Manchester City Council

Better Outcomes, Better Lives

Briefly describe the initiative/ project/service; please include your aims and objectives

In 2020 we worked with a consultancy to carry out an in-depth analysis of Manchester’s adult social care. We reviewed our current practices and how our demand was expected to change over the next few years. We identified significant opportunities to improve practices in order to reduce, prevent and delay demand on services, while also improving outcomes for people in Manchester. Financial pressures in the service meant that we needed to identify significant savings, but we setout to do this in a way that delivered a better service for people and made better use of the resources we have.

Following the review, in January 2021, Adult Social Care in Manchester embarked on an ambitious, wide-ranging three year transformation programme, called Better Outcomes Better Lives. The aim of the programme is to build a social care system that starts from people’s strengths and puts in place support earlier, so that people can lead more independent lives for longer. Doing this right means that Manchester citizens receive the right support at the right time, based on individual needs, delivered at neighbourhood level by integrated teams. The programme will ensure that Adult Social Care in Manchester can be delivered sustainably and is key to delivering the savings set out in this year’s and next year’s budgets.

The main workstream, Maximising Independence, focused on practice led improvements to social work to support people to lead more independent lives. Communities of Practice (CoPs) were the key part of delivering this workstream. Culture and practices in social work in Manchester have sometimes been risk averse and disempowering for residents. We knew the best practice in social work takes a strength-based approach and starts by looking at what a person can do, what they love, and what makes their life good. It then looks at what additional things a person needs putting in place, to build on that person’s strengths. When social workers and social care assessors work in a strengths based way, the people they work with are happier, healthier, feel more in control and able to make choices. It leads to better outcomes. Analysis of Manchester’s care packages shows that on average, we put in place more care than people really need or want, which costs us more money than necessary. This means that if we improve social work practices we should see packages of care reducing, on average. This should reduce the increases in demand that we would otherwise expect to see. We knew that there were things that got in the way of practitioners taking a strength-based approach with residents. Things such as not being able to access the right commissioned provision, not having enough capacity and not knowing what impact the approaches had. The wider transformation programme contributes to addressing those barriers.

Communities of Practice
One of the barriers that was identified was a lack of professional support for practitioners to help them implement approaches learnt from training. To address this, we established CoPs. These are weekly meetings, held in teams, which give practitioners a space to learn, reflect, share experiences as well as enable peer support and challenge. Using a case discussion to ground the conversation, facilitators will guide the group to reflect, share and explore strengths- based approaches. This approach is underpinned by the Kolb Experimental Learning Cycle, which demonstrates the importance of reflecting on experience to learn.

Each CoP facilitator has been trained to facilitate reflective discussions that encourage professional curiosity and explore strengths-based approaches. This includes encouraging the group to discuss the least restrictive options available to maximise independence, utilising community assets or technology enabled care. The Strengths Based Approaches Practice Handbook and Framework KcVETS model is utilised. This encourages exploration of not only knowledge and experience but also the values, ethics, theory and skills that can be used. More detailed information about a particular issue that has been discussed in CoPs is delivered through Spotlight sessions. These improve practitioner knowledge and awareness of services, resources and tools available, or theory and approaches of supporting different residents.
When issues are identified that prevent strengths-based approaches being used and cannot be resolved via a spotlight session, this is feedback into the programme to be tackled by the relevant workstream. This means that discussions taking place in CoPs play a key role in influencing the activity of the programme through identifying challenges and blockers to strengths based approaches. Communities of Practice are fundamental to truly embedding strengths-based approaches in adult social care, and therefore critical to delivering the overarching priorities of the programme.

What are the key achievements?

A key objective for the programme was establishing Communities of Practice (CoPs) in each integrated neighbourhood team and learning disability teams. Working with and alongside teams to embed strengths based approaches to achieve better outcomes. CoPs are a fundamental part of the programme and support both the:
– acceleration and embedding of strengths-based approaches
– identification of challenges and blockers to strengths-based working that can be picked up and tackled by the programme
So far, we have established:
– 15 Communities of Practice have been launched across the city establishing weekly forums for reflective, peer forums in each integrated neighbourhood team and 3 Learning Disability teams.
– 15+ COPs facilitators have been trained to facilitate their neighbourhoods’ CoP, this has strengthened the Senior Social
Workers role in supporting practice and development within their teams.
– Facilitators have started to experiment using Social Care for Excellence videos and resources to generate discussion, explore social work theory and embed strengths-based practice.
– 4 Social Work Consultants act as CoPs Convener strengthening the infrastructure around the CoPs, identifying key themes, plan spotlight sessions and support the future CoPs development.
– Improved relationships being built with Commissioning colleagues who have started to attend CoPs and hear first-hand challenges to SBA and any gaps in services that might exist.
– 11+ Spotlight Sessions have been delivered to enhance practitioner knowledge on themes including the Wellbeing Principle, how to access Community Assets, working with people who have autism.
– Through identifying issues and barriers to strengths based working, commissioning gaps have been identified and prototype commissions developed to respond to these gaps in services.

