Derbyshire
Working Together for Change Process
Adult Learning Disability Services
6th and 9th May 2011
We opened the day with a round of introductions and went through the meeting map outlining the purpose of our 2 days together, agenda for the 2 days, roles and rules
We then explored the Working Together for Change Process, themeing information, root causes and establishing success indicators
Iseult opened the day and shared some local context around the Working Together for Change process in Derbyshire and Peter Bailey shared how the information for the process had been gathered
We were using information from peoples person centred reviews across a wide range of adult services inDerbyshire from peoples top two:
-What’s Working
-Not Working
-Important to in the future
What’s Working
Outlined below is the cluster and theme information from What’s Working
Key What’s Working themes:
I get about
I have choice over my care
I like getting out in the evenings
I get to socialise and do activities
I enjoy my job
I feel safe
I feel healthy
I communicate my needs and want
I like my independence
I can do things on my own
I am an individual and can do what I like
I like living with my family
I like and trust my staff
I like a break away from home
I do the things I like
I like my holidays
I am able to spend time with people I love
We celebrated the areas that were working well. These themes could be useful in the future in relation to growing or developing the areas that work for people and/or extending to more people in adult learning disability services
What’s Not Working
We then moved on the theme and cluster the areas that Weren’t Working for people
Key Whats Not Working Themes were:
I don’t have the right support to do the things I want to
I don’t like sharing a bathroom
I don’t understand money
I want a relationship but don’t know how to go about it
I am bored
I don’t like change
I don’t get the time I want
I don’t like to wait
I don’t feel safe
I fear losing skills after school
I don’t get to do the things I want to do when I want to do them
I don’t always like the people I have to spend time with
Important to in the future
Finally we clustered and themed the information from the Important to in the Future’ information
Key Important to in the Future themes were:
I need more funding
I want skilled support I can trust
I want to choose where and how I live
I want a job
I want a phone I can use
I want to exercise my beliefs
I want to live my life the way I want to live it
I want to meet new friends
I want to try new things
I want to go on holiday
I want support to keep me healthy
I want to keep people close to me
These Key Themes are to help us in our thinking when we get to action planning the areas that don’t work for people
We could also use this information eg in exploring what we already have in place in relation to the top things that are important to people in their future and exploring were the gaps are
Prioritising
We then went back to the What’s Not Working information and multi-dot voted on our priority areas for change
We chose the top 4 priority areas for change (from the information from ‘What’s Not Working’) These were:
I don’t have the right support to do the things I want to do
I want a relationship but don’t know how to go about it
I don’t have any control over my support and I am afraid of the future
I’m not listened to
Root Causes
We then explored some possible root causes as to why these things may be happening in our adult learning disabilities service
We then chose what we thought were our top root causes for each of the 4 themes from What’s Not Working and voted on these:
Top Root Causes:
I don’t have the right support to do the things I want to do
Not enough staff to support diverse needs of people we support
Limitations from family carers – financial – safety – expectations from family can be different
Individuals we support to have more of a voice in recruitment (only some involvement)
Top Root Cause – Assessment process – needs to include all circles of support, sometimes it’s the voice of the family not the person, assessments are more focused on the needs of what people want, very system lead and time restraints
I don’t have any control over my support and I’m afraid of the future
Lack of listening to people – lack of time and lack of empathy skills
Lack of choices, options, planning and other people holding the money
Having to fit into services – services don’t fit the person
Top Root Cause - People not been given control – risk averse – staff/parents/society therefore lack of experience
I want a relationship but dont know how to go about it
Lack of consistent resources to help people eg friendships and dating agencies
Not all staff see it as part of their job to support people to make relationships
Training and the policy not getting to everyone
Top Root Cause - Culture change needed to include relationships consistently in Person Centred Plans – domination of the care management perspective
I’m not being listened to
Staff don’t take time to listen
Professionals know best – culture change – some professionals feel comfortable with this – look at service solutions
Joint Top Root Cause - Lack of training and induction and support for staff
Joint Top Root Cause – Not respecting how I communicate – time and negative labels
Defining Success
Our next step was to explore what success would look like. We decided together that we wanted to explore what success would look like from the perspective of:
Individuals
Family members
Providers
Assessment teams
Commissioners
I don’t have the right support to do the things I want to do
Individuals – some one helps me plan my social life
Family – More flexibility to get support when you need it – I choose
Providers – Assessments reflect and deliver the resources required to provide effective services to meet peoples outcomes – get involved in recruitment and selection
Assessment – My assessment empowers the person I am working with to explore their dreams and aspirations and to then have access to a range of informal and formal support that enables them to do the things that are important to and for them
Commissioners – Wide range of support approaches available in localities (wide market commissioned and non – commissioned)
I don’t have any control over my support and I’m afraid of the future
Individuals – I recruit my staff asking questions at interview and my worries are listened to
Family – I want to know and meet the people who are going to support me and to have a say in who is going to support me
Providers – Confident well trained staff who are comfortable supporting people to have continuous access to support services
Assessment – The person I am working with has had creative support planning and to develop their support plan identifying their prioritise and how they are going to be supported
Commissioners – High proportion of people receiving direct payments (by making it easier)
I want a relationship but dont know how to go about it
Individuals –I have a good relationship with someone my family are happy with
Family- meeting up with friends in a safe place – more Hacketts Bar events – support available
Providers – Comfortable well trained staff who are comfortable supporting people and have continuous access to support services
Assessment – I feel confident and comfortable in my own ability to support the person I am working with to explore relationships and friendships in their assessment and support plan
Commissioners – High quality assessment and review process to inform commissioners in place
I’m not being listened to
Individuals –I take on more responsibility and speak up
Family – I would feel more confident to speak – take time to express how I communicate and people not taking me for granted
Providers – staff are trained in a diverse range of communication strategies – the individual is given opportunities and support to give feedback and complain knowing their concerns will be acted on – staffs roles should prioritise communication.
