Direct Payments in 2022

We asked Marie Dunnion, our Facilitator in England, to reflect on 2022. Marie’s Facilitator takes place in Leicester and aims to identify the experiences of direct payments in black and minority ethnic communities.

IMPACT Facilitators work within a local organisation, leading an evidence-informed change project. Through close collaboration, facilitators review the evidence, lead local change and evaluate the effectiveness of the changes that take place. Successful findings and outcomes will then be shared with others for replication across the social care sector.

The Direct Payments Landscape

It feels almost unbelievable that 2022 is drawing to a close, as that means I have been an IMPACT Facilitator at Leicester City Council for almost six months! It seems a good half-way point to pause and reflect on what has been achieved in the first six months and what I wish to achieve over the remaining six months, with the project due for completion in June 2023.

I have become well-versed with the academic side of the project topic, especially as my project uniquely incorporates an academic literature review conducted by the wider IMPACT team. On the other hand, I have also been working hard to embed myself in the working life and culture of Leicester City Council, with an obvious focus on direct payments and learning about the various systems and processes in place. The Facilitator model has made it possible for me to function as a member of Leicester City Council staff, accessing the people and information necessary for me to understand the current direct payments landscape at Leicester City Council.

The Facilitator role has allowed me to explore the experiences of direct payments in Black and Minority Ethnic (BAME) communities, which is crucially what lies at the heart of my project. The highlight of my work has been speaking to people in Leicester’s BAME communities, actively listening to their stories of how direct payments are working for them and/or how the process could be improved. One challenge I have encountered has been finding people to speak to, which reflects the difficulty that Leicester City Council has experienced in obtaining feedback on Direct Payments from BAME communities. However, from those I have spoken to, a lot of what they have said corresponds to the academic literature; for example, they enjoy the improved control and flexibility that direct payments allow them to have over their own care package. This might include hiring a Personal Assistant (PA) who is a friend or family member or selecting a PA who they feel aligns with their ethnic, cultural, and religious values.

Looking Ahead

In 2023, I hope to further explore PA recruitment, especially as Leicester City Council have just launched a PA database, which will include comprehensive information about PAs, for example what languages they speak (relating to peoples’ cultural needs). As the literature has identified a gap in knowledge from the perspective of the PA’s experience, my aspirations are extending towards speaking to PAs where possible. I have also been made aware that some people in BAME communities simply do not know about direct payments, so it would be good to know why this may be and how awareness could be raised.

Since the beginning of my project, I have felt that ‘being successful’ by the end of my time with Leicester City Council will take the form of a collective account of direct payments, comprised of experiences from lots of different BAME communities and representing various areas of adult social care. To achieve this, I will continue to listen to peoples’ stories, such as the one Hashim Duale MBE told me when speaking of the Somali community as an oral society, and sharing the advice, “Give people information in the way that they can best digest that information.” He surprised me with the concept of talking leaflets in audio format – a simple but effective alternative to written materials. This is just one example of how peoples’ stories can be used to inform new practices within Leicester City Council; I’m looking forward to seeing how this and other evidence is implemented over time.

Decision aids and Dementia in Wales

We asked Leanne Taylor, our Facilitator in Wales, to reflect on 2022. Leanne’s Facilitator is in Ebbw Vale, Wales, and aims to introduce a decision-aid tool about support for family carers of people with dementia at end of life.

IMPACT Facilitators work within a local organisation, leading an evidence-informed change project. Through close collaboration, facilitators review the evidence, lead local change and evaluate the effectiveness of the changes that take place. Successful findings and outcomes will then be shared with others for replication across the social care sector.

What have been your highlights of 2022?

The developing relationship with the CARIAD (Care And Respect In Advanced Dementia) service within Hospice of the Valleys and the wider hospice has been a clear highlight for me. The rapport with the CARIAD service has been easy to form and they have been super welcoming of my role and my presence. It has been easy to ‘slot’ into the team and be treated like a fellow team member who is included in routine internal meetings and updates. They have always been willing to find dedicated time to discuss the project I am introducing to their service and the surrounding evidence base.

