want to experience?  It means social care workers have got to have different conversations with people. They need to be really honest and open about the constraints on money; but then support people to find new and innovative ways of meeting their needs. And people recognising those pinch points has been really a significant thing.

Another thing I would have to say is that I know Doncaster has been doing some innovative work in the last of 18 months to two years but what I witnessed was there are lots of other areas that I didn’t previously know about, doing some really good work too. There’s lots of good practices and it’s peppered throughout the country including Yorkshire and Humber.

We were really impressed with the sort of diversity and innovation seen at a very difficult time (pressure on budgets; lots of plans around integration; and then the Care Act), so lots of pressures but it was evident that people are doing some really good work.

It is events like this where really good practice gets shared and people do fantastically well in articulating how they are working with the challenges that they have. And they’re not afraid of sharing with other people, and that was one of the most important messages to come out of the day.

After the event I’m feeling very optimistic for the future.

Watch Tim at the Doncaster event:

Care and Support Planning- Workforce Matters

Zoe Thomas from Skills for Care, and Madeline Cooper-Ueki from NDTi facilitated a workshop on workforce implications for Care and Support Planning at the recent Conference on Bringing the Care Act to Life in Doncaster. Care and Support Planning is about people; having great conversations and supporting people to get the life they want. Zoe Thomas and I spent much of our workshop putting questions to those who took part. The kinds of questions you need to ask when you are an organisation planning your workforce.

Who is the workforce and who does it need to be?

The Care Act doesn’t tell us who the workforce should be, but it does give us a clue. It points to factors such as people being in control of their own care as much as they want, having the right information, choices and support to achieve their own experience of well-being. Thinking beyond the traditional workforce is key, particularly when time and money are tight. We need great outcomes and need to be creative to get them. People are assets, and many of them bring connections, skills, ideas and resources way beyond those we usually think about from a paid workforce. We were delighted that the 25 people in the room shared in our thinking that the workforce might be support workers, nurses or social workers, and they may also be peers, carers or friends. If this is the case, organisations need to be considering how they support not only their staff, but others around, to have the resources and skills they need.

What do they need to be able to do, what skills and attributes do they need?

As Zoe points out in our film “it might be that at the moment, the workforce that’s supporting people has a particular set of skills that’s been right for the past 10 years, but might need to change”. Reflecting on the statements about what good looks like, workshop participants considered the kinds of skills and characteristics people would need. Many of them were about behaviours and attitudes such as being pragmatic, practical, listening, inspiring. Others mentioned knowledge: knowing the community, understanding and being able to break down jargon, being able to assimilate information. The creativity in the workshop generated by the discussion came up with what might be the start of a fabulous person-specification for the role.

And what should you consider when building the workforce that will be right for the people you are supporting?

The right people only thrive when the organisation allows them. Encouraging people to develop, through learning opportunities, practice and support is a great start, and remember, workforce development isn’t all about training. People learn in many ways, and will change when they feel valued and inspired. As well as thinking about workforce development, organisational culture is key to ensuring people implement what they learn. We’ve heard all too many horror stories about poor culture in health and care, leading to behaviours in staff which are the opposite of what we want. Zoe shared the culture and dignity toolkits from Skills for Care which can be a good starting point to getting it right. When it comes to planning a new role in your workforce: start by posing the questions; listen to what people say matters; think together about who would be best to carry out the role; then look for the people and partnerships you need.

Individual Service Funds are Exciting!

This was a slide show by Certitude’s May Lee, Transformational Change Programme Manager and Hirila Anaughe, Service Manager, Mental Health at last week’s conference on Individual Service Funds. The national conference was hosted by the Health Services Management Centre (HSMC) at Birmingham University, and facilitated by Senior Fellow, Robin Miller. The participants were commissioners and providers, and the conversations and workshops conveyed a strong sense of positivity around ISFs.

