This webinar looks at how leadership in strengths-based approaches requires a shift from the traditional paternalistic model focused on ‘fixing’ people, to getting alongside them and taking a holistic picture of their lives to identify how best outcomes can be achieved.
Delivered by Ewan King, Chief Operating Officer, Social Care Institute for Excellence Andrew Reece, Head of integrated Learning Disability Service, London Borough of Camden Charlotte Augst, Chief Executive, National Voices.
The webinar focuses on leadership behaviours and practices and it accompanies a new SCIE report on this topic. They talk about encouraging creativity and innovation, a positive attitude to risk – and a no blame culture and encouraging professional autonomy and trust the workforce.
What are your strengths and the strengths of those around you? Consider this when watching the webinar and consider how often you focus on these, as opposed to focusing on developmental areas.
“Welcome everyone. Hello. I’m really grateful for so many of you taking time out of your busy schedules to take part in this webinar, during which we’re going to look at the issue of leadership and strengths based social care. In fact, we’ve got an enormous number of you taking the time to join this webinar. We’re almost over 270 participants. And just to give you a sense of who’s out there, we’ve got people from Derby, Surrey, Birmingham, Devon, Peterborough, Hull, Wigan, Wales, and our friends from Northern Ireland have joined as well, and Republic of Ireland. So it’s absolutely fantastic to see so many of you taking part in this session.”
“So just in terms of introductions, my name is Ewan King, I’m one of the directors at the Social Care Institute for Excellence. We’re a UK wide charity committed to evidence informed improvement in adult and children social care. So that’s me. And I’m really pleased to be joined by my colleagues, Charlotte, I’m going to get her surname wrong if I’m not careful, but Augst?”
“Augst. I knew I would still get it wrong. Who is a chief executive of National Voices, an umbrella charity committed to placing the person and their family at the heart of decisions about care and health. And Andrew Reece is joining us as well, I got that right? Head of service from the London Borough of Camden. So we’re going to hear more from my two colleagues shortly.”
“Just in terms of the rules for today. Rules is a bit strong and not particularly strength based. Let me start again. Some of the things that we’re going to be discussing today include the opportunity to hear about some new research that Sky has produced on leadership and strengths based social care. I’ll talk you through that. We’ll then have some opportunity for conversation and questions. Charlotte will then talk about her perspective from being a chief executive of an umbrella organization that represents a host of charities that are all engaged in different ways and strengths based approaches. And then Andrew is going to talk about the journey in Camden towards becoming a strengths based borough.”
“Just going to move the slides so you can see the running order. So this is broadly what I’ve just outlined. There will be slides made available in about two days time, along with the recording of the webinar, and any questions and answers. So if you do have to leave early, don’t worry. You will be able to catch up with the webinar later. And if you’ve got any colleagues that unfortunately had to miss out today, do make them aware that there will be a recording and slides of it available in the near future.”
“So here’s the plan. I’m going to talk briefly about the research that we published last week. This is research on leadership in strengths based environments. Looking at what the role of leadership looks like, what does the leadership task entail, and also addressing the question of whether leadership is fundamentally different in a strengths based social care context. Does it need to be different. So I’m going to talk a bit about that. And then, as I’ve said, we’ll have opportunities to look at some of the questions coming in, and then Charlotte will speak. More time for questions after that, and then Andrew will speak. But we will leave as much time as possible at the end to make sure that we cover all the questions and discussion points coming in on the screen in front of us.”
“So I hope that makes sense as a plan. We do have one final rule, and this is a charity contribution rule. Any mention of Brexit and I have to put one pound in a jar to go to charity. It’s five pounds if anyone mentions the DUP. It’s 10 pounds if you mention Dominic Grieve, and it’s 20 pounds if you mention the [inaudible 00:04:16]. But anyway. A bit of a charity element there. You can’t just write on the screen, you actually have to put the money into a charity if you decide to go down this route.
“Okay. So I’m going to kick off now with… I see to be stuck, Steve, on the slides. Thank you. Still stuck there. Could you get me on to the next slide, please, Steve? Thank you. Okay. So as I’ve said, about two weeks ago we published this paper on leadership and strengths based social care. It builds on a number of papers and think pieces that we’ve been producing for really about four years now, ever since the Care Act. And it seeks to explore, as I’ve said, some of the issues about how you do really effective leadership in a strength based social care context.”
“But just before I go into that in any more detail, I do think it’s important to give you a definition, because I think not everyone necessarily knows a lot about strength based approaches. We recently produced a guide for the National Institute for Clinical Excellence on strength based approaches, and we defined it very simply as a way of delivering parent support which focuses on people’s strengths, skills, and resources in communities, as well as their needs and difficulties. So you’re not ignoring the fact that some people do need support, but you are trying to start with their strengths, their capabilities, and their social networks. And on that, and from that, build supporting care that gives that person a better life. So that’s the definition that we’re working on. If you go onto our website, under strengths based approaches you’ll find videos and resources that can give you more detail about strength based approaches. Next slide please.”
“So, one of the first issues that the paper tries to explore is a definition of leadership and strength based approaches. One of the things that really struck us over the last four years is that we’re not really talking about a traditional model of leadership that’s often applied in public services. So it’s less about the development about one or two heroic leaders, charismatic leaders who single-mindedly drive change from the top down and make things happen. And everyone looks to those leaders for change, for their direction and for their inspiration. That kind of approach to leadership really doesn’t work within a strength based environment. It is much more about convening people, bringing them together to develop a shared vision, a shared plan for changing services. It is much more about working with people who provide care and support, and service users and citizens, in designing care that works for them. So it’s about co-production.”
