By Naomi Russell and Lorraine Mighty

Waiting for a social care assessment is becoming increasingly common across the UK, causing frustration and distress to people with care and support needs and having a demoralising impact on frontline staff and managers.

In September 2023,  IMPACT, the UK centre for implementing evidence in adult social care, and East Midlands Association of Directors of Social Services (EMADASS) began a year-long project to co-produce resources that would help staff, carers and people who draw on care and support negotiate some of the challenges associated with waiting lists.

Understanding the impact of waiting

The proposed outcomes for the project included:

• better understanding of the impact of waiting lists on people, carers and staff;
• agreeing a regional approach to managing waiting lists;
• increased satisfaction for people who draw on care and support and carers;
• development of co-production expertise across the region.

Using surveys, online meetings and face to face workshops, the views of around 104 people with lived experience and 140 staff from across the East Midlands were gathered. These insights were analysed alongside an evidence review of relevant literature to identify common themes.

Frustration for people with lived experience and staff

People who responded highlighted staffing resources, lack of consistency, over-complicated systems and increasing demands as factors that contributed to waiting times.

People with lived experience cited stress and frustration, a deterioration in mental health and decreased independence as some of the impacts of waiting for an assessment.  Staff told us they experienced stress and frustration, low morale and feeling they were not doing a good job.

What needed to change

Based on this feedback, the following themes were used in workshops across the region to generate discussion about what needed to change:

1. Use of resources
2. Communication
3. Systems and processes
4. Working with other organisations

The workshop notes were carefully analysed by the Co-production Steering Group, which was established as part of project governance arrangements, and by EMADASS. This identified the need to develop guidance for staff, and an information and advice pack for citizens, on “waiting well”.

From April to July 2024, task and finish groups comprising staff from East Midlands local authorities, third sector organisations and IMPACT worked alongside people with lived experience to develop the recommendations. Work progressed well and the products were finalised in August 2024.

Guidance for staff and advice for citizens

The guidance for staff is designed to support and equip them to provide a consistently good response to people and carers across the East Midlands. This includes information and advice for staff on where to seek support if they are struggling with managing waiting lists.

The waiting well pack for citizens is designed to provide helpful information and advice about services that can be accessed prior to an assessment/conversation. It also explains how to contact the local authority if you think you need an assessment/conversation, and what will happen when you do.

Co-production in practice

Both IMPACT and EMADASS were committed to co-producing this project. The project team benefited from good practice around co-production across the East Midlands, and with support from social care staff in each of the ten local authorities, people with lived experience were identified to join the project steering group.

The regional workshops were well attended by carers and people who draw on care and support, who co-produced recommendations about what changes are needed.

Formal and informal contact was maintained with workshop attendees to establish good relationships.  As a result, the task and finish groups had a good balance of staff and people with lived experience.  People with lived experience became leading voices and strongly influenced the finished products.

Next steps

All ten local authorities have committed to using the regional templates for staff and citizens.

EMADASS invested additional funding beyond the IMPACT project to commission a consultancy to develop an implementation readiness tool. This enabled local authority project leads to assess and access the support needed for effective implementation of the products.

Each local authority is updating the templates with relevant community information and co-ordinating distribution.

The distribution of the waiting well pack will be monitored and evaluated by each local authority to gain an understanding of the impact of the information and advice for recipients. This data will be collated by the EMADASS improvement team to understand the regional impact of this project.

Developing expertise in co-production

Whilst it will take time to understand the outcomes from the distribution of the waiting well pack for citizens and the staff guidance, a key project outcome that has already been felt is the development of regional co-production expertise.

By demonstrating good practice across the region, this project has renewed confidence in incorporating co-production in strategic improvement work and has set expectations for future projects.

Naomi Russell is deputy demonstrator lead and Lorraine Mighty senior strategic improvement coach at IMPACT; they were project leads for the waiting lists project. IMPACT works across all four UK nations, drawing on insights from research, lived experience and practice knowledge, to make a difference to frontline services and the lives of those drawing on care and support and of carers.

We are back with another live episode of the Social Work Community Podcast – this time from Wiltshire adult social care. The session took place at Community Care Live 2024.

In this episode you will hear from Abbie-Jo Lawrence, who not only works for local disabled people’s organisation Wiltshire Centre for Independent Living (Wiltshire CIL) but also uses Wiltshire adult social care’s services.

This session is about how people with care and support needs and practitioners can work together, through co-production, to enable disabled people in Wiltshire to be able to live the life they want.

In this session, Abbie-Jo and colleagues from Wiltshire Council and Wiltshire CIL talk about practical ways to enable this to happen, such as by changing assessment forms and language. They explain how working together has improved the lives of adults with disabilities.

You will also hear the Q&A segment at the end.