Tim Gollins opened day with ISFs within the Care Act and guidance. Clause 11.32 of the Guidance states that the local authority should:

  • provide people with information and advice on how the ISF arrangement works and any contractual arrangements
  • explain how the provider (s) will manage the budget on behalf of the person
  • provide advice on what to do if a dispute arises
  • consideration should be given to using real local examples that illustrate how other people have benefited from the ISF arrangements

He strongly presented ISFs as the default choice if people do not want to take a direct payment, ahead of a managed budget, the third option.

If the term ISF still feels a bit hazy, here are two good resources:

An animate with TLAP Director Sam Bennett describing what they are, and a short film of Simon Duffy explaining what they mean for providers.

Tim Gollins is clear that ISFs give choice and control without the administrative burden.  He gave four benefits to using ISFs:

1) Responsibility for decision-making is located closer to the person, supported by people who have the right information, motivation and expertise to make decisions with them.

2) Decisions can be made quickly and easily, as problems and opportunities occur. There is no undue delay or contractual restriction

3) Resources can be used flexibly and creatively in order to build on the person’s assets and community. Resources are not tied into particular kinds of services of support.

4) Clarity exists about everyone’s rights and responsibilities. There is no confusion or undue complexity in the arrangements.

Tim also said that ISFs have to be introduced by local authorities unless they have a cogent reason not too – and he challenged anyone to describe what a cogent reason could be!

Robin’s presentation put the learning about ISF in the context of current practice, and reminded people of what good looks like in practice.

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We then heard from three early adopters of ISFs, provider organisations who have done some of the early learning about what ISFs look like in practice, Choice Support, Certitude and Borough Care Ltd.

The Choice Support example is rightly famous – the largest example of ISFs for 83 people. It is usually presented as they example of how ISFs can result in savings, however we heard a slightly different take on this from listening to the commissioner who led this work. He explained that the savings were created as a result of top slicing them from the overall budget/cost of the block contract and then creating ISFs from the remaining monies. Choice Support then changed their terms and conditions, took out a layer of management and were creative with assistive technology to deliver a service that still improved peoples lives.

What was clear was the crucial partnership between commissioner and provider to achieve this. The importance of this relationships was echoed in the other two presentations.

With infectious enthusiasm evident from their slide ‘ISFs are Exciting’ May Lee, Transformational Change Programme Manager and Hirila Anaughe, Service Manager, Mental Health shared how Certitude had worked to deliver ISFs.This picture shows their thoughtful approach to project activities, and how they used person-centred practices to deliver a change for people and a change in culture.

Certitude Project Activities

Their key learning included this:

“Staff teams meaningfully developed their understanding of person-centred working and Personalisation– much more than any training sessions would’ve done”

Can ISFs be delivered in a care home for people living with dementia? Gill Bailey says yes, and shared how the principles of ISFs – being in charge of your time/money, choosing how you use it and who supports you – absolutely still apply in a care home, and can be achieved. You can hear more about this approach here:

Personalisation in Residential Care video

Making Individual Service Funds Book

In the afternoons there was a choice of workshops looking at how to support managers to achieve this change in practice (Helen Sanderson), some of the different approaches to delivering change with individuals  (Michelle Livesley, Helen Sanderson Associates) and how to evaluate progress (Robin Miller).

A new free App is being launched in the next few weeks for commissioners and providers to understand what ISFs look like both in residential care, supported living and home care services.

There was a sense of the beginning of a learning community developing, recognising that it is only through a different partnership between commissioners, providers and people who use services, can we realise the promise of ISFs. We are working with Robin Miller and HMSC at Birmingham University to develop a programme for commissioners and providers to support them to start ISFs. We would be very grateful if you could take 3 minutes to complete this short survey to help us learn what would work for you.

https://hsauk.wufoo.com/forms/q15bduxc1yh2osj/

ISFs were exciting

Care and Support Planning in practice

Blog by Michelle Livesly

I recently hosted a workshop at the Doncaster ‘Bringing the care act to life’ event. My workshop focused on Care and Support Planning in Practice, and using a toolbox approach to capture rich information from people to develop their Care and Support Plans.

