The Blog


Three conversations – multiple benefits


11bed6cLyn Romeo
Chief Social Worker for Adults at the Department of Health.

Regular readers of my blog will know how keen I am to have a focus on relational strengths based social work practice at the heart of adult social care. The Care Act has provided us with the legislative architecture to do just that.  Re-framing the way we work and addressing the tendency for processes and procedures to tip the balance in the wrong direction is a constant challenge.

In my visits to local authorities I have been heartened by the developments in practice that are focusing on strengths based approaches and the different conversations social workers are having with the people with whom they are working.

On a recent visit to West Berkshire, I heard about the focus on restorative practice approaches and the 3 conversations model and was pleased to meet with Sam Newman, a social worker and Director of Partners for Change, a bespoke change management organisation specialising in personalisation, innovation and financial sustainability. He kindly agreed to be my guest blogger this week. I will be working with people across the sector to develop a practice framework that brings these approaches together in a helpful way.

‘I am convinced that the only way to make change really happen is to get to the heart of what people think they do when they turn up to work.’

Sam Newman

“It was great to spend some time talking with Lyn about our 3 conversations model and how it can contribute to a blueprint for adult social care that delivers on the promises of personalisation, and is practised in a context of community and asset building, local area co-ordination, restorative practice and other like-minded approaches.

It seems to me that, unless we collaborate together to build a sustainable and compelling story about how social care and social work can deliver value, and really add to people’s independent lives, we face a distinctly uncertain future.

I am convinced that the kind of change Lyn is talking about is essential and I have become more than a little obsessed about how you really make change happen.  I have lived through a series of paradigms, world views, approaches in adult social care and yet, on my watch (and others) we have still ended up with a system that is process led, bureaucratic, and – despite many fine words – is in constant danger of losing the person at the heart of it all.

As one director recently put it ‘we have built a system based on queues and waits’.  I would call it a sorting office – they may well work for letters and parcels, but not for people. Queues and waits are really bad for people – particularly those who have probably spent many weeks trying to find other ways of creating solutions for themselves or their family members and have had to fight their way through the system to arrive at their own particular queue or ‘wait’.

In our current way of working a social worker’s quality, performance and productivity is measured in terms of forms completed per hour/day/week.  Adult social care systems, by their own admission, have become ‘assessment for services’ factories.  And we try and control spending in our austere times by making it harder and harder for people to get anything from us.

So how come person centred planning came (and went) – and didn’t change these things?  Who decided that direct payment processes must become so onerous, so bureaucratic, and so self-defeating that people with direct payments would often wonder why they bothered – because they would often end up with the same kind of things that they would have had anyway – but having expended much more effort. (This is not to deny that for some, a direct payment has been a lifeline to choice, and to quality of life). Where did the half a billion pounds of reform grant to support personalisation go.  What return did we get for that?

Prevention strategies (including those I participated in creating) may have had many fine words in them but largely they have not influenced the core experience of people and families who need support to get on with life. Commitments to dignity, respect, autonomy and citizens’ rights have still left us with practice which is largely governed by the requirement to complete assessment forms that have grown like topsy and have too often become the end in itself, rather than the means.

So it was really refreshing to talk with Lyn about the requirement for really deep listening – and how we can re-introduce it as the default activity. I have become convinced that the only way to make change really happen is to get to the heart of what people think they do when they turn up to work, what practice they display, what behaviours characterise their work, and ultimately the detail of the conversations they have with people and families.

The ‘three conversations model’ provides a set of tools to enable our committed, principled and skilled workforce to have conversations based on what people want to tell us, not what we want to ask them.  It makes us see them as people (not clients, service users or even customers), reminding us they are often part of a family neighbourhood and community.

I have seen how, if you dynamically and intensively replace our ‘assessment for services’ culture with a commitment to proper conversations, we can really listen and begin to deliver the holy grail of better lives for people and families, and a reduction in the consumption of health and social care resources, matched with a liberated, productive and inspired workforce.”