In our recent conversations with other experienced and esteemed practitioners in the field of health and social care, a regular topic keeps coming up. Why aren’t we seeing real progress in Adult Social Care transformation?
Why now is it still seen as ‘progress’ when a student Social Worker talks about a person they are supporting on the basis of their skills and strengths? This is not new, and it is not innovative. In fact, if a social worker is describing this type of practice, they are merely demonstrating their compliance with the Care Act and Care & Support statutory guidance. We are not seeing change, because those who are the gatekeepers of the change are still seeing ‘new innovation’ as practice which is aligned with what the innovators were discussing and doing 30 plus years ago.
Innovative work is often observed from an external position, where the work of the innovators is recognised, admired, heralded and celebrated but still seen as separate to ‘what we can do’; therefore those that are in a position to make a difference do not recognise the role they have to play in making it happen. They don’t recognise how they can be part of making the difference themselves – always seen as something the the people on the other side of the statutory fence do. It is common practice to attend conferences and online events which are presented as ‘an audience with the innovators’. The problem with this is that innovation continues to be seen external to the audience and the very gatekeepers of change.
So what would it take for people not only to see and admire the ‘innovative’ work but to embed it into their practice, for them to model this approach and build it into what they do, rather than celebrating it as ‘best practice’ and ‘something to aspire to’?
Is this about providing support and guidance; and to be alongside people, building it into their practice as they stretch their comfort zones until it becomes part of their comfort but preventing them from going into the place of panic? Is it about bringing in what is covered in the Be Humankind practitioner experience around recognising your circles of influence, concern and curiosity; functioning from a position of influence and courage whilst being in high states of self care?
Organisations need to focus on building an organisational culture that has psychological safety as a foundation, so that those with the passions, skills and understanding can dare to do things differently and to feel safe and supported in the pursuit of this. We need a health and social care system that is not defined by users and providers but by people being alongside each other in the pursuit of a better life experience.
Wherever the answer lies, it is this dynamic shift in culture and practice we need to see before we can expect to observe any dynamic shift in the way care and support is organised, sourced and experienced.
Independent Support Brokerage creates the shift by working with one person at a time. It does not start with standardisation of processes, forms and templates (which often squeezes out creativity and innovation). Instead it focuses on some key principles:
Listen: to what is happening for the person. Use discovery conversations to understand what the person wants to change or achieve. Start with the strong stuff. Relationships, skills, interests, passions, connections, hobbies. Learn from listening about what a good life looks like for the person. From this foundational information, exploration and planning can happen.
Explore: From the basis of what has been learned from the person, support the exploration of possibilities, opportunities and resources which are available to support the person in what they want to change and achieve. From this stage of the listening, learning and thinking, the person can begin to form some clear ideas of how they want their life to look, and how they would like to be supported with it.
Connect: From the exploration which has taken place, create some ‘maps’ of assets, relationships and opportunities which the person wants to include in their planning. Make connections. Facilitate conversations. Access resources (which could include statutory funding such as a Direct Payment of Personal Health Budget) and secure assets which will support the implementation of the person’s ‘good life’ plan.
Action: Support the bringing together of the final plan. This may need to be signed off by statutory decision-makers, so it is important that the plan meets eligibility and requirements for sign-off. The plan should include costings for any paid-for elements of support, but could also include non-paid elements which still contribute towards the person’s overarching wellbeing outcomes. Once the plan is agreed, an action plan to support the implementation of supports and resources is helpful to ensure that support is put in place for the person. Ongoing support around review and update of the plan may also be helpful.
We’ve been thinking a lot recently about how the neurological levels from Neurolinguistic Programming (NLP) can really help to enable to change to happen authentically, and be lasting. Our founder, Liz Leach Murphy is a Neurolinguistic practitioner, and has incorporated her training and knowledge in this area into our practices as an organisation. As a team, we have recently been reflecting on how this could really help to make things happen where we often get stuck.
When trying to create change in a system, we often don’t take into account the multi-layered dynamics. The need for change is recognised, but often the ‘change process’ works with only one layer of the system whilst overlooking the rest.
