Agenda Item No Manchester Health and Care Commissioning Board. Agenda Item: 2.3 Date: 25 th April Report Title: Adult Social Care

Transcription

1 Manchester Health and Care Commissioning Board Agenda Item: 2.3 Date: 25 th April 2018 Report Title: Adult Social Care Prepared by: Presented by: Summary of Report: Dr Carolyn Kus Dr Carolyn Kus Update on current service activity and performance Strategic Objective: To improve the health and wellbeing of people in Manchester To strengthen the social determinants of health and promote healthy lifestyles To ensure services are safe, equitable and of a high standard with less variation To enable people and communities to be active partners in their health and wellbeing To achieve a sustainable system Board Assurance Framework Risk: Outcome of Impact Assessments completed (e.g. Quality IA or Equality IA): Outline public engagement clinical, stakeholder and public/patient: N/A N/A Recommendation: The MHCC Board is asked to note the report. 1

2 1.0 Introduction This report gives an update of the current activity within adult social care this also includes current performance dashboard. Adult Social Care is a complex business held under statute and adheres to the law of the Care Act. So this report will focus on several key areas where there has been activity over the last few months. 2.0 MLCO The biggest event has been the transfer of assessment and Care management staff into the MLCO 400 moved across this consider with the new Director of Adult Services coming into post. Work has been undertaken to develop structures, this alongside the workshop on the legislation of adult social care has helped to develop understanding and build a positive relationship. Deliverables have been agreed with timelines a key area is the set up of the INT it has been agreed that all those health and social care staff who match integrated neighbourhood team manager post will be in post by end of June. 3.0 Adult Social Care workforce Staff training in strength based models of care continues, and work is on-going to increase the number of qualified social workers. Staff engagement sessions are in place with a staff conference held on 20th April to launch staff reference groups with some 120 staff volunteers. Cllr Bev Craig and Chief Executive Joanne Roney opening the session. Attached as A is the OD work programme proposal 4.0 Health and social care commissioning group In order to both progress and have oversight of the transformation agenda this group has been set up it fits into the current governance of MHCC and MCC, and as wide membership including political and clinical. - provide system-wide assurance of the transformation and integration of health and social care particularly focused on the priorities of out of hospital care, and residential, nursing and homecare - provide leadership and decision making to ensure appropriate resources are agreed and put in place to progress agreed work programmes 2

3 - connect with MHCC, LCO, MCC and Greater Manchester to make decisions on the system needed to drive transformation, and strategic oversight of progress on key issues - address system wide and organisational barriers to transformation - cultivate best practice and promote a culture of high expectations that is mutually supporting, promotes learning, creativity and innovation The group has evolved from the previous Adult Social Care Reform Board to now bring together a broader group of system-wide leaders, covering MHCC, LCO and MCC, and a broader set of issues within health and social care integration. It will include a specific focus on the CQC action plan. The strategic aims of the group are aligned with the MHCC aims and priorities for 2018/19, which are shown in the diagram below. The group will focus on: - priority 1: develop high quality, effective residential, nursing and homecare - priority 2: deliver effective out of hospital care - relevant parts of priority 5: deliver strategic priorities in line with city s priorities (learning disabilities and cancer) The group will also make the connections with the other priorities shown below (numbers 3-6) to deliver effective integration of health and social care across the whole system. The group will align its work with the single operational plan that MHCC will have in place from April, in order to have a consistent approach to planning, implementation, monitoring and reporting. This will also need to satisfy all organisational and individual accountabilities within MCC and MCCG. Within the operational plan there will be a common approach to delivering and planning savings proposals, through a Financial Sustainability Plan (FSP). The group s work will focus on the develop of strategic commissioning as defined in the following interconnected documents - Strategic commissioning work programme covering design, functions, performance, contracting, finance and quality and safeguarding - Strategic commissioning framework - Strategic intentions - Models of delivery including toolkits for commissioning 5.0 Performance Management Framework Work has been ongoing to develop fully the suite of performance indicators which monitors outcomes, which enables us to focus on areas of future development and take relevant actions in areas of concern. 3