I wanted to write a summary of what I presented in Doncaster about assessments and how to use the guide to help with good Care and Support Planning. You can also watch a video of me speaking here – https://vimeo.com/album/3266072/video/119935772

We have new Care and Support Planning cards developed by HSA in partnership with ‘in Control’ and ‘shop4support’ – a resource that we’ve been sharing with people at the conference – which detail many person-centred thinking tools that can be used to capture essential information. All of the tools mentioned in the guide, can be used to help frame good conversations with people.

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In Doncaster, Care and Support Planning assessments are actioned by social workers, and they really focus on making sure that they get clear outcomes to work towards. The intention then in Doncaster is that the assessment is handed over to the person. If the person can develop their own support plan or has people around them that can help, brilliant. But if they need support to do that, it won’t be the job of the social worker; it will be the job of a support planner, which is a different, more radical way of thinking about support planning.

Support planning has to be proportional, so we have to think about how much information we need based on the outcomes. The Care and Support Planning cards are a toolkit that can help people to choose different tools to frame conversations so that they can capture information that’s relevant. So rather than working through a lengthy form, it’s all about having good conversations.

I’m going to use my mum, and my mum’s Care and Support Plan as an example of how this can work.

When my mum was first assessed for a Care and Support Plan, it was in a very traditional way and her outcome was deemed to be three visits a day and two baths a week. The problem is that’s not an outcome; that’s a potential solution.

So we started by having conversations with my mum and the rest of my family and actually, after we had captured good information about what matters to my mum, about how to keep her healthy and safe, and about her entire well-being (which would be best practice around support planning), it turns out that three visits a day and two baths a week was the wrong solution.

From the information that we had gathered, we realised that one of my mum’s main outcomes was to stay living in her own home in the street where everybody knew her. She lived in fear of going into residential care, and she was somebody who was at her best when she was in the centre of people she knew. She was the hub of the family and was somebody who was always the life and soul of the party.

The reason she ended up needing a support plan and a budget in the first instance was because her main carer, my stepdad, had suddenly died, and my sister became her full-time carer. My sister was a full-time nurse as well, so that created some problems.

Additionally, my mum had COPD so she had some health needs but she also had some other mental health needs as she was suffering from depression, partly due to bereavement.

Another outcome was to be able to talk about her late husband, and that was a problem at the time as this made my sister feel upset.

One of the other outcomes was to feel safe when she was home alone. This time when my mum was assessed, Mum imagined she would need 24-hour support and sleepovers in her own home, particularly if Katie was at work (my sister). But actually she was assessed as needing 21-3/4-hour support, which was a real shock to her. It wasn’t to me but it was to my mum.

So the next step was to look at what was getting in the way of these outcomes, and that helped to start us thinking which of the tools in the toolkit would be helpful to use.

One of the things getting in the way was that her daughter was now the main carer and also a full-time nurse, so her time was split. Because of that my mum was worried that she was becoming a burden on the family, and that was really contributing to her depression. When she tried to talk about her late husband to my sister, got really upset and emotional so that wasn’t a viable outlet for her.

If Mum was in on her own she didn’t have the strength to make a meal or lift a kettle. She could only just walk to the downstairs toilet, so she couldn’t actually fend for herself when she was at home.

If there was a crisis, she couldn’t actually get to the phone because she’d become breathless. If there was something going wrong she was likely to be more unwell, and less likely to be able to get help because she couldn’t get to a phone. She was constantly anxious about power cuts. Because she had COPD she was hooked up to her 24-hour oxygen machine. In the past she had experienced power cuts, and it had been a really difficult time for her. These were some of the things that were getting in the way.

Taking into account the things getting in the way of the outcomes, the next step was to think about which tools out of the toolbox might help us to capture information that would help develop a support plan that met her assessed needs, but also took into what matters to her and the essence of it. And not just thinking about her needs, but thinking about the whole of her life.

