Implementing the Care Act: ‘People have a stronger voice. Staff have a renewed energy’

by Community Care

Published in partnership with Hertfordshire County Council. Content editorially independent

Denis, 91, would love to throw his Zimmer frame away.

“I had two heart attacks, the doctors never thought I’d pull through,” the former corporal in the home guard explains.

Two months ago, Denis was reluctantly resigned to going into a care home. He’d had a couple of falls and attempts to keep him in his beloved family home had failed.

But thanks to an innovative scheme run by Hertfordshire County Council, John Harle, an HCPC registered paramedic and health and social care co-ordinator, was able to offer an alternative.

“I didn’t like John at first. I thought, ‘who’s this bloke?” says Denis. “But taking John’s advice has worked a treat. I’ve got everything I need and I’m so comfortable here.”

Flexibility and wellbeing

‘John’s advice has worked a treat. I’ve got everything I need and I’m so comfortable here’, says Denis

Denis is a now living in Lea Springs, Harpenden. A pioneering “flexi-care” scheme, he has his own flat but support is on call when he needs it. A carer pops in three times a day and downstairs there is a communal area complete with restaurant, hair salon and laundry.

“I’m quite happy here. It’s all very sociable, it’s all local people and I’ve made a lot of friends,” says Denis.

For John, the Care Act is making a “massive difference” to the way he can support people like Denis.

“It’s much easier to say to people up front you don’t meet our criteria. But with the wellbeing side of the Care Act it’s also much easier to justify why someone does need a service. You can say, there are things you can’t do, but that affects wellbeing,” he says.

“It’s made every assessment much more person-centred and gives each service user much more involvement in their care planning. We’re asking, ‘what help do you want?’”

This focus on the person and their wellbeing means that seemingly small things matter. Take Denis, a life-long early riser, John was able to tweak his care plan so that a carer pops in at 5.30am to change his catheter from a day to night bag, something not possible with traditional care in the community services, which usually start an hour later.

“I can then get up as I wish, things have been a lot better since I’ve been in here,” says Denis.

Landmark changes

Staff from different Herts teams got together to discuss the early impact of the Care Act

Back at Hertfordshire council’s offices in Stevenage, a group of 18 social workers and occupational therapists are reflecting on their own experiences of implementing the Care Act.

The Act came into force on 1 April. Dubbed “the most significant reform of care and support in more than 60 years”, it ushered in several landmark changes.

The first ever national eligibility criteria for social care – linked to outcomes and wellbeing – replaced locally-set criteria. A lowered threshold for carers’ assessments was introduced alongside a duty to support carers who meet the separate carers’ eligibility threshold. And councils were given a duty to provide a universal information and advice service to link people up with preventative services and help them make decisions about their care.

The Act comes with 500 plus pages of practice guidance. Hertfordshire’s care teams admit that it is “early days” in putting it all into practice but several benefits of the new system are already apparent.

Staff say they are getting better at identifying and supporting carers. Social care assessments have also improved, thanks to a revised set of forms that have cut paperwork for care teams and shifted the focus to a person’s strengths and wellbeing rather than their deficits.

There are, of course, plenty of challenges too. The financial pressures on social care departments across the country are well known. Staff also say that the Act is pushing both service users and social care teams “out of their comfort zones” as they adjust to the new system.

Assessments

Senior social worker Nikki Burton says the new assessment framework is already making a difference

Hertfordshire is hosting regular group supervision sessions to help staff work through issues but initial feedback suggests that the Act is offering a welcome departure from the “tick box” culture that has dominated social care for too long.

“The new assessments provide a much better idea of who this person is and what’s important to them,” says Nikki Burton, a senior social worker who has led on Care Act implementation in her team for older people with physical disabilities.

“Before, we were having very intimate conversations that had perhaps quite a negative flavour. Whereas now we’re walking away and service users and carers are having a much more positive experience of a social care assessment and their interaction with professionals. I hope that continues.”

Stepan Ptacek, an occupational therapist with an early intervention team, agrees: “I said to my manager that this is the way I’d like to be assessed if I was at home.”

Focus on outcomes

Mark Harvey, Hertfordshire’s principal social worker

To illustrate the shift towards outcomes-focused assessments, Mark Harvey, Hertfordshire’s principal social worker for adults, uses the example of someone who can’t get out of bed on their own without additional support.