“And it’s also about working beyond the narrow confines of your own individual organization or service. It’s about what some would describe as being a systems leaders, looking to other partners, looking to the voluntary and community set, looking to citizens to help you move forward. And this is a quote from Alex Fox, he’s a chief execute at Shared Lives, plus he’s also on Sky Sport. And I think it’s a really good one, I think it brings this definition to life. A strength based approach requires a new kind of leadership, which draws strength from many more sources: the whole team, the voluntary sector and other partners, and most importantly, from citizens themselves. Leaders practicing strength based approaches will not try to affect change by themselves, they will share rather than hoard power, which in turn will enable them to ask more of those around them. The key measure of success is not your own strength, but the combines strength and capacity of the whole system. So I think that’s a really useful definition to have in your head when you’re thinking about how to do leadership in this context.”
“So moving on. The paper then goes on to discuss a number of themes that emerge through the research. So when we spoke to directors about social care, principle social workers, to inform this research, we were told one of the most issues was for leaders to encourage a positive attitude to risk. Very much harder to do in realty than it is to write this down on paper. But it is something that’s absolutely critical to the success of strength based approaches. And this entails having a different story, or narrative, to telling risk. It’s about saying that taking risk can often bring about benefits and improvements as well as harm. Risk doesn’t always lead to harm. If you encourage your practitioners and your colleagues to take appropriately managed risks, then they can really bring about improvement. And Andrew is already agreeing from his perspective in Camden, that’s absolutely crucial.”
“And that entails leaders giving people the permission to take risks. And backing them up when something goes wrong. So avoiding that blame culture, which so often permeates social care. And it’s about providing constructive, not harmful challenge, not critical, negative challenge, but constructive challenge to colleagues so that they do feel that they have the space to be brave and to take positive action.”
“Another theme that emerged from the research is about the importance of encouraging professional autonomy, which again links to this idea of encouraging people to take positive risks. This is about empowering staff to take ownership of solutions and interventions. By that I mean getting staff at all levels involved in actually designing services, designing commissioning frameworks, evaluating services so that they fell that they own it. It’s about providing staff with a broad framework of principles, but then trusting them to get on with it. And I was actually looking at a quote last night from someone called Dona Hall, who is recently chief executive of Wigan Council, and they are doing, I think, very well in strength based approaches. And she said it’s about being tight on principles, loose on delivery. And I think it’s really quite a powerful quote.”
“So by giving staff control over resources as much as possible, and I’ll come onto that shortly, it’s about devolving responsibility to the lowest level that seems proportionate. So increasingly in areas that are doing well on this, you’ll see very localized teams working closely with the local community. And they seem to have a degree of autonomy and power to make decisions on behalf of residents and others.”
“So this is an example from a colleague in Wolverhampton. They focused very specifically on devolving responsibility and control to staff. So they’ve really tried to move away from funding panels, where all the decisions about funding and for care packages have to be made by managers. They try to devolve this decision making down into the team, down into huddles of colleagues who get together and think very creatively about how they can support an individual. And similarly, they give people a budget which they can spend for an individual at their discretion, which is a very powerful thing to be able to ask a colleague to do.
It’s all about investing in leadership across the organization. As I’ve said, and as Fox said in his quote, it’s not about hoarding power and control amongst a few individuals. It’s about enabling leadership to take route in many parts of the organization. So it’s about engaging staff in early conversations about what you’re trying to achieve, and how you’re trying to achieve it. I think we’re going to hear more from Andrew about how they’re doing that Camden. So by sharing and devolving decision making to all levels within the organization… And I think I’ve said this already, it’s about supporting them to actually take ownership of new ways of delivering services. Thank you.”
“Much of this is about going back to what was good social work many years ago. This is not necessarily anything brand new. So very good social work involves very good reflective supervision, which people can benefit from. So in areas that are doing really well on strength based approaches, we heard a lot about the importance of very well organized, reflective supervision, enables people to focus on their skills, and also hear about what’s working well, and learn from what’s working well. It’s about having reflexive conversations, it’s about employing tools like motivational interviewing and open ended inquiry to encourage people to open up and reflect on how they are supporting people. And it’s about protecting time. Never easy to do in practice, but it is something that is critical if you’re going to get this right.
Thank you for waiting. So co-production. Absolutely a strength of those doing this really well across the country. So in places like Hertfordshire, they’ve set up a strategic co-production board comprising people with lived experience who really do get stuck into strategic decision about how adult social care is organized and delivered. In Camden, they have a citizens assembly which they go to in order to test out ideas and develop new ways of delivering services. There are many examples across the country which people can learn from. So it’s about engaging with communities in early conversations, avoiding the surprises that inevitably happen when you make decisions without people being involved. It’s about looking for those opportunities to involve people, and that really should be all the way through the process of designing, commissioning, delivering, and evaluating services. And as I’ve said, looking for those platforms, but being creative using digital technology, using existing forums which people can piggyback on, to try and bring people together to look at and get involved in decisions.
I’m just going to end with a really nice visual which is from Camden, actually it’s going to reappear a bit later when Andrew speaks. But this is a really attractive, beautiful picture which was created by an artist who basically captured the conversation during a day in Camden about what people wanted from a strength based approach. And it wasn’t just done for its own sake. The actual diagram was used to inform tools that are now used to evaluate the impact of strength based approaches in Camden. So it was a really powerful exercise that informed how they deliver services across Camden. So that’s it from me for now, but what I’m going to do is just see, first if my colleagues want to contribute on the back of my presentation, but also see if there’s any questions that have come up so far that I might be able to answer.”
“They seem to have a few questions about payment cards. I don’t know whether you want to say something about that, frontline staff being able to actually spend some money.”
“So yes, so the example I gave is one example, but I know it’s not universal that staff have access to payment cards. I do know that our colleagues Think Local Act Personal have produced a paper recently on payment cards and adult social care. It may well be worth looking at what they’ve come up with through their research. SO have a look at that, and I think my colleague Steve will try to find the reference for that. Andrew, do you want to comment?”
“Yeah. Just seen a question come up about the graphic facilitator from Camden. If you look carefully when the slides come out, her name is at the bottom. Clearly we wouldn’t want to put a picture out there without giving her appropriate praise. I can’t read it from my slide, but I’m sure we can find it and stick it in there so people… But there are a large number of graphic facilitators out there who are doing excellent jobs.”
“Right. Sandra Harragate. Sandra Harragate. Thank you for that, Andrew. Any other questions that we should take at this moment? If not, I’m going to suggest that we move on. So Charlotte, it’d be great if you could now take us through your presentation.”
“Okay, thank you so much. So my name is Charlotte, I’m the recent CEO at National Voices. National Voices is an umbrella organization, coalition of about 160 charities across health and care. Personally, I know a lot more about the NHS than I do about social care. So I’ve got a slight imposter syndrome seeing who’s on this chat and who’s on this webinar, since you all know so much more about how social work is commissioned and designed and delivered. So I really look forward to our discussion later, and learning from you as well.”
“The other thing I should probably say, is that I’m less involved in front line delivery, or point of care delivery. I’m [inaudible 00:17:36]. And part of the reason why people give membership fees to National Voices is that they want us to sit at the top table of influencing, which is something we do, but it means I come at it maybe more from a policy and service design level rather than service delivery. But I think you’ll hear later from the actual point of care. So I think in combination, it should be a really interesting range of perspectives. So if you move me onto my next slide. Thank you.”
So, I am basically going to try to convince you that in order to asset based and strength based work, you need to really understand what goes on in people’s lives. And that’s easier said than done. I think if you don’t understand what goes on in people’s lives, you can’t answer three really important questions. Who cares, who is on the team, and who adds value around here, and what adds value around here. And I’ll always show a picture, and I hope you can see, that it doesn’t come out too small on your screens.
There’s a baby lying in a cot looking up at a toy. And clearly the toy’s been designed for people looking down on it, because the interesting bits of this baby toy, the heads that let you decide whether you’re looking at an elephant, or a pig, or a tiger, are right at the top, whereas the baby only sees bums, which are pretty ill defined. So for me, this captures really quite nicely that we do not know what goes on in a service and how it feels to engage with it if we do not get into the user’s shoes. And that is the challenge I’m going to try to talk to you about.
My next slide starts off with a statistic that anyone in health policy will know already. I don’t know whether you’ve all seen it before. Assuming we’ve got about 5,000 waking hours in a year and the average diabetes patient might spend around five of those with a healthcare professional, that amounts to 0.1% of time we spend in the presence of a healthcare professional if we have one long term condition like diabetes. So that raises some really acute questions about where is health actually being created around here. Who manages diabetes? And where should we focus our efforts to improve health and care, and what makes for good outcomes.
So my hypothesis would be, if you’re a diabetes nurse and you’re delivering a diabetes service out of primary care, you haven’t got a chance in hell of improving someone’s outcomes if you do not understand what goes on in those 4,995 hours where the diabetes patient does this on their own. And the chances of actually getting to the bottom of that and really improving someone’s outcomes are going to be massively reduced if the patient and the person living with diabetes isn’t able to say, this is what goes on for me. This is how I feel about food. This is the food I cook for my children. This is the money I have every week. This is the place where I live. I haven’t even got a cooker. I haven’t even got a fridge. So if all of those things don’t surface in a professional consultation, I think our chances of achieving good health outcomes are very much reduced.
The next slide I’m going to talk about is, again, one that if you have been hanging around health policy circles you will have come across before. This one actually is [inaudible 00:21:21] health and social care. And it’s a web of care that was documented by Barbara, who looked after Malcolm for about 17 years, and Malcolm had diabetes. Not diabetes, dementia. And this web documents the last seven years of Malcolm’s and Barbara’s engagement with services. So we could obviously talk about care integration and care coordination, all of that, and I’m 100% sure you have to conversations. I want to zoom out a little bit and say, who knows who’s on the team? And I think the only person who knows who’s on the team here are Malcolm and Barbara.
So normally in charge of this web of care probably is the consultant. So Malcolm would probably be, towards the end of his life, under the care of a dementia or Alzheimer’s consultant. But I would test that this consultant would not know how to reach the mattress technician. Maybe not even how to reach the physiotherapist. And then might not even know who employs the mattress technician.So if we do not listen to the person at the center of this web, we haven’t really got a clue who is around that person and who makes this web. Now, Barbara said, and I think that it’s true and will forever be true, care is care, and care is care, we’re the only ones who divide it into primary, secondary, and social care, and so on.
I would add one more thing, that this web is not even complete in my view, because what’s missing here is clearly that, and I’m now improvising, I don’t know whether this was going on or not, I’m not Barbara, there might be a neighbor who drops off a meal once a week because they’ve agreed that, and they want to help Barbara because they think she’s got a lot on. And there might be a doctor who lives a long way away, but she makes a point of coming one weekend a month to give Barbara time off, or to take Malcolm out. And there might be someone from the church where Malcolm and Barbara have been for years and years, who takes them on a Sunday and includes them in their activities. So again, if we want to really think through how we can improve people’s outcomes and how we can provide much more effective support, we need to bother listening to people like Malcolm and Barbara, and let them map out for us who they’re drawing their strength from, and what is already helping their lives.
And I could show you diagrams like that for every single condition, and a lot of people have more than one thing wrong with them, which is entirely possible, if not likely, that Malcolm had more than Alzheimer’s towards the end of his life. And it was this insight that led us to another piece of work I did in a previous role. I was previously involved with The Richmond Group of Charities, which is a smaller coalition of large charities if that makes sense. And we set up this cross sectoral task force, which was wanting to look at people living with multiple long term conditions. And we interviewed a whole lot of people, but this gray, blurry icon, there is a little video that if you get these slides at a later stage you can watch.
We produced four short videos, and there are four crucial questions we’ve identified from listening to people living with multiple long term conditions, what goes on for them. We were trying to understand how we could talk about their lives respectfully and in a way that would make a difference, and we arrived at a framing that said, this is about a series of losses and adaptations. We didn’t just want to tell a story of miserable lives, because those people had adapted really well to what was going on for them. And there were four areas where we thought, this is what health service providers need to know about. Mental well being, mobility, social connectiveness, and the ability to self care. And the people in our sample, here you can see Vivian, or you can’t because you’ve only got the icon, they had found really interesting ways of coping with their loss of mobility, or limits to their mobility, or the impact their various conditions had on their mental wellbeing and their social connectiveness.
So, in summary, what I’m really trying to push home, is that we cannot afford not to understand what goes on for other people, for the people who use our services. In other sectors, if we didn’t understand how our users live, we would go bankrupt. And here we just become unsustainable. I think those are two really nice quotes, one very modern one and one very old one, that sets out why we really need to work harder in understanding how people’s lives are lived.”
“So I’m going to have two very brief additional points to make. One is, what does this mean for charities. And I would really like to hear your thoughts on this, because I see on the chat that some of you do work for VCSE organizations, and some of you don’t, but it’d be interesting to understand that. I think we sometimes say in a slightly glib way that we’re better at this than statutory services. And I want us to challenge ourselves a little bit around this. What makes us think that our services are better at understanding where people are at and building in their assets? And what does it mean for VCSE staff to be in service provision? Do we just plug the gaps that are left behind when statutory services pull out, or do we have a more transformative ambition that enables people to regain their independence, to build stronger connections and to live more active lives. And is the role of a charity staff member… Could we maybe summarize it as being someone who helps people strengthen their connections.
I’m thinking of a charity who is a member of National Voices, Groundswell. I don’t know whether you’ve heard of them, but they help homeless people access health services, which is really hard for them to do. And obviously they could send someone like me out on the streets and talk to people who are in street homelessness to help them access their GP services. But they don’t. They actually send people out who have themselves been affected by homelessness. And they have a really interesting peer support model where people who are themselves affected by homelessness take other homeless people to register with GPs, and help them go to appointments, and help them make sense of what our professionals are saying. And they’ve also branched out into really interesting peer research methodologies, where people who are living with homelessness or are vulnerably housed actually put on the record what are issues that health services need to address. And they’ve found a really sustainable model of working whereby half their staff have come out of homelessness, and they’ve created roles that are accessible to people who are otherwise a long way away from the labor market. So I think it’s those sorts of models we need to think much more about.
And then finally, I happen be know re-structure, and a re-strategy, and a re-purposing of National Voices in the way that you do when you start [inaudible 00:28:40] somewhere. And the question of what does this mean for an umbrella organization has really become quite acute, because I think we are a very small organization. When I wrote these slides we were six people. We’re now eight I’m pleased to say. But it’s still a tiny organization. And we could keep saying, oh, we’re too small, we can’t do this. We’re too small, we can’t come to your event, we can’t field someone for your working group, we can’t find a person with this thing going on in their lives. Or we could start thinking, what are our assets? We’ve got 160 members. We’ve got 100 directors of policy, we’ve got 100 CEOs, we’ve got 100 directors of services. Surely they can field someone, surely they can find someone who can help them. Surely we could between us commission some research.
So I’ve been trying to grapple in my own organization with what this means, to work in an asset based way. Are we small or are we large? And I think we’re probably both. So, that’s it for me. I’m really interested to hear what your questions are? I hear a few questions that came to my mind as I was thinking through the topic of today’s conversation. One that’s very hot in my mind is, I’m sometimes a little bit suspicious when I hear politicians, particularly on the right of the political spectrum, saying, oh yeah, we can cut this service because we’ll have to all just be better neighbors, and we have to all look after each other a bit better. And I think we need to be very careful in talking about asset based services and asset based ways of working, that we don’t, inadvertently, fall into a trap of saying, people don’t need personal care, they need better neighbors.