We started by thinking with her about what gave her a good and a bad day, and started to capture the essence of that. Just asking people what matters to them doesn’t necessarily give you good information so what we said was, “Tell us all the things that you look forward to if know you’re going to have a good day. What are the ingredients of that? If you know you’re going to have a bad day, what do you think might happen?” And that gave us some information that we could start to think about.

From the information that we captured we developed a one-page profile that detailed what was important to her and also what good support looked like. But also within that is knowing what she brought to the table herself? Just because she’s got health and social care needs doesn’t mean that she doesn’t have stuff to give, so it was really thinking with her about that too.

We also created a one-page profile so that anybody who was going to spend time with her (whether that was a personal assistant, whether that was my sister, or whether that was me) knew what mattered to her from the rich information contained on her profile.

We also needed to think about my mum’s history. What were the milestones in her life that actually might be useful to pay attention to while we were capturing the support plan?

We also thought about the relationships that she had; if she wanted to stay living in her home in the street where everybody knows her, then we need to think about what community resources she’s got.

When we did that, we realised her next door neighbour, Beatrice, popped in every morning so we asked Beatrice how she would feel about coming in and making my mum her breakfast so that she could have her medication. In return, she could have a breakfast with my mum, which was often bacon and egg. Beatrice was really up for that and my mum didn’t feel like she was taking from a friend; she felt like it was a reciprocal arrangement. It felt really natural, but meant that we could utilise my mum’s support package hours so that a personal assistant was used differently within that arrangement.

Another factor that we thought about was community connections because feeling safe for my mum wasn’t just about in the house – it was about the threat of anybody coming in – but she was absolutely insistent that people could pop in every day, so she always had the door open.

So we talked to people who lived in the street and said, “My mum really loves it when you pop in, so can you make an effort to do that? Could you knock on the window and see if she wants something from Michelle, or see if she needs a cup of tea?”

As she had been a community builder in her life (and she would never describe herself as that), people were more than willing to help her as she’d helped others out.

We also used the working and not working person-centred thinking tool, which meant that we thought about the current reality and analysed it, starting with my mum’s perspective, and thinking about my sister and the rest of the family’s perspective. We also considered anybody else and the professionals that are in my mum’s life, so that we could create some conversations that addressed what’s not working without undermining what’s going well.

From that we looked at what would my mum’s perfect balanced week be, because it’s not enough just to stay healthy and safe; we have to think about what makes it worth being healthy and safe? What makes life worth living?

We created my mum’s perfect balanced week so that any paid support and any family support was not just maintaining her being at home, but was supporting her to have a good life.

The person-centred thinking tools that we used really helped us to create and frame some conversations that helped to meet the assessed need around her budget, but also create a support plan to enable her to have a good life.

Care and Support Planning- what role can support providers play?

Blog by Madeline Cooper-Ueki, NDTi

TLAP’s Delivering Care and Support Planning defines the key stages and process for the care and support planning journey, which individuals coming into contact with social care for the first time should expect to receive. Yet many people have been supported, often for many years, by the same provider. They may being living in registered or supported settings and receiving up to 24 hours support, effectively encompassing all aspects of their lives. For these people, having the opportunity to identify and review chosen outcomes and exert choice and control over day to day life and longer term plans, is an essential element of ensuring they have a good life. Most will have a basic yearly review of their support with a duty social worker, but the reality is that this may not facilitate the person centred conversations which can be core to identifying and implementing personal aspirations and outcomes.

A number of provider organisations therefore take the leading role in facilitating a process by which those who they support, families and friends, can identify what really matters to the individual and develop a care and support plan.

An example of this practice is Joseph Rowntree Housing Trusts’ Excellence guide, which they worked with NDTi to co-produce with people they support, staff and others. This framework ensures that each individual’s care and support plan is personal to them, as well as ensuring an element of quality by providing a whole life framework on which to plan.

The TLAP guide identifies the importance of support solutions getting beyond just paid service provision. This may include a neighbour supporting someone to have lunch at a café instead of a home-care worker cooking for them, or it may be about an individual’s support being from a colleague in their place of work. NDTI and Community Catalysts research on widening options for support for older people with high support needs, identified that people are far happier with their support where there is a mutual benefit and enjoyment, rather than a receiver and care-giver relationship. This is harder to achieve in a provider- individual situation.

