Change Model Stage 1: Agreeing on the Issues

The Facilitator project in Ebbw Vale initially focused on introducing a decision-aid to support carers of people with dementia who are approaching end of life. However, there was a potential clash between the culture of the organisation and staff values, which were focused on promoting the voice of the person with dementia, and the decision-aid tool, which was designed to support carer voice. This potential lack of fit between the local context and the chosen tool prompted a range of conversations with wider stakeholders including carers of people with dementia.

The ability of the Facilitator to recognise this and adapt their approach in line with the real needs of the hospice was integral to the success of the project. Staff did not feel that it was part of their role to engage with research evidence, but then introducing lived experience evidence was successful in encouraging their engagement.

Practitioners recognised the value of the decision-aid only after hearing about the benefits it had for carers, underpinning the importance of published research being translated so that its practical application and benefits are made explicit.

By encouraging open discussion to understand carer and staff needs, the project was able to instigate culture change, with the hospice becoming more evidence-informed in its practice and having a renewed focus on the needs of carers (alongside the needs of the person with dementia).

IMPACTAgewell is an asset-based community development project located in a rural locality of Northern Ireland. Link workers meet older people in their own homes to learn what matters to them and discuss options to improve their social situation and health conditions. Where appropriate and with their agreement, the older person is connected with relevant community groups and statutory bodies.

The asset-based Demonstrator project aimed to widen access to IMPACTAgewell within local communities and share learning outside Mid and East Antrim. The project was led by two steering groups – a Community Group involving older people and voluntary sector organisations, and a Practice Group involving professionals, health and social care organisations, funders and broader networks.

The steering groups set out key implementation questions to be explored initially through research, practice and lived experience evidence. Insights from evidence were discussed at a World Café event involving professionals, older people, and community groups.

A ‘theory of change’ was developed following the event which identified these areas for development: engagement from professionals, including GPs, social workers and pharmacists; accessibility to older people from minority communities; strengthening collaboration with and across the community sector; and widening learning and impact.

At the end of the project, a second World Café enabled stakeholders to reflect on the progress and learning and to identify recommendations for future practice and policy.

Networks follow a collaborative process in which members help to shape the questions and content for discussion and provide insights from their own practice and lived experience.

At the initial briefing meetings, an online post-it wall is used to ask co-ordinators to feed in suggestions of what the first evidence review-based discussion material should include. They are then invited to feed back on the first draft of its scope and content, and to share examples from practice or lived experience that the evidence review process hasn’t picked up.

For example, in the Remodelling the Front Door Network, members identified a gap in understanding about population needs and the importance of this in shaping approaches to managing the ‘front door’ when people first try to access social care support. In response, action plans were established to gather data to understand local population needs and strengthen involvement of lived experience evidence to understand if needs have been met.

The Demonstrator Project about in Pembrokeshire focused on identifying how well supported local young people and their families felt when moving from children’s to adult social care.

The senior strategic improvement coaches gathered evidence about the local landscape and looked at how this compared to approaches elsewhere. They reviewed the current information available to young people and their families in Pembrokeshire about the transitions process. They established a stakeholder group to co-produce the project which included young people, families and practitioners from Pembrokeshire and beyond.

At their first meeting, the stakeholder group, ‘Transitions Together’ drew on their own experiences and the evidence that had been gathered to agree on priorities and next steps.

• Improved multi-agency collaborative work
• Better quality and accessibility of information for everyone
• More opportunity for short breaks and community-based activities
• A broader training offer for staff

Whilst technically an option in Northern Ireland, managed budgets, in which people can use their allocated funding through contracting direct with agencies, have never been widely promoted or used, despite widespread support for the concept. This project started by exploring the barriers and enablers for managed budgets within Northern Ireland through conversations with individuals with lived experience, practitioners, service providers and policy makers. Because of the complexity of the issue, , time was taken to engage with people in different roles and system levels – this included: senior staff in the Department of Health and regional policy leads, the self-directed support leads and commissioning in each of the five health and social care trusts, service providers and over 30 people with lived experience and family carers

The coach also spoke with experts from other countries including the rest of the UK, Australia, America and Finland to understand how they have implemented self-directed support, and how they have tackled challenges within their systems.

Collectively, these discussions highlighted the key issues, including concerns about how to manage risk in contracts, and in the care planning process being sufficiently flexible and person centred.