Learning from mistakes: reflective learning in social work

No one likes to talk about their own mistakes. They are an inevitable part of the human condition, highlight our flaws, inabilities and limitations and can place a spotlight on what happens when resources and people are stretched too thinly.

In certain professions, including frontline social work, mistakes – however innocent or unintentional – can have potentially life-changing effects for service users. Keeping them to a minimum is of paramount importance. And it’s important that if mistakes have been made that they are not only rectified but also analysed to consider what went wrong, and what can be done to avoid the same thing happening again. For social workers the stakes could not be much higher – people’s lives are in the balance. So how can social workers not only recognise, reduce and rectify mistakes, but also use them as learning opportunities to improve performance and decision making in the future?

Making the most of our mistakes

It is important that practitioners and their managers know which strategies are most effective for them and their team when it comes to extracting valuable insight from mistakes. This only comes from having a strong and secure working relationship, where people feel able to talk openly and reveal insecurities and inadequacies, as well as recognising the positives within their practice.

Working out the correct strategies for each occasion and for each team member will take time. However, some tools and strategies include:

  • learning how to generate effective questions to explore not only how a mistake happened, but why and what steps can be taken to prevent it from happening in the future
  • adopting a strengths-based approach, rather than a deficit-based approach to staff and any mistakes they made
  • reflective frameworks that can be formally incorporated into everyday practice
  • encouraging staff to find a “critical friend” to offer an external perspective and extend personal reflective capacity
  • encouraging staff to take up reflective writing (in everyday life, not just at work) including journals and diary entries
  • training staff on creative models of reflection and on how to give and receive constructive feedback
  • finding ways to feed back to an entire organisation regarding the lessons learned from mistakes and how they can shape practice in the future.

The reflective cycle

One of the traditional models of reflection for social workers is Gibbs’ cycle of reflection (1988).

Among social workers, reflective practice is often promoted. Personal experience and participation should be seen as a positive and an opportunity to develop new skills, learning or approaches. Reflection should be focused on professional errors, asking questions like “why”; “what went wrong”; and “what did I do wrong.”

Reflection can happen at three levels:

  • personal
  • one-to-one with another person (a supervisor, colleague or family member)
  • in groups (at organisational level)

It can be useful to reflect at all levels, where possible, in order to get the most out of the experience and have the biggest impact with regard to what can be learnt from mistakes and how this can be passed to others to avoid them making the same ones.

Taking and giving constructive feedback

Although it may be uncomfortable at the time, social workers and people from other professions should welcome feedback from colleagues and service users as they can be powerful sources to drive professional growth. However, it is important to distinguish constructive feedback from blame. Highlighting helpful advice and using it in a constructive way is not the same as finger pointing and fault picking, and managers must develop the ability to distinguish between the two.

Final thoughts

Mistakes happen, and although we don’t like to talk about them, they can sometimes provide some of the most useful insight for learning and improvement within an organisation. Beyond the organisational level, personal reflection on practice and taking time to consider how you approach certain situations is a vital aspect of the self-aware, continual improvement that social workers must strive towards, even if they don’t always meet the exacting standards all of the time.


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Zero suicide cities: learning from Detroit in the UK

Suicide is the biggest killer of men under the age of 45. Yet people still experience stigma when seeking help for mental illness, despite high-profile discussions of mental health issues such as those by members of the royal family and sportspeople. And a report into the Government’s suicide prevention strategy in March 2017, suggested that although 95% of local authorities now have a suicide prevention plan, there is little or no information about the quality of those plans, or whether adequate funding is available to implement them.

The lack of progress made on improving suicide and general mental health provision has led to a growing frustration among professionals and resulted in attempts to create new approaches to tackle mental health issues, and in particular to improve access to support for people in crisis or at risk of suicide.

The idea of a “zero suicide city” was first adopted in Detroit in the late 2000’s, with others following its lead in subsequent years. With reports finding that around 14 Londoners a week took their own life in 2015 (735 in total), an increase of a third from the 2014 statistics, a report in February 2017 by the London Assembly Health Committee suggested that London too should take this approach.

So what can London, and other areas of the UK, learn from Detroit’s approach? And how can services act to reduce the number of people taking their own lives?

Zero-suicide cities

Poverty and high unemployment in Detroit are contributing factors to high levels of depression among city residents. As a result of these high rates of depression and very high suicide statistics, Detroit-based mental health professionals adopted a new approach to tackle the stigma around mental illness and use identifiers to highlight cases of crisis, or potential crisis. The focus is on preventative care, encouraging professionals to act upon signs of mental illness before a suicide or attempted suicide takes place.

