In 2015 the adult social care pathway was re-designed and a team established to manage people seeking care and support, called the Initial Contact Service. This case study forms part of our productivity experts resource.
Managing demand for adult social care, whilst providing timely access for those needing care and support, is critical to support the council to meet the needs of its community whilst addressing the financial challenges facing the council.
We wanted to review the arrangements to determine improvements that could be made to prepare the pathway for integration with community health and closer working with voluntary sector partners.
- Failure to respond to referrals promptly leading to increased demand and lost opportunities to offer a strength based resolution. The service had significant waiting lists. A snapshot on one date evidenced 447 emails awaiting attention (146 of which were considered to be non-urgent), 42 contact referrals to be managed and 234 visits outstanding.
- Capacity to answer calls and respond to emails. 31 per cent of telephone calls made were not answered and an average of 1,500 emails were received each month.
- Too few contacts resolved through advice, information and guidance. 46 per cent of new contacts and 23 per cent of existing contacts were resolved by the provision of advice, information and guidance or referral to a preventative service or low level provision (e.g. equipment). Best practice would suggest figures closer to 70-80 per cent. Additionally only 50 per cent of cases passed to a long term team for assessment resulted in a care and support plan, suggesting that too many cases were being passed to the long term teams with opportunities missed for the provision of advice, information and guidance.
- Staff capacity reduced by number of face to face visits undertaken. The structure of the team led to a focus on face to face visits.
- Cases held by service for too long. 87 per cent of contact referrals were completed in six weeks, which was considered too long as the service was only seeking to undertake urgent assessments.
- Strength based practice not sufficiently embedded. A strength-based approach focuses on the positive attributes, of a person rather than the negative. The challenges in embedding this approach may have been due to the process driven approach taken by staff when responding on the telephone, driven by the screening form used. Screening was not proportionate with a tendency for staff to complete all sections of the form regardless of relevance.
- Channel shift – improve the information provided on the council web site and introduce online forms for the public, professionals and providers.
- Improve contract management with the external customer call centre including clarification of role and agreed expectations regarding the level of service provided.
- Design new pathways for new customers (for screening and where assessment was required), existing service users and urgent activity.
- Undertake focused development work with staff in the service on strength based approaches and increase awareness of local universal and community services.
- Review equipment and occupational therapy pathway including promotion of self service options and reducing amount of equipment delivered directly to customers.
These were all areas identified by our productivity expert.
The introduction of online options is beginning to reduce contacts by telephone/email. The greatest gain will be achieved by moving G.Ps and home care agencies to online referrals/contact, which it is anticipated will take several months to fully embed.
Performance in terms of the percentage of calls answered by the external customer call centre has improved and continues to be closely monitored. The percentage of calls not answered has reduced from 31 per cent to 14.5 per cent.
New pathways are being designed but have not yet been implemented. They include work to develop Intermediate Care Lambeth, an integrated health and social care service delivered by staff from Lambeth Adult Social Care and Guy's and St Thomas' Trust. This service will include initial screening, an urgent response where needed and pathways into Reablement and Rehabilitation.
The new approach is intended to save approximately £500,000 by 2022/23, although it is challenging to accurately identify and capture savings achieved through improvements in demand management.
How is the new approach being sustained?
An action plan has been agreed, overseen by a Project Board chaired by the Director of Adult Social Care supported by a number of task and finish groups.
- Changing behaviour takes commitment and time as well as user friendly tools.
- Data is important to guide decision making but most useful when all parties are in agreement about what the data is saying. This could have been better supported by sharing early data analysis between the productivity expert and the local data owner. A wide range of data was collected for this project including data on volume of telephone calls and emails, the number of requests for support and the action taken, staffing activity and equipment issued.
Maria Burton, Assistant Director Transformation
0207 926 7540
Links to relevant documents
Range of papers can be shared upon request: