Revolutionary not evolutionary – Derby’s approach to Community Led Support

The UK has known about the demographic challenge of our ageing population since the 1970s but has only recently began to transform itself following the financial crisis of 2008 and ‘austerity.’ However, that transformation has been variable in different local authorities and - despite various reviews the issue is again in the spotlight with talk of crisis, tipping points and doom.

Derby City Council was not at the vanguard of adult social care transformation. But under new leadership in 2010, the senior management team did commit itself to developing a new approach. We started from the belief that the right question to ask people was not, “what service do you need” but “what makes a good life – or a good day – for you”. This approach has led to many examples of change that have delivered better outcomes for our customers and financial savings for the Council.

Five years on, an external reviewer described the approach as revolutionary rather than evolutionary. I would agree – we are constantly learning from what has come before.

Learning From Local Area Coordinators

Both Putting People First (2007) and Think Local, Act Personal (2010) described the importance of supporting people to make use of the social capital in their lives – their network of family, friends, neighbours and community relationships – as invaluable sources of care and support. These relationships are, by definition, beyond council services. Therefore, in 2011 we considered how, as a Council, we could support people to build on and build up their social capital and subsequently deployed two local area coordinators (LACs) to work with people not yet known to services, those approaching the council for an assessment and those already in receipt of care and support.

LACs carry out a wide range of activities with people that is often misunderstood as ‘light touch’ prevention. In reality the major part of their role is to provide complex/crisis support in ways that keep people away from services and reduce dependence on services – thus reducing costs. LACs work with people to make the fullest possible use of their social capital – and if they have none, to build their connections with the community and increase their individual resilience. In so doing, they also identify the things that the person themselves has to offer, so that support becomes mutual and people contribute more to their local community. Local area coordination operates on the basis that the solutions to social care needs are about more than money and services. It is probably one of the best examples of the Council delivering differently.

The lessons that we have learned from LACs are driving wider reform of adult social care in Derby and have led us to change our ‘front door service’ through the NDTi’s Community Led Support Programme. We chose NDTi’s programme because the values, principles and practice that underpin community led support are the same as those behind local area coordination. Community led support conversations are similar to those which local area coordinators have with people, so it was the right model to help us change the practice of our customer service centre and assessment staff.

The programme is helping us to face a number of challenges;

• reduce waiting lists
• the need to reduce care costs
• how to further increase customer self-service
• increasing productivity of social care staff
• improving the skill mix of our ‘front door’ teams, and
• most importantly, to have different conversations with customers & carers.

Local hubs also appealed to us as a way of enabling staff to be more productive – meeting people in a safe and comfortable environment over a cup of tea, yet at the same time enabling them to see many more people than they would by making home visits. It appeared to be a way of making staff more productive without asking them to ‘pedal faster.’ The experience in other places was that the approach could have a real impact on waiting lists.

The action-learning approach also matched the way in which we have endeavoured to develop our services in recent years – co-producing change with front line staff and managers, alongside statutory partners, the voluntary sector, community groups and local people.

The result has been change and progress at pace – even faster than the already ambitious plan that we had.

Generally NDTi work to an 18 month timeline with local authorities, but in Derby we wanted to begin expanding out from the innovation site across our city in month nine and completed the process in 11 months. This was already very ambitious by any standards, so what we didn’t expect was that expansion to begin in month seven, led by the team managers of the other localities. They were already very positive about community led support and once they saw the reduction of waiting lists in the innovation site and felt the enthusiasm of the innovation site staff and managers, they couldn’t be contained! They have fully bought into the approach, even initiating conversations with partners to identify sites to become hubs in their localities.

This pace could have been a cause for concern but we were reassured by some key feedback. Working with CCG colleagues who are leading on ‘place based work’ with GP practices, we learned that primary care partners were delighted at the pace of change. Their view was that we usually take too long to manage change and that this approach was refreshing. Also, despite drastic cuts to council funding for local voluntary sector organisations, they quickly understood their contribution and also welcomed the pace of change.

It’s people who make things happen and we have some great people working with us in Derby. One of these was the colleague who agreed to lead on our communications work and has done an excellent job. It was a collective decision to call our local hubs ‘Talking Points.’ Soon after that was agreed our Facebook page, Twitter account and regular newsletters were up and running.

Another hugely significant factor in our progress so far has been the way in which the NHS, housing, voluntary sector organisations, community groups and local people have responded to us reaching out to them. The buy-in has been tremendous, with partners actively making connections with complementary work in their own organisations and actively promoting the programme throughout their organisations. This has led to places being offered to us to become talking point hubs with members of those organisations volunteering as ‘meet and greet’ staff.

We could not have made the progress that we have without our own staff, managers and leaders buying-in to the approach. This is exemplified by our Cabinet member for adult social care, who was pleased to be part of a video that we made in November. In setting the scene he chose to focus on the emphasis that the approach is giving to seeing people as soon as possible, in a less bureaucratic way … in his words … “It’s about putting people before paperwork!”