4 Below is the ASC dashboard showing the 3 core areas behind this however sets a lot suite of data intelligence which is broken down into targets and is compared against regional and national performances with each manager given an accountable role to deliver. This is monitored through the health and social care commissioning group. 6.0 Recommendations To note the contents of the report To agree frequency of updates To agree areas would like to receive reports on in the future. 4

5 Appendix A Social Care Reform OD and Culture Change Programme: Activators Group 32 Volunteers Managers Empowerment Programme Full Staff Workshops ASC Online Community Social Care Reform OD & Culture Change Programme Strengths- based development Leadership Offer Welfare Programme Workforce Strategy Involvement in LCO OD Programme - Values & 5

6 1. Context and Drivers: 1.1 Our Manchester The Our Manchester strategy sets out the vision for Manchester to be in the top flight of world-class cities by It describes the transformation that the city has undergone resulting in more jobs, improved housing and public transport, stronger international connections, expanding and improving schools and investment and development in science and research. It also acknowledges the real challenges the city faces, to ensure that all our residents can benefit from these opportunities. Poor physical and mental health remains a critical issue, with Manchester having some of the worst health and wellbeing outcomes in the country. This is both underpinned and compounded by multiple disadvantage and poverty in many parts of the city which drive inequalities. The strategy states the intent to radically change health outcomes over the next decade - with a focus on preventing illness, transforming care and unlocking the potential within communities. This is described and the progressive and equitable theme of the Our Manchester Strategy. In recognition that a radically different approach to delivery public services was required to deliver the ambitions of the strategy, the Our Manchester approach was co-designed with a wide range of stakeholders. This set of principles and behaviours represent a significant change to the way Manchester s public services will work with residents, partners and the workforce to deliver the Our Manchester Strategy. The four basic principles of Our Manchester are: Better Lives - it s about people Listening - we listen, learn and respond Recognising strengths of individuals and communities - we start from strengths Working together - we build relationships and create conversations 1.2 Health and Social Care Integration: Healthier Together is Manchester s strategy for health and social care integration. People in Manchester have poor health and care outcomes averaging 8.5 years lower life expectancy. The current system is fragmented and siloed, there are pockets of integration evident but not at scale or pace across the City and a 150m budget gap is projected across health and social care over the next 10 years. Healthier Together sets out our vision: 6

7 We want people to have equal access to health and social care services, and receive safe, effective and compassionate care, closer to their homes. We want people to live healthy, independent, fulfilling lives and be part of a dynamic, thriving and supportive community. We want Manchester to be the best it can be where the people have the same opportunities and life chances, no matter where they're born or live. We will invest to develop a confident, engaged, integrated workforce driven by its passion and values and equipped and enabled to innovate and make reform happen. A Healthier Manchester embodies the Our Manchester approach. It describes: A stronger emphasis on prevention and enabling self-care with people, as active partners in their health and well-being A strengths based approach to assessment that focuses on what matters to the person The development of and connection to assets in communities that support people s health and wellbeing Our Manchester is a long-term strategy requiring behaviour and culture change at a significant scale. Health and care services that truly work across traditional organisational boundaries and develop a different relationship with local communities and the VCSE sector are critical to the success of A Healthier Manchester. Less risk averse, more innovative new ways of working will be needed at all levels of the workforce which will require different leadership, management and supervision. We aspire to build a progressive social care model in Manchester run by staff who are empowered, skilled and competent in ensuring a strong social care voice within the wider health and social care system. 2. Behavioural and Cultural Baselining: Between October and December 2018, significant engagement activity has been carried out with staff from Adults Social Care which provides a strong baseline of information and intelligence to inform the OD and Culture Change Programme. This activity comprised 3 key mechanisms: 7

