In putting together its New Models of Care programme, through what were termed ‘Vanguard’ sites, NHS England had ‘replicability’ as one of its assessment criteria. There was no point in having a national programme if what you were doing in your area couldn’t be applied somewhere else.
At the same time, this has always proven tricky in practice. Plus, it’s not just an issue in healthcare. Many social care providers are aware of pockets of good practice happening around integration or more joined-up services, but to find out about what’s going on, or to be able to do something with the information, is hard-going. It takes time and attention, when people are already over-burdened and services are under-resourced.
Even if they’re worthwhile, innovations can sometimes be temporary, stopping when the funding runs out. This means that by the time you hear about them, there’s no-one left in-post to ask. Also, if you haven’t been directly involved in a new development – and independent sector social care providers are often last on the list to be included – it can feel difficult to apply something that was constructed to fit different circumstances or geographies.
If you’ve found yourself in this position, there are things you can do to learn about, and apply, what’s happening elsewhere. The starting point is to get away from ‘magical thinking’: stop hoping for the ‘one big thing’ – a website, person or organisation – that is going to wave a magic wand and explain everything to you (and, ideally, apply it for you).
Then – and this is the beauty of this approach – there are lots of small steps that you and people in your organisations can take.
You make it everybody’s business
Finding out what’s happening, with a view to continuous improvement, is part and parcel of social care leadership. The Leadership Qualities Framework for Adult Social Care has ‘Improving Services’ as one of its seven key Dimensions, and this includes critically evaluating services to identify improvements and create solutions; actively encouraging improvement and innovation; and facilitating transformation.
Leadership is for everyone, no matter what their level or role – it’s about how they behave in everyday situations. If you’re a frontline worker, good leadership means being actively engaged with improving the lives of the people you support and promoting change. At operational or strategic level, it means creating a culture of continuous improvement, championing excellent care and ensuring that good practice is adopted. It also means empowering your staff to seek out opportunities for change and innovation. As such, looking for innovation, and thinking about how to apply it, can be built into everyone’s role. It doesn’t have to be purely down to a single individual at the head of the organisation, or someone with the word ‘Development’ in their job title. Myron Rogers, who writes extensively on systems thinking and change, has two sayings, ‘Real change takes place in real work’; and ‘The people who do the work make the change’. Giving your frontline staff explicit permission to think about change, some ‘fail-safe’ areas in which to try out new things, and – importantly – permission to fail (because not all innovation is going to work) is a great way to improve opportunities for learning about, and applying, new ways of working.
This means building, and using, networks and relationships
Leadership, in this context, means systems leadership: how you lead, with other people, when you need to reach across organisational and sector boundaries. This means thinking in terms of using networks, and building relationships and trust. If you want to be a change agent, your position in an informal network is much more important than your position in a formal hierarchy.
There is research evidence that people who are highly-connected have twice as much power to influence change as people with hierarchical power. Social connection, and discussion, has been calculated to be 14 times more effective than written reporting or toolkits in supporting change. So the thing to do is to start using the networks you have, or that your staff have, and use them to learn, ideally face-to-face, about what’s happening elsewhere, and think together about what this might mean for you.
If you have a local care association, or you’re a member of an organisation like Care England, the National Care Forum or Voluntary Organisations Disability Group, they’re a good place to start. Many have networks for specific groups such as HR and finance directors, and chief executives. Skills for Care and the National Skills Academy have Registered Manager Networks that can be a valuable source of emerging good practice and insights too. It’s also worth becoming a part of online networks like the Academy of Fabulous Stuff – for health and social care – which has a wealth of information and garners thousands of views alongside direct queries.
It’s fine to start small
There’s a tendency to feel you should know everything, or have thought through all potential implications, before starting to do anything new. This is not the case. This doesn’t mean that you hare off down a new path without thinking through how you want it to work: of course, you need to think things through, get all the information you can and get as many people as possible in the room to think through the consequences with you. But it does mean that you don’t have to wait for perfection. You just need to make a start. Start anywhere, follow it everywhere and don’t feel you need to ask permission.
At the same time, be aware of some of the bigger initiatives and what they can offer
There are national initiatives, particularly the Enhanced Care in Care Homes Vanguards, that are making major strides in joining up health and social care for the benefit of service users. They have a wealth of experience and evidence, and are happy to share what they’re doing and how they’ve done it.
The Wakefield Connecting Care Vanguard has set up a number of network hubs, looking at different service mixes and trying out new ways of operating. One network focuses on working with a community geriatrician, with weekly GP visits to residents with complex neurological problems in specific homes. Two others involve advanced nurse practitioners acting as care co-ordinators for residents identified as high-risk, with regular pro-active care visits and better links with GP practices. A fourth is prioritising better collaboration between primary and secondary care, and Age UK, with better use of video links and access to shared care records.
As a corollary, there has been more emphasis on skills development for care home staff, funded through the Vanguard, so that staff can deal with more complex medical needs and prevent emergency call-outs. They have moved towards using multi-disciplinary teams across health and social care, often with the registered manager being the pivotal figure, and working with a range of health and social care practitioners, including district nurses, social care staff, pharmacists and specialists in palliative care.
The teams use a screening process to identify care needs which, if not met, may lead to residents needing to be admitted to hospital unnecessarily. The team can then support the care home to meet these needs to reduce reliance on hospital admission and improve people’s quality of life.
It’s having a really positive effect. Outcomes from the pilots include a 25% reduction in ambulance calls; 30% reduction in A&E attendances, and at least 50 weekly visits to care homes by GPs – a significant increase. As a result of care reviews, 53% of residents saw changes in their medication, often with less medication required.
Similarly, in the Sutton Homes of Care Vanguard, providers working alongside local GPs, Age UK and Alzheimer’s Society, are involved in building a provider network to support training across local care homes, as well as a new model of care that enables people to get specialist support at home rather than having to go into hospital.
Again, this is translating into enhanced education and training for care home staff, with specialist modules in dementia, diet and nutrition, falls prevention and management, diabetes and working with challenging behaviour. A care co-ordinator role has been developed to bolster nursing leadership within care homes and maximise the input they have into the way GPs review care.
The Vanguards have recently published an enhanced health in care homes framework, setting out what they’ve been doing, and how they’ve got started, along with contact details. They have ‘spread’ their work across the country as a core aim, and are a great source of insight and support.
Go beyond the usual contacts
Alongside seeking information and insights from local health and social care contacts, and from those involved in national initiatives, it’s worth making links with other organisations involved in the delivery of services, particularly local voluntary and community sector organisations and housing associations.
There are many examples of how just making these links has fostered innovation. In Dudley, the Council for Voluntary Services (CVS) has joined local multi-disciplinary teams and now delivers an ‘Integrated Plus’ service, using specialist link workers, to join up health, care and other sectors. In the West Midlands, domiciliary care provider, New Outlook made connections with Nehemiah Housing Association that have now developed into a formal partnership to deliver services, with outcomes that have included better satisfaction levels, more take-up of services and calls to ambulance services dropping by 66% over the last two years.
Take up your leadership role
As many of the examples have illustrated, these innovations often happen because social care providers – owners, managers and staff – have stepped up to the plate and taken up their leadership role, both in their own organisations and working collaboratively with others, as true systems leaders. Learning about innovation, and getting in on the ground floor to influence development, can be difficult, but it can be done. Plus, it’s much better when social care gets involved. The thing to do is to start somewhere, and show how it’s social care leadership that makes all the difference.
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