So that’s one of the questions that came to my mind, being more on the political side of my work. But you might obviously have very different questions or very different thoughts. Thank you.”
“Thank you Charlotte. That was really good, really helpful. I’m just picking up a few questions here, which we’ll try to address before I hand over to Andrew. So there was a question about whether Sky had resources to support practitioners’ work with people with different cultural backgrounds, different levels of mental capacity, and various other circumstances that make it sometimes difficult to work with people. We do, on our website there are a range of videos, and tools, and resources that I think can help practitioners work with communities of all types, and people with all kinds of backgrounds. So do have a look at our website, there’s plenty on it.”
“And someone said they also would like an interactive guide about what works in strength based approaches. I guess Sky, along with organizations like [inaudible 00:31:36], Think Local Act Personal, Skills to Cal, LGA, are gathering examples of good practice all the time. We tried to bring many of those examples together on our website, but if you do have a good example, a case study, a bit of evaluated work that you’re proud of, do send it in to us and we’ll try to get it onto our website. We’re happy to post blogs as well with people telling us about what they’ve achieved locally. So please do that. I think that’s the main question. We did see some examples of people working very productively< very successfully in the local virology sector, including Marie Curie was mentioned, and McMillan, so that’s really good to hear. Any questions, thoughts, comments that you would like to pick up on? Charlotte, Andrew, before I hand on to you?”
“There’s one question I’ll pick up within my… Someone asked about servant leadership, and maybe I’ll try and cover that when I get to the right slide if I remember. If I don’t, prop me.”
“And apologies if I ended up using jargon, I hadn’t realized that VCSE is actually really quite jargony. It stands for Voluntary Community and Social Enterprise Sector, I think. Yes, so we all speak to our own little bubbles and we get used to using our own little terminology. So thanks for picking up on that, and thanks for whoever explained it. I should have explained that myself.”
“Right, Andrew, would you like to talk about your experiences in Camden?”
“Absolutely. I regularly go to something called Planning Together, which is that partnership board in Camden. And we have jargon buster, who rings a bell if we use long words, or words that people don’t understand. Hopefully, because I’m so used to comply with that and not get the bell rung, I’ll get a red card even if it’s terrible, then this’ll be pretty straightforward.”
“My name’s Andrew Reece, I’m head of Camden Learning Disability Service. I’m part of Camden adult social care senior management team. My email address is on the slide, if there are any questions that come up that you want to follow up. What I’m going to give you is a bit of an overview about what I like to think is the first leg in our journey to becoming, or to at least start to deliver strength based practice or become a strength based… We’re an organization that’s focused on people’s strengths. I’m not going to read out the slides because they’re there, you can read them yourselves. I’ll be offering some commentary as we go on, I think that’s the most accurate way to describe what I’m going to do.”
“This slide is about the vision in Camden, and I think it’s vital that a strength based approach has to be based on a very clear vision. It has to be a whole organization approach, it’s not just a case of putting in some new assessment paperwork and thinking that’s going to make the difference. It’s something you have to pretty much review everything you’re doing, I think, in terms of how you’re going to do that. And some of the most interesting work we’re doing in Camden, I think, is about re-evaluating our relationship with providers. I think we’re working really hard to change that, and that’s a really important thing for us. It has to be based on the values of the organization, I think. So it’s owned by the whole council.”
“And the values here, I think you’ve already talked about Citizens’ Assembly, these were co-produced through our Citizens’ Assembly. It was led by a leader of the council, Georgia Gould, who’s very much behind the concept of citizens’ assemblies. If you read the Guardian you’ll know that Camden had a Citizens’ Assembly on climate change. We didn’t do one on Brexit, but I know a lot of people in Camden think-”
“One pound in the jar, here we go.”
“A lot of people in Camden think about Brexit on the whole.”
“Three pounds in the jar.”
“And I think it was also informed by an exercise across the council, which was called an Outcome Based Budget Reviews. We looked at that budget strategically, and tried to work out exactly what outcomes those budgets were delivering. The fact that I’m spending money in social care, that also has an economic benefit because in theory it creates jobs. How do we think about that as a whole council, and in particular how do we then make sure that when we’re spending social care money it’s benefiting people in Camden. People in Camden are getting the jobs.
And as of that co-production type approach, we developed two strategies. So the first one was the Supporting People, Connecting Communities. That was developed throughout our social care, again through the Citizens’ Assembly. You see some of the output from that Citizens’ Assembly in the slide that Ewan showed earlier. And also Camden 2025, which is our corporate strategy. And again, that was developed in a co-productive thing. I think it’s great to work for an organization. One of the values is, everyone has a chance to succeed, nobody gets left behind. I think we can hang pretty much everything we do on that, particularly in the learning disability field, is making sure people don’t get left behind. And it’s a really good way of motivating staff and reminding people why we’re there.
If we move on… This is another one of the slides that we produced at the What Matters event. Again, that was a co-production thinking about what does… You can’t really see it very well here, but I’ve got a little outtake of it later to focus on. So that was the focus groups held with people who use social care services, and these were the things that were important to them. Within Learning Disability, we had a smaller initiative around working out what was important to people. And we went out and talked through Plan It together, which is that partnership board we talked to, groups of people with learning disabilities. We talk to their families, we talk to their providers. And just ask the basic question, what does good look like? And then we took what we got back from that and turned that into the CLDS Promise. So this is what we’re going to try to do. It’s an easy read. If you click on where it says CLDS Promise when you get the slides, there’s a link to the document there, so you can actually see the things people told us.
