NG86: Walking in the shoes of people who experience adult social care – reframing our services with new eyes

Aims:

• To improve the design and accessibility of public-facing information on the City Council’s website
• To work with people who use adult social care services and their carers as far as possible to co-produce

Objectives:

• To build a co-production approach
• To review, update and design a new suite of public information resources

The NICE guidance (NG86) includes recommendations in line with the Care Act under section 1.2 on local authorities’ role in information provision about care and support services for people and carers.

The NICE guidance emphasises the importance of involving people in service design and improvement:

1.6.1 Local authorities must provide opportunities for people who use services to be involved if they want to in strategic decision-making about services, not just their own care and support, in line with the Local Government and Public Involvement in Health Act 2007. This should include involving people in:

• decisions about the way services are commissioned, run and are governed and
• checking that the service is delivering quality care and support.

The Policy, Guidance and Public Information (PGPI) Group at the Council, led by the PSW wanted to understand how NICE recommendations were reflected in current practice and so did a baseline assessment against recommendations in NICE NG86. This identified areas where action was required to provide services that reflected NICE’s guidance. The findings were considered by the group.

Colleagues in Coventry discuss who is most appropriate to evaluate NICE guidance in relation to current practice. In this instance, because the guideline related to adult social care services, it was agreed that the PSW was the most appropriate. Leading on research and development and implementation of good practice, together with supporting the organisation’s vision and priorities both internally and externally is a key role for the PSW as set out in the guidance on the role, function and purpose of a PSW in adult services. The group also reflected and considered the feedback loop from service users and their carers, at the time served by the annual adult social care survey (ASCOF) and biannual carers survey. These evaluations are a requirement on local authorities to routinely undertake. The group felt these exercises, whilst a valuable source of feedback, were too infrequent to capture real-time experiences that most services now seek in order to inform continuous improvement.

You can read more about Coventry’s PGPI Group in their associated example published here.

The group also reflected and considered the feedback loop from service users and their carers, at the time served by the annual adult social care survey (ASCOF) and biannual carers survey. These evaluations are a requirement on local authorities to routinely undertake. The group felt these exercises, whilst a valuable source of feedback, were too infrequent to capture real-time experiences that most services now seek in order to inform continuous improvement.

The NICE guidance recommendations and Care Act requirements build a clear mandate around involving those who use adult social care services and their carers, as much as possible in the co-production of information that services provide, organisational policies and procedures and staff training.

In response to the findings from the baseline assessment, the group committed to starting to build an organisational co-production approach at the Council. The approach and terms of reference for the stakeholder reference group (user/carer representative group) at the council were reviewed and a new co-chair agreed with a local authority officer and service user/carer representative taking chair and co-chair roles respectively.

The group have agreed to use the Think Local Act Personal (TLAP) Framework and statements to shape the priorities for the group https://www.thinklocalactpersonal.org.uk/_assets/MakingItReal/TLAP-Making-it-Real-report.pdf

A key ‘we’ statement for the group is;

‘We work with people as equal partners and combine our respective knowledge and experience to support joint decision making’.

At the same time Coventry City Council has responded to NICE’s recommendations and the principles set out in the Care Act through the ongoing development, review and publication of ‘public information’ resources on the Council’s publicly facing website. These include information resources covering:

• Safeguarding
• Mental Capacity
• Advocacy
• Getting involved in adult social care (ASC)
• Complaints

The council is mindful that a proportion of the population still does not have access to or routinely use the internet and so a select few of these resources are produced selectively as hard copies and these include resources on complaints, safeguarding and financial assessment. An example of the safeguarding resource can be accessed here.

To further improve accessibility the resources are webpage based so that they can be viewed through Google translate for service users who don’t use English as a first language.

The review and update of these resources was overseen by the NICE Implementation Group within the Council, chaired by the principal social worker and including internal and external stakeholder representation, including experts by experience who represent the views and needs of service users.

Recognising that annual and biannual surveys can capture feedback but not in a way that allows for a continuous improvement, the team designed a real-time survey which further reinforced the team’s commitment to creating a culture of co-production and to improve the quality of services received by service users.

Service users are asked to complete the survey at the end of their 6 week/annual review:

Intentionally high level, the survey is intended to elicit general responses regarding people’s experience rather than specific types of service. They are however aligned to the questions within the ASCOF.

It’s not a mechanism to gain feedback about individual practitioners but to determine how effective interventions and support have been through Adult Social Care. This was designed to improve the ASC team’s understanding of the experience of those who access support and to encourage people to ‘get involved’. This helps both to improve support and promote a culture of co-production. The experience survey method also forms a key part of strength-based approaches to adult social care.

Findings from the survey are fed through to a performance dashboard which can be used to oversee quality, customer experience and satisfaction and prompt to respond where need arises. The dashboard enables the user to compare real-time results against those taken annually to the adult social care survey (results for carers taken every 2 years).

Reports generated from dashboard are then reviewed by an adult social care stakeholder reference group, chaired by the principal social worker. The group meets monthly and includes people using services and their carers. It’s membership also includes representatives from the voluntary sector. The combination of real-time feedback coupled with representatives on the group ensures that the voices of those who can and can’t be around the table are heard.

Feedback through the survey can often be a prompt to follow up action by the associated service at an earlier stage e.g. if information is found by service users to be lacking around discharge – this can then serve as a call to action for the team on site at the local hospital. Qualitative feedback was previously seen as anecdotal or isolated whereas the dashboard system helps to gather overarching themes and concerns which can be routed through to ASC commissioning colleagues to ensure this informs future commissioning decisions and management of existing contracts.

Enabling a feedback system in real-time provides a further route to supporting people to be involved in the services which relates back to the ambition to involve those who receive ASC services in co-production. Those who complete the survey are asked if they want to be involved in the work of adult social care, if they say yes then they start to receive our ASC bulletin. Although still early days, nearly 50% of those people completing the survey are asking to keep in touch and get involved.

• The Care Act 2014 says advice and information often needs to be available in a number of different formats duties will not be met through the use of digital channels alone.

• If we want to work in a strength-based way we must engage with people’s experience, are postal surveys sufficient to enable this?

• Remember that co-production is a journey not a process. This also requires time commitment.