Patients attending health clinics for other illnesses, including diabetes or heart failure, are also now screened for depression and other mental health issues before they are released. This allows people deemed to be ‘at risk’ to be identified as soon as they come into contact with medical professionals, who can then refer the patient to a mental health specialist if needed, rather than reacting to mental illness once it reaches crisis point.

In order to support this approach, a centralised IT system was created which means results are traceable, and surveys and information are standardised so they can be used and accessed across clinics throughout Detroit. Coordination with non-medical practitioners, including social workers, employers and family members, has also been key in identifying people at risk and signposting them to help at every possible opportunity. There has also been additional training for staff to improve recognition of identifying factors. Patients can email their clinicians or liaising staff directly and attend regular drop-in appointments. Up to 12,000 patients using mental health facilities are tracked each year in the city and some statistics suggest that the clinics reduced suicides by over 80%.

There have been some criticisms of the system however, despite the reduction in the number of suicides in the city. Critics highlight the fact that many of the poorest and most severely in need of help are not reached as they do not have health insurance and so do not attend those clinics involved in the scheme.

Ultimately, however, the scheme seeks to provide better preventative, coordinated and targeted care to those who are at risk or show some signs of mental health crisis. And some in the UK have suggested there are lessons that could be learned from this approach.

Whole system approach to suicide prevention in the East of England

Four local areas in the East of England (Bedfordshire, Cambridgeshire & Peterborough, Essex and Hertfordshire) were selected in 2013 as pathfinder sites to develop new approaches to suicide prevention based in part on the Detroit model.

Since then, Mersey Care, Cambridge and Peterborough Clinical Commissioning Group and Teesside councils have also become aligned with the programme and are continuing with their approach towards improved suicide prevention. The Centre for Mental Health evaluated the work of some of the sites during 2015.

The evaluation found there were a range of activities that had taken suicide prevention activities out into local communities. They included:

  • training key public service staff such as GPs, police officers, teachers and housing officers
  • training others who may encounter someone at risk of taking their own life, such as pub landlords, coroners, private security staff, faith groups and gym workers
  • creating ‘community champions’ to put local people in control of activities relating to promoting positive mental health and signposting to help services
  • putting in place practical suicide prevention measures in ‘hot spots’ such as bridges and railways
  • working with local newspapers, radio and social media to raise awareness in the wider community
  • supporting safety planning for people at risk of suicide, involving families and carers throughout the process
  • linking with local crisis services to ensure people get speedy access to evidence-based treatments.

However, subsequent research also highlighted some of the challenges. The marketing of the pilots was seen to be damaging and misleading with regards to creating “zero suicide areas”, rather than suicide prevention areas. It has also been suggested that although the campaigns serve to raise publicity and awareness, there is little evidence that the schemes actually reduce the number of suicides in an area any more than “traditional campaigns” to better signpost people to available support.

In addition, many of the projects struggled past the initial implementation stage to have long-term impact, as the buy-in from local GPs and other service professionals was not as high as was expected.

Final thoughts

Widening and improving access to support and services for people at risk of mental ill health or suicide is a big challenge for health and social care professionals. Identifying those people at risk is one of the key barriers and taking inspiration from schemes like those trialled in Detroit is one way for professionals in the UK to adapt their approaches in order to overcome these barriers.

Providing more opportunities for people to get help, and better training for professionals who may come into contact with people with mental illness are some of the ways that current schemes are trying to address mental health and suicide in particular.

However, as many of the evaluative studies from test sites in the UK have found, going beyond that to take mental health into the community, in order to create whole system pathways of care across multiple settings and professions, remains a challenge.

As the London Assembly report pointed out, another key aspect is creating an open environment for people to talk about how they are feeling. This week is Mental Health Awareness Week 2017 and the theme is ‘surviving to thriving’ – and emphasising that good mental health is more than the absence of a mental health problem. Whether in the workplace or in the home; with friends, family or colleagues; it’s important that everyone feels that they have a space where they can talk, and to cultivate resilience and good mental health.


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Who am I? The importance of life story books for looked after children

paper family on hand

By Heather Cameron

Every adopted child in the UK should have a life story book – an account of a child’s life in words, pictures and documents containing information on the child’s birth family, care placements and reasons for their adoption – which is given to them and their new family when preparing for a permanent placement.