From the outset, it was clear to me that they wanted to be accommodating and supportive of the role. Cariad’s initial curiosity about the facilitator role and its purpose was encouraging and led to many insightful, unplanned, and in-depth ‘corridor’ discussions where I was able to gain deep learning about their aims, purpose, practice, challenges, and underlying values. My growing insight in this regard has allowed me to present my work and ideas in thoughtful and sensitive ways that are considerate of the service and its surrounding context.

What have been the challenges this year?

Untangling the knowledge exchange role has been important to understand what it means in the hospice setting and its value. On paper, it reads easily as “supporting the hospice and staff in their practice of carers of people living with dementia, nearing the end of life”. However, working in a setting where staff have a plethora of knowledge and past practice experience that guides their everyday practice, has meant I’ve been privy to a collective work ethic that is person-centered, bespoke, and dynamic, where practice and decisions occur “on your feet”. It’s therefore been a challenge to master the introduction of new and different knowledge in this context; doing so has meant encouraging a pressured and relatively small staff team to make time to reflect, think and plan new ways of working.

We are working with a specific decision aid too and in addition to scoping out how the tool would sit in other parts of the hospice, I, with the support of the CARIAD staff, am looking at how the tool can be used, presented, and re-framed to complement the service’s strong identity.

How have your aspirations for the project/IMPACT changed?

I am not sure that they have changed. When I started the role, I was excited about bringing lived experience, practice knowledge and research and evidence into closer contact and more explicit communion, and I am still very passionate about how the Facilitator model can support this process. If anything has changed for me, it has been about how I operationalise the project. Initially, I wanted to gain insight by encountering and supporting a range of staff members, carers, dialogues, and stories. However, the real-world pressures that carers and staff members experience mean that opportunities to reflect, analyse and participate in purposeful collective learning are thin. This means that I have needed to look for depth rather than quantity, where I capitalise on the rich and deep lessons present in the small number of case studies and discussions that my work is supporting, and where I can think about how these lessons can interact with my background research and reading to be made meaningful for the hospice and IMPACT.

What have you learned so far?

I have gained insight into the dementia and care setting in Wales, its strategic priorities and ways of working. I have also learnt about dementia, the challenges that carers confront, and the many national activities and interventions that are taking place to support these groups and tackle their challenges.

In terms of my practice, I have had to learn about and work with real-time experimentation and learning. I have needed to deal with the feeling of working with a model as it develops which is exciting but a little scary!

What are your hopes for next year?

From my perspective, it would be great for the staff teams and individuals I am working with to engage with the experience of trialing new evidence in practice. I am looking forward to seeing what comes of the process; the creativity that can be revealed and harnessed when reflecting on real-time learning and practice. I also hope that these experiences encourage ongoing curiosity and learning within the hospice, long after my tenure.

What does success look like?

My idea of success mirrors that of the hospice. While every voice in this knowledge-sharing process matters, the voices of those with lived experience need to be heard loudly and clearly, and in this case, that is the voice of carers. The Welsh Facilitator project will be successful if carers and staff feel that their needs, ideas, and challenges, have been engaged with, understood, and addressed as a result of this process.

What’s unique about your decision aids project?

This project and subject matter are unique because it is addressing end of life planning and care for people with dementia, which has not been considered extensively enough in Welsh and national policy. According to Hospice UK and others, generalist social care services tend to designate end-of-life planning and conversations to “specialist” palliative services, while really, this is a conversation that everyone should be engaging in. The piloting of an evidenced tool that is intended to support carers who are supporting people nearing the end of their lives, and talking about the tool with external, non-specialist services, is perhaps going someway to normalising end-of-life conversations.

Asset-based approaches in 2022

We asked Robin Miller, IMPACT Demonstrators Lead, and Sarah McLoughlin, our Strategic Improvement Coach, to reflect on 2022 and the Demonstrator project so far. Our Demonstrator is taking place in Northern Ireland, and is looking at ‘asset-based approaches’, and how older people can have a better life via health and social services working in new ways with them, the community, and the voluntary sector.

What have been your wins/highlights of 2022?

The potential value that can be generated through IMPACT partnering with an innovative local area to learn from their experiences and support them to build on their strengths. Mid & East Antrim has been a great place for the Demonstrator model to be piloted due to MEAAP’s established networks with older people and with policy and practice partners. Our World Café stakeholder event was an excellent reflection of this – 50 people with lived experience and/or professionals coming together to discuss, debate and design.

