A report on the progress of Croydon’s Health Wellbeing & Adults department’s work to adopt and embed a strength based community led support approach and influence working with other Council departments and partners in health, community and voluntary sectors.
The Adults Health and Wellbeing Project Manager introduced the item by informing the Panel that this piece of work had been considered for a number of months, with research having been done into other areas of the country where this model had been adopted. It was explained that this model had gained some traction with other authorities in the country, and that the approach was an alternative way of working with service users to build different relationships and have different conversations. This involved gaining a better understanding of individuals’, families’ and communities’ strengths and assets, and using these to build resilience.
The Panel heard that with an increased focus on early intervention there would be considerable time saved, with fewer investigations needed and less referrals between departments. This would also result in a greater number of users being seen, and seen earlier, leading to improvements in both the quality of the service and users’ lives. One of the major changes would be to focus less on assessing criteria and eligibility, and referring people between departments; this would lead to fewer people on waiting lists, and those who were on lists would wait for shorter periods. The reduced bureaucracy would have a significant impact on the morale of staff, with people feeling more fulfilled and impactful, with greater capacity and time for more meaningful discussions with residents. This had a positive knock on effect with recruitment and staff retention.
The Adults Health and Wellbeing Project Manager stated that in some cases this model had delivered savings, but it was stressed that this model should not be adopted as a money saving exercise, but as a way to improve the overall quality of the service for users and staff, with savings likely to follow.
The Adults Health and Wellbeing Project Manager explained that other authorities who had adopted the model had advised that support would be needed for implementation. The two organisations which had been looked at to partner with were the National Development Team for Inclusion (NDTi) and Partners 4 Change, of which NDTi had been selected as the preferred partner. NDTi brought the expertise of having worked with 20 other authorities, but Croydon would be leading the way as the first London borough to work with NDTi, with the Executive Director of Health, Well-Being & Adults sponsoring, and Director of Adult Social Care as the implementation lead. The next steps were an on-site readiness visit by NDTi in December 2018, followed by a collaboratively drawn up plan in January 2019. Members heard that this would involve workshops with community organisations and teams from the council, starting small and scaling up slowly, incorporating the lessons learned along the way. The Panel were told there would be a focus on listening to service users and trying new things. The experience that had been reported from other authorities was that other teams had seen the changes in the teams implementing the new model and had been keen to get involved. Members learnt that there would be a two day residential event, with 18 other areas implementing the new model, including authorities from Scotland, Shropshire, Warwickshire, Derby, Leeds and more.
The Panel heard that in practise the new model meant changing bureaucratic processes, cutting lengthy assessments and cutting overlapping referral questions. The Adults Health and Wellbeing Project Manager stated it would require support from senior officers to change prevailing thought, and to not necessarily be ticking every box in assessment questionnaires, but that there had been high expectations this would be embraced. The new model also meant working in the community (in places like GP surgeries, community centres and libraries) to provide a “one-stop shop” with, as an example, benefit advisors, social workers, housing officers, voluntary sector staff, etc. This approach focused on connecting users to extant community assets, such as clubs, residents groups and social groups to connect residents to each other. The Chair informed the Panel that the BME Forum had recently completed some work on asset mapping in the borough, and had produced a directory; the Adults Health and Wellbeing Project Manager explained that asset mapping would be crucial, with work planned to make sure there was a wide reach and to avoid duplication.
Members enquired as to how earlier interventions would be achieved, and were informed that this was the advantage of greater integration into communities. The example was given of Leeds, where the hubs had been set up in libraries and other public spaces, which had a great impact. The work being done on the new ‘front door’ was essential for this to work, with staff sticking with cases all the way through; this would be achieved with greater staff capacity from reduced bureaucracy. The Chair added that the current assessment form was 48 pages and that work was being done to reduce this down.
The Chair commented that the new ‘front door’ integrated well with the new Local Plan and the three planned locality hubs, and enquired as to what the conversation would look like when users contacted the service. The Adults Health and Wellbeing Project Manager explained that work on this was ongoing, and that both staff and users were being engaged in this process to avoid a top down approach. The Head of Adult Safeguarding and Quality Assurance commented that greater integration between teams working on the new model would have a positive effect, and told the Panel of recent work with partners coming into the call centre to observe the day to day workings.
Members enquired as to how the new hubs proposed by the model would support residents who did not use the facilities where they were based, or were unwilling or embarrassed to visit them. The Head of Adult Safeguarding and Quality Assurance reassured the Panel that Huddles should help support these residents, with the Adults Health and Wellbeing Project Manager adding that some GP surgeries would be host to some of these hubs. The Panel explained that this would be difficult in the South of the borough, as there had been difficulty in getting the GP surgeries there to adopt Huddles, and there were no major dentists other than in Selsdon, Purley and South Croydon. The Adults Health and Wellbeing Project Manager replied that it would be helpful for Members to meet with NDTi when their assessments were carried out, and relay these views, so as to cover all residents and not only those in the more deprived areas of the borough.
The Panel expressed some concerns that there would be a focus on directing users to online resources, which may fail to meet their needs. The Head of Adult Safeguarding and Quality Assurance assured Members that the new model would not be solely online, but that this was an important aspect of the implementation as it allowed the maintenance of anonymity and helped capture users already online to seek information. The Adults Health and Wellbeing Project Manager explained to Members that there would be “no wrong front door” for users to contact the service, and that there would be access to advice, information and support for all residents.
Members enquired as to whether more staff would need to be hired to facilitate the implementation of the new ‘front door’, as there were existing concerns with the contact centre, and with reports of residents calling multiple times without being able to get through. The Panel also explained that they felt vulnerable people were being missed because of this, as they were ending up in hospital, not a GP surgery, and it was only then that the council was becoming involved. Members further expressed wishes for a matrix to measure the complexity of users’ needs. The Adults Health and Wellbeing Project Manager explained that the proposed changes to the ‘front door’ were under consideration, and that this included staffing changes, but that it was hoped that reduced bureaucracy would mean that there would be increased capacity for staff. The Panel also heard that there would be daily evaluations as part of the approach, and that this included looking at the impact on the workforce.
The ‘good conversations’ model that would be used in conjunction with the new ‘front door’. This would be a key part of the new approach, with conversations that first asked what was most important to the user and what could be done to help to support resilience, including making community connections. The second was to intervene immediately when a resident was in crisis and stick with the person to ensure they were safe and that their situation improved; the third was for those people for whom a statutory response was required, which may include a package of care. It was further explained that work was being undertaken with the Hospital Discharge Team to understand the complexity of users’ needs to try and halt the ‘revolving door’ by providing information on possible points of referral.
Members asked if more money would need to be spent on infrastructure in order to implement the new model. The Chair replied that Croydon would be coming from a strong base of infrastructure and clarity of approach, and that advice from NDTi would help to inform these decisions. The Panel also queried why there had been three recent pilots in the council on deprivation, when issues such as complex needs and hospital discharge had not, in light of social care being one of the largest expenditures in Croydon. The Adults Health and Wellbeing Project Manager asked that Members be present for an upcoming meeting with NDTi to assist in informing their decision of exactly where the work should begin. The Chair expressed a keenness for the Panel to have input with NDTi and to attend these meetings, with the possibility of NDTi reporting back to the Panel in future.