8 - Significant programme of staff engagement for all staff with more focused sessions held for adults social workers, PAT and LD officers. 332 staff participated in these events. - The annual BHeard survey which attracted a response rate of 37% - CQC Review The key headline findings from this activity were: Big operational challenges to address Low level awareness and understanding of Our Manchester Need to strengthen Leadership Integration isn t the issue - staff are generally positive and enthusiastic about integration, they just want to understand more Need for progressive model of social work and development opportunities for staff to enable transformation of existing services Underpinning these headlines are some fundamental culture and behavioural issues which it is essential to address if we are to achieve our aspirations for a strong, confident and progressive social care workforce. These include: Staff articulate with passion why they came into the profession, strong shared values and sense of common purpose evident. This is a fantastic base to build from. Culture of learned helplessness - staff can clearly and passionately describe the issues and challenges that are getting in the way of them doing an even better job but there is little evidence of people feeling able to, and understanding how to, address these issues and challenges Variable understanding and buy-in to a strengths-based approach - a really mixed picture, some staff feel they are already working in this way, others feel that moving to a strengths-based approach will deskill them. A strong narrative and thread between Our Manchester, Care Act requirements for strengths-based working, social work standards and operational practice is lacking. Strong inward-focused and silo mindset exists in parts of the Directorate and staff require support to understand how to work in a whole systems way, how to connect and build relationships and maximise influence with colleagues from other parts of the system Low morale and high stress levels are evident in parts of the Directorate. Of particular concern is the lack of investment in staff development, CPD and opportunities for progression which has resulted in staff feeling undervalued and unable to reach their potential. There are a good number of staff who are positive and enthusiastic about planned changes and are keen to get involved and help to shape how we work in the future. 3. What are we trying to achieve? 8

9 Having set out our current baseline and some of the behavioural and cultural issues, it is important to articulate where we aspire to be culturally and behaviourally as an adults social care workforce. Equally, it is important that staff are involved in articulating and developing our new culture and this will be enabled through the OD programme. The following set of principles underpins the OD strategy: Our Manchester Underpins everything we do We build from the passion and common purpose uniting staff We do with and not to at all levels within the Directorate Success and sustainability is dependent upon strong service leadership Mechanisms to engage staff in shaping, driving, creating change to be maximised Operational issues have to be addressed as a priority to enable people to engage with reform 4. OD Strategy: The initial scope of the strategy is adults social workers, Primary Assessment, LD and citywide services as these are the services most directly impacted by the social care reform programme and LCO implementation. It is envisaged that the scope will be expanded over time. It is important to acknowledge that the LCO will develop its own OD strategy which will incorporate the same group of staff. There is close joint working between the social care OD lead and the LCO OD leads to ensure synergy. The focus of the LCO strategy for the next 12 month is establishing the LCO values, induction/onboarding and appraisal, and integrated neighbourhood management. The primary focus of this ASC OD strategy is culture and behaviour change for adults social care staff. This will be a time limited programme of activity to prepare staff to transition to the LCO and to build a strong, confident and progressive social care voice within the LCO. It is envisaged that over time, there will be a single integrated OD strategy however, at this point in the evolution of the LCO there is not the capacity for a distinct focus on adults social care OD so it is important that this is progressed internally whilst ensuring that the right connections are in place. 9

10 The OD Strategy comprises 8 interconnected elements. Each of the elements is explained within this strategy. Detailed design and implementation plans will be developed for each of part of the strategy and it will be important to understand the impact of the different components as well as the overall collective impact on culture change. 4.1 Activators Group Activators Group 32 Volunteers What is it? These are our 32 staff volunteers who have stepped up and committed to get involved in taking forward the changes. Whilst they have expressed an interest in particular areas, we want to cultivate them as a group of activators who will act as peer influencers on a day to day basis. This group will evolve and grow over time as trust levels grow and staff see there are genuine opportunities to get involved and help to shape future ways of working Why are we doing it? To encourage and empower staff to adopt Our Manchester behaviours To signal change and a new way of working with staff To distribute leadership and influence To prepare people for the transition to the LCO To ensure connectivity between the people leading change and those charged with making it happen To disrupt more traditional and hierarchical methods of implementing change, communicating and engaging with staff and seeking feedback on what s working and what s not To provide opportunities for personal development 10