How have your aspirations for the project/IMPACT changed?

The overall aspirations for the project – understanding how to engage all of the relevant stakeholders in a local area with innovation, identifying what the important elements of an asset-based approach in primary and social care – remain the same. Through the gathering of lived, practice and research evidence the opportunities to support improvement have become clearer though, for example in relation to responding to the different expectations of diverse communities and demonstrating to professionals how the approach can save them time as well as benefit older people and their families.

What have you learned so far?

When planning future Demonstrators, it will be important that there is a good level of commitment from across the social and health care system, and a local organisation who is well connected and willing to lead on the process in this area.

There are relatively few people with all the knowledge and skills necessary to undertake a strategic improvement role in social care – therefore part of the role of IMPACT needs to be on workforce development and building a cadre of people with these skills.

What are your hopes for next year?

Apart from the very practical hope that our second Improvement Coach is appointed, we want to take forward the actions that are set out in the theory of change regarding increasing the spread and further strengthening the depth of this asset-based approach. We would also hope for policy makers in Northern Ireland to learn from our experience in Mid and East Antrim as they develop the integrated care system.

What’s unique about your ‘asset-based approaches’ project?

The strength of connection with older people in the local area, the high level of commitment from stakeholders, and the capacity building activities with the voluntary and community sector.

Any highlights, stories, or surprises you’d like to share?

The World Café event we ran in November, and feedback from older people and wider stakeholders is a great example of the project’s impact to date.

Find out more about the Demonstrator project.

Relationships and meetings of the mind

IMPACT and The Health Foundation logos

Earlier this year, IMPACT’s Co-production Advisory Group had the pleasure of meeting and engaging with The Health Foundation Inclusion Panel. This created an opportunity for IMPACT to focus on building relationships between organisations. Early in the process we agreed this would be a two-way engagement and we would focus on the theme of co-production. The detail of what that would look like took a little longer to decide.

Co-producing an event

We agreed to co-produce the preparation and delivery of our co-production themed event, involving two members of each group plus the coordinator of each group. Narrowing down such a big topic is challenging – it can be time consuming and a little messy, but this is time well spent. As co-production means different things to different people, it involves accommodation and relationship building, seeing things from alternative perspectives and not being prescriptive. Not being prescriptive means that it can take time to tease out the theme and agree on questions to address and perhaps working in a way that’s different from what we are used to.

Happy to say I’m quite reassured it’s come a long way. I didn’t think you would get there, well done guys!  Testament to real coproduction in action.

Isaac Samuels, member of the Co-production Advisory Group

Building relationships for a successful approach

Cohesiveness, trust, and building relationships takes time for groups. This applies internally to groups and in external engagement. This is an ongoing challenge when time to co-produce, plan and deliver is limited or restricted by the reality of projects and work programmes.

A takeaway for me was the importance of building relationships to ensure effective co-production.

Ann Marie Penman, member of the Co-production Advisory Group

As a fledgling group meeting, engaging, sharing and learning with an established group was insightful. We are at different points in our journeys – we are starting out on our journey and the Health Foundation Inclusion Panel is working out its path for a sustainable and productive future. The experience of meeting a more established group reinforced the point that relationships, group trust and dynamic takes time to build. The sense of family and community from the well-established Health Foundation Inclusion Panel was palpable. This was inspiring and settled us as a group that we are right to spend time on building relationships and trust within our group.

In the practical sense, the process of co-producing the joint event has prompted us to try this approach in our preparation and meeting delivery. Until this point, we were somewhat self-critical of our own approach – a ‘knowing’ that we weren’t quite there but not quite sure how to get where we want to be.

Reflections

I am very proud of our work as the Co-production Advisory Group in 2022, particularly our ability and willingness as a group to be flexible, listen to each other, to feedback and most importantly to act upon it. Building relationships involves building trust and confidence. This takes time. A key takeaway from this meeting is co-producing the preparation, delivery and follow up. We are implementing this approach in our workplan for 2023.

