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Transforming adult social care

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LGC features editor Rachel Dalton talks to Newton’s Steven Phillips about the work done at Kent CC and Kinsgton RBC to drive efficiency while maintaining service quality

Transformation is moving quickly up local authorities’ agendas as discussions about how services can be made more efficient without affecting quality become increasingly relevant. The creation of the Department for Communities & Local Government’s Service Transformation Challenge Panel in April, and the LGA’s imminent report on transformation, are testament to the increasing need to focus on changing services for the better.

As local authorities consider how they might best achieve true transformation, two councils keep cropping up in discussions about innovation and best practice: Kingston RBC and Kent CC.

The LGA programme

Both Kingston and Kent were part of the LGA’s efficiency programme. The association proposed to fund projects to help local authorities with cutting edge ideas on efficiency to take the plunge from thinking to doing. It provided £20,000 to Kent and £25,000 to Kingston to help them make their ideas a reality.

Both authorities used their grants to employ Newton Europe to carry out a diagnostic of their adult social care services and identify areas that could be made more efficient. Both councils later ran competitive procurement processes through which they hired Newton to work alongside them to implement those changes.

Kent’s financial deficit over 2014-16 was estimated at around £200m, and within this, its adult social care spend accounted for a third of its non-school budget. The council’s plan was to reduce that spend by £18m in the first year of its four-year transformation project.

Kent head of paid service David Cockburn said: “Kent concluded that savings of the magnitude needed could not be delivered from short-term efficiency changes and hence a transformational approach was required.

“Kent joined the LGA programme because we felt an external organisation would bring an outside challenge to the way we currently do things and to the solutions available to us. Using a consultancy on the LGA framework offered us an independent, impartial, fresh viewpoint free of personal interest, preconceptions or existing traditions and loyalties.”

Not just the bottom line

Neither council’s projects were exercises in simply slashing spending.

Kingston director of adult services David Smith said: “The diagnostic was to look at how elderly people are supported by social care, and that was the main focus of the work. The challenge was about improving outcomes and efficiency, not about cutting costs. What we all believe is that if we improve outcomes we deliver efficiency.”

Newton associate director Steven Phillips added: “We are speaking to a number of authorities who want to make savings as a by-product of transformation of service; we don’t support organisations that just want to make cuts.”

Solid foundation

Mr Phillips said Newton’s approach is underpinned by data analysis.

“In the assessment phase, we work with the organisation to understand their vision,” he said. “We carry out an incredibly granular bottom‑up analysis of how the systems work, spending thousands of hours on the front line by going out with appropriate staff, for example social workers and administrative staff.”

It is close scrutiny of data driven intelligence that helped enact change for Kent.

Turning vision into a reality is somewhere local authorities fall down

Mark Lobban, Kent CC

Kent director of strategic commissioning Mark Lobban said he knew where efficiency could be improved, but that the council lacked the tools to identify waste within its systems and in the current economic climate, there was no room for guesswork.

He said: “It wasn’t so long ago that we had the social care reform grant. We had more money than we knew what to do with. We went out and delivered good things. At the end of the year when our budgets came in on line, we thought, ‘Well, that must have worked then,’ but could we actually link those things to what we had achieved? Now budgets are so tight that we have to be absolutely sure of cause and effect.

“I was convinced we had the right ideas around managing demand, but we were struggling with the analytical skills we needed to break down the information.”

Mr Lobban said Newton’s attention to detail and analytical skills helped Kent find the areas of inefficiency it could not see itself.

He said: “A team of Newton employees came to Kent. We had already agreed a transformation blueprint, so they took that and embraced it. They went out and met all the teams, did lots of field studies, and observed staff. Then they took information from our computer system and ran it through their own programmes. Suddenly we got a very different perspective and truly understood what was going on inside our organisation.”

His colleague Mr Cockburn added: “Kent wanted to take an evidence-based approach to change. Our work with Newton allowed us to practically translate the vision (top down) and have a granular level of understanding of what was happening on the ground (bottom up).”

Kingston’s Mr Smith agreed data was key in his authority’s transformation. He said: “Newton’s work is strong on reporting and metrics, which is something we lacked.”

In-house vs partnerships

In both cases, the councils realised that once they had the diagnostic they would be unable to deliver changes by themselves.

Mr Smith said: “As a small council, we knew we didn’t have the capacity to drive through some of these changes. We could do the diagnosis, but in terms of how we would implement it, there were just not the people on the ground.”

Kent’s Mr Lobban agreed. He said: “In the diagnostic, Newton had uncovered an opportunity to save between £26m and £40m annualised. Yes, we might have been able to do this ourselves, but we wouldn’t have been able to save as much or do it as quickly.”

He said the adult social care team lacked the skills needed to see through the changes.

“Turning vision into a reality is somewhere local authorities fall down. Newton staff have very different professional training; they employ people who have backgrounds as engineers and having that skillset is really important to have things moving at pace and scale.”

Where the changes were made

Newton’s Mr Phillips said the design phase of a transformation project is very important, but often missed in the rush to get to implementation.

“This is where we ask: how do we design our service to deliver our vision? How do you go about doing that? Do you choose in-house, commissioned, or integrated services?” he said.

