Tackling long social care waiting lists through co-production

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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.