Karen McCormick, Lived Experience Engagement Lead 

My own reflections were about how important it is to consider the whole process in effective co-production. That is, thinking about before, during and after i.e. how do we make sure we give the opportunity of involvement to everyone, how do we bring people together in a suitable space (physical and otherwise) and how are people kept involved and updated afterwards? A lot of our discussions focused on the being together part, but I think it’s important not to lose site of the ‘before’ and ‘after’.

Ann Marie Penman, member of the Co-production Advisory Group 

Relationship building extends beyond the relationship between two groups. Bringing in another group can somewhat shift the dynamic within our own groups. Sharing lived experiences and a passion for co-production with another group was empowering for members of IMPACT’s Co-production Advisory Group, a sense of shared purpose, a healthy respect and acknowledgement of the perspective of others.

Reflections on Co-production

Zoom screenshot of Co-production Advisory Group meeting

We asked members of the Co-production Advisory Group, to reflect on the year, and the work of the group so far. Scroll through to read reflections from Karen McCormick (Lived Experience Engagement Lead), and Ann Marie Penman who co-designed and co-facilitated the last Co-production Advisory Group meeting of 2022.

Karen McCormick’s Reflections

Our Co-production Advisory Group has been given the freedom this year to co-design and co-develop our way of working (Charter), our workplan and how we will meet strategic objectives. This approach has been a breath of fresh air. However, it is not without challenge. There is a fine line between coordinating, supporting, and delivering for the group and the project but in a way that is not prescriptive.

We created a reflections document, which collates the sentiments, thoughts, and ideas of group members. Starting from “you said”, we move towards the outcomes we want to achieve and some actions that we can either take as a group or put forward to other team members in IMPACT that may be helpful in delivering the outcomes.

We have a number of priorities for 2023, including: establishing and embedding two-way communications with and across IMPACT, continuing to identify the skills and assets of the group and expand our engagement offering, and establishing a feedback loop.

Thoughts from Ann Marie Penman

It seems to me that we’ve come a really long way. We’ve come together from across four nations, with different backgrounds, experiences, skills, and opinions but with a shared belief in the value of co-production to make things better.

It’s been a really steep learning curve, in terms of getting to know each other, the wider work of IMPACT and what our role is and might be.

Our remit is very broad, but there are three key aspects:

  • develop, support, monitor and review IMPACT’s co-production activity
  • produce an annual report
  • identify areas of good practice and areas for development

In our first year, it feels like we’ve had an inward focus, quite rightly looking at us as a group and what we bring, our strengths and our assets. As well as that, we’ve been exploring and gathering more information on the wider work of IMPACT.

Each time we’ve met, we have raised questions, made observations, picked up issues and contributed comments – and it’s all of these that have been gathered together into our reflections document. Essentially, it’s giving us a direction for our second year. It’s clear in these recommendations that it’s still important that we continue getting to know each other better but there’s also now an increased emphasis on our personal development, for each one of us. What is the benefit for any one of us in being part of this group?

And there is a clearer balance now in terms of what we want to be bringing to the wider work of IMPACT – what difference do we make, what value do we add and how are things better because of us, the Co-production Advisory Group?

The reflections document is our own development plan. It’s what we’ve come up with ourselves in terms of what is important for us but also recommendations for the IMPACT Leadership Team, for all the different IMPACT projects and the whole organisation.

I think it’s important to remember this is a living document. It will grow and develop each time we meet as we go through the next year. We can add to it, change it and further develop it but also what we want to do is think about, for each recommendation, what is the outcome that we want to put forward as the Co-Production Advisory Group, what will be better and specifically what is the benefit and for who?

Working with the NIHR Delivery Research Programme

A paper setting out a framework for collaboration between NIHR Health and Social Care Delivery Research (HSDR) and IMPACT was discussed at the HSDR Programme Oversight Committee in April 2022. The principles for closer working to promote and enhance social care research were welcomed by the HSDR Programme Director and committee. The Committee endorsed the approach, setting out how this informal collaboration might work and key touchpoints where there would be mutual benefit in close working to maximise HSDR outputs and reach wider social care audiences. This was seen as an exciting opportunity for the Programme.