11 How will we do it? Initial Activators conference - to get activators on board, explain our proposals, make our offer, get to know each other better, agree how we want to work together. Develop an offer in recognition of the work that Activators do eg. early access to Our Manchester experience, opportunities to be involved in testing staff development programmes, public recognition of status of activators, involvement in design and delivery of full staff workshops, opportunities to get involved in areas of development, early notice where appropriate of key developments. Activators group will evolve as more people commit to get involved. We need to enable the group to grow organically whilst ensuring we capture who wants to be involved and ensure they have access to the activators offer. We will orchestrate the group behind the scenes providing co-ordination, information and support. We will bring the activators together regularly to work with us and will empower them with challenges and tasks to enable them to influence and do work with their peers. We will ensure there is synergy in the timing and focus of activity with the managers empowerment programme so that staff in services experience influence, challenge and support from their managers and their peers simultaneously. This group requires some protection. It is not a champions group to be used to communicate key messages and carry out tasks on behalf of managers. It is intended to be the start of a social movement of change agents who are empowered and equipped to get involved and influence change with their peers. The group also requires access to senior management support and sponsorship to remove barriers and blockers that are getting in the way of making change happen. 4.2 Managers Empowerment Programme 11

12 Managers Empowerment Programme What is it? It s a programme of development and culture change which is aimed at building the capacity of managers at all levels to drive culture and behavioural change. The programme will engage and empower managers giving them tools and techniques to work differently with their teams so that they are driving cultural and behavioural change with their staff. It will be informed by learning from the Children s Management Development programme that was delivered as part of the improvement journey. It is distinct and separate to the leadership offer which is more formal offer of learning and development activity. Why are we doing it? To encourage and empower managers to lead in an Our Manchester way To set the tone, to be clear about expectations To drive culture change with the managers across Adult s Services To distribute leadership To prepare managers for the transition to the LCO To empower and equip managers with the behaviours, skills and competencies to drive culture change with their teams To enable and encourage managers to think about what conditions for change need to be in place and how they will facilitate these To encourage managers to take responsibility for their own performance and development and that of their teams How will we do it? We will bring all managers together every c6 weeks Co-design and co-delivered with Service Leaders 12

13 Each themed session will include: - introductory input to get people talking, help people to shift to a different mode (come away from the day to day operational pressures and distractions) - Input on the substantive topic from Carolyn, Bernie or another senior manager - Interactive learning sessions - Tasks being set for managers to progress outside of the session with their own service or team which will help to drive culture change - Feedback from people to demonstrate they have taken responsibility for carrying out the set tasks, to share stories which capture learning and ideas, support each other and to encourage people to develop peer relationships and networks The sessions will focus on culture and behaviour changes needed to enable positive and effective transitioning to the LCO and integrated strengths-based working. Anticipated themes include: Introduction and Setting the tone, Translating Our Manchester Behaviours for Adults Social Care; Tools and Techniques to Influence with Confidence (team, peers, system); Creating the Conditions for Change- what are they and my role in creating them; Strengths-Based working; Working Together - how to work effectively within health and social care system; Review, Reflect, Share Learning and Move Forward. We will ensure there is synergy in the timing and focus of activity with the activators group so that staff in services experience influence, challenge and support from their managers and their peers simultaneously. 4.3 Adult Social care online Community ASC Online Community What is it? The Adult Social Care (ASC) online community is owned by community members and provides a tool for direct communication with and between Adults Social Care Staff, 13

14 beginning with the staff who are in scope for the staff engagement programme - social workers, PAT and LD staff. It is not intended to replace management communication but to complement it. It is intended to be the go to place where staff go for updates and information about the Adults Social Care Reform Programme and is a mechanism for staff to get involved, debate and discuss issues. It is intended to be fast-paced, current and importantly, a space owned by the community itself. Why do we have it? To enable staff to feel more informed and involved To encourage and enable staff to connect across teams and services To disrupt traditional hierarchical methods of communication To signal change To enable staff to take responsibility for keeping updated An opportunity to have a say and see it make a difference Ability to promote and be publicly recognised for things they or their teams are doing well Opportunity to ask questions and debate issues with colleagues How are we running it? Three key functions to maximise impact: Posting - proactive posting to draw people to the community, keep people informed, interested and excited about change, encourage staff to proactively post, key role for activators Engagement - interactive engagement - asking questions, seeking views, encouraging discussion and debate Observation of content will enable temperature checking of how staff are feeling, areas of challenge to inform OD activity. Guidance shared to support staff to get the most out of their membership and clarify expectations about appropriate usage Tone to be conversational, light and positive Essential that staff feel they have ownership and are allowed to discuss and debate challenging issues without management intervention and within guidelines of appropriate usage Anticipated to be a slow burner as staff develop trust and confidence in engaging in this way 14