Local authorities have a statutory duty to create life story books for all adopted children, providing them with a sense of identity and understanding of their early life before adoption. They are a well-established practice in the UK and most local authorities provide guidance on preparing them.

However, research has found that the quality of life story books varies hugely.

Variation in quality

The research, conducted by the Voluntary Adoption Agency, Coram, in collaboration with the University of Bristol, focused on adopters’ perspectives on their children’s life storybooks, which it identified as lacking from the academic literature.

Although adopters welcomed the idea of life story books, they were critical of their execution. And despite accounts of positive experiences, there was a broad consensus that:

  • many books were of poor quality;
  • children had been poorly prepared to explore their histories;
  • adoption professionals and agencies did not seem to prioritise life storybooks; and
  • adopters felt poorly prepared in how to use and update life storybooks with their children.

While 40% of adoptive parents said their books were ‘good’ or ‘excellent’, a third said they were ‘terrible’.

Issues were raised around lack of communication, opportunity to provide input and what was included in the books. One adopter said “We did not have the opportunity to discuss but what I would have said was this is rubbish – all of it is rubbish”. Another said “I can never show my daughter hers because there is stuff in there that I don’t ever what her to see”.

Another theme to emerge was an excessive focus on the birth family, foster family or social worker rather than the child, and the use of inappropriate language.

For those who regarded their books in a positive light, they believed the story was told well, was age appropriate and honest, and didn’t construct a ‘fairy tale’ that would give the child an unrealistic view.

Invaluable

For adopted children, life story books can be key to providing details of their history and background, providing continuity in their life histories and preparing them for a permanent placement.

Often, they are the only thing an adopted child has by way of personal, accurate and detailed information on their past. As one mother commented on the importance of birth photos, “It’s all they have left of their own babyhood”.

Done well, they can be invaluable, as described by one adopter:

‘a good quality life storybook builds a bridge back to that huge part of her that we didn’t see and it is her main link to her past’

It has therefore been argued that life story work should be prioritised and appropriate support provided.

Ingredients for success

Coram’s research highlighted several key things for successful life story work; one being having staff dedicated to life story work.

Bournemouth has been highlighted as an example of good practice for their life story work. Their separate adoption department appointed a dedicated family support practitioner to take on responsibility for the life story books for children adopted in Bournemouth.

In 2012, the council received an ‘outstanding’ rating by Ofsted and was named as joint adoption service of the year.

Also highlighted by the research, was that gaps in the narrative were not helpful, and support for adopters is paramount, as is training for social workers.

To improve the quality of life story work across the board, Coram’s report urges adoption agencies to make considerably better use of life story books and invest in improved training for professionals, while monitoring the quality of books produced and providing better access to support and guidance for adopters to engage in such important work with their children over time.

Bournemouth illustrates the importance of doing life story work well. And as the research concludes, “linking a child’s past and present is crucial ‘bridging’ work in enabling permanence in placements”.


If you enjoyed reading this, you may also like our previous articles on kinship carers and the value of foster care.

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World Social Work Day: promoting community and environmental sustainability

Tomorrow is World Social Work Day (WSWD), and this year the focus is on community sustainability. The theme is inspired by the third pillar of the Global Agenda for Social Work, which was created in 2010 to integrate the aims and aspirations of social workers across the world. It stresses the important role of social workers in prompting sustainable communities and environmentally sensitive development.

This includes:

  • working closely with other partner agencies – including those beyond social work – to create communities of practice, particularly in relation to environmental sustainability;
  • promoting community capacity building, through environmentally friendly and sustainable projects, where possible; and
  • responding to environmental challenges, including helping communities to be resilient to and recover from environmental and natural disasters, as well as in relation to “human disasters” which includes refugee families fleeing persecution or war.

But how does this play out in everyday practice?

Supporting integration

Across the world, social workers are being asked to address ‘human disasters’ as they seek to support and integrate refugee families fleeing persecution and war in conflict zones. Some of the biggest challenges for social workers today relate to refugee and displaced communities. As well as dealing with the effects of trauma, they also help integrate refugees successfully into existing communities and build bridges with others to promote cohesion, reduce tensions and help them make positive contributions to society. Social workers also have a responsibility to encourage all members of the community to help with this support and integration process.

However, in a UK context, supporting people to make positive contributions to their community is not limited to refugee families. It also relates to intergenerational work, valuing the experience of older people, developing the skills of vulnerable adults, or encouraging children to feel connected to a place and community so that they might better take care of it as they grow up.