Whilst there is a natural tension for a support provider in looking outside their own organisation, rather than within it, to help someone identify the support they want, this is a step some are taking. For example, Certitude support has intentionally developed a more inclusive approach to helping people reach their outcomes, planning with people to make the most of local community and natural support systems such as friends and families. They and other organisations also facilitate reviews for the individual and family to review their experiences and the outcomes over the past year, using a person-centred review process. Such providers must and do remain open to new support options being considered as part of this process.

The best practice and an important aspiration may be that every individual has access if they choose, to independent support to develop their care and support plan. But for the many for whom this is not currently a possibility, support providers getting things right can make a huge difference.

All about outcomes

I am getting ready to present a session on care and support planning and outcomes at the conference in Doncaster next Thursday. It has reminded me how much debate and sometimes confusion about what we mean by an outcome. In this longer blog are the 8 steps that we are using to enable people to develop person-centred outcomes.

Here are some dictionary definitions of the word outcome:

  • A final product or end result; a consequence
  • A conclusion reached through a process of logical thinking

Sometimes there is confusion between aspirations and outcomes. Aspirations describe what someone wants their life to be in the long term, like living in their own flat, having a job and going out with friends. Outcomes describe the specific things that the person will do over a 2-3 year period to help them achieve their long term aspirations

A good outcome is:

  • Building on something that is working well
  • Changing something that doesn’t work well
  • Addressing needs
  • Moving the person towards their future aspirations

If the outcome being considered doesn’t address any of these issues, then it probably isn’t an outcome. A person-centred outcome can be described as:

  • Being expressed from a personal perspective, not a service perspective
  • Within the control and influence of the person and/or those involved
  • Specific to the person and measurable

What mistakes do we make with developing outcomes?

Apart from confusing outcomes with aspirations, there are two further common mistakes often made when developing outcomes. They are:

  •  Embedding the solution or provision into the outcome
  • Not being specific enough to be able to measure whether it has been successfully achieved

Embedding the solution – often you will see outcomes that describe the solution for achieving the outcome as part of the outcome or they are describing the provision that will help the outcome be achieved. For example, to have 3 sessions of home care each week 

A solution is the resource (provision) that you need to achieve the outcome. It can be an item or an activity and it may have a cost attached to it or may be free.

In the process below you can see some tools to help you explore whether the outcomes you are developing have the solution embedded in them.

Not being specific enough – if an outcome is not specific enough it becomes really hard to measure whether it has been achieved and has made a difference in person’s life, for example, to improve my fitness and stamina. This outcome statement is not specific to the individual and we have no way of measuring if it has been achieved. We don’t know what to be fit looks or feels like to this person or what is important to them about improving their fitness and stamina.

In the process below you can see some tools to help you explore how to make outcomes more specific and measureable.

How can we ensure that we develop person-centred outcomes?

The 8-step process described in detail below can help you develop outcomes that are person centred.

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Step 1: Check

Developing outcomes has to start with the person themselves. This should always be our very first port of call. We cannot support people to develop person-centred outcomes if we don’t first understand two key things at least. We must know what matters to them and what their future aspirations might be. This ensures our starting point is rooted in the things that are important to them, not to others and sets the direction of travel.

Not having this understanding puts us in danger of imposing our own ideas and often developing service driven outcomes.

To gain this understanding you need to have a person-centred conversation. The outcome of this conversation can be recorded in lots of different ways; it is the quality of the conversation that matters.

You can use person centred thinking and approaches as a framework for the conversations and record the information in a one-page profile.

Step 2: Now

Once we have checked that we have a good understanding of what matters to the-person, we need to establish a clear idea of current reality. This helps to establish the issues that are the priority for them and those that know them, to focus on.

If we use the working/not working tool to identify these issues, the outcomes that are ultimately developed will be relevant to the person and gives others that know and care about them, the opportunity to create a clearer picture of current reality and priorities.

