by Lloyd Watkins
Published: 28 Mar 2023
Introduction
Our inquiry considered the effectiveness of existing ways of challenging local authority decisions about people’s entitlements to adult social care. This included, but was not limited to, complaints to local authorities, ombuds, and judicial reviews. It is important to ensure that people who use social care have choice and control over their care decisions.
Key findings
Our inquiry found that the system to challenge decisions about social care is slow, confusing and challenging. People are often not given the right information or support to challenge decisions effectively. They fear that if they challenge decisions, they will face negative consequences and lose access to care. People are deterred from seeking help and they feel ignored and disempowered. Some are in crisis and desperate for help. As a result, the system is failing those who need it. It is therefore important that there is enough scrutiny to make sure care decisions are right first-time round. We found that Torfaen County Borough Council established good practice early in their processes.
Torfaen case study
Our inquiry found innovative practice in Torfaen. The Adult Services Leadership Team was inspired to change the way it worked by the Social Service and Wellbeing (Wales) Act 2014.
Torfaen invested in training for Adults Services Teams in 2015 and 2016. This supported the design and implementation of a new system to deliver their obligations under the new legislation. They changed from using a deficits or disability-based system to one that focused on people’s strengths and desired outcomes. This focused on what matters to people. To support this, they moved their social care professionals out of the council's central office and into ‘small patch locality teams’, working across the county. These teams were more accessible to people. They developed a greater understanding of the support and assets available locally to support and maintain people’s wellbeing.
Innovative thinking: sustained results
Our inquiry found that it was important to try and get the correct decision for people's care the first time. Torfaen achieved this by implementing their innovative ‘fishbowls’ approach.
Fishbowls bring together a mix of social workers, community care workers, occupational therapists and others. These professionals discuss assessments and recommendations up to three times a week. Fishbowls are based on collaborative conversations. They focus on maintaining the person’s existing networks of support, and on what matters to them. This process looks at a person’s strengths and assets and the risks of not achieving their desired outcomes. It puts the council’s expertise upfront, creating an extra layer of challenge within a safe space.
Fishbowls thinking
The purpose of ‘fishbowl’ discussions is to:
- help practitioners stick to principles
- help practitioners challenge and test their assumptions
- help practitioners identify problems/blockages to solve
- support each other.
In line with the practice of some local authorities, Torfaen have appointed senior social workers as ‘practice coordinators’. They help to develop skills among less experienced colleagues. Practice coordinators can provide a systemic approach to identifying issues and assess any need for new training or practice changes. This means that there are effective methods in place to learn from challenges and complaints. Workforce regulators and professional bodies are in favour of practice coordinator roles because they offer social care workers opportunities for career progression.
Torfaen’s innovative approaches have resulted in fewer appeals or formal complaints. This is because there have been several collaborative conversations to understand what matters to people. When someone is unhappy with their outcome, teams use challenge as a chance to review and learn. Torfaen has seen a sustained reduction in the use of residential care. Their focus on the ‘Home First’ principle means that people are more likely to get good outcomes by being cared for at home.
Recommendations
Torfaen’s work to ensure that decisions are right the first time, and that authorities learn from complaints and challenges, addresses some of our inquiry’s key findings.
Our inquiry makes several practical recommendations to local authorities, national governments, ombuds and regulators. It is important to ensure that people’s voices shape the care they receive.
In Wales, there are many opportunities for the changes we recommend to be embedded in social care practice. This includes the launch of Llais, the new Citizens Voice Body for Health and Social Care in Wales. The new organisation will represent the views and opinions of people who use social care. It will also make representations to local authorities. This will ensure that people’s experiences drive a culture of continuous improvement.