It was agreed that information on current studies in the pipeline could be shared regularly with Jon Glasby and staff at IMPACT, perhaps on a quarterly basis. It was suggested that pilot work would be done with early engagement with teams and projects on linked studies on family group conferencing and support for people with learning disabilities/autism leaving long-stay hospitals which are likely to be of great interest to social care practitioners and service users. 

Jon Glasby is also linked into other parts of NIHR, including the School for Social Care Research, Research for Social Care programme and the NIHR Centre for Engagement and Dissemination. Developing ways of working with HSDR programme may be a useful pilot arrangement which could be the model for other parts of NIHR.

This paper was then discussed at the IMPACT Leadership Team meeting in June 2022.  With a few minor changes in wording or emphasis, IMPACT would be keen to pursue all the opportunities below as a way of supporting NIHR as it extends its social care expertise and presence, and as a way of supporting a number of IMPACT’s key objectives.

Frameworks for working with NIHR

Background

IMPACT is the UK centre funded by the ESRC and Health Foundation to implement evidence in adult social care.  Following a scoping phase with surveys and Assemblies to identify pressing topics and ways of working, the new centre will enter a steady state for five years from 2023-27. After this, the aspiration is that the centre, or key elements of its work, becomes a more permanent feature of the social care landscape (future business model tbc).

NIHR Health and Social Care Delivery Research (HSDR) Programme is a national funding programme awarding more than £20m a year for research on the quality and organisation of services in health and social care. Projects relevant to social care range from evidence synthesis on strengths-based approaches to social work to ambitious evaluations of family group conferences for vulnerable adults. 

Suggested areas for joint working and synergy

  • Anticipating research pipeline and maximising funded outputs

HSDR has a number of projects underway in the area of adult social care. This includes £7m+ investment in local adult social care research partnerships around the country, projects on self-neglect, care workforce and support for older carers. In the first instance, this could be a pilot for one or two research teams and projects to work with IMPACT, with IMPACT delivery staff working to implement findings from these studies. This would need to depend on their being an appropriate ‘fit’ between forthcoming research and IMPACT’s priorities for 2023-25 (to be submitted to IMPACT’s funders in September 2022). NIHR studies would also need to be working with a similar definition of evidence (which IMPACT defines in terms of insights from different types of research, the lived experience of people drawing on care and support and carers, and the practice knowledge of social care staff).

  • Identifying gaps/research needs

IMPACT’s broad and deep engagement will help to identify priority areas for future research. This is already evident from outputs from the survey/Assemblies which highlighted the importance of research in areas like prevention and wellbeing, asset-based approaches, carers’ health and wellbeing, and support for people who work in social care. Having chosen a series of key topics for its forthcoming work programme, IMPACT also goes through a ‘triage’ process to make sure that there is enough evidence with which to work, and checking for gaps – in either research, lived experience or practice knowledge. HSDR could work with IMPACT and constituent partners to work up briefs in priority areas, identifying important areas of research interest and important gaps in knowledge and framing calls in ways that will resonate with social care researchers and communities. 

  • Building capacity and sharing expertise

Consider opportunities to develop and strengthen capacity and community in adult social care research. Some approaches for embedded research and capacity building are being tested in the new HSDR adult social care partnership research awards, as well as particular opportunities through NIHR Academy Incubator for Social Care. There may be other opportunities – for instance, shadowing or sharing resources around review and research methods through the rapid evaluation and synthesis centres. This is a key priority for IMPACT as one of its four objectives is around building capacity in the workforce, and there may be scope to explore for IMPACT to support the local stakeholders with whom it is working on the ground to encourage stronger applications for existing NIHR capacity building schemes and helping to create a pipeline of credible candidates for these opportunities.

HSDR would also benefit from the expertise and networks of IMPACT to strengthen funding committee and reviewer base to make the right decisions with the right expertise for new projects.

Next steps

  • IMPACT and HSDR Programme staff to meet to take forward above areas for development – with quarterly meetings suggested going forwards
  • There is a particular opportunity to build in 1-2 topics from current NIHR projects into the draft work programme which IMPACT submits to funders in September 2022
  • IMPACT and HSDR to explore scope to publish a statement about this relationship/ways of working

Equality, Diversity & Inclusion

It has been a busy few months for IMPACT with all of our projects up and running, and the team travelling from across the four nations to Birmingham, to meet for an Equality, Diversity and Inclusion training day, facilitated by Clenton Farquharson and Luke Geoghegan from our Leadership Team.

Amongst all of the busy, hard work, there has also been good news across IMPACT we’d like to share.

Clenton Farquharson, our Leadership Team lived experience lead, has been named as one of the 50 most influential Black, Asian and minority ethnic people in health, by the Health Service Journal.

IMPACTAgewell, who are hosting our Demonstrator project, won the Best Health Creating Population Health Management Approach award, at the UK Excellence in Health Creation Awards.

IMPACT’s Director, Jon Glasby, joined the Scottish Parliamentary Committee on Health, Social Care and Sport to provide evidence on the National Care Service (Scotland) Bill. You can watch the session back here.

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Build a Collaborative Future Using Evidence

On Monday 3 October, IMPACT hosted a Conservative Party Conference fringe event in Birmingham city centre: ‘Utilising the Evidence to Build a Collaborative Future for Adult Social Care’.

The panel was made up of:

  • Jon Glasby, Director of IMPACT and Professor of Health and Social Care at the University of Birmingham
  • Damian Green MP, Co-Chair of the APPG on adult social care and MP for Ashford
  • Sarah McClinton, ADASS President and Director of Health and Adult Services and Deputy Chief Executive for the Royal Borough of Greenwich
  • Ruch Amos, self-described “average guy who has a passion for reducing inequalities for disabled people”
  • David Brindle (Chair), senior commentator and ex-Guardian Public Services Editor

Learning from lived experience

The panel was focused on how we can promote good practice, scale up, aid innovation and remove the barriers. The discussion started with Rich’s lived experience of adult social care, emphasising the importance of having a network of friends and the effect of changes to funding – after moving into local authority accommodation, individual care budgets were replaced by collective ones.

“Funding was only available for us to exist.”

Rich Amos

He reflected that there was a real lack of attention to individual support needs and was told his housemates should be his source of social interaction. He and his housemates were treated as one unit, not individuals. Rich has now moved to a different local authority, where he was reassessed and it was recognised he needed one to one support, which he now receives through PAs supporting him 24 hours a day.

The challenges

“The overwhelming barrier is the lack of capacity.”

Damian Green

Damian Green emphasised workforce provision and a lack of smooth planning as significant issues – constituents have told him that care home space is available, but it’s very hard to get domiciliary care. He said a lack of organisation, paired with a need for more funding, means innovation in social care is hampered.

Sarah McClinton said it’s important to reflect on the breadth of care, with over half a million people waiting for social care right now. She also said crises feed into short-termism, and longer-term planning is challenging.

Jon Glasby called for adult social care to be reframed nationally, with care seen as able to change lives. At the moment, there’s a lack of visibility: challenges are not well-understood by the public and policy-makers, and social care is portrayed as a burden. He added that people feel policy claims what they should be doing but the question is how do we do this for real? IMPACT’s co-design survey found people want more practical support, rather than evidence.

Rich Amos emphasised the external factors that are playing a part in challenges finding accessible accommodation, from Covid to the lack of accessible new build properties. He said the system needs to be more flexible and adaptable, and that we’ll keep having these conversations unless learnings are shared and the system changes.

Opportunities for change

Damian Green said we need to change planning rules, so a percentage is set aside for accessible housing/housing for those drawing on social care. He said it could make a radical difference, challenging the crisis narrative if care was embedded in people’s lives and routines. He also emphasised the possibilities an imaginative use of assistive technology could open up.

Sarah McClinton agreed, emphasising the control these changes could give people. She said we will all need housing that lets us be independent for the longer. Discussing the future of the sector, she highlighted: broader housing standards and more flexible approaches. She also suggested more integrated care systems, with more focus on recovery and building independence, as well as learning from COVID (data on support needs/vulnerability presents the possibility to do preventative work).

“Good support isn’t just about ‘services’ – it’s about having a life.”

Jon Glasby

Jon Glasby said you have to start with the person and the life they want to lead, and build back from that – a person-first approach. He added that community navigators and local area coordinators are really valuable, so we need to have creative conversations about what support people need & from whom.