 Step 3: Prioritise

You know what matters to the person, you have a clear idea of what is currently working and not working, it is now important make sure that the outcomes that are developed are important to the child and their family.

Again, taking the person centred approach; priorities should be agreed in partnership with the person and their family where appropriate. An agenda created collaboratively is far more likely to lead to outcomes successfully achieved and often people who are supporting the person to develop the information are the same people who will be involved in making sure actions are achieved.

Step 4: Success

It is important to reach agreement on what success looks like if the thing that is not working is resolved. This step is about being clear of your broad long-term aim for each priority area that has been identified.

By asking the person what success looks like for them then we are likely to make sure the outcome is specific to them and not assuming that a previous well trodden path for others in a similar situation, would automatically apply here.

It doesn’t have to be detailed or specific at this point

Step 5: Test it

We now need to get clear and specific by asking some questions. There are two main things to check are if your ideas to so far are actually outcomes or actually solutions disguised as outcomes and also that we haven’t drifted off the initial starting point too far and we are keeping close to what is important to the person.

The problem with confusing solutions with outcomes is that it shuts out alternative possibilities and other solutions too early. For example,

To have 3 hours of home care every week, may be a solution but we don’t really know what the person wants to achieve or whether the home care service is the best way or only way to help them achieve that.

To test if you really have articulated an outcome, the following questions, can be asked in no particular order or number of times.

What would it give you?

What would it do for you?

What would it make possible for you?

The second thing to test the outcome for is to check that we have really understood what is important to the person about this specific issue. We can do this by using the important to/important for tool. So exploring the fitness and stamina outcome:

Priority issue

Improving my fitness and stamina

Important to me about this issue

To be strong enough to use a

manual wheel chair all the time.

To be able to do more than one thing per day without getting too tired

Not being too tired to go out in the evenings with my friends.

Important for me about this issue

To improve my general health through exercise

Not to get socially isolated because I am too tired to see family and friends

 

My Outcome

I am using my manual wheelchair 12-14hrs per day and I am not too tired and having to go to bed in the afternoon. I am going out 2-3 evenings each week with my friends.

Congratulations- you now have a robust, clear and truly person centred outcome. So what next?

Step 6: What’s stopping you? 

You have your outcome but at this point it is useful to ask what some of the barriers might be and the obstacles to achieving this outcome, so that we can take this into account when we identify our next steps.

Step 7: Action

Having identified the overall outcome and what’s getting in the way, the next step is to identify the steps that you need to take to achieve the outcome and overcome those obstacles. Try to think creatively, and not to jump to the obvious service options.

This is where you can identify small targets or goals to help achieve the broader outcome. Different places will do this in different ways and have different language to describe this and that is fine as long as there is clarity about what the outcome is.

Having identified the goals/targets then you can identify the first step actions to get started, SMART of course with timescales, people responsible and resources required.

Step 8: Record

Strangely the first starting point for organisations when thinking about outcomes, is sometimes to initially focus on what recording methods are being used at the time and equipping employees to be able to fill this in appropriately. The energy and focus can be on whether the paper is capturing the right information and we become absorbed in data collection rather than knowing what we do is making a real difference to people’s lives. If we always take our starting point as the person themselves, the recording that we do, should and could be led from that.

So in summary…..

Start with the person; know what matters to them, what is working and not working and their aspirations for the future. Make sure you find out what the priorities are and what it looks like when they are achieved. Check you have robust and clear outcomes from this, know what barriers you need to overcome and set clear actions from this, which you record in a transparent and clear and sensible way.

Lets see what the participants at the conference next week think.

What does good look like?

