As someone said recently, “we are using the word ‘unprecedented’ to an unprecedented extent.” Many a true word…!
In this blog we want to share some early learning from Councils, their social care teams and their partners on how they are responding to the current COVID-19 crisis.
We want to look at what this learning might mean for future care offers and ways of working.
How are Councils responding?
It’s firstly inspiring to see the relentless and often selfless levels of work going into managing the impact of COVID-19, particularly amongst key workers and staff at every level across many sectors.
Staff in NHS hospitals and intensive care units are working flat out in dealing with people needing the most acute healthcare.
Staff across the adult care sector are similarly working tirelessly, at risk to their own health, to keep older and disabled people safe and supported, reduce wherever possible massive pressures on NHS acute care, and to prevent the further escalation of this crisis.
Surely this is the NHS, local government and their partners working at their very best. One DCS said her authority’s management of the recent floods now seems like “a low scale warm up exercise”.
Front-line staff are going way beyond traditional care briefs, leading and supporting effort across agencies statutory, voluntary and private, and in communities. As one manager said: “It’s as if the old tensions and rivalries have melted away.”
So what learning can we take from this experience and how can we start to reflect and build this learning into our future ways of working?
Looking forward, we see senior teams are already thinking ahead. As one Director put it, “What will the new-norm look like? How will the need for traditional social care be defined and met in future? And what does this mean for Councils’ roles and expectations”.
Another Director spoke of the opportunity to “reset and accelerate” community-based solutions – using the best of current volunteering and neighbourliness, and worrying less about providing services and more about supporting local connections and celebrating and sharing community initiatives.
This is a far cry from one local authority experience (not so long ago) where local people were prevented from helping cut down overgrown shrubbery in a park with council equipment because they hadn’t had health and safety training.
The truth is, despite some much-publicised flouting of government social distancing requirements, there are far more stories of what one person called “the milk of human kindness”, not just mutual help but also small but important gestures like just smiling and saying hello in the street (even from two metres away!). And this warmth has less to do with our grand strategies and more to do with people and communities supporting each other’s physical and mental well-being and building safer and stronger communities.
So, drawing all this together, we think there are four accelerated learning themes to grasp and use as we seek to emerge as positively and confidently as we can from the current crisis. We believe these themes provide an ideal platform for driving innovation and improvement in the planning and delivery of care services.
The growth of the new contact management channels
Prior to COVID-19 80% of GP appointments were conducted face to face. Whilst there are obvious merits to this model it is arguably an expensive and unsustainable way of operating services particularly in a digital age.
The BBC report that during the COVID-19 lockdown this figure has switched dramatically, with now of more than 80% of consultations done by video conference or over the phone.
Not only does this offer a potentially more efficient and cost-effective way of working it also enables the potential for triage and risk assessments to be completed digitally. This means increasingly using technology to direct patients towards the most efficient channel according to their needs. This, in turn, could lead to patients becoming increasingly self-sufficient and using digital information tools and assets to find the support they need.
Importantly it enables a much more systematic and efficient process of data collection which in turn could be used to identify trends, risks and make earlier, preventative interventions.
Galvanising the work of communities, volunteers & the 3rd sector
COVID-19 has focused the hearts, minds and efforts of everyone around a common theme. The crisis has brought together often disparate activities and objectives into a clearer and more cohesive effort.
Many local authorities have identified or established voluntary or community support organisations to act as an umbrella, for bringing together this effort into risk-based common strategies to identify and support those most at risk. This has been achieved at break-neck speed and is a huge achievement – it would be a shame to see it dissipate.
Local authorities and their partners now need to find the right tools and mechanisms to build on this platform and engage and empower these mechanisms to continue to perform vital roles.
We need to celebrate the power and potential of the NHS, local government, carers, volunteers and communities and the 3rd sector to support each other and harness innovation, to do what works in pragmatic ways. This requires the statutory agencies to operate in far less directive ways.
Working beyond organisational boundaries
Whilst we have been talking about health and social care integration for many years – and there are many examples of great practice across the country – it does feel like progress has been hampered through misaligned performance management regimes, incentives and organisational budgets.
The COVID-19 response (whilst by no means perfect) seems to be have brought a pragmatism and cooperation that has brought together front-line staff and has helped to shift outmoded and unhelpful organisational barriers.
Whilst there remains much work to do, really getting to grips with what has worked and how teams managed to move at such speed to get things done has to be the essence of the health and care sector’s future ways of working.
Better decision making and use of data
Decision support tools – data and technology – are increasingly being used to target scarce resources and to identify the responses that are most likely to be effective both now and in the future.
Many authorities are now focusing on how managers and front-line workers can use data and technology to make better informed decisions and to demonstrate transparency and consistency in practice.
The more systematic data sharing and analysis have been highly effective in targeting support to those with COVID-19 risks.
Terms like “predictive analytics” and “algorithms” can feel alien. However the better use of data around understanding symptoms, frailties, long term health conditions, life-styles, isolation, debt etc. will genuinely help to identify people not only in likely need of assistance now or in the future, but also what type of interventions might best help.
Sharing this data with GPs, carers and support organisations is more likely to create better joined up responses that get to the ‘root-cause’ of issues (as opposed to the partial pictures we often have today).
Of course, social workers are trained to recognise every person as an individual with their own unique networks, history and goals, so anything that smacks of pre-determined ‘one size fits all’ approaches can sound Orwellian and can stick in the throat. This is even more so now we have moved towards more ‘person-centred’ and ‘strengths-based’ approaches with the aim of helping people live the lives they want.
However, if we position the use of such data as to inform and support decisions rather than replace professional judgement, the benefits become more apparent:
- for senior managers, aggregated predictive data assists in showing levels of anticipated need, in turn making the setting of criteria and budgets more informed and deliverable;
- for individual workers, use of such information as a starting point to personalised discussion and assessment can give greater confidence in case decisions and a feeling of being less exposed.
- for residents delivering a more streamlined experience by delivering on the ‘no wrong door’ and ‘tell us once’ ideals
A range of data led projects and initiatives are now being explored across the country. These projects are starting to yield great benefits – better care experiences, reduced non-elective admissions, more comprehensive population understanding and management, and real savings across the system through better coordinated approaches.
Some organisations, like Barking and Dagenham and Thurrock Councils are leading the charge in moving these ambitions into live capabilities that are beginning to be used to support strategic decision making as well as operational efficacy and efficiency improvements.
It is clear that the better use of data and technology to support difficult and complex decisions will be an increasing part of the post COVID-19 era.
So, a lot to reflect on for us all here. Why not share your views and join the debate?
The last few months have been a rollercoaster for most of us and a dreadful experience for many people – but we must not overlook or forget what has been achieved and learnt.
We owe it to people with care and support needs, to the dedicated and selfless staff working on the front-line and in communities everywhere, not only to learn the lessons of COVID-19 but also to frame and build on the platforms and opportunities the crisis now provides.
By Tony Hunter & Chris Buttress