How social workers and management consultants teamed up to deliver efficiencies without cuts

Social work and consultancy are not the most obvious bedfellows but the two disciplines have combined to help one council deliver the steep adult social care savings it needed without cutting levels of service.

Back in 2010 Kingston already considered itself an efficient council in adult care. During 2010-11 it took £1m out of its £53m adult care budget by restructuring teams and reducing staffing levels. However, then came the government’s comprehensive spending review, bringing with it the need to take a further £6m out of annual adults’ services spending by 2015.

Kingston took up the offer of £20,000 from the Local Government Association to explore ways of improving efficiency in adult social care and brought in consultancy Newton Europe to analyse where it could improve value for money. It was told it could save £2.75m a year – almost half the required total. Then, Newton won a tendering exercise to help the council deliver those savings on a payment by results basis, from December 2012 until March 2014.

The company is set to receive a big fee but this will be proportionate to and dependent on the savings realised – so far just over £2m a year has been realised from the nine work streams Newton is working on, so it is on course to hit the target.

While adult social care savings programmes often focus on making changes to commissioning and procurement, in Kingston there has been an equal focus on reshaping operational practice and care management.

Newton’s approach has been to analyse in depth Kingston’s performance information data to identify where efficiency was being lost, drawing on available evidence of the impact of different interventions.

It then worked with adult social care teams to identify the root causes of the problems and suggest improvements in systems or practice. This has involved examining in detail the decisions made by practitioners during assessment, support planning and review to identify inconsistencies in approach and areas for improvement.

The idea of consultants suggesting ways social workers can change their practice initially raised hackles, but Newton’s way of working changed attitudes, says Pearce.

“At the start there was a degree of hostility to consultants coming in,” he says. “But because they’ve been [based] here with us there’s much less of that and much greater appreciation of what they’ve done. They didn’t tell us what to do and shove off – they’ve helped us to deliver.”

His point is echoed by Marion Sawyer, a support co-ordinator in the council’s community review team. “We weren’t sure where they were coming from or how clearly they understood the work that we did. But they listened to us – they would come up with suggestions that we would challenge and we would make modifications.”

One issue where substantial changes have been made in telecare. Newton found that Kingston used more telecare per head than comparable authorities but most referrals were for pendant alarms, rather than more modern and effective systems.

“We know that [using pendant alarms] doesn’t save money or improve outcomes,” says Bill Guthrie, business manager at Newton. It also found that some social workers made a lot of telecare referrals but “many weren’t referring very much at all”. They then held a series of workshops with practitioners to find out why, identifying three main reasons.

“They didn’t know the outcomes from telecare, they didn’t understand the technology and what it did and there was a concern that if they referred the amount of human to human contact would reduce, reducing quality of life,” says Guthrie.

Newton’s response was to show social workers what telecare was available and what it could do, and to suggest that befriending services, if required, could be a more appropriate response to loneliness than a care assistant.

The company’s analysis showed that, of 558 home care users in the borough, 195 could benefit from telecare but were not receiving it, increasing costs for the authority in the process. Subsequent investment in telecare has yielded £200,000 in annual savings from reduced care costs.

The council has recruited a telecare co-ordinator whose role it is to keep up with developments in the sector, source equipment and demonstrate it to practitioners, and all teams now have a telecare lead to champion this area of practice. And social workers are seeing the benefits.

“I recently had a case of a lady with dementia, whose husband was the main carer,” says Amanjit Garcha, a social worker on the community review team. “She was wandering day and night and previously she may have gone into a residential home. We put some exit sensors on the door to help manage the risk. It enabled her to stay at home.”

“The range of products now available is incredible,” says Sam Robinson, team leader in the council’s short-term team. She says the telecare co-ordinator’s demonstrations of equipment has been particularly effective. “People are much more knowledgeable now.”

As well as shaping practice decisions, Newton has helped design new systems to help social workers do their jobs more efficiently.

One highlighted by the review team is their case tracker. When they are allocated a case, they note down on a spreadsheet expected dates for completing each stage of the process: making the initial phone call, carrying out a first visit, doing the review, having it authorised, making any revisions to the care plan, arranging any financial assessment and then returning the case to the ‘review tray’. They then separately note when they completed each stage, highlighting where delays were occurring.

One source of delay was having social workers carry out the financial monitoring of how people were spending their personal budgets. As a result, the team produced a business case for having a dedicated staff member to carry out this work, and hired personal budget monitoring officer Sufion Khan.

“We previously had no tool that enabled us to track where were were,” says review team leader Carol Parker. “I think that’s been the biggest benefit of working with Newton – identifying where the backlogs are and where social workers may not be best placed to spend their time, which frees up the social workers.”

For senior managers, Newton has provided additional capacity to design and deliver changes that would be otherwise difficult to deliver in a small local authority. For practitioners, the firm’s staff have provided the analysis of practice systems and processes that can be hard for social workers and team managers to carry out alongside the busy day job.

“They come from a completely different perspective and they could back it up with data,” says Robinson. “We knew that there were things in our processes and systems that we could do better but we didn’t have the time to fix it.”

The challenge now for Kingston, says Pearce, is to embed the learning from the past year so that it is not lost when the consultants leave in March 2014. However, for Kingston, as for other councils, there is an even bigger challenge to come after the 2015 election, with further reductions in government funding.

“You’ve got efficient services, you’ve got efficient commissioning,” says Pearce. I think it’s something that ever adult social care department worries about facing. You reach a floor and if then someone says ‘find another 15%’ then you can only cut services.”

 

All pictures: Gary Brigden