15 Mobilisation plan essential for proactive posting and to draw people to the community 4.4 Full Service Workshops Full Staff Workshops What are they? Regular workshops that bring together staff from across teams, services and localities to reinforce the culture and behaviour change activity lead through activators, managers and the online community. Why will we have them? To complement, support and reinforce the activity of the activators, managers and online community to drive culture and behaviour change. To complement and support the whole Directorate engagement sessions run by the Strategic Director To co-create the overarching behaviours, principles and ways of working that will underpin local culture change activity To encourage holistic culture change with teams and services having the opportunity to come together, connect, share stories and experiences with a whole-service focus To ensure that locally driven change fits with the strategic direction for Adults Services and to enable consistency of approach (what, not how) To ensure staff receive key messages and information in a consistent way with senior leadership sponsorship To prepare people to transition to LCO To bring together in one place, and give visibility to, the range of activity that staff are involved in shaping and influencing 15

16 To share learning, to build relationships and networks To understand what is getting in the way of change that can t be resolved locally and agree how to remove barriers How will we run them? To take place a minimum of 4 times per year. Sessions will repeat across localities to encourage maximum attendance Sessions will be co-designed and co-delivered by the service and OD colleagues We will encourage activators and middle managers in particular to get involved in the design and delivery of sessions An overarching programme will be developed with flexibility maintained to enable the focus of the sessions to incorporate themes and issues as things arise 4.5 Strengths-Based Development Programme Strengths- based development What is it? A programme of development to equip staff with the mindset, behaviours and skills to work in a strengths-based Our Manchester way. The programme will be designed to have a wider reach than adults social care and will be designed for staff from across health and social care and the wider Manchester system to access. Why will we have it? 16

17 To enable the Manchester workforce to work in an Our Manchester, strengths-based way To focus managers and leaders on enabling people to work in an Our Manchester way, including removing barriers and blockages that get in the way and exerting influence on different parts of the system To bring together the best of what we have available through the range of current programmes and build on this to design a programme that is bespoke for Manchester To ensure members of the Manchester workforce have the opportunity for common learning experiences To provide clarity for staff about what they should access to support them to work in an Our Manchester way How will we run it? As a modular programme with generic elements for everyone and more specific modules that people will access depending on the role they are in. Subject to co-design so detail will emerge 4.6 Welfare Programme Welfare Programme What is it? A commissioned programme to support staff to be resilient through change and to learn strategies for managing stress and maintaining positive health and well-being. Why do we have them: 17

18 To recognise that some staff are telling us they feel stressed by their work and are struggling with not having definitive answers about how the changes will impact on them To invest in our workforce and send a strong message that their well-being matters to us To give staff strategies and tools that will help them to manage their own health and well-being To acknowledge that different people cope with change differently and that for some, the scale and scope of change and the uncertainty that creates for individuals creates anxiety or stress. How we are running it: We have commissioned MIND to run the bite-sized sessions that were designed to support MHCC staff during transition to the new arrangements and was wellreceived with positive feedback Four bite sized sessions lasting an hour and a half, each delivered as close as possible to people s work base. People can opt to access them all or pick and mix. The focus of the four sessions are: Finding a Healthy Balance: stress management and relaxation Techniques for Balanced thinking: Mood and stress management. Cognitive Behavioural techniques. Mindfulness Managing thoughts about the future: managing worry and anxiety One full programme per locality commissioned to run Jan - March with option to commission additional sessions dependant upon take up. 18

19 4.7 Leadership Offer Leadership Offer What is it? A leadership development programme which equips managers with leadership skills and behaviours to effectively fulfil the expectations of their role. Why we will have it: The engagement activity carried out highlighted some leadership challenges within the services. The leadership offer gives leaders and managers at all levels the opportunity to access development opportunities and develop their skills and is part of the Council s commitment to develop our existing workforce. There is an existing corporate leadership offer available. To date, take up by managers within Adults Services has been low. Engagement activity has highlighted existing leaders and managers who are passionate, committed and have the potential to develop behaviours and skills and play a key role in the future of Adults Social Care for the future. How we will run it: Initial focus will be on ensuring all leaders and managers from across the Directorate access the corporate offer which is available to them. The component parts of the corporate offer are: Managers Induction - new to the organisation or new to the role (half day) Our Manchester Leadership Programme - for managers above grade 9. Programme aims to equip senior managers with approaches, tools and techniques to lead in an Our Manchester way and includes modules on being comfortable with chaos, strategic influence, strengths-based leadership, leading from place, creativity and innovation. 19