Overall practitioner feedback about the Communities of Practice supporting them to use strengths-based approaches is consistently positive. Weekly learning logs are completed by practitioners and from October-January 22, 95% of respondents said their participation in a CoP had helped or partly helped them to develop their strengths-based practice. What this means in practice is:
– Greater awareness of alternative support available in communities that practitioners can use to maximise independence:
‘They have increased my knowledge on resources in the community to sign-post people to.’
– Building relationships with colleagues, partners and other services:
‘The past few themed weeks have opened a minefield of developing knowledge and relationships with 3rd party services. The impact is incredibly positive and empowering.’
– Sharing of learning and experience about approaches have created the best outcomes:
‘Overall CoPs have improved my strength-based conversations and assessments, improved outcomes for service users; and boost my confidence working with complex cases.’
‘The critical thinking at the CoPs reflection meetings has continued to provide me with learning and development to use in practice. The additional benefits of listening to other staff discussing cases of their lived experience in practice is priceless. This job can be very challenging, with all the multi-complex and trauma cases that we listen to, and the CoPs are a safe place to speak to other people that may understand.’
In addition to this, the CoPs have provided regular space within the week for teams to meet and support each other throughout the pandemic when many teams have been working from home. This has been an added benefit of the forums providing a positive and supportive space. This has been especially impactful for newly qualified staff who have missed asking questions and learning from colleagues on site. In these aspects, the CoPs have exceeded our expectation in supporting teams.
Our use of reflective practice forums and the role that CoPs have played in supporting learning and development of practice has been recently acknowledged by Research in Practice for Adults as best practice. Through a focus on strengths based working we hoped to impact on behaviour, culture and improve outcomes for residents. Following a year of this approach, the signs of a positive impact of this being seen. Manchester has managed to keep demand for residential / nursing stable at lower rate than pre-pandemic levels and homecare demand / spend has reduced. This is bucking regional trends. There is further work to do through 22/23 to identify and attribute further savings to the programme as the wider context changes as we recover from the impact of the pandemic.

How innovative is your initiative?

The use of behavioural insights and approach to changing culture and behaviour through the programme has challenged the status quo in how large transformation programmes have previously been delivered. The CoPs are fundamental to thisapproach. CoPs demonstrate a change in approach of how we influence and embed behaviour. They provide space to reflect on experience and an on ongoing mechanism to do this to support culture change. Rather than a traditional training programme, they build learning and confidence within teams about strengths based approaches. These conversations encourage practitioners to reconnect with what makes them passionate about what they do – making a difference and improving outcomes. Through utilising behavioural insights and the Experimental Learning Cycle, we anticipate that this will bring about much longer and lasting change in behaviours.

In addition to this, through equipping Senior Social Workers to facilitate CoPs, they are also active agents and participants in the change process. They are equipped to facilitate the conversations around strength-based working that will make a real difference. This goes beyond providing communications briefings or key information to share about the programme. This is about engaging and equipping the workforce to be part of the change. It has also provided Senior Social Workers with a real active role in shaping practice and development of their team. Again, this is something new and different in terms of how we are delivering the transformation change programme.
In addition to the focus on ongoing reflection and equipping staff within the service to be part of the change, the CoPs approach also provides a voice and influence into the transformation programme from frontline teams. Issues and gaps in services that are discussed in COPs will be picked up by the wider workstreams of the programme. This has meant commissioning prototypes have been developed from the gaps identified in CoPs. This is another new and different approach for Manchester.
In terms of the wider programme, prototypes have also enabled us to be more creative, testing and learning from this testing to build an even better, more responsive solution. This more agile approach challenges much of the traditional programme and change work previously used in large transformation programmes. We have explored, through the programme what it means to test, learn and build – developing solutions iteratively rather than trying to launch a perfect solution. Finally, something that makes the programme unique is the unifying focus on outcomes. Through a relentless focus on strength based approaches at CoPs, at Steering Groups, Working Groups and at Board there is a culture of improving outcomes. The culture of the programme is to be strengths based, challenge the status quo and deliver better outcomes.

What are the key learning points?

One of the primary learning points is that real, sustainable behaviour change takes time, energy and resources to do properly. We have exceptional leadership, with our Executive Director of Adult Social Services and Deputy Director of Adult Social Services Strong providing clear, strong direction, but trusting the programme, and teams across the service to deliver the work. Being practice-led actually builds more capacity into the change approach. If front line staff are engaged in the change and Team Managers are part of your change agents you impact on behaviour change and engage people in the programme at the same time.

We have established clear governance structures that are supportive, not overly bureaucratic and burdensome. They support momentum of the programme, they don’t hinder it. This should be obvious, but so often doesn’t happen. It also means the senior officers leadership trust people to get on with the work. Building consensus around a clear vision and having flexibility about the approach to deliver this. We’ve learnt the value intaking an iterative approach to problem solving. Whereas previous large-scale transformation programmes have tried to design too much and reach a level of perfection without getting on and doing the activity. We have managed to create a sense of shared values across the whole service. We fundamentally believe this is the right thing to do for the residents of Manchester. We championed that belief even when impact didn’t emerge immediately.