In the past local authorities would focus narrowly on the physical need and place too little attention on the person’s wider quality of life, he says.

“Now we need to be thinking ‘what’s the outcome?’. What’s the point in supporting someone out of bed if they then sit there lonely all day? Everybody getting out of bed should be able to enjoy something or do something that will impact positively on their wellbeing.”

Reconnecting with communities

Jamie Stone, a social worker in a learning disability team, sees the Care Act as a chance to link people into their communities

Hertfordshire’s care teams are finding creative ways to deliver those outcomes, including looking beyond the traditional services commissioned by local authorities.

Jamie Stone, a social worker in learning disability services, points to a drop-in event that his service held to connect people with different local community organisations. A local ladies football team, a martial arts group and conservation groups were all present.

The idea, Stone explains, was to link people into the groups not just to find out what the group might offer them in terms of a service, but also to see what the service users could offer the groups in terms of potential volunteering or other roles.

“It’s recognising the opportunities that come from linking within your communities and trying to make sure that people tap into that,” says Jamie.

“Care management drove social work down into an individual basis. We need to step back from that. It needs to be about connecting with people on an individual basis within their communities. We need to support people to be part of, and be active within, their communities. That also begins to challenge some of the stereotypes around things like learning disabilities, mental health, being old.”

Rooting social care provision in local communities is key to Hertfordshire’s approach to delivering the Care Act. The practice guidance is open-ended in terms of the staffing mix councils should use to deliver the Act. But Hertfordshire has placed social workers and occupational therapists at the heart of its strategy.

Recruitment drive

NQSW Annabelle Austen has been impressed by the training on offer at Herts

The council has launched a recruitment drive to hire around 90 extra social workers, occupational therapists and community care officers in the next two years. Hertfordshire’s leadership says it wants to create an environment where teams feel able to practise creatively and can develop their skills.

Ask how that translates to the frontline and staff come back with different examples.

Annabelle Austen, a newly qualified social worker, says she’s received far better training at Hertfordshire than at other councils she’s been at where “everything was just e-learning”. Burton points to the support she’s had from her manager to take on a role with The College of Social Work on top of her day job. Nicole Daly, a social worker in autism services, says that the council’s willingness to try things allows staff to pilot ideas rather than being told “it won’t work because we’ve always done it this way”.

You can see some of this reflected around the offices. An innovation board invites people to pitch their suggestions and win up to £10k to implement them. Training is also a priority – there’s even a sign asking “when was the last time you went on a training course?” A booklet reminds staff that “There are reasons we chose to be social workers…let’s not forget those reasons!”

Going the extra mile

Principal social worker Harvey says that there is “much more to do” – including improving the council’s application of the social work employer standards. But there are signs that the investment in staff development is already paying off.

Hertfordshire was a finalist in the ‘making a difference’ category at this year’s national learning disability awards. Recently, a group of social workers in learning disability services volunteered to do a night-time audit and visit service users at 9pm at night to chat about how their care packages were working out out-of-hours. A similar project to canvass the number of people with learning disabilities who voted was also launched.

Harvey says that the social workers’ willingness to take on extra duties never ceases to amaze him: “To have 60 of them do that in their own time, for free, speaks volumes.”

‘Back to our core values’

Lynsey Patterson says there is a ‘renewed energy in services’ following the Care Act’s introduction

That kind of enthusiasm could be crucial to ensuring the Care Act delivers for those who need it most, particularly in the tough financial climate facing social care departments. In Hertfordshire, staff admit they don’t have all the answers, but they see real opportunities to make a difference.

“It feels like there’s a renewed energy in services, in workers. And there’s more ownership from people who use our services about their rights,” says Lynsey Patterson, a senior social worker. “I just feel that their voice is stronger and it’s underpinned by the Care Act.”

Sandra Teal, a deputy manager in learning disability services, agrees: “It’s not the case that the Act’s come in and all of a sudden we’re brilliant. Obviously we’re all still learning. But there is a shift. It feels much nicer to work in because, for the social workers and OTs, it kind of gets back to the core values of why you wanted to do this.

“You want to enable people, you want people to be part of their communities. We’re really challenging ourselves to think about that, recognising we’re not always getting it right, and thinking about what more we can do.”