Listening to this episode will benefit anyone who works in adult social care. And don’t forget, this podcast episode also counts as CPD.

The workshop was hosted by Kaylie Chapman, principal social worker at Wiltshire Council adult social care.

Taking part were:

• Dan Wilkins – head of transformation and quality assurance
• Leila Dickson – assistant team manager in the advice and contact team
• Abbie-Jo Lawrence – pioneer from Wiltshire Centre for Independent Living
• Rachael Hanwell – SEND resource facilitator at Wiltshire Centre for Independent Living

Listen to “From Community Care Live: How to co-create inclusive environments in adult social care” on Spreaker.

Read the transcription here.

The Social Work Community Podcast explores the issues that matter to social work practitioners in their working lives. You will hear directly from social workers in your community about their successes and their challenges.

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By Corinne May-Chahal and Sarah Carlick

Many think digital safeguarding is about staying safe online but it means much more. Our work seeks to develop innovative ways in which children and young people can digitally and safely self-refer to children’s social care, allowing them to communicate harms and experiences in real time.

Such a digital front door would support frontline practitioners to manage risk in real time and build better relationships with their communities.

We recently interviewed senior managers across eight local authorities to scope their readiness for children’s digital safeguarding. We found an openness and some creativity, but a lack of policy or strategy supporting digital safeguarding.

Pandemic experience

The use of digital communications was inevitable through the pandemic. This presented challenges for children’s social care, but services were quick to adapt.

Photo: Jacob Lund/Adobe Stock (posed by model)

Unsurprisingly, tools used were limited to familiar platforms such as Zoom, Microsoft Teams and WhatsApp as there is little availability of dedicated safeguarding tools or applications (Carlick, 2018).

During our research, senior leaders provided evidence of digital services enabling children to participate in some aspects of service delivery.

Involving children in co-designing systems

But the idea that children could be involved in co-designing the system architecture from the point of referral and throughout the safeguarding journey was new.

Technology could enable children to see, amend and contribute to records, know their service history, build trusting relationships with practitioners and feed back to them.

In response, practitioners would need to be consistently flexible and creative when working with them, and systems would need to be adaptable.

Social work skills and training gaps

However, echoing previous research, (SCIE/BASW, 2019), interviewees said their workforces were not sufficiently digitally skilled, and that current case management systems were not able to adapt to the ways in which children communicate.

The skills gap is the result of  specifically focused digital skills training not being widely available within local authorities or safeguarding partnerships. There are no digital safeguarding training programmes or digital skills frameworks to work towards and it is not embedded as an essential core subject.

Furthermore, digital skills is not a standard core element within social work qualification programmes. It simply is not on the radar!

Directors stressed the benefits of having a workforce that was proficient in using and ‘talking’ digital technologies.

They described how this had worked in the past with children with more complex needs, who did not want to engage face to face. For example, some workers who were interested in gaming and digital activities used these as a tool for engagement, which resulted in positive connections.

Barriers to implementation

Participants reported challenges and barriers to adoption and implementation of digital safeguarding at both national and local level.

This included a need to integrate purchasing across councils and services; creating social care tech teams and bringing together social care and tech staff so they co-design systems together; and the costs of implementing local authority-wide digital transformation.

Image: Dzmitry/Adobe Stock

Addressing these requires policy changes and for the government to adopt a digital safeguarding approach.

The new Working Together to Safeguarding Children (2023) urges safeguarding partners to co-design services with children and families to ensure different communities get the help and support they need.

However, it does not go far enough in bringing social care and technology together and making clear that digital is not just about datasets and case management systems.

The need for social workers to work out of hours

Digital accessibility also includes having a digitally resilient workforce that works outside normal office hours.

Photo: Antonioguillem/Adobe Stock

This is because child maltreatment and children’s needs can arise at any time of day or night, and having access to a social worker out of hours will support the relationship-based practice that is crucial to the success of digital safeguarding.

Finally, changes need to be made to case management systems to enable children and families to engage easily and digitally (Munro, 2011; MacAlister, 2022).

Such systems must be agile, continuously updating in response to emerging technologies, and facilitate easy engagement for practitioners, children and parents.

In sum, there is a will to make a success of digital safeguarding but we must work with children to find the way.

Corinne May-Chahal is professor of applied social science at Lancaster University. Her research focuses on helping children and adults keep safe in a digital world

Dr Sarah Carlick is a digital safeguarding consultant whose work focuses on how organisations can use tech for good, through co-design with children and young people

References

Carlick, S (2018) Creative art-based technologies for interagency working together for safeguarding children and young people 

MacAlister, J (2022) The Independent Review of Children’s Social Care final report

Munro, E (2011) The Munro review of child protection: Final report – A child-centred systems

SCIE/BASW (2019) Digital Capabilities for Social Workers: Stakeholders’ Report

The term ‘co-production’ is used a lot in social work practice but how can local authorities authentically imbed it into the services they run? 

