Agenda item

Richard Keble, the Council's Assistant Director of Adult Services had been invited to provide an update and evaluation of the Three Conversations (3C) programme for social work in Adult Services, and summarised the main points of his presentation.

Two Locality Managers of social work teams were also present, to provide feedback on the new approach.

The new model was about people, conversations(s), promoting independence and building on strengths; the focus was on enriching people's lives, not providing services.

The three conversations involved in this new model were:

·         Conversation 1: Listen and connect – Listen hard. Understand what really matters. Connect to resources and supports that help someone get on with their chosen life, independently.

·         Conversation 2: Work intensively with people in crisis – What needs to change urgently to help someone regain control of their life? Put these into an emergency plan and, with colleagues, stick like glue to help make the most important things happen.

·         Conversation 3: Build a good life – For some people, support in building a good life would be required. What resources, connections and support would enable the person to live that chosen life? How did these need to be organised?

In April 2017, the model had been introduced with two innovation sites for Older People's Teams (Pershore and Upton, Redditch Central), and from August the Young Adults Team started as the third innovation site. The Acute Hospital Teams were due to go live in October. An integrated health and social care approach in Malvern, with the GP Practice and Worcestershire Health and Care Trust, was targeted to go fully live in December.  Redditch South and Droitwich, Ombersley and the Rural Older People's Teams had been identified as the next to prepare for innovation. Roll out needed to be gradual, to allow time for development and support.

Processes had been mapped and were being standardised. A Communications Plan had been developed and local services were being mapped. Neighbourhood offices were being identified. Each team had a separate space to reflect, learn and support each other, teams took direct calls and there were new, simplified records.

Feedback from the public and staff was shown to the Panel, which was very positive and indicated support from service users and staff.

The majority of staff reported that people and carers were receiving less funded long-term on-going support with the new approach. Cost analysis continued, and costs of care were similar in 3C and non-3C teams, however the long-term package conversion rate for the 3C model was currently more than 50% lower. 

Over four months, nearly 600 people had been worked with; the term 'cases' was no longer used. The Panel was shown a graph which showed that 70% of people only needed the 'Conversation 1' stage to have a positive effect (519, compared with 115 Conversation 2's and 48 Conversation 3's).

With the 3C model, most conversations started immediately (with an average wait of 2 days), which was an important factor in keeping people independent. Previously, the average wait for assessment was 45 days, during which an interim care package may be put in place, which could affect people's ability to regain independence.

The Panel heard from Locality Managers Rachel Fowler (Pershore and Upton) and Ann McDowall (Redditch Central), whose teams were innovation sites for the 3C model.

They felt that the new model was 'fabulous', 'empowering' and meant they were 'doing social work the way it should be'. The previous way of working had involved so much managing, prioritising, people waiting and had generated assumptions that a care package was needed. The new approach cut this out; the teams were the first point of contact and stuck with the person, with immediate conversations about what had changed, what had prompted someone to call. The Locality Managers felt much more engaged and part of their communities, and worked closely with partners including GPs and Primary Care colleagues. The public felt more reassured and were pleased not to be passed on to someone else.

Rachel gave an example of a lady in her 80s with early dementia, whose family and GP had noticed becoming withdrawn and aggressive. Over a number of conversations and visits, the social worker was able to discover that the lady had been an actress and pianist, that she was not at risk, but needed to reconnect with these interests to improve her wellbeing. The social worker arranged for the lady to play piano at a residential care home, and also to join an acting class. Support had been person-centred, and accessed local services, without assumptions being made or being risk averse.

Ann told the Panel about a lady who had been referred by her district nurse with concerns about her back as she was sleeping downstairs on the floor. This would previously have been responded to by completing a 27 page assessment, identifying a care need and perhaps bringing the lady's bed downstairs.  Instead the social worker was able to gain the lady's confidence and through a number of conversation 1s, discovered that the obstacle to the lady using her stair lift to sleep in her bed upstairs, was a large wall unit in the lounge which she could not get past in her wheelchair. The solution was to hire a local handyman to remove the wall unit and add an additional wheelchair at the top of the stairs. 

Staff had access to procurement cards to address care needs, however were also encouraged to ask people whether they were able to pay themselves..

The Panel asked a number of questions of the Locality Managers – the main points were:

·         It was a very different way of working, but one which felt the natural because of the principles behind the 3C model. The transition had taken some staff longer than others, but introduction of the new ways of working  had been helped by staff being able to sit together with their manager.

·         Staff feedback was positive, including those from other local authorities.

·         Teams worked closely with GP surgeries and health teams, with some having a GP desk presence, depending on the available space.

·         The Panel would be provided with details of GP Clusters and how they mapped to the geography of the County.

·         Many staff members were local to their areas, which helped build knowledge of local services and gave them added incentive to find more. Services were also being mapped out and providers invited in.

·         Managers had more oversight of their team's work.

·         There were strong links with the Carers Association.

·         Links with councillors would be mutually beneficial, both in building information about local services and also in developing councillors' understanding about the new way of working.

·         A Panel member acknowledged that budget pressures may have played a part in requiring the Council to find ways to work differently, but the result here was positive.

·         Where solutions were offered through working at Conversation 1 or 2, what happened when those involved believed that a higher level of intervention was required (Conversation 3)? The social workers advised that this would be addressed by talking to those concerned to understand the barriers and needs involved.

·         While the need to go beyond the first stage of conversations (Conversation 1) had reduced, assurance was given that crisis response (Conversation 3) would be readily actioned where required and that in these instances sticking with the person concerned was even more necessary. The Assistant Director pointed out that the model actually freed up capacity for staff to react to crisis cases.

·         Work was in hand to ensure that relations with providers were outcome-based, however the model was already building links with the voluntary sector and supported the way in which the Council commissioned.

·         Capacity within the community was not seen as an issue, and there were examples where the new approach had encouraged more people to volunteer.

·         The model was being rolled out across teams and it was hoped to start the process for the 16-25 year old learning disability sector by the end of March.

·         On occasion a member of staff would need to pass on a person's case if other expertise was required, but this would be carefully explained.

·         Most staff were permanent and there had been no reduction in the number of qualified social worker staff as a result of the new model. There were quite a lot of staff at lower levels (25%) but it was important to keep social workers (75%) involved.

Comments were invited from the representatives of other organisations present.

John Taylor from Healthwatch Worcestershire talked about the organisation's work alongside the Council, to gather experiences. Feedback from social workers was very positive and the public were thrilled to be able to speak to the same person.

He highlighted the need to recognise the role of  the voluntary and community sector, and its capacity to address the volume of level 1 conversations, which may need a back-up plan. The Assistant Director gave reassurance that the model was all about conversation and understanding what was required, not a signposting service. The Council had created a culture previously whereby the public expected it to step in, when this was not always the best solution.

Sandra Hill from Speakeasy N.O.W was really looking forward to the new way of working for those with learning disabilities, which would be easier with some than others.

The Panel found the new approach refreshing, exciting and sensible and the Chair thanked the Locality Managers in particular for attending, which had made the discussion more meaningful.

The following outcomes were agreed:

·         Healthwatch report to be circulated when available

·         further updates on the 3 Conversation Model to be arranged

·         Panel members were invited to contact the Locality managers to arrange to visit

·         Locality Managers invited any suggestions from councillors about local services and ways of working