Supporting sustainability

The role of social workers in supporting the sustainability agenda may not be so obvious. The ability of social workers to adapt and respond to the needs of communities which are experiencing environmental sustainability issues is of growing importance in developing countries. However, social workers in the UK can still contribute to this element of the global social work agenda.

This includes behaving in a way that recognises the need to protect and enhance the natural environment. In practice, this may mean social work departments having policies on going paperless where possible, recycling in offices, and reducing the use of cars, or car sharing (for frontline social workers, however, this is often impractical).

Social work practice can also consider how it supports sustainable social development outcomes within a community, and maintaining personal CPD, education and training levels to reflect this. There should also, as always, be an attempt to share best practice and learn from others.

Final thoughts

This World Social Work Day, let’s take a moment to reflect on the positive contributions that social work professionals are making to their communities as well as to the lives of individuals. It’s also a chance to consider what the future might hold for the profession and how it can continue to promote and support the growth and development of sustainable communities.


If you would like to follow the events going on to mark World Social Work Day or, share any of your own stories you can do so on twitter using the hashtag #WSWD17.

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Helping people with dementia to live well through good urban design

Earlier this year, the Royal Town Planning Institute (RTPI) published their first practice note on how good planning can play a stronger role in the creation of better environments for people living with dementia.

It summarises good practice guidance from Oxford Brookes University, the Alzheimer’s Society and the Scottish Government, among others.

Living with dementia

According to the Alzheimer’s Society, there are currently around 850,000 people living with some form of dementia in the UK.  Although the risk of developing dementia increases with age, it is not just a disease of the elderly.  There are currently around 40,000 people with dementia in the UK under the age of 65.

The vast majority of cases of dementia cannot be cured. However, there is a lot that can be done to enable someone with dementia to live well with the condition. Many people with dementia can continue lead active, healthy lives for years after diagnosis.  Even most elderly people with mild to moderate dementia can continue to live in their own homes.

The importance of good urban design

Evidence has shown that well-planned, enabling environments can have a substantial impact on the quality of life of someone living with dementia and their ability to retain their independence for longer.

For example, being within easy walking distance of shops and other local amenities can help people with dementia to remain physically active and encourages social interaction.

Having access to green space and nature also has particular benefits, including better mood, memory and communication and improved concentration.

Key characteristics of a dementia-friendly environment

Drawing on the principles set out in ‘Neighbourhoods for Life’, the RTPI advises that urban environments should be:

  • Familiar – functions of places and buildings made obvious, any changes are small scale and incremental;
  • Legible – a hierarchy of street types, which are short and fairly narrow. Clear signage;
  • Distinctive – including a variety of landmarks and a variety of practical features, e.g. trees and street furniture;
  • Accessible – access to amenities such as shops, doctor’s, post offices and banks within easy, safe and comfortable walking distances (5-10 minutes). Obvious, easy to use entrances that conform to disabled access regulations;
  • Comfortable – open space is well defined with public toilets, seating, shelter and good lighting. Background and traffic noise minimised through planting and fencing. Minimal street clutter;
  • Safe – wide, flat and non-slip footpaths, avoid creating dark shadows or bright glare.

Dementia-friendly communities

In addition to specific guidance on how to improve the urban environment, the RTPI practice note also highlights the crucial role of planners in the creation of ‘Dementia Friendly Communities’.

This is a recognition process, which publicly acknowledges communities for their work towards becoming dementia friendly.  It aims to involve the entire community, from local authorities and health boards to local shops, in the creation of communities that support the needs of people with dementia.

There are 10 key areas of focus.  Those particularly relevant to planning include:

  • shaping communities around the needs and aspirations of people with dementia;
  • the provision of accessible community activities;
  • supporting people to live in their own home for longer;
  • the provision of consistent and reliable transport options; and
  • ensuring the physical environment is accessible and easy to navigate.

There are currently over 200 communities across the UK working towards recognition as dementia-friendly.  Dementia Friendly East Lothian and the Dementia Friendly Kirriemuir Project are two such examples.

Local government policy

By 2025, it is estimated that the number of people diagnosed with dementia will rise to over one million.  Significant under diagnosis means that the number of people who experience dementia may be even higher.

However, the RTPI report that at present few local authorities have made explicit reference to dementia in their adopted local plans.

Worcestershire County Council and Plymouth City Council are notable exceptions:

  • Plymouth have set out their ambition to become a ‘dementia friendly city’ in its current local plan; and
  • Worcestershire are currently developing a draft Planning for Health Supplementary Planning Document that covers age-friendly environments and dementia.

