Claire Leandro, Service Director, Adult Care and Support
Cornwall is a lovely part of the world, but some aspects of our Adult Social Care were in a difficult place; we weren’t coping well with the pressures of delivering care with the inexorable increase in demand, in the current financial climate and after the introduction of the Care Act. We had restructured teams and improved leadership, but key markers were not shifting; numbers waiting for assessment, delays in hospital, sickness and fatigue among staff.
We recognise our key asset is our staff, and we know that our practitioners are hugely professional and committed; they absolutely want to do the best for the people in Cornwall. We were looking for a way to better access those attitudes and skills. Alongside this we knew that in social care we had lost our way in terms of working with communities and community assets and wanted to reconnect our staff to the wider solutions that people can make use of. The 3Conversations model appeared to provide a clear technique and approach to put this into practice.
Political leaders, the Strategic Director and the CEO were all active supporters and advocates standing with us whilst we innovated, which was a huge plus for the staff.
What is ‘The 3Conversations’
The 3Conversations is the antidote to the imbalance where process and bureaucracy seem to take precedence over practice and working effectively with people, and where quality and productivity are measured by the completion of assessment forms. The 3Conversations invites workers to really listen to people and understand what might help them get on with their chosen lives, and it liberates workers to help make this happen. Instead of trying to divert people, and then make them wait for an ‘assessment for services’, workers have meaningful interactions aimed at helping people get on with their chosen lives.
What We Did
In early 2017, as part of an overall Transforming Adult Social Care (TASC) Programme we kicked off with three innovation sites covering about a third of Cornwall. With the help of Partners4Change in February and March, we created our own ‘story of hope’ working carefully but energetically using the 3Conversations, and invited staff to express their interest in replacing their current way of working with this new way. We received 148 completed expressions of interest from a huge range of people from the voluntary sector, colleagues in other parts of the council as well as frontline staff and managers. As a result we established our three innovation sites that went live in May.
The project covers three geographical areas, defined by postcodes across East, Mid and West localities in Cornwall – each site covers an adult population of approximately 40 to 50,000 people. Each team has a team leader and six members of staff. This is what we are learning from our innovation sites….
To date (November 2017):
We have had 1091 people through our three innovation sites.
45% are ‘new’ people with no existing paid for support arrangement.
The conversion rate of new people becoming recipients of ongoing support is 3% – significantly lower than any benchmarked ‘old system’ performance.
45% have existing support.
10% were from waiting lists that came with the innovation sites.
70% of conversations have been completed.
120 Conversation2s have started – where we are working urgently and intensively with people in crisis.
What Our Staff Are Saying
As part of our evaluation of our first phase of 3Conversations innovation, we made a short film involving people in Cornwall who had experienced this way of working and our staff. In relation to staff one of our frontline workers said: “this saved my social work career. I was about to quit. I can now do the job I thought I was employed to do.”
A View from Nel Freegard – Social Worker
“Before we started using the 3Conversations it felt like I had no control at work. It was as if there was a massive pile of work on the computer, and at regular intervals it would appear in my workload. It was if we were all on a hamster wheel. What’s different now? We have ownership of what we do, we work much closer together as a team, we are always discussing something. In our daily huddles there are always people to check things out with. We are put in touch with people in our area immediately – people haven’t been waiting on a list! We can do things that make a difference. People genuinely enjoy coming to work. And if people are in a crisis their social worker is their resource, working with them, being with them, building a relationship that can help things get better.”
A View from Adrian Bartram – Innovation Site Lead
“Moving to the 3Conversations has been a revelation in many areas. Working with no waiting lists, and being focused on what would make people’s lives better is great. 360 people have been through our innovation site and no one has asked for an ‘assessment’. We now have a strong sense of teamwork. Before, we worked much more as individuals. Workers felt more isolated, head down, working at the desk and behind a computer. Now, we discuss daily how to handle things, using joint visits and sharing tasks. This way of working has freed up management time from constantly monitoring waiting lists, and speaking to people ringing up to ask when something is going to happen. I have daily engagement, and meaningful conversations with my staff, now. We thought we were personalised – with a new ‘choice based’ form. Now we really are focused on listening to what will make someone’s life better. The 3Conversationsit turns everything away from us and the form, to the person and what matters to them.”
It is not easy to accurately benchmark the new way of working with the old, not least because accurate information is difficult to get hold of from the current way of working. However the 3% conversion rate in our innovation sites compares with our knowledge that in December 2016 we were calculating that approximately a third of assessments led to an ongoing provision.
Stories of difference
We were contacted by a Supported Living service about a man recently diagnosed with autism. Support worker was requesting assessment for personal hygiene, housing and benefits.
What would have happened: Wait in queue then reassessment and likely provision of more support.
What did happen: Instead of an assessment, an innovator talked with the individual. His hygiene is fine, he is already linked to an employment service, and is currently bidding for properties to sort out his accommodation. What he really wants is friends. The social worker is looking at opportunities where he can meet people.
Story about a woman in crisis using a bucket as a WC.
What would have happened: Rapid response would have undertaken emergency assessment, and provided a commode and short-term home care.
What did happen: Immediate needs identified by the innovator and she brought around a commode and fan. This was a great example of the ‘sticking like glue’ approach of the 3Conversations. There were frequent visits, and an agreement b’ased on I will help you if you help yourself’. At end of crisis no ongoing service was required.
A repeat phone call was received from a carer of someone with dementia who after a long wait had received a carer’s assessment and had been allocated the carer’s grant of £300. However this had not addressed his needs. He called back four weeks later for further support.
What would have happened: Referral to carer’s service for further assessment and likely consideration of putting in some respite to ‘give the carer a break’.
What did happen: Innovator listened and realised that he needed to be connected to local support networks rather than receive a modest carer’s budget – which he said he didn’t want and didn’t make a difference.
What is working well?
We have been really heartened by the difference we make to people
Quick response, which surprises people
No hand off between teams/services
Big increase in job satisfaction of staff
Reductions in time spend in disproportionate process – increase in doing things that work well for people
We have been pleased to see the impact on team working
Team work and team huddles each day
More joint working with Health colleagues
Really good mix of skills within teams
Knowledge and confidence to work with creative solutions within communities
Pulling together as a team
Access to credit card, it used to take months to purchase things!
There have been obvious benefits for the service too
evidence of reduction in need for long term services – saving money
we are learning that there are opportunities to reduce bureaucracy and processes which will free up staff and service time
What is not working so well
Using Mosaic (IT) – old work flows/steps are still in place
The ‘old’ world and the ‘new’ world processes and systems clashing
Brokerage and delays for services
Claire Leandro – Final Thoughts
What I have found so invigorating about this work is that we have learnt so much together as staff and managers, which has built an actively curious, but brave approach. Our evidence shows that this model delivers for Cornwall in many ways.
We are now in the process of co-designing our ‘phase 2’ of innovation which is likely to be a mixture of scaling up existing sites to include all activity, and beginning new ones. We hold on to the key element of collecting data and understanding it thoroughly. There is a long way to go, and taking this work from a sizable innovation trial to, in all likelihood, the majority of what we do, will not be a straightforward task. We are confident that with the firm foundations and ethos we have built, we shall co-design and build this way of working.