“I have often heard it said that ‘It takes a village to raise a child.’ Now I feel certain that it takes a village to care for our elders.”
The Coalition for Collaborative Care (C4CC) Co-production Group is a group of organisations, working together to improve support for people with long term conditions and is looking for new members to join. The group works with the C4CC central team and partners to influence and co-design the work of C4CC. If you are interested in joining please find more details here.
Albert Heaney is the Director of Social Services in Wales. Which – given that Albert is warm, approachable, and genuinely interested in people rather than systems – is a distinctly good thing.
Here’s his take on the Social Services & Wellbeing Act:
“This Act does not just change a few rules here and there, it is not simply a case of adjusting what we do now. It replaces and rewrites completely the legislative basis for care and support in Wales. It is a whole system Act, and for that reason it represents a totally new landscape for us in Wales.
It is worth highlighting some of the key themes underpinning the changes we are taking forward.
People – this means putting an individual and their needs, at the centre of their care and taking full account of their family and community. We want to ensure that people have a voice in, and control over, the services they receive.
And this includes:
Well-being – shifting our system to well-being and supporting people to achieve their own well-being and independence;
Earlier intervention – we want to shift the systems of care and support to ensure people get the help they need quickly and easily to minimise the escalation of critical need and enable people to lead healthy, active lives;
Collaboration – strong partnership working between all agencies and organisations for the benefit of people.
The Government’s White Paper ‘Sustainable Social Services for Wales: A Framework for Delivery’ published in 2010: stated that:
Better services can be brought about by service users and carers having a much stronger voice and greater control over services.
The values of mutual support we hold dear in Wales must lie at the heart of our approach.
We believe that people want to contribute not simply receive.
We want to go much further and embed stronger rights, voices, control by citizens, individually and collectively, in the way services are created and delivered.
We want […] to change the way we work, how we think, and how we plan services.
Underpinning this must be a wholesale shift in focus, from paperwork to people, from process to outcomes […] with professionals working side by side with people, jointly determining the support needed to maintain or improve people’s well-being.
But what will this mean for you? For your practice?
The concept putting people at the centre – of giving them a strong voice and real control recognising both their rights AND their responsibilities is now secured through the primary legislation ensuring that these things are not just tick boxes or add ons. This approach is central to promoting people’s well-being and to safeguarding them. For me it is at the core of professional practice.
At the moment we hear a lot about co-production – about producing solutions withpeople not for them. The commitment to this approach is central to the policy and to the Act.
The Act is critical to the transformation of social services because:
. It supports an approach based on prevention and early intervention.
. It improves solutions and interventions by drawing on people’s strengths and allowing them to make the best use of what is available.
. It allows people to retain independence and to focus on recovery.
. It encourages a more creative and more efficient use of resources and encourages flexibility
. It underpins the development of new, more effective service models, including social enterprise and co-operative models and services run by users themselves
. It allows resources to be better targeted by understanding need at a community and individual level.
. It promotes the safeguarding of people.
We have a golden opportunity now as we drive forward the transformation of social services, not just through the legislation but through leadership and cultural change.”
Our Integrated service provides early intervention by Health & Social Care professionals working in a co-productive and prudent way, as one service across different health & social care organisations in Monmouthshire. We work alongside service users, helping them to lead as independent a life as possible and providing proportional, timely interventions based on encouraging independence.
We help to keep people independent for as long as possible by asking the “What Really Matters to You” question, listening to the responses and working creatively to find solutions and achieve people’s personal outcomes. Our aim is to enable individuals to reach their goals and their full potential.
The Integrated service in Monmouthshire comprises of Community Occupational Therapists, Social Worker, Physiotherapists & Community Nurses working together as locality focussed teams. The Community Nursing services within Monmouthshire were restructured so that District Nursing, Chronic Conditions Nursing & Rapid Response Nursing services are managed as one Nursing Team and work as one Nursing “Family”, a model which is now being rolled out across all other boroughs and Community Nursing Teams within ABUHB.