A beneficial environment for all

While these are important first steps towards the greater recognition of the role of planning in supporting people with dementia, it is imperative that planning explicitly for dementia becomes the rule, rather than the exception.

Not only will this benefit people with dementia and reduce healthcare costs, it may also benefit the wider community, including young families, people with disabilities, and older people.

As the RTPI rightly state, “environments that are easy for people to access, understand, use and enjoy are beneficial to everyone, not just older people with dementia.”


Girls with autism – a hidden issue?

Three young girls hanging upside down in a park and laughing

by Stacey Dingwall

At the end of last month, the National Association of Head Teachers (NAHT) held its Big Shout conference in London. The event gathered together school leaders, health and education experts, parents, carers and women on the autistic spectrum with the intention of raising awareness of the ‘underdiagnosis of thousands’ of girls with autism.

Gender difference in diagnosis

The National Autistic Society points to various studies that estimate the ratio of male/female autism diagnosis as being anywhere from 2:1 to 16:1. Last year, the National Association of Special Educational Needs (nasen) published a guide to supporting girls with autism spectrum conditions which states that the ratio is typically regarded as 4:1. The guide notes that this is an average figure, and that the ratio increases to 10:1 among intellectually able individuals with autism spectrum disorder (ASD), and shrinks to 2:1 for groups with ASD and moderate to severe learning disabilities.

Nasen suggests that this gender difference has only recently been questioned, and points to several possible explanations for the variation:

  • Gender bias in existing screening and referral processes, diagnostic criteria and tools
  • Protective and compensatory factors in females
  • Different gender-specific autism spectrum condition (ASC) profiles

Nasen points to research going back as far as 1944 which found that while the girls who took part in the research displayed signs that were “reminiscent of autism”, they were not as “fully formed” as those seen in the boys.

As noted by Francesca Happé of the MRC Social, Genetic and Developmental Psychiatry Centre at King’s College London, diagnostic systems, as well as research studies and stereotypes of ASD, are still based on the experiences of males to this day. Despite evidence which indicates differences between girls’ and boys’ social-communication skills – an important factor in the diagnosis of ASD – girls are being assessed using a system that is biased towards the opposite gender.

The only specialist state school in the UK

Limpsfield Grange school in Surrey is the only state school for girls with autism in the UK. Headteacher Sarah Wild believes that girls can often go undiagnosed due to their tendency towards ‘masking’. She suggests that autistic girls are often more interested in socialising and building relationships than their male peers, and learn to copy the behaviour of those around them from an early age as a coping strategy.

Nasen makes a similar point with regards to the topics that girls with autism can become obsessive about, which is often a neurological sign of autism. Girls’ special interests can tend to materialise in areas such as boybands, or looking after animals – interests that don’t seem out of the ‘ordinary’ for their age group. Boys, on the other hand, are more likely to focus on technical, niche topics that can make diagnosis more straightforward.

Sarah Wild is not a fan of the word ‘diagnosis’ when it comes to autism, which she thinks “makes it sound like cancer” or another illness. As opposed to US schools which focus on “curing”, Limpsfield Grange employs a ‘hybrid’ model that focuses on moving away from the medical model and towards the social integration model in place in Australia.

Taking action

As the only school of its kind in the UK, Limpsfield Grange recognises its important role in raising awareness of females with autism. The school has published two novels that follow the journey of an autistic girl called M, and made a documentary that was shown on ITV in 2015.

Speaking at the Big Shout, Professor Francesca Happé said that “Unless we change our male stereotypes of autism, and find out much more about female autism, girls will continue to miss out on the recognition and support in childhood that could have helped them to understand themselves and interact with others, to fulfil their potential.”

Her words were echoed by Professor Barry Carpenter, Chair of the Autism and Girls Forum, who said that action from politicians and researchers in this area was “desperately needed”.


Follow us on Twitter to see what developments in public and social policy are interesting our research team. If you found this article interesting, you may also like to read our other articles on children and young people.

Eating or heating: tackling fuel poverty in the UK

nastural gas flame

It is a complete scandal that people die because they can’t afford to heat their homes. ‘I, Daniel Blake’ shows the tragic circumstances and daily dilemma of ‘heating or eating’ faced by many thousands of people in Britain today.”