David Brindle asked a quick-fire question. What would you prioritise, to improve adult social care?

  • Rich Amos: Co-production is key, the benefits are clear. We need a national, universal approach to this instead of pockets of excellence and of fragmentation.
  • Damian Green: Ending the conception that social care is funded by council tax. It must be funded nationally. We also need a proper workforce plan.
  • Sarah McClinton: Making the sector more attractive to work in: better pay for the social care workforce, parity with NHS staff, the workforce needs to feel truly valued and that there are career development opportunities
  • Jon Glasby: Organising care well relies on relationships – building relationships locally with partners, and between central and local partners.

Rich Amos said people must be involved at every step of the journey when designing services, with equal relationships and power dynamics removed to create better outcomes for everyone involved.

Jon Glasby said good leadership is needed at all levels but there’s currently an ambivalent attitude towards leadership across the sector – need to create routes where people can keep doing what they love in their jobs as they move up the career ladder. He added there’s no shared approach and united sense of what success looks like in social care so we end up arguing with ourselves & presenting varied messaging to policymakers.

Sarah McClinton emphasised that work is needed to improve staffing and resourcing, through a workforce plan.

“Adult social care can be very scary for individuals, but we all need to remember the impact it has. We get so focused on policies, agendas, but adult social care comes down to humans supporting each other and if that works well it enables people who draw on care to live fulfilling lives.”

Rich Amos
Attendees talk before the event
Jon Glasby, David Brindle and Rich Amos sit on the panel chatting before the session had started
Attendees talk before the event
A woman in the audience taking notes
The audience, sitting around round tables
Sarah McClinton holding a microphone with the panel looking at her
Someone in the audience asks a question
The audience claps
Sarah McClinton and Rich Amos chat after the event was over
Attendees and Rich Amos sitting on sofas and chatting after the event

Examining Choice and Control in Care

Choice and Control Pro and Con Brainstorm

6-week reflection by Amber Cagney, Networks Manager

I’m Amber Cagney – I work part-time with Kate Hamblin (Networks Lead) and Maria Teresa Ferazzoli (Project Officer) on the IMPACT Networks. My role is UK Networks Manager, which includes recruiting Local Network Coordinators across the four nations, supporting them to run their Local Networks and meeting them in between each one to debrief and decide together how to run their next meeting. We’re currently running our first pilot network on choice and control and recruiting sites for the second network pilot on values-based recruitment and retention.

I worked in the anti-slavery sector for almost 10 years after starting out as a volunteer! My previous job with West Midlands Anti-Slavery Network was as the development manager where I set up a safe house project for male survivors of modern slavery in a multi-agency partnership. I still work within the sector part-time, and I’m a trustee for a charity delivering long-term support to survivors of modern slavery and human trafficking.

I’ve been with IMPACT for six weeks and am reflecting on the work we’ve done so far.

Equality, Diversity, and Inclusion

Equality, diversity, and inclusion are at the centre of IMPACT’s values. Having come from a human rights background, I believe the Universal Declaration of Human Rights should be central to any work or research into the care and support of people. The Declaration states “All human beings are born free and equal in dignity and rights”, it also states the rights to equal access to public services, the freedom of movement, and many others; these are core principles and it’s essential that our work is grounded in the pursuit of equality for all people to have a good life and the ability to thrive.

Equality is about ensuring that every individual has an equal opportunity to make the most of their lives and talents. It is also the belief that no one should have poorer life chances because of the way they were born, where they come from, what they believe, or whether they have a disability. Equality recognises that historically certain groups of people with protected characteristics, such as race, disability, sex, and sexual orientation, have experienced discrimination.

Multi-agency Interactions

IMPACT’s Networks are a good example of inclusive multi-agency interactions that are exploring the issues related to choice and control and values-based recruitment with a range of individuals who either draw upon care and support or help deliver it. Our first pilot is underway, tasked with exploring mechanisms, systems, and behaviours in adult social care that enable choice and control.