Assessment – I am confident that the person I am working with says they are being listened to and this is reflected in their support plan
Commissioners – Evidence that support commissioned is meeting key outcomes for the individual (from providers and reviews)
The next step was to think about what we already had in place that would help us move towards success
Radical, Traditional and Community Solutions
We then began to think about some creative solutions to solving what doesn’t work for people and moving towards our success indicators. We thought about this in relation to radical, traditional and community solutions:
We shared these with the rest of the group and voted on our best ideas:
:
Our best ideas were as follows:
The top ideas are underlined
I don’t have the right support to do what I want to do
Radical ideas – compulsory disability awareness training for everyone and get rid of assessment and create a new benefit like Disability Living Allowance
Community (Different) –Looking to other funding streams – partnership agreements and looking for community based solutions not services
Traditional – more consistently good support plans – personal service plans and more out of hours social activities
I don’t have any control over my support and I’m afraid of the future
Radical – opt out rather than opt in to direct payments and pay as you go
Community (Different) – Develop community connecting role – funding community for groups and individuals and advertise for support in local shops and cafes etc
Traditional – support for people to speak up for themselves and others eg care and share and reps on board and continued opportunity for person centred support planning eg one page profiles and task force day
I want a relationship but dont know how to go about it
Radical – Support to get a room – 18 - ?, holidays in the friendship bus and family only receive care monies if they pass exam on facilitating relationships and staff
Community (different) – Make links with local dating agencies and raise awareness through relationship workshops and support people to develop self awareness
Traditional – Friendships and dating agencies and social events eg Hacketts, Just Good Friends , S Club and Speak and Eat
I’m not being listened to
Radical – Commissioners ask people to score staff on how they support people to meet outcome from their support plan and transfer stake holder engagement to team share holder power
Community (different) – Pyramid advocacy and Facebook befriending
Traditional – Communication passports/advocacy/advocacy groups/meetings and take time to listen – address working practice in supervision
We then plotted our ideas on a grid to highlight success versus cost/energy in relation to:
-quick wins,
-major projects
-fill ins
-thankless tasks
We took each idea that were under the categories‘Quick Wins’ or ‘Major Projects’ and developed an action plan for each idea
Who / Will Do What / By WhenTrish / Nominate 2 assessment staff to participate in ‘brown paper’ exercise / End of the week
Andrew / Feed this workshop into the exercise and will email DG / Tomorrow
Iseult / Meeting on 7th July will hear about workshop / 7th July
Louise/Board Members / In the process of looking at role of countyPB / Next meeting June 15th
Pauline Dawson / Review of reps on board – where do we go next / Tomorrow – next meeting
Pat / Local initiative in AV / Planning meeting May 11th
Andrew (Claire Davis/Chris Smyth, Erewash) / Unit managers meeting will discuss opportunities for further action / Thursday
Deb / Raise the profile with James Matthews to review current arrangements / Tomorrow
Deb/Iseult / Ownership agreement idea Deb and Iseult to discuss from todays feedback and build into future commissioning
Iseult / Feedback to people in the Partnership Board, Derbyshire Carers / Following follow up, Tomorrow and ongoing following follow up and action plan agreed
Pat, Janette and Jane / Feedback to Morewood / Following follow up, Tomorrow and ongoing following follow up and action plan agreed
Bridgette / Parents group / Following follow up, Tomorrow and ongoing following follow up and action plan agreed
Iseult / Invite Jem to feedback meeting
Burning Issues:
What can we do to improve on our resource allocation system – it doesn’t always work for people who have learning disabilities?
Ideas to think about in the future
Check out REMPLOY for work opportunity support
Permitted earnings around job opportunities
Closing Comments and Evaluation
Enjoyed it
Good to see different ways of going things – really interesting
Lori’s energy was phenomenal – aggregating needs is what we have always talked about, now we have seen it and done it in just 2 days
I like the way the exercises have been done – especially the radical thinking
The radical thinking bit was so exciting – gave me permission to go mad – a very positive experience
Seen it through to the end – really interesting – these aren’t new issues but this has made people more aware of them
Really liked having different people with different perspectives
Really enjoyed watching how possible solutions came about
Its exciting
Like seeing things developing from what people say into actions for the future
Really enjoyed meeting everybody – I have worked so hard over the last 2 days – its been excellent
Love radical thinking
This is about a man with a twiddler and he has got to say about what works and doesn’t work about how he is being supported – looking forward to next 3 days
Enjoyed coming back to learning disability perspective – I like the part re making it happen
I manage a busy service – this has been time to reflect and be around positive people
Really appreciate other peoples point of view – we are all thinking similarly – this is a powerful cross section of people – I think the family carers and reps involvement has been up-lifting
Loved radical thinking and I statements
Liked the way Lori talked clearly
From specific to general
Group-work exercises
Having family carers and people who use services here
Exercises to generate lots of ideas from a range of perspectives
I like the tools – make sense
Getting everyone to work together
Do differently
Introduce JSNA info if possible
Include more people who use services – separate session if possible
Do actions for more of the solutions or find another way to not loose the good ideas
More structure to action planning