Those were the words of I, Daniel Blake lead actor Dave Johns as he backed a report published in November 2016 by the charity National Energy Action. The report, which looked at the health problems related to fuel poverty, claimed that a child born today may never see fuel poverty eradicated from the UK unless more assistance is given struggling families.

Identifying the “fuel poor”

In England, according to the most recent official government statistics, more than 2.3 million (10%) households are living in fuel poverty. Leeds, Birmingham, Manchester, Liverpool and Cornwall are among the places worst affected. At risk groups include single parent households with dependent children, rural households, and those living in the private rented sector. Research also highlights that those customers who use prepay meters, which include a large proportion of the most vulnerable customers, are more likely to be “fuel poor” as they do not have the flexible tariff options and reduced rate deals which are offered to customers who pay via direct debit.

The picture is not much better elsewhere in the UK. A report produced by the Scottish Fuel Poverty Strategic Working Group estimated that there are currently over 800,000 households (35%) living in fuel poverty, with levels as high as 50% in rural areas. Meanwhile, in Wales the latest estimates suggest that 23% of households are currently living in fuel poverty.

heater gauge

Tackling the causes of fuel poverty

Not being able to afford to heat your home, or having to choose between eating or heating is the stark choice many families in the UK are being forced to make, however it is clear that fuel poverty stems from a number of different factors, including the cost of fuel, the price of energy, and rising energy consumption habits.

The latest Scottish Government strategy on tackling fuel poverty suggests that four drivers of fuel poverty need to be tackled before fuel poverty can be eradicated. These are:

  • Raising incomes  8 out of 10 households (in Scotland) in income poverty are also fuel poor.
  • Making energy costs affordable  in many cases the cost of fuel is rising faster than household incomes.
  • Improving energy performance in housing  people living in a home with low energy performance are 3.5 times as likely to be suffering from fuel poverty as those in a home with high energy performance.
  • Changing habits of energy use  adopting energy-saving behaviours can make a significant difference to fuel bills by reducing overall demand. There is also a need to better understand and increase use of “green energy”.

But what about energy suppliers?

In December 2016, a report from Turn2Us suggested  that two million households suffer from fuel poverty. Subsequently, the “big six” energy suppliers met at Westminster to discuss what they could do to help tackle fuel poverty. At the moment, there is no legal requirement for energy companies to take action to reduce fuel poverty. However, they are coming under increasing pressure to help tackle fuel poverty, by reflecting some of their profit margins in the rates they give to customers. The idea of automatically putting vulnerable or “at risk” customers onto the lowest fuel tariff was discussed. However the bulk of the discussion, according to reports, concentrated on how to increase awareness of existing options, including the government-led Warm Home Discount, individual support grants, the Cold Weather Payment, and practical support from suppliers themselves.warm fire

Practical strategies to tackle fuel poverty

A number of schemes have been developed to try to help tackle fuel poverty, with national roll outs being supplemented by more localised programmes often funded by local authorities or charities.

In November 2016 the Scottish Government pledged an extra £10m to be spent on tackling fuel poverty. £9m was allocated for councils and housing associations to make it easier for tenants to heat their homes. A further £1m is to be made available to provide interest free loans to help people make their homes more energy efficient.

Other schemes have also been introduced by local authorities to try and tackle fuel poverty, including Ready to Switch? Launched in November 2012, Peterborough City Council’s collective switching scheme uses the combined buying power of residents and businesses within the community to negotiate cheaper prices with energy companies. According to figures from Peterborough Council, to date, hundreds of households have switched to save on gas and electricity, with some reducing annual bills by nearly £150.

Boilers on prescription (BoP) is a new funding stream which is being tested in a number of local authority areas, including Sunderland. The fund is managed through NHS Clinical Commissioning Groups, and householders at risk of cold related illnesses are referred for heating upgrades via health professionals. One of the main ideas behind BoP is to reduce a resident’s need for NHS interventions by improving their thermal comfort at home. It is hoped that a warmer, healthier home could reduce the number of GP appointments or emergency admissions.

Energie

 

Altering the design of new homes and subsidising the retrofitting of older ones is also a key policy strategy for tackling fuel poverty. Providing homes which are designed or adapted to be energy efficient through improved insulation, the installation of solar panels or using appropriate lighting or heating systems will allow the government not only to reduce fuel poverty in the present, but should also reduce the likelihood of more people falling into fuel poverty in the future. Reducing the demand for energy by creating homes which use less of it may also help to drive down the cost of energy, resulting in even bigger savings. However, it is not just the responsibility