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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