social

Facing Forward – Co-producing 2023!

Co-production group members attending a zoom meeting

As the complexity of problems and crisis management in adult social care continues, so too do the efforts of those working across all sectors to do their bit to effect change. Change does not happen quickly or magically. There is no wand. The crisis in health pushes adult social care further down the agenda. A growing and resilient social movement for change such as #SocialCareFuture across the UK is helping to bring it back to the forefront. So too is IMPACT, an implementation centre enabling practical improvements on the ground and making a crucial contribution to longer-term cultural change. Karen, our Lived Experience Engagement Lead, shares how IMPACT’s co-production work was shaped in 2022 and the upcoming plans for co-producing in 2023.

Our co-production approach

IMPACT projects, or sites as they are known, take a co-production approach. They span many areas of adult social care, such as direct payments, decision aids in end-of-life dementia care, and technology-enabling care. Expressions of interest are now open for organisations wishing to work on change projects in partnership with IMPACT in 2023-2024.

IMPACT’s co-production advisory group ensures the voice of those with lived experience is equally represented across IMPACT’s work. As will be reflected in our first annual report when it is published.

Co-production group members attending a zoom meeting

Learning from 2022 and co-producing into 2023

Looking back, co-producing our own work plan in 2022 was challenging and sometimes frustrating, but hugely rewarding. Relationships, time, and space were key themes. Time was well spent laying the foundations of our working relationships. We also acknowledged that co-production requires more space than we often afford – or can afford it. That will be a key lesson facing our work for 2023 – more space. A safe space to keep building trust, airing opinions freely, and listening to the voices of experience. We want to improve how we communicate this experience across IMPACT teams and beyond, by engaging further with like-minded groups.

In 2023, we begin to learn about the evidence emerging from existing sites and how IMPACT is practically working. We will continue with our flexible and responsive approach to our work. Our approach will continue to adapt based on what we hear. We also aim for many of our contributions to continue being implemented across IMPACT. We will draw on the strengths of our group members to inform, guide, and ensure that those who have lived experience of drawing on social care support are central to our work.

As we scale our projects, we want to ensure that co-production remains a core approach throughout all of IMPACT’s work. We want to ensure that this is consistent and transparent. Thankfully, the IMPACT team is traveling in that same direction and is listening with open ears. And listening to hear – prepared to act upon the feedback, and committed to effecting change. Each positive change in social care, however small it may seem, can lead to another, and another. Perhaps not from a magic wand, but from these tiny ripples come great waves.

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.

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

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 in 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.

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