adult social care Archives

A Warm Welcome for our Funders

March 14, 2023February 2, 2023

This week we held a visit from our two funders, …

No one gave me a job description

February 7, 2023January 25, 2023

The below article is by Jacqui Darlington, a member of …

Technology and Care in 2022

September 6, 2023December 15, 2022

We asked Esme Foxworthy-Bowers, our Facilitator in Scotland, to reflect on 2022. Esme’s Facilitator is in Glasgow, and aims to increase the use of technology in care at home services. She is reviewing and synthesising evidence to support the implementation of a new model developed by Scottish Care.

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. In order to encourage replication across the social care sector, we will share our successful findings and outcomes with others.

What have been your highlights of 2022?

I’ve been working with Baillieston Community Care in Glasgow on technology implementation, with their care at home services. This is working alongside the Scottish Care project of ‘Care Technologists’. The role supports people to access care and helps them use technology as part of their everyday activities. To understand what has been working well or needs improvement, I’ve spoken to some of the people that the Baillieston Care Technologist has been working with. This has been one of my highlights. It has been great to be on the ground as staff and people who use the care-at-home service have learned more about technology.

Working with the Care Technologists has been another highlight for me. The team is so enthusiastic and has been doing fantastic information sharing with me! The project is allowing people who use care-at-home services and staff who provide support to identify the changes they would like to see, and to express their thoughts and opinions.

The number of opportunities for learning during this project has really impressed me. Scotland is currently working to develop a National Care Service. I’ve been in meetings where I have spoken about IMPACT’s work and the Facilitator project with individuals from the National Care Service working groups. The results will help them incorporate the practice knowledge and lived experience evidence into the development of the National Care Service. It would be incredible to see the work from this project used for such a large-scale re-design of care at home.

What have been the challenges this year?

At the beginning of my role, it was difficult to find information about previous technology projects or tests of change in the care at home sector. This prevented me from getting a grasp of what was already being done. I also needed to find out more about technology implementation. Initially, this was harder than I anticipated to navigate. A big part of my job is around evidence-based information ‘brokering’, and there isn’t a lot of information available or published at present.

How have your aspirations for the project/IMPACT changed?

I think now that the groundwork with Baillieston Community Care has been laid, my aspirations have shifted more toward plans for the Facilitator project itself. Personally, I love the information distribution aspect of this job. I want Baillieston Community Care to feel like they have more options, more knowledge, and are more enabled to explore technology in their service by the end of the pilot.

What have you learned so far?

So far, the gap between practice and research has been particularly emphasised. There is not a lot of large-scale research on technology in care at home, and services are often very stretched due to staff shortages and time.

A learning point for me was really emphasised by the equality, diversity and inclusion training that IMPACT staff attended in November 2022. This really highlighted the need for everyone in the system not to be viewed as cogs in a machine. I realised that everyone in a service has their own worries, lives, hopes and happiness to think about every day. I think this notion is consistent with the way that carers and people accessing care view technology. There is not one size that fits all and it is very individual. There is also a real worry that staff will be replaced by technology. Often this worry overshadows the potential for technology to complement care and support.

What are your hopes for next year?

I will be engaging more staff at Baillieston about IMPACT and the Facilitator project. I will also find out what kinds of technology would make a real difference. Through this, I hope I can bring an understanding of the background evidence for using technology in care at home in a way that acknowledges but takes steps to remove the fear that is sometimes present.

I am hopeful that this project can allow staff to work in ways that suit the needs of their role. They will begin to work with technology that’s suited to both them and the people accessing care. I hope the Facilitator project allows multiple organisations to understand their staff and the people that access care. Ultimately, enabling them to design ways of working that suit everyone.

What does success look like?

Success for me is ensuring that Baillieston’s hopes for this project are fulfilled. Baillieston Community Care is hoping to increase staff confidence with technology. They also want to develop case studies that can demonstrate what helps and hinders the use of technology in care at home services. This might identify the need for training in digital skills for example. By working with the Care Technologists this may encourage questions to them, which might alleviate some concerns or difficulties people face which they’re unsure about how to solve.

Conversely, it’s also becoming clear that part of success in a technological context is recognising hesitancy when using technology. Whilst there are benefits to assistive technology and information provision, digital access is about maintaining the right of people to say no to technology. Success in this context means that people benefit from technology if they choose it, and staff feels able to implement and use technology in care at home.

I think importantly, this success comes from the Facilitator contributing to evidence-based practice in this way. I am effectively distributing and encouraging the use of evidence-based practice.

What’s unique about your ‘technology in care’ project?

It’s become clear from my work so far that it is easy to assume that many social care organisations already have technology and technological skills. However, this is not necessarily the case. My hope is that confidence will increase in the future. To do this, I think we need to understand the needs, wants and fears of technology from staff and people accessing care at home.

I feel that there is a real opportunity for the Facilitator project to support this. In the future, I hope we will be able to help people in geographically different areas using technology (especially as social care provision can look very different in remote and rural areas).

A real surprise for me has been running focus groups. There have been some productive discussions about what is working and not working in terms of technology and implementation. There have also been success stories and practical knowledge sharing.

I also feel I’ve become a better ‘knowledge broker’. It has been great to experience people coming to me to ask if can share any research relating to technology implementation. This part of the Facilitator role has slotted very well into the social care setting and it feels as if I am providing a useful and relevant role. It is also great learning for the Facilitators of the future after the pilot year!

Direct Payments in 2022

August 8, 2023December 15, 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

August 8, 2023December 15, 2022

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

March 6, 2023December 15, 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.

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.

Working with the NIHR Delivery Research Programme

March 6, 2023November 16, 2022

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

Build a Collaborative Future Using Evidence

September 19, 2023October 10, 2022

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-de s ign 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