The Royal Borough of Windsor and Maidenhead began using the ‘3 Conversation’ model in the Autumn of 2016, and have called their approach ‘Each Step Together’. The three Conversations replaces the default ‘contact, divert, triage, reablement, assessment for services’ process with a dynamic asset based approach to listening to people aimed at supporting independent lives, and reducing the need for dependence on formal services. Please see our website www.partners4change.co.uk for more information.
Before we hear from three members of the team to get a sense of their experience of working in this new way, and tell one story of difference, this is what Angela Morris, Deputy Director of Adult Social Care has to say:
“Using the 3 conversations model has resulted in a real step change for our service. It has been refreshing to work on something that has real time, tangible benefits for local residents and their families. In addition it has given us confidence through linking with other councils who have adopted this model to question and challenge the over engineered national process for completing assessments, and put in place a simple responsive and safe model. ”
Jeanette – Manager (Short term support team)
I’ve found working in this new way really liberating as a manager. The ‘3 Conversation’ model has allowed us to do away with the enormous amount of bureaucracy that we used to have to deal with. It’s really rewarding as a manager to allow staff to ‘let go’ and give them the permission to work differently. It’s been a particularly good experience with new members of staff who have been able to get straight on and stuck in with the new way of working, rather than get involved in the ‘old world’ way of doing things. This new approach has energised the whole team. People feel like they’re doing good work – the work they trained to do, and want to do.
I think the key difference between the way that we used to work, and this new way of working with the ‘3 Cs’, is that the person is truly at the centre. Everyone liked to think that we were working in that way before, but in comparison, we weren’t. I really feel that we are now. It’s been particularly effective in allowing the team to work across disciplines and opening up resources, since there is now a focus and responsibility to speedily enabling and empowering people who get in touch with us, rather than put them on a waiting list, as we used to. This speed and absence of bureaucracy means that the public is getting a better service, and staff are finding their work more rewarding, and as a manager, I’m seeing this in staff’s appraisals and levels of enthusiasm across the team. It’s a much better way of working.
There have been some challenges, though. For some, it has been difficult to ‘forget’ the old practice, and I envision there being some teething pains with long term care need teams where the challenges and cases can be complex in different ways. It’s as much a mind-set change as a new way of working. It certainly encourages more ‘true’ team work in that to maintain the speed of service, it’s necessary for everyone to work together, across disciplines and teams. It’s really liberating to be able to focus on those who come to us with most need, and to have a structure that enables us to stick with them throughout a crisis. It makes more sense for them too, since they know what to expect and who their main point of contact is, rather than being ‘handed off’ multiple times throughout their journey with us. Our reviews used to be at crisis point, but now we track them all, so people are being reviewed more regularly and thoroughly, which is really positive and best practice.
Hari – (Management Information Officer)
I work on the ‘data’ side of things, and what I’ve really noticed about working using the ‘3 Conversation’ model is that we are having much more contact with the person – speedily and proactively – whereas before we would have put them on an allocation list. This new way of working means that we are dealing with requests and helping people within 24 hours and are able to offer immediate intensive help to those in crisis who need short term help to improve their situation. There is no doubt that working in this new way is better for the individuals we are trying to help, and that the speed and response rate are incomparable to the ‘old’ way of working. However, the most important aspect, I think, is going to be to tailor the model to the Royal Borough of Windsor and Maidenhead’s (RBWM) way of doing things, so that it slots seamlessly into our processes.
One issue that we have experienced a few challenges with, is how to record our data and ensuring that the paperwork side of things is sorted so that our social workers are adequately able to record the conversations they have, and the work that they are doing in a consistent way. We’re in an interesting transition between ‘old’ and ‘new’. This really is a totally new way of working – a complete change of mind-set. I think there is a lot of value and importance in having a really strong and united steering group to guide the wider teams to working in this new way.
The onus of Adult Social Care provision should not only be on the Council, but instead it should look more widely at what the community can also offer and chip in. The ‘3 Conversation’ model has given us the permission to begin to change the old mentality and to begin those conversations with the wider community and service providers. This way of working is a lot more personable: we are no longer treating people as a number, but are truly trying to help them to maintain their independence according to their ability and need. The old way of working essentially put people into ‘boxes’ and would restrict where social workers and the ‘system’ could take them, and as a result, the extent to which they could be empowered. It was a people processing machine. In this new way of working, the ‘personal’ has been put back to the front and centre of what we do. This is about an ongoing conversation with people, and putting a name rather than an ID number against members of the public.