People working in different areas or layers of the system will come to the change conversation with their own opinions, and little awareness of the wider impact on the person at the centre of the process or the system. Nobody is listening to each other. The change may be agreed, but is never embedded because the different layers are not all involved together; or they don’t communicate with each other. There is no coproduction. There is no Asset-based approach.
Unless all layers of the system are involved, we will always come across some resistance or a lack of engagement in making real change happen.
In a Health and Social care system, where change is needed, these layers can be composed of:
If these layers can be aligned and congruent, we may experience some element of change.
What are the conditions? Respect, equal power, asset and strengths outlook, a solution focus; but more than anything else, a commitment to really listening to each other and working together to make a change.
The starting point is a shared vision.
With a clear sense of the vision we want to achieve, this then provides the why and the purpose of what we do. We can then explore- “What do we do?”
Checking if the actions we have identified collectively are aligned to the vision and how we do it.
Common barriers to multi-layered change can include:
-Silo working…”I am here to do my job, which is…..” (even if it doesn’t fit with the vision)
-Hero status…” I have been doing this for years. I am the expert, and I have all of the answers”… (even if there is no recognition of the vision or listening to those who are at the centre of the process)
-Time pressures…”We need to get this done by xxx date”….(the date then becomes the driving factor, rather than thinking about what is reasonable, practical and helpful to achieve the outcome)
-Budgetary pressures…”We can only spend this amount during this time frame”…(which can ultimately lead to the wrong outcome and causes higher costs in the long term)
-Forgetting the focus…”The professionals involved all need to have a meeting without the person & their family present”…(which can ultimately lead to misinformed and harmful decision-making which has not included the person or their family)
So… how do we approach a change conversation?
-Start with ‘why’ to identify and agree a clear purpose
-Recognise the expertise, experience & knowledge within the layers of the system or organisation, which can be brought in to effect the change (skills & asset-mapping)
-Make time to discuss and identify each of the neurological levels which need to be addressed to enable the change
The neurological levels start by addressing the environment for the change conversation. They then examine behaviours, capabilities, values and beliefs before arriving at identity.
After looking at each of the neurological levels together, try completing a forcefield analysis together, to identify the forces for change and the forces of resistance. You can then use this as a basis for action planning. (Click here for a template and explainer video).
We can use the neurological levels as a checkpoint for the change.
If you’d like some support with initiating a change conversation; or would be interested in exploring how the neurological levels can help you to drive change in your project or organisation, we’d love to hear from you.
Contact us by email at:firstname.lastname@example.org
It’s quite common to hear about ‘person-centred approaches, ‘choice and control’, and ‘self-directed support’ in Adult Learning Disability and Autism services; but we don’t often hear about innovations and personalised approaches in the delivery of older people’s care and support arrangements.
Imagineer has been delivering training in person-centred approaches including support brokerage for many years; and recently we were approached by a forward-thinking provider organisation in Devon- Love2care
This organisation provides home care support services mainly to older people across the Torbay area of Devon. They are rated as ‘outstanding’ by CQC and have a really unique, creative and personalised approach to the way they deliver their services.
Traditionally there are 3 main types of service model adopted for the care and support of older people:
The founder of Love2care Devon- Maddy Bird was keen to train her staff team in the principles of self-directed support and to develop their skills as Support Brokers so that they could really open up the way they supported their clients both at home beyond the traditional models of support, and also when there were any transitions into a hospital environment or a change in their care and support needs. Love2care commissioned Imagineer to deliver the full accredited Support Broker training to an initial group of staff at the organisation. Due to Covid-19 restrictions, the training was moved to online delivery, via the Zoom platform.
Maddy talks below about their experiences of doing the training and the impact it is making on their work as an organisation:
Love2care has people at the very heart of the service, and when we talk about ‘people’ we don’t just mean the person we are caring for. We mean them – absolutely, but their loved ones also – the carers who provide paid and unpaid support. We also value our team and employees, as people. We focus on getting to know what matters most on an individual basis – not just feeling like we are completing a set of tasks for someone; but that we are facilitators and part of a support system, as advocates, listening ears, and objective eyes.
