In Manchester, we have been on a long-term journey of transformational change focused on how we deliver adult social care, working with our citizens to achieve better outcomes.
We started four years ago when staff told us that they needed more resources and wanted to be more strengths-based. Following our Adult Social Care Improvement Plan in 2018, we secured significant investment in recruitment of staff across our services.
We further built on this through Better Outcomes, Better Lives which is our programme to embed strengths-based practice.
We launched the programme in January 2021; during lockdown and when our staff were feeling the effects of a relentless COVID response. It would have been easy to press pause, but we knew strengths-based practice was part of the solution, so we took a leap of faith and haven’t looked back since. We had support from IMPOWER to design, launch, and deliver the first phases of the programme alongside our teams and it has felt like a real partnership. Together we have created an innovative approach to transformation which is owned by our staff, and we are starting to see the impact: better outcomes for citizens, financial savings, and more resilient adult social care, through managing our current and future demand differently. I am excited to be able to share our work with the sector at this week’s ADASS Spring Seminar.
Keeping citizens at the heart of everything we do, I believe that Better Outcomes, Better Lives has been successful because it has been led by our frontline practitioners, with the right support from senior leaders in Manchester. The programme is organised around a number of workstreams, collectively focused on strength-based practice and maximising independence through a more effective short-term offer, responsive commissioning, the right support at the front door and strengthened performance reporting arrangements. Central to our approach are our Communities of Practice where teams come together to reflect and work through issues.
Any unresolved issues are reported back into the programme, and we act upon them which has created real trust with frontline teams. One practitioner told us the Communities of Practice has been ‘incredibly positive and empowering’. This is exactly what we want – staff being empowered to lead the change.
Some of the issues identified by practitioners are challenging to resolve. We have used a prototype approach in which we test solutions on a small scale, we learn, we test again, and we grow. We don’t wait to have all the answers before we try something, we work with what we know, and we continuously learn.
Prototypes have helped us to improve outcomes for citizens in our reablement service, and to enhance our front door offer, as well as in testing new commissioning models directly informed by frontline staff.
We have had great support from the start from our chief executive, our executive member and full engagement with the Manchester Local Care Organisation (MLCO) team of which adult social care is a key part.
The programme governance recently got the highest level of assurance from our internal audit, which shows the confidence the organisation has in us which has given us the opportunity to deliver significant impact for the citizens we serve.
We are starting to see improved outcomes for our citizens. We are preventing, reducing, and delaying the need for statutory services. We know that we are supporting people to be more independent in their own homes, with 61% of people leaving our reablement service with no ongoing care requirements.
In the South of Manchester, where the programme rolled out first, we have seen an 8% fall in commissioned homecare.
Since April 2021 we have only seen a 1% increase in nursing and residential placements, in contrast to pre-COVID trends which showed steady increases, so we are supporting more people to remain in their own homes. This tells us that we are creating better outcomes and better lives for our citizens by promoting their independence and supporting them to have more fulfilling lives.
By focusing on outcomes we are starting to see a positive financial impact, allowing us to reinvest into the programme so we can deliver even more. We are now strengthening our change team, recognising the importance of the right capacity to deliver transformation.
With the right resources there is an exciting future for Better Outcomes, Better Lives. Working as part of the Manchester Local Care Organisation we are in partnership with our health colleagues to embed the principles in community health services and into the work we are doing with our hospitals. This will enable the whole system to become strengths-based and more integrated. We also know that we can apply the Better Outcomes, Better Lives approach to population health management to start changing outcomes across the life course.
Fundamentally, we knew how important it was to create the right culture where staff – our most valuable asset – understand, help design and own the vision and I cannot thank them enough for embracing the programme, despite the many challenges we have faced over the last two years. We are confident we have the right conditions of success in place to deliver the strategy and realise the benefits for citizens, staff and the whole system and I am excited for the future benefits we will deliver together.
Bernadette Enright is executive director of adult social services for Manchester City Council
@ManCityCouncil