“This is where we come up with a clear design of what the service wants to be, a complete understanding of where savings and operational improvement will come from, and where the risks may lie.”

At both authorities, Newton and the adult social care teams were able, by working together, to identify areas where resources were being wasted during the design phase.

Kent joined the LGA programme because we felt an external organisation would bring an outside challenge to the way we currently do things

David Cockburn, Kent CC

Mr Lobban said: “We had three programmes of work. One was about care pathways, where we made sure people get the right type of service at the right time, predominantly focusing on enablement and telecare.

“Another programme was optimisation, which is looking at when people come in to social care, how quickly we see them and deal with their needs.”

This programme involved looking at how social care workers delivered services and finding where their time was being spent.

Mr Lobban said: “We were counting hours that weren’t allocated to people within some of our services. That gave us the opportunity to make savings which weren’t about cutting costs.” This meant being able to provide enablement to more people.

“By observing staff we began to find how they spent their time. Our social workers spent 25% of their time doing face-to-face with service users. There was very little ‘red time’, which is complete waste time. Most of the time was identified as ‘amber time’, where workers were filling out forms and feeding the computer.”

Kent was then able to change the way staff spend their time, which has resulted in reducing the lead-in time for a service user’s first assessment by 66%, and increasing the number of assessments staff can undertake by 500%.

A further programme focused on improving the efficiency of the services Kent commissioned from domiciliary care agencies. At the start of this programme, the council had contracts with more than 100, so monitoring value for money was difficult.

Mr Lobban said: “Our approach to commissioning was very transactional. We had no longstanding partnerships with providers. 75% of spend was on only 20 providers.”

Kent reorganised its contracts, using a rigorous commissioning process which reduced the number of providers to 23. Crucially, Kent will now be able to form longstanding partnerships, providing not only better value but a higher standard of care for service users.

At Kingston, the story was similar. Mr Smith said it too had a complex and inefficient matrix of contracts with domiciliary care providers.

“Over the years social workers had referred people to the providers they felt were appropriate, which meant there was a lot of local discretion,” he said. “The council had a lot of contracts but some weren’t being used so we weren’t getting value or control.

“We used to refer people into 25 home care providers with no proper contracts. Now it’s just three contracts to three providers, which has saved us £800,000.”

However, the move to simplify contracts was not simply an exercise in moving business to the cheapest bidder, Mr Smith said.

“We defined a number of quality standards for our services, put them out to the market and said ‘if you can meet these standards we’ll talk to you further’. There were six companies that could meet them, and then we let the contracts to the three firms that made the most sense financially.”

Mr Smith said Kingston also used technology to drive efficiency, which in particular helped to prevent residential care admissions when service users were discharged from hospital.

He said: “We dramatically improved the offer around telecare and telehealth, using new technology to support people living independently in their own homes.”

Payment by results

Both councils said the model of linking payment for transformation partnership services to achieving predefined results was of particular importance when making their decision.

Mr Smith said: “We are delivering about £3m in savings recurrently, and the contract with Newton is very much tied to delivering those savings because we wanted long-term sustainable changes. Normally you just pay consultants to come in and do a piece of work.”

We dramatically improved the offer around telecare, using new technology to support people living independently

David Smith, Kingston RBC

Mr Lobban and Mr Cockburn said linking payment to clear objectives was vital to gaining support from elected members.

“The deal was that we would appoint Newton and they would help us achieve between £26m and £40m in savings, and we would pay them a one-off fee,” Mr Lobban said.

Mr Cockburn added: “Members were keen to take a transformational approach but had some concerns about entering such a significant partnership relationship with one consultancy.

“Members had to be convinced the consultants would deliver. Newton provided an exceptionally strong evidence base for the changes being proposed, and their payment is contingent on results, which reassured members about both delivery and value for money.

“Members are happy with how transformation in adult social care is progressing.”

Sustainable change

No councils want to simply cut costs in the short term, Newton’s Steven Phillips said.

“The councils that are interested in efficiency partnerships want it to be about transformation and want services to be person-centred, but also want savings,” he said. “For it to be ultimately sustainable it has to be done the right way, otherwise those costs will find their way back into the system.”

Kingston’s Mr Smith said sustainable efficiency was the only appropriate path.

“We set up a transformation board to make sure the changes delivered continue to be delivered,” he said. “We have to maintain some of the changes such as the emphasis on providing telecare so we don’t lose any of the improvements we’ve made.”

Kent’s Mr Cockburn added that the council built sustainability into its contract with Newton.

He said: “We ensure the change is embedded in the business and that we learn from Newton so we have the capability to deliver transformation without continued support.

“The contract sets out clear expectations around skills transfer and sustainability.

“Our frontline staff have been involved in all the elements of the transformation process, from identifying the problems to contributing to solutions, implementing the changes and taking ownership of the changes.

“Clear accountability for ensuring changes are sustained, and training provided to ensure that managers know how to sustain the changes, will encourage and embed the right behaviours, supporting the culture change.”

 

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This feature was sponsored by Newton. The subject was agreed by LGC and Newton. The report was compiled and edited by LGC. See LGCplus.com/Guidelines for more information.

 

 

Transforming adult social care

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