20 Raising the Bar - for managers up to grade 9. Programme focuses on what it means to manage in an Our Manchester way and includes modules on strengths-based management, developing, motivating and empowering others and people management Our Manchester Experience - an interactive experience aimed at enabling staff to fully understand the Our Manchester approach, what it means for them and how to drive it forward. Over and above this standard offer, there is a brochure of leadership and management development programmes that are available and can be accessed. We will ensure that About You conversations are taking place and that managers are enabled to access the right support to meet identified need. Examples of additional programmes available include: people and resource management courses, technical development, presentation, commercial and political awareness skills. Performance Management Training - as part of the Children s Services improvement journey a day-long performance management training module was developed for service managers to support them to build their confidence, knowledge and skills in managing staff. The session aims to develop managers understanding of the role of effective performance management, understanding the difference between capability and conduct issues and how to manage them both and their responsibilities in relation to performance management and developing confidence in managing performance. Feedback from managers was very positive and similar sessions could be run for Adults Services managers. 4.8 Workforce Strategy Workforce Strategy What is it? A strategy which brings together in one place our aspirations, priorities and plans for developing our adult social care workforce, ensuring they have the skills, opportunities and conditions to act as a strong social care voice within the LCO, deliver the highest quality of professional standards and develop new skills and ways of working to underpin new delivery models. 20

21 Why we will have it: Lack of access to learning, development and progression came through as one of the strongest themes from our engagement activity We recognise the passion and strengths of our workforce and are committed to ensuring they have access to development and progression opportunities so that we can retain our valuable resource within the city To meet our aspiration of ensuring a strong professional social care voice within new health and social care integrated arrangements To revisit and reconnect staff with social care professional standards and expectations and equip them with the knowledge, skills and tools to work to them. To equip staff with tools, techniques and skills to work in an Our Manchester way As we introduce new delivery models and new ways of working, we must enable staff to understand them and how to work within them To maximise apprenticeship opportunities within adults social care How we will develop it: Opportunity for strong staff involvement in shaping the strategy through online community and other mechanisms which will be developed Will learn from national and local best practice Aligns to career pathways - including opportunities for progression to and from roles within the health sector Will encapsulate Manchester s offer to its employed social care workforce acting as a key enabler to the recruitment and retention of highly committed, passionate and skilled staff Developing clarity about apprenticeship opportunities and how to maximise them to maximise the benefit to both current employees and local residents Connect to commissioning strategy for the independent sector, seeking to engage the sector in identifying opportunities for joint working, particularly in relation to apprenticeships By looking ahead and understanding the workforce requirements of new care models and new ways of working and being proactive in enabling staff to develop what is needed to work within them Seek to balance quick wins to build staff confidence and demonstrate commitment with longer term developments which future proofs adults social care for the future 4.9 Involvement in LCO OD Programme 21

22 Involvement in LCO OD Programme - Values & Onboarding What is it? As explained at the beginning of this section, the LCO will develop an OD programme which over time will reach all staff working within these arrangements. It is important that we achieve the right balance, ensuring a robust focus on securing a strong and confident professional social care workforce whilst simultaneously working together to design and take forward the LCO OD programme. This will ensure that there is synergy in the shorter term and that in the longer term, the two strategies merge into a single OD programme when the time is right. Why we will do it: To ensure synergy across the adults social care and LCO OD programmes so that any development and support is complementary and lines up with LCO and MCC priorities To ensure that whilst the LCO stands up and evolves, there is a strong focus on adults social care until such a time that the LCO is at a mature enough stage of development to give focused attention to ASC OD To enable two-way influence between ASC and LCO OD programmes To ensure that when the time is right, the two OD programmes can be brought together without undoing any positive developments How we are doing it: ASC and LCO OD leads co-located for part of the working week and proactively working together Weekly meetings of OD staff from across MCC and LCO to ensure synergy and joint work 22

23 Ensuring ASC staff have the opportunity to shape LCO values and other OD developments 23