“It shocked us all at first,” says adult disability social worker Lauren Hines. “We’d had this almost tick-box approach that divided people into boxes for so long that our reaction was ‘Oh wow! What do we do now?'”
The shock Lauren is talking about is the approach to adult social care that Hertfordshire County Council has been developing with social workers and went live in March.
The council calls it Connected Lives and at its core is a steadfast belief in social workers’ professional judgment, values and practice. Prescriptive assessments have been replaced with citizen- and professionally-led assessments that don’t require management sign off.
Every social worker now controls a budget they can use in whatever way they believe will deliver outcomes for the adults they support. And for good measure the council has drastically slimmed down its social work policies to give practitioners more freedom in their practice.
Rights-based social work
“Care management hasn’t worked,” says Mark Harvey, the principal social worker for adult care at Hertfordshire. “That transactional relationship with social workers has fundamentally undermined the profession. So we’re putting the power back into the hands of social workers and citizens to shape more positive and responsive social care.”
Connected Lives is built on a bedrock of values- and rights-based social work and occupational therapy systemic thinking and relationships-based practice. It focuses Hertfordshire’s social workers on using their professional skills to help adults live their lives rather than just narrowly prescribing packages of care.
It’s about recognising that care can be as disabling as it is enabling if done incorrectly or in a risk averse way.
“My gut instinct is we must trust social workers because they are trained to do this,” says Mark. “Anyone can tick some boxes and say you are entitled to this. Social workers have spent years training and learning on the job. There’s nothing to gain from killing that knowledge with directive policies and processes.”
Reinvigorated social workers
Lauren feels liberated by the new approach: “It brings back your skills as a social worker and that’s what I like about it. The council trusts us. They’ve put the trust back into social workers to make informed decisions.
“The old assessments were about what the person couldn’t do and led to questions that were irrelevant. Because that question was on the form you had to answer it and it pushed you towards thinking in a prescriptive way. The new open-ended process keeps you focused on why you are working with the person.”
Heidi Bailey, an older people’s social worker at the council, agrees: “It’s reinvigorated all of us. It makes us think more and analyse what we’re trying to achieve. Instead of saying to people, ‘This is what we can give you,’ now it’s, ‘What do you want to achieve and how can we work towards that?'”
Social workers with a budget
Having control of a budget is also an improvement. The amount each social worker controls varies but it could be used to allow for short-term enabling interventions that allow people to retain and or regain control over their lives.
“Social workers are encouraged to consider using any budget in a way that supports outcomes and not just think about buying care visits etc.,” says Mark.
“Social workers are also very much encouraged to consider themselves as the intervention. Spending time with a social worker completing specific work may be more powerful than any care plan that can be commissioned.
“I think some of our social workers were petrified of their budgets at first,” he adds. “They were still thinking that there must be rules on how that budget can be used but the only rule is your professional responsibility.”
Whole council approach
Heidi says having control of that budget is really helpful: “It gives confidence to the person we are working with because now we can go, ‘Actually we can help you with this’ straight away rather than having to say ‘I’ll go check and let you know.'”
The change introduced by the Connected Lives model doesn’t stop at the frontline, adds Mark.
“You can free up social workers to practice but if your commissioners write restrictive contracts that don’t require providers to be innovative or your finance department puts up barriers the model would be undermined,” he explains.
“So our model is a single approach for the whole council. In fact it’s now core to Hertfordshire’s social services plan for the next 15 years. Our commissioners are fully supportive and are helping social work to make this happen.”
And while it was only introduced in March the decision to put power back into the hands of social workers is already paying off.
“We are already seeing improved outcomes,” says Mark. “Our hospital discharges are person focused and led by social work not numbers. People are reporting higher satisfaction with their lives. Social workers are much clearer about what they are trying to achieve.”
Ultimately it comes down to respect for social workers as professionals and that’s something Lauren says is reflected not just in the new approach but in the support social workers get from their managers and directors.
“Our managers treat us as professionals,” she says. “As with all councils there is a worry about saving money here but I feel Hertfordshire’s main focus is about the people we work with. When we speak to managers as long as we’re putting the individual first and we’ve looked at all the options they will listen.”