Wiltshire Council’s principal social worker for adult social care (ASC), Laura Roberts, says the authority has reflected, reset and refocused to ensure disabled people are being understood and really listened to. 

Laura says: “We recognise that what is significant for service provision is not always aligned to what disabled people in our communities feel is important to them.” 

It surveyed 2,000 disabled people in Wiltshire to help develop a new framework to enhance their lives. 

“We firmly believe that disabled people are the experts in their own lives, they are best placed to tell us what matters to them, what’s important to them and what we, as a local authority, need to be able to hear,” says Laura. 

“People have shared the importance of being involved and being part of their local communities, they have fed back that living in Wiltshire ultimately has a positive impact on the quality of everyone’s lives.”

Co-production with other organisations

One of the ways adult social workers are underpinning their practice with co-production is with the work they do with Wiltshire Centre for Independent Living (Wilts CIL). 

Wilts CIL is a small charity commissioned by Wiltshire Council to support disabled people in the area. It embodies co-production in all its services and also tries to employ as many people with lived experience of disability as possible. It has also helped shape the way social workers carry out Care Act assessments. 

Abbie-Jo, a personal assistant (PA) development worker and trainer for Wilts CIL, says: “Instead of standing at the top and things being done to us we’re starting at the bottom and saying to people, what do they need? What do they want to have a good life? And then we feed it back to Wiltshire Council.”  

Abbie-Jo helps people with their direct payments and getting them the right type of support. Having cerebral palsy means that she also has a PA and a good grasp of what some disabled people may need. 

“It’s about having a say about how they want services to work for them rather than us fitting into a box and having tick boxes we didn’t necessarily fit into,” she says. 

A young adult at a visioning event

Pioneering events

Wilts CIL and Wiltshire Council organised several ‘pioneer visioning’ events where disabled people and social care staff came together. 

Not only was it an opportunity for people with different needs to meet up and socialise but it also enabled Wiltshire’s social care staff to ‘hang out’ with disabled people in an informal setting. 

The events featured ice breakers and other fun activities so people could get to know each other. The house rules for the events were that no lanyards, work calls or laptops were allowed, promoting the idea of equality and being present in the moment. 

“These events are really genius because it shows that we’re all on the same side and fighting for the same thing,” says Abbie-Jo. “It’s a really lovely opportunity to put them [social care staff] in the same room as people like us. They really appreciated that for those two hours we were all equal and on the same level.”  

Wiltshire social care staff at a visioning event

The importance of co-production

Caroline, a social worker in the locality ongoing support team in ASC, really enjoyed attending some of the visioning events. She says a lot of services have closed since the pandemic and working closely with Wilts CIL has helped her with the adults she supports. She explains what co-production looks like to her: 

“It’s about listening to people, that’s probably the key thing. Years ago, it was very much that we were providing a service and trying to make it fit the person, now things have changed over the years and now we’re looking at shaping services for what people want, which has got to be more meaningful and more important. 

“I think when you’re actually asking people who have experience, because of a disability of some kind, actually asking them what they want and what they need in their local community, that’s really powerful. I really liked the co-production event because of that.” 

She shares a story of an 18-year-old man with cerebral palsy who wants to live a more independent life now that he is a young adult, and not be so reliant on his mother.  

“He wants a PA so that he can access activities safely but without his mum tagging along, just like any other 18 or 19-year-old would want. You get to know a little bit but Wilts CIL has an ear to the ground. 

“After the co-production event, I just thought I’m going to tap into them and use them as a contact to try and find out what else is out there.” 

In the 23 years I think we’ve tinkered with co-production but this is the first time I’ve actually seen it in action in such a proactive and positive way. 

Peter, a social worker for 23 years and service manager for the Living Well service, which looks after many different teams in ASC, is also keen to make sure co-production guides all the practitioners he manages. 

He says: “Our priority within all assessments now is around ensuring that we hear the voice of the customer; really understand what’s working for them and what’s not working for them. 

“Our work with individuals is really key. We need to engage and develop that relationship where we are equal to the individual to understand what’s important to them, what a good life looks like and how we can work with them to achieve that. 

“In the 23 years I think we’ve tinkered with co-production but this is the first time I’ve actually seen it in action in such a proactive and positive way. 

“Co-production now is one of our golden threads really and I think there is the need to imbed that into any development or changes that take place. We want to work with our communities and individuals to inform our services that we deliver.” 

If you want to find out more about how co-production is implemented you can attend the seminar ‘Co-creating our Wiltshire vision’ at Community Care Live 2023.

Are you interested in a career a Wiltshire Council? Check out the latest vacancies or the Wiltshire Council employer profile.

Find out more about Wiltshire here.