Initial Feedback

The feedback from our first Local Network meetings across England, Scotland, and Wales has been really interesting to read and reflect on so far. The definition of care is “the process of protecting someone and providing what that person needs”. The feedback strongly suggests the shift needs to be in the “process” and ensuring that the person being cared for has a voice, choice, and control in what their care looks like, with the recognition that every person is unique and has their own wants and needs. All individuals who access public services for care have the right to be protected from harm, and the right to be supported to live with as much autonomy and freedom as possible.

Choice and Control Pro and Con Brainstorm from the Scotland IMPACT Local Network Meeting

Choice and Control in Care

The networks discussed enablers for choice and control in care, which included:

  • Being asked – sometimes decisions can be made for people. True choice and control means asking, then asking again in the future – not assuming one answer stands forever – and also considering the person’s communication needs.
  • Being supported to make decisions – decision making can happen at lots of different levels, and people should be supported to make as many decisions as they can, and at every level possible.
  • Good information – being able to access information on providers, activities, or groups, that is up to date and free from jargon, but also accessible.
  • Good relationships – there are power dynamics in relationships, about how one person could be seen as being quite influential and pushing a decision in a particular way. Facilitating open conversations is important, potentially using advocacy.
  • Transparent systems and clarity over budgets– clear understanding of the eligibility criteria for different monies and knowing what they could be spent on

The local network attendees also acknowledged hindrances and barriers to choice and control, including both systemic and human decisions such as:

  • Risk – people should be supported to take risks and try new things, but attitudes – from the person, their family, support provider, or social worker – can be a hindrance. Proactive risk management with the supported person and mitigating risks together can be positive.
  • Relationships – sometimes the “family knows best” perspective can be a hindrance to the individual making progress. Also relationships between different partners- care providers feel like they are consulted to a lesser degree than a social worker, for example.
  • Rigid systems and processes
  • Time  – time to review support plans is not seen as a priority, and choices should be revisited, not taken as permanent.
  • Location and availability of services – very rural locations mean choices can be limited.
  • Disconnect between social care and health – health paying directly for some services rather than putting it into the budget so the individual can choose.
  • Covid-19 – many projects and activities were paused during the COVID-19 pandemic.

Next Steps

The next steps of the Local Networks are to explore what an effective mechanism to enable choice and control with finances and support plans looks like, and to share best practice amongst the different regions

We are currently facing the ongoing challenges of the COVID-19 pandemic, in a complex adult social care environment that is systemically underfunded, undervalued, and neglected in policy; we are very aware of the challenges of creating change, however, to progress and move forward to a more equal society and nation, these are exactly the types of conversations we urgently need to have, and there is no better time than now.

Thinking about 2023

In 2022, we’ve been getting up and running as a national centre and testing our four delivery models via a series of pilot projects across different parts of the UK.  In 2023, we want to work in even more places and cover a broader range of topics.  We’re still working on the detail of this, but we hope to be able to go out to the sector in late 2022 with an ‘expression of interest’ – looking for partner organisations who might be interested in hosting future projects. 

Topics for 2023

The topics for 2023 would be based on the priorities which came out of our national survey and from our Assemblies.  In particular, we’ll focus on topics which:

  1. Make a real difference
  2. Tackle inequalities
  3. Make good use of scarce resources
  4. Have enough evidence for us to work with (where there isn’t enough evidence we’re trying to make sure that we feed this back to partner organisations so that they can try to fill these gaps as quickly as possible)

This is likely to include topics such as:

  • Prevention and well-being
  • Assets-based and person-centred care
  • Carers’ health and well-being
  • Support for people who work in social care

Identifying Partner Organisations

When we identify sites that might want to work with us, we want to get a real mix (e.g. in terms of geography, and the nature and needs of the local population).  We also want to make sure that we don’t just work with organisations that usually volunteer for these opportunities – but with a wide range of people.  This might include small, innovative community organisations; user- and carer-led organisations; and services that are really struggling and wouldn’t usually be able to think about taking part in something like this.

To help people plan, we’ll be clear about the funding and support we can provide, but also about the things we’ll need in return (for example, we’ll want sites that are committed to co-production and to sharing learning with others). 

Expressing interest

There will be more information later in the year – but please start thinking about whether your organisation might be interested in expressing an interest. You can sign up to our newsletter and follow us on social media (Twitter, LinkedIn) to be among the first to find out more.

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