I often say to people that Love2care is a person-centred organisation, because although we may be juggling a lot of changes or difficult situations; we are disciplined in our practice, ensuring that others don’t feel that strain. We are careful to ensure that people feel listened to, heard and valued. We then support each person to look at ways to address what it is that they want to achieve.
Our service is very much focused on building & maintaining positive relationships, and having clear boundaries. We work hard to avoid getting caught up in bureaucracy. We truly try to work with the people we support, so that they can live the life they want to. For me, the word ‘facilitators’ is very apparent within the organisation.
My work background prior to Love2care was in a corporate organisation, and my role was ‘brokerage manager’ – working under a ‘prime provider’ framework with my local authority. I loved being able to help secure care and support for people, but what I quickly realised was just how ‘un person-centred’ the processes were. I felt that (for me) care has been a vocation, and a journey, and yet throughout my career I was starting to come further and further away from the person. I was brokering care and support for people whose names I didn’t know, as it was done via an excel spreadsheet. For me, this just wasn’t ok.
I felt that I needed to do more.
I then established Love2care, and through my work, I have just always had a passion for changing that experience. I have been able to do that via Love2care in some areas, but I then had a vision that my team around me would have the competence and the desire to support people more, enhance their lives, and also have meaningful conversations.
I think within our service we regularly felt like we had more to give, but less autonomy through local authority contracts. We equally wanted to support our local community – so there were definitely feelings of restriction and limitations in our role. I developed an idea using support brokerage, and using our CQC registration, which explored a new model of care offering the potential to free up social care time and resources; and work in a much more personalised way with people to self-direct their own support.
We really enjoyed our training. There were a couple of things for me, firstly being able to invest in my team to develop them personally and professionally; giving them a skill set and knowledge base that not all front-line social care staff have the opportunity to normally receive. The training is giving them the confidence and competence to be able to have more in-depth conversations, and autonomy to look beyond a task list for people.
Secondly, what I also took away really positively was that our care and supporting planning was really person-centred already. Recognising that as a home care provider, we had the resources and we were utilising them; but through completing the training we were able to go deeper. I now have more resilience and flexibility within the service, to offer people we may not necessarily need to provide with direct support, but to offer them a brokerage service that means they are feeling heard, and that they can self-direct their own support.
My staff team have the autonomy and confidence to go beyond the norm. They understand how to look at different resources, so people remain independent for longer. Even just our conversations as a team have changed – I feel that we have given people more choice and control – allowing them to make the decisions they want for their lives.
Our local commissioners are really enthusiastic about us thinking differently. We are looking at developing Individual Service Funds (ISFs) within our local teams; however, due to the restrictions of Covid (and now heading into winter pressures), I think there is some delay – even though in one sense and in an odd way, I also feel that because of Covid – we are years ahead.
We will keep doing our thing, and hope that people see that a new model of care could really make a difference.
Surely we have to try?
Are you interested in finding out more?
Imagineer offers accredited support broker training, mentoring and other training/resources relating to self-directed support and strengths-based approaches regularly throughout the year.
Visit our explore our website for further information which can be found under the drop-down menu heading ‘What we do’’ for further details, and subscribe to our mailing list to be kept up to date with future training dates.
To find out more about the work of Love2care- Devon, visit their website: https://love2care.uk/about-us/
Liz Leach Murphy is the Founder of Imagineer Development UK CIC, Chair of the National Brokerage Network and a Freelance Consultant working on personalisation within the Health and Social Care sector/community space.
Sarah Holmes is a Freelance Consultant working on personalisation within the Health and Social Care sector/community space; and a Director of Imagineer Development UK CIC.
Maddy Bird has worked within Adult Social Care for 10 years, in various roles from Community Carer, Care Coordinator, Brokerage Manager in a prime provider commissioning model, and is now founder and leader of an Outstanding Rated organisation, Love2Care Devon – established in 2017.
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