Blog by Helen Sanderson

It is crucial that councils care and support planning is compliant with the Care Act, but that is not enough. In developing and writing the new Think Local Act Personal (TLAP) guide to care and support planning (see our new graphic of ‘what good looks like’), we wanted to go further than compliance and costs and also look at whether care and support planning is happening in the way that people want. We need to both be compliant, and be moving towards what people want and expect from care and support planning – what good looks like from the perspective of the person. In the guide are 10 powerful statements that set the standard for what people want. Care4 “Really? I can have this? This is possible?” was the response from one carer when she read them. Yes. In future blogs I will focus on how, but in this one I want to explain how these statements were developed. Several years ago, in the days of Putting People First, Helen Bown and I worked with older people and people who use mental health services to determine what best practice looked like from their perspective. Their answers, and the resulting report gave clear messages about what needed to happen to ensure support planning was led by the person. To read the report, click here. care5 We brought together members of the TLAP National Co-production Advisory Group and the emerging equivalent at the Coalition for Collaborative Care to develop a set of statements that reflect how care and support planning has to keep the person at the centre of decision making, and be done in a way that maximises people’s choice and control over their lives and services. We did this though sharing stories with each other of people’s best experiences of planning, and distilling the key elements of that into the set of ten statements. I think they are appropriately ambitious and challenging, and set an agenda for what coproduction at the individual level looks like. care7

‘I recently attended the event facilitated by Helen Sanderson regarding Care & Support planning. The session gave me a opportunity to provide my unique perspective through lived experience, share and explore innovative ideas and ultimately to coproduce how are I, and the group as a whole could make positive changes to how carer and support planning are delivered’

Andrew Walker, Living Your Dream Consultancy

Event – Bringing the Care Act to life: assessment, care and support planning and review

On the 12th February  Doncaster council, and Yorkshire and Humber ADASS network are supporting a fantastic practical and interactive event to explore how councils are going to be delivering what the Care Act expects in relation to RAS, assessment, care and support planning and review. This event is for both councils and third sector organisations.

12 workshops are scheduled, of which, people can choose two to attend and there is the opportunity to take part in the market place – a space to learn and share. Come and have creative conversations and go home with practical ideas and resources

The event includes a conference bag with resources from each of the 12 workshops, regardless of which one you choose to attend. There will also be an opportunity to book a 15 minute slot with an ‘expert’ to support you with any particular issue that you want to explore.

Additionally, TLAP will be launching some of its latest work on care and support planning through these workshops.

If you are not available to attend the conference, there will be videos and resources from the day posted on this site to keep you up-to-date.

Click on this link to book your place for the event: https://www.eventbrite.co.uk/e/bringing-the-care-act-to-life-assessment-care-and-support-planning-and-review-tickets-14973626520

The itinerary/details are below:

12th February

Doncaster Racecourse

9.30 Coffee

10.00 Welcome and introductions

  • What do people want from care and support planning? The national co-production advisory groups have produced 10 statements that reflect what great practice in care and support planning looks like. A chance to hear what these are and reflect on how well you are delivering these.

11.00 – 12.00 Workshop 1

12 – 12.45 Lunch

12.45 Marketplace

There will be a market stand for each workshop, so you will have a chance to talk to people about the other topics too.

1.15 – 2.15 Workshop 2

2.15 How do we want to keep in touch and share learning through the implementation of the Care Act? A chance to look at the support and connections that you would find helpful or could help with.

2.45 Next steps

3pm Depart

 The 12 Workshops available to attend are:

  • Changing the culture – moving from tick boxes to creative conversations
  • Assessment and RAS – what this means for professional judgment and keeping the person at the heart of the conversation
  • Making this work with your IT system – learning from Care First
  • Partnerships – working with the third sector around care and support planning
  • Doncaster’s story – from seeds of ideas to redesigning processes
  • What does this mean for reviews?
  • What does care and support plans and planning look like now?
  • What does this mean for the role of social workers?
  • What this means for the workforce
  • Thinking differently about signing off plans – the death of panels?
  • Organisational change and challenges
  • Care and support planning in practice – a tool-box approach

This is a wonderful opportunity for councils and third sector organisations to get to grips with implementing the new Care Act and to bring the Care Act to life.

If you can think of other people that might benefit from the event then please share this as well as letting people know on Twitter using the hashtag #Careact2life

We hope to see you there!