One thing to note, is that we are a small borough, and that poses challenges with adopting a new model of working, that larger authorities with bigger teams and budgets may not face. It will be interesting to see how we will role this out across the board, inform staff of the new model and prepare them for the change. Some see the ‘3 Conversation’ model as something similar to what we used to do in the past, but I see it as very different.
In terms of the numbers across the various innovation sites we have worked with about 350 people. These have amounted to 464 conversations with our residents. Approximately 88% of the conversations we had with our residents were conversations 1’s. These have focussed on helping people connect with their community, supporting family carers and enabling people to get around through connecting them to equipment and other daily living aids. These conversations have been both over the phone and also sometimes via home visits.
The remaining conversations were evenly between a conversation 2 and conversation 3 (about 6% each). The main type of crisis (Conversation 2) was related to carers and the resulting plans were focussed on supporting them. Conversation 3s largely focussed on support during the day.
In our new ways of working, we have seen a marked improvement in responding to people. In November and December 2016, our most significant service area (Physical Disabilities & Older People Team), were responding within 24 hours. In the preceding 2 months (September & October 2016), only 52% of referrals were allocated within 24 hours – with any action being at some point after this. This improvement aligns itself with the feedback we are receiving from residents who state they are extremely satisfied with our degree of responsiveness in assisting them the issues that made them contact us.
Olga – (Service Manager)
I manage a team of social workers and the main difference that we have found is the drastic decrease in paperwork and bureaucracy. Our assessment form used to be 40 pages long (!), and moving to the ‘3 Conversation’ model has liberated us from that, so we have seen a huge decrease in staff time spent sitting at a computer. We are able to get through cases much faster and we are able to work with our community and be more creative, which is what, as professionals, we’ve always wanted to do.
As a manager, it’s a better way for me to work too, since it allows me to help reduce my team’s workload (regarding paperwork), and enables me to encourage them to use their creativity in helping people to live more independently. It also sends a really important message that local authorities can’t do it all on their own, and that there shouldn’t be an assumption that all assistance and help is met by a government body.
The hardest part of the process so far has been our own internal IT systems – it’s very frustrating that our systems are lagging behind and slowing us down. I’m finding that the team are doing a wonderful job of working according to the new model, and that that side of things is going very well, but that the majority of the teething pains are to do with our IT system, not with our people.
Working in this new way highlights that as social workers our profession is all about empowering communities and staff, and the ‘old world’ was stifling that. We had been feeling increasingly, that our freedom and creativity as professionals had been curtailed, and it’s nice to feel that we are gaining permission to work in this way as a result of the new model. Thinking about how we used to work makes me realise quite how much time we spent “feeding the beast” (the computer!), and quite how cumbersome the paperwork and waiting list pressures had become. We spent so much time filling in forms! It’s great to see staff feeling more empowered, and that joy as a manager is something that I haven’t felt in a long time. I’ve also found that everyone is talking more as a result, since the work we now do often requires us to personally make connections across teams and disciplines rather than ‘hand people off’ as we used to in the past. It will be interesting to see how the transition goes from the ‘old’ to ‘new’ world once we roll the model out across the board.
One story: NP had just move into the area into a halfway house having lived in an institution for more than 10 years. He became known to the innovation site, with the information that he may struggle to do his shopping and prepare meals.
What would have happened: NP would have become a referral through the contact function at the council and then waited to be allocated to one of the teams. After some weeks had passed he would a have been allocated and someone would have visited to do an assessment, check eligibility and if he was deemed eligible offer him services. Services could have included meals, and/or some help around the home.
What happened: the innovation worker visited within days, already prepared if necessary to buy this man a second-hand tablet and help him shop on the internet. It became apparent that he already owned a laptop. He also had facilities that would enable him to cook but he did say he struggled to open jars. The worker had access to an on line catalogue of equipment designed to help people with minor disabilities and the staff at the home agreed to help the man decide what he needed. Everybody was happy with the outcome of the visit.