The Integrated team is supported by a new Integrated Assessment process (and documentation) that focuses on proportional assessments of people’s needs. Key to this is to find out what matters to the individual. This means not making assumptions based on what traditional District Nursing, Occupational Therapy, Social Worker & Physiotherapist’s assessments might think is important. This work is based on the WAG Older Persons & Prudent Healthcare guidance. All community services work together to reduce overlap and duplication of assessments between the different professionals, who are required to think beyond traditional remits and traditional care needs (and boundaries) to help people with the needs they identify as important to them. Our goal is to help people live independent and fulfilled lives, lessening their need for traditional health & social care services.
What people have told us in response to the “What Matters” question has been surprising and at times humbling:
- “I just want to be set free to live my life and not let cancer rule me and not wait in for District Nurses to visit” – a patient who we taught to self care for his PICC line.
- “I want to be able to go to a tea dance not have to stay in because I have Parkinson’s disease and am at risk of falls” – a gentleman supported by the Chronic Conditions Nurse at Caldicot. She linked him with the local Community Coordinator (Monmouthshire Initiative) for Caldicot who linked him in with a local group in his area who then provided transport and company for the tea dance.
- “I was listened to about what I am actually worried about which are the daily things not my imminent terminal prognosis”.
- “I am amazed that I can have intravenous antibiotic treatment at home, the service is amazing and it’s brilliant that I didn’t need to stay in hospital”.
The greatest challenge is that this requires staff to change their culture and to think in entirely new ways. The ethos is based on Edgar Cahn’s view of co-production: to “enable citizens and professionals to share power and work together in equal partnership, to create opportunities for people to access support when they need it”.
Hilda Hallett, for example, had bilateral circumferential leg ulcers of 10 years standing with lymphodema and multiple co-morbidities and agoraphobia. She received care through the Integrated Service. This included proactive planning to respect her wishes not to go into an acute hospital when unwell & acknowledging her low self esteem & agoraphobia. The outcome was two community hospital admissions where bedrest was provided to allow her leg ulcers to heal, which they did in an amazing 10 weeks. Community Nurses in-reached to provide the specialist lymphodema bandaging whilst she was in the local community hospital and contribute to her discharge plans. Her discharge home was facilitated with a reablement package of social care and she regained her independence despite living in cramped accommodation, further complicated by being a bariatric lady. Her social package of care ceased. She remains independent.
Her leg ulcers have remained healed: her bandaging is undertaken weekly by the nursing team (previously 2 nurses at approximately 90mins per visit x 3 per week) and support garments provided by the Lymphodema Specialist Nurse based in the Acute Trust as an alternative to bandaging. Two years on she has enough self confidence to move to a ground floor purpose-built flat within the local area where she will have social contact with other residents. Continuing NHS healthcare has funded a recliner chair to facilitate her leg elevation to support her lymphodema management and maintain leg ulcers healed. Previously she would not have met the criteria for a social services funded rise and recline chair as she did not need this to get up to be mobile. Equipment to maintain her independence at home has been provided by the Community Occupational Therapist and we have “set her free”.
Asked what was important to her, Hilda responded that it was the fact “that we never gave up on her”. Working in a co-productive and integrated way with people on what really matters to them is contributing to the future health and well being of the population. By working in a smart and prudent way to facilitate independence the Integrated Service hopes to reduce people’s future need for health & social care support.
The Carers Strategies (Wales) places a duty on Local Health Boards and Local Authorities to work together to prepare, publish and implement an Information and Consultation Strategy for Carers. We took a co-production approach, setting up 16 creative co-design events which ensured that carers and third sector partners were actively involved in the production of the strategy, and in planning the initiatives that would deliver it.
Why is this co-production?
- Without the involvement and input of Carers, this strategy for communication with Carers would not have been truly co-produced, but carers had an opportunity to feed into the process from the very beginning, shaping the strategy and the resulting aims and action plan.
- The strategy was a true multi-agency partnership effort. Each member of the strategic group had a role to play in the provision of information, and development of the strategy, providing a clear steer on what it said, and also, on the delivery of the resultant action plan.
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The Coalition for Collaborative Care is founded on the need for a new relationship between people who use health and care services and the professionals working with them. This collaborative relationship combines clinical and patient expertise together. It also enables people to develop the skills, knowledge and confidence to live much better with their health conditions. Via Nesta.
New Zealand’s nascent alliance model has yet to be fully tested. It does, however, offer a promising alternative for public health system and integrated care governance, which NHS policy makers could consider if they’re serious about finding a fair and workable system. Via The Conversation.