social

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.

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.

IMPACT Network is officially live

We’re mid-way through our 2022 Establishment phase, and deep in the middle of setting up pilot projects to test our four delivery models. We are delighted to share that our first IMPACT Network has been set up.

IMPACT Networks are one of the four delivery models IMPACT is piloting to achieve change in adult social care. Our first network is looking at choice and control for people with learning disabilities and/or mental health issues in supported living. Our Network Coordinators are:

What are IMPACT Networks?

Networks are being piloted across the UK, with local networks in Scotland, Wales, Northern Ireland, and England, all focusing on the same issues. The aims are:

  • To improve practice and outcomes in adult social care at the local level and solve common, yet complex challenges.
  • To bring together practical solutions at the community level to create solutions that can be scaled up to help inspire and inform change across the UK.

Each local network, made up of 8-10 people – people with experience of care and support, carers, front-line staff, funders/decision-makers, and relevant service providers – will meet four times over a period of six months. They will discuss a particular issue using materials provided in advance, such as findings from research, practice knowledge, and lived experience. Members will share their experiences and learning and suggest practical solutions.

They will feedback to the Networks Lead, Kate Hamblin, and Networks Manager Amber Cagney, and learning will be shared with the other local groups working on the same issues, creating a network of networks. The aim is to produce an action plan to take a particular issue forward and enact change.

The inspiration

IMPACT Networks were inspired by one of our Critical Friends: Nka, the Swedish Family Care Competence Centre. For many years, Nka has worked with ‘Blended Learning Networks’ – a method where people with a common interest and from various backgrounds work towards a common goal. They learn from each other and share experiences and convert research results into practice and policy. The networks always focus on carers, but each local network is based on a specific theme of interest to key stakeholder groups, including informal carers and their organisations

A local network consists of 10-15 people – carers, health and social care practitioners, decision-makers, local politicians – led by one or two members. The leaders of the local networks in turn have meetings with staff from Nka, forming a national network.

We were also inspired by Etienne Wenger, who in the field of education, developed the concept of communities of practice in organisations to solve common issues they were facing. Communities of practice are formed by people who engage in a process of collective learning – they share a concern or passion for something they do and learn how to do it better through regular interaction.

Next step for our Network

The first Network meetings will take place in late July.

Amber Cagney has recently been appointed as the Networks Manager, and will be working closely with Kate. Maria Teresa Ferazzoli has also joined the team in Sheffield recently as the Project Officer. We will update our project page with updates from Kate and the team.

A Co-production Charter

The beginning of the journey of the Co-Production Advisory Group

A key element of IMPACT, the UK evidence centre for adult social care, is the commitment to co-production in all aspects of its work. The first step towards this commitment involved the Co-Production Advisory Group, and their group Charter.

The Co-Production Advisory Group’s role is to develop, support, monitor and review IMPACT’s co-production activity, producing an annual report for the Leadership Team on progress made during the year, areas of good practice and areas for further development. This work is supported by the Lived Experience Engagement Lead, Karen McCormick.

“Quite often when new groups come together for the very first time, it can be a challenge to gel. We are all a little bit nervous and perhaps unsure of each other’s circumstances. However, this was not the case with IMPACT’s new Co-Production Advisory Group. They are an animated, confident and lively bunch – this bodes well for us as a group.” Karen explained.

Creating a Charter

A charter is a nice way to document how we intend to collaborate together and our guiding principles.  It’s a way of acknowledging the work we have to do, such as project objectives and the parameters we have to work within, but also allowing space for members of the group to have their say on how we approach it and work together.  

“My approach to starting a charter is to include the knowns, leaving space for the unknowns and being open to the aspirations.” Karen tells us.

“The knowns are the practical things such as structures, definitions, the fact that we need to have 3 meetings this year and produce and annual report. The unknowns are things like the topics we are going to discuss and the schedule for this. Unknowns are also things like the shared vision for the work of the group, the strengths and assets of the group and the language we use and barriers to participation.  Suggestions around practical tips for working together online, communicating and engaging are also included in the early version.

“These were collated into a draft charter (a working document) and presented as suggestions to get us started at the induction meeting – the first coming together of the co-production advisory group – all subject to change through engagement and agreement among members of the group. Ideally with more time, we would come with a blank page but we have a lot of work to do in a short space of time.”

A Living Document

It is intended that the charter will be a living document. Just like charting any course, it will need revision – the group will have waypoints, needing to check where they are and if they are heading in the intended direction. It is hoped that by the end of the first working year together all members of the co-production advisory group respect the journey, and recognise each other and themselves as valued members of the crew.

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