Here’s the next slide. And I think at both these events, both the What Matters Events, which is the wider social care, and also think when we were creating the CLDS Promise, one of the things that really came out, and this resonates with a lot of what the chief social worker is talking about at the moment, is the importance of relationship based practice. People very clearly told us the want to work with the same person. They don’t want to get confused, have a different social worker every time, whether that’s through the social worker or whether that’s through the staff who provide their support. They want to have that continuity. And the picture on the right is a little outtake from the picture you just saw earlier, the graphic facilitation. Someone you trust who comes on the journey with you, I think that’s really important. And it’s a really strong message that underpins all the feedback and the messages we’ve had from our Citizens’ Assembly and our co-production events.
If I then talk more practically about Camden’s journey towards a strength based approach, I think you need a model to start you off on the journey. You need some sort of theoretical framework in which to start to build your practice. There are lots of different models out there, we opted for the Partners of Change development model called the 3 Conversations. Again, there’s a link to the Partners for Change website at the bottom of the slide. It was a starting point I think, and it provided a framework and something we could then use to co-produce a new way of working. I’m not going to go into the theory of the 3 Conversations model. You can look that up yourself later, if you’re not doing it. By the sound of it, there’s a lot of you doing it anyway, because the 200 pound budget that the payment cards want, that’s one of the really important messages coming out of the Partners for Change, is devolve particularly that quick and easy way to spend money down to the practitioners.
And I think the other thing that we have used in terms of a model, is we used the model as something that staff can then develop and build on. So it doesn’t arrive, it’s not a Lego kit. You don’t build it into something and you know exactly what it’s going to look like in the end. You start this journey, you don’t quite know where you’re going to end up in the end because your staff will take you in a different direction, and the consultation you have with people using services might also change that as well. Sorry, next slide.
One of the things I thought was really helpful about 3 Conversations is these rules. And I think these rules are again, a scaffolding. They’re something that helps you build. And they’re a challenge to make you think differently. They had a very strong emphasis on changing the language. Don’t talk about a whole list of banned words, front door, pathway, all sorts of things where you started to talk about process. And their language is much more focused on people. Don’t talk about assessment, because what is an assessment. Talk about conversations. It’s about making your contact with people more personal, and more real and every day, rather than more formal and more professional. And I think part of what we need to be able to do is abandon the language of care management.:
Most of us, I call it Friday ’96, so the NHS Community Care Act was out by that point, we’re so embedded almost within the culture of care management, assessments, and reviews. It’s really difficult to let go of it, but I think we need to. We need to be able to move on and start thinking differently about it. And stop measuring processes in the way that we’ve been measuring processes for so long. Next slide please.
And then, as I said, we had a really strong message from people we engage with about the importance of relationship based practice. So I just wanted to mention a couple of things that I think are most interesting that we’re doing in Camden, a plug from our services, the Camden Learning Disability Service, and our work on the Named Social Worker model. We were so privileged to be part of the Named Social Worker pilot, and this is very much developed out of the Named Social Worker model, and the challenge that that gave to our social work team, in particular about how we re-think our relationship with people.
The Named Worker model also developed out of some quite difficult work we did around safeguarding adults review for someone we support who was placed in a care home in Sussex. And there was a very serious incident with him while in that care home, his leg was broken. Someone else’s leg was broken in the same way on the same way, and we started to think about the risk for people who are placed out of area, a long way away. And so we particularly used that Named Worker model in working with people in out of area placements because they have the highest risk.
But also we want to make sure that people aren’t just stagnating if they’re placed out of area, that there’s some sort of progression, that we expect people to change and develop, and not just, they’re out of sight, out of mind. The Named Worker model we’re also using in support of living, and a bit part of that is around, we’ve got I think 30 supported living schemes within the borough. And each scheme has a named social worker, so everybody living in the scheme has the same worker working with them. And that’s part of that drive to improve partnership, working with providers…
When we started doing this, our providers described CLDS as patronizing, vicious, and condescending. And we know we need to do something about that. So this is very much… Paraphrasing this. This is very much part of how to improve those relationships and become more effective by doing that. And we’ve had some really positive feedback from providers, from people living in supported living, from families as well about what a difference is made knowing… You know who you need to talk to. You don’t have to get stuck in the phone system trying to work out who’s going to come back to you, or sending an email and when you get the ‘out of office’ thinking, who am I going to contact next?
The other model that I think Camden is really leading the way on is adult Family Group Conferences. So this is a model that developed in children social care, think it came out in New Zealand originally, and was well developed within children social care in Camden. And someone had a bright idea, let’s start using that in adult social care. And it’s starting to make a real difference where you’ve got stuck systems, where you’ve got a family that’s in dispute with the council, or in dispute with itself, often. A Family Group Conference can be really positive. And it’s really good about helping the network of people around an adult with care needs. Understand what those strengths are, who can do what, and getting people together. Not being exploited and used instead of paid for services, but actually being a much more relationship based and real life support network of people.
The other thing in terms of strength based working is the emphasis on knowing your localities, and knowing what’s out there. So we’re moving it towards within social care, the broader adults social care, which might be traditionally understood as older people’s teams. We’re moving towards the neighborhood working teams, and so there we’ll be integrated with district nurses, etcetera. But one of the things that these local teams are doing, and they’ve been doing some of what they call ‘walk the mile’. So they’re basically doing lunch and learn sessions where people from the locality get together and go walk around the local neighborhood. And you can read some really nice quotes from the people who’ve done that, about the things they find when they’re going out on those walks, the people they’re bumping into, the resources they’re finding out about, which is all part of helping people connect into their local communities more effectively.
And then just finishing if we move to the next slide. It’s just some thinking about what happens next. Moving towards becoming a strength based organization is a long journey, and we’re in the early stages of it in Camden, I think is the fair way of saying it. And what else are we doing in order to take the next steps of that program. And so we’ve got a What Matters program for staff and we’ve had very strong feedback from staff about how effective that is. And that’s making staff think differently about the type of conversations they’re having, and thinking about having coaching type conversations with people. And that, we think is going to be really effective.
There’s some further development of things like the recovery model in mental health, social work, and getting a clearer idea within learning disability social work, and learning disability services more generally, about the progression model, and what sorts of things we do in order to remember that everybody, even the people with the most profound level of needs, can progress. Even if they’re only very tiny steps, that people can still make small steps. And if you understand that person well, you can start to think about exactly what a progression might mean for them, for that particular person.
We need to get better at employment. Our employment rates are not good. We’ve got a project launching, which is looking at a whole council approach to getting people into employment who have traditionally not found it easy to get employment. So some of that’s around neighborhood working, because we’ve got pockets of high levels of unemployment in a relatively affluent borough. But that’s also particularly looking at disabled people, and the council thinking about what it can do to be a better employer. We’ve just launched some supported internships within the council, and we’ve got our supported intern working in the team with us, helping as part as our meet and greet, and welcoming people into the council team.
You’d be a bit shocked to hear this, but Camden hasn’t currently got a Shared Lives. So we’re developing our Shared Lives off what we think that’s a really important part of supporting people to be staying within their local communities. And we’re starting to think about what our performance framework would look like. [inaudible 00:48:48] is probably 11 years old now? I can’t remember exactly. There are bits of it that are good, but there are other bits of it that we still need to think about more, and then trying to develop that more.
Okay, so that was the end of my presentation. So there’s a question here. How difficult was it to move from the organizational approach to co-production? I think it’s about deciding you’re going to do it, and having a chief exec, a leader of the council, and a Deputy Chief Exec, who are all committed to that, it’s really important I think. This is a whole organization thing. You can do little bits of co-production on your own, there’s nothing to stop individual services and individual teams to also do that, but if it’s part of that wider whole it’s much more effective. And people understand where it’s coming from as well I think, which is also really important.
Just one more for you. Thanks for that, Andrew. Right, just one more about Family Group Conferencing. Just to say that our last webinar, which we did with Camden, focused of Family Group Conferencing for young people, and it’s really well worth having a look at that. But there’s a question about, can you have a young carer in a family group conference to get their perspective on what’s needed? A young carer.
Absolutely. If there is a young carer, they would be absolutely essential to a family group conference. The family group conference brings together everybody. And sometimes it won’t just be people in the family. It can be neighbors, other relevant people. It’s up to the subject of the family group conference to decide who’s going to be there. And I think one of the things that makes it work well for Camden is we have independent facilitators for it. So the social workers step back and allowed people to have a conversation when they’re not there, to a certain extent. And then reflect that back to the social workers. So it gives a really high level of independence. The skill facilitators are very good at drawing out what’s important to people.
“Then the question about performance framework. Well when I know I can post on that. But I think it’s much more thinking about moving away from process based measures. I think one of the things that I’m particularly proud of in Camden is we had nobody with a learning disability admitted to a mental health hospital last year. I think those are the sorts of things we need to be thinking about more. How do we measure prevention? Not being admitted to hospital I think is really important. Getting people out effectively and quickly, yes, you need to be able to do that. But actually stopping going in the first place is really important. So we had an initiative last year we’re repeating this year about trying to get as many of our staff to get flu jabs. Our nursing team went off and got themselves trained as peer injectors so they could give people flu jabs because Public Health England are telling us that the most important thing you can do as a social care organization is make sure everyone’s had a flu jab. Stops people going into hospital in the first place.”
“Thank you very much.”
“Focus on prevention is really important for this.”
“Thank you. I’m just going to hand over to Charlotte. I think there’s a couple of questions”
“Yeah. There was a question from someone called Andrea, I think, about co-production [inaudible 00:51:59], which obviously you know is a truism. And I’ve always seen it’s quite helpful to think co-production on three levels. On one level, we are all citizens and we pay for health and social care. And the way that we just heard Camden engage with citizens about what they want from their health and social care. And I think it’s really important to understand at that level that a lot of people don’t use health and social care very much. I think something like 80% of people are very casual or occasional users of health services, and it’s probably gotten even more so with social care. And therefore they don’t understand health and social care very much.”
“One thing around social care, for example, might be that they don’t understand that there is lot of working age adults who use social care. So you have to be careful what questions you ask of a citizen when you do co-production. And in healthcare, people who are just citizens and aren’t actually very heavy users of social care, most of them care about access points. So they care about the GP access, and the A&E access. And they have much less of a view about what goes on behind that door, and how we need to coordinate services a lot better. So that’s the citizen engagement.”
“And then the second level is, people who actually use services, the community of people who use services understand what services need to look like in order to deliver for them and their lives. And when you re-design your pediatric services, or your kidney care services, or your home visiting, you need to engage with the people who use the services.”
“And then on the third level is the personal level. When you sit with a health professional, or with a care professional, and you talk about what needs to happen in your life for the next year or so, or in this emergency of crisis situation, the outcome is we help reduce. So I think it’s really helpful to understand that this needs to happen at different levels, and that different questions are appropriate for different people. Sometimes I feel the NHS wants to engage with citizens about questions that really only matter to people who are very heavy mental health service users and vice versa. So you need to get your questions right, and then find the right channels to communicate with people.”
“Brilliant. I just spotted quite a few questions being raised about…”
“Can I chip in on one then?”
“Yeah, go for it.”
“There’s a question, I think it was Daniel. What did we do to get our leader of the council to engage? We didn’t. It was very much driven from the top. She was very keen on this, this is something that’s very important to Georgia Gould, our leader. If your leader chief exec aren’t interested, it will be challenging. But I think pointing to other councils and the sort of things they are doing, I think is something that everyone can do.”
“Absolutely. And there’s a few questions raised about the Named Social Worker model. Sky was actually fortunate enough to support the pilot of that model across several local authorities. And on that, on our website you’ll find a whole host of information about the impact of that model, of that way of working, evidence or what outcomes were derived from the Named Social Worker model. And also some very easy to use pickup and use tools. So have a look at that.”
“I think one of the biggest questions and issues”
“There was a question there. It’s gone, it’s disappeared at the top. But it was something about case loads but for social workers with the Named Social Worker model. I think this is part of letting go of the old world. And if any of the social workers in Camden are listening, they’re going to [inaudible 00:55:16] daggers or whatever. But the old world is about case loads, and reviews, and assessments. And actually, if you’ve got 200 people in your case loads, that might sound… I’m sure it won’t be that high. Totally intimidating. But if it’s a better relationship and you know them really well, and you’re not having to pick up a case file and read it when you’ve never met the person before, or you’re going out to do a review of someone you’ve never met before and will probably never meet again, thinking about case loads in the way that you traditionally would I think is… We need to re-think it and re-frame the discussion around case loads.”
“So I’ve got one big question that’s come up for Charlotte, and I think this is really important, about the investment in the voluntary sectors. Sky doesn’t think that you can do good strength based practice without investing in the voluntary sector and working in the voluntary sector. Is that your thought on that, Charlotte?”
“Well obviously. We are having suck difficult conversations with system partners about this. It’s like the NHS is finally discovering the VCS and is then confusing it with free resource. So I think we need to message this really well, because if we are coming across are petulant VCSE leaders who are stamping our little feet and saying, we’re not playing until you pay us, none of this push towards prescribing and the beta integration of the voluntary sector into primary networks and all that is going to work. But we need to also make it clear that we are very often very good value, but we are not free.”
“And I think the confusion starts right at the top, when Mike Hancock, our current Secretary of State introduced social prescribing and the idea of there cannot be social prescribing. He said, rather than putting people on expensive antidepressants we can put them on free activities like Walking for Health, and Power Brands. And whilst these things are cheap, they are not free. So I think this is such and ongoing issue, we need to find a better way of landing that with our system partners. And I think the conversation we’ve just had about outcome based conversation and looking at the money in the round, if you do that properly, then there should always be a slice of money that can go to the third sector to support people and communities in this way, because they can achieve these outcomes and you won’t be able to achieve them on your own.”
“Okay. Just about to run out of time actually, but I should say that there’s been a few questions raised about children social care. Strength based approach is absolutely thriving in many children social care environments. We have a paper on our website we’ve produced with Leeds Council on strength based approach on children social care, so do have a look at that. So we’re absolutely aware of the many good things going on in children’s social care. I’ve got time just for final reflections from my two colleagues before we have to say goodbye.”
“Okay. So I just want to chip in very quickly, emphasize the point about investing in the voluntary community sectors. Camden does invest quite heavily. In the model I’ve heard about, might be worth checking out, is Coventry and the way they’re investing in their voluntary community sector, particularly around people’s first contact. And then the other thing is, we’re calling the Named Social Worker approach here because you’d recognize it. Within Camden, we’re calling it much more of a Named Work Group approach because it doesn’t have to be a social worker. The way we’ve got care coordinators [inaudible 00:58:50], or nurses, or whatever, the model is the same. It’s that constant duty of care. We expect if you a nurse, that the next time you see a nurse it’ll be the same nurse.”
“Thank you Andrew. Finally, Charlotte.”
“It’s really just a personal reflection, that I think I would really benefit from listening more to people who know a lot about social care and social work. And that there is a lot of differences I think, but also some parallels to how health is structured and delivered. And sometimes I think because health is obviously based on medical knowledge, we over complicate what happens in a clinical conversation. But I think we could learn a lot from, what I heard particularly from Andrew today, about really getting value about that engagement and really keeping the relationship personal. I really want to continue that conversation and take some of that thinking into how we influence health services more.”
“Brilliant. Okay, well thank you very much for taking part. As I said, all the slides and the recording will be available to you very soon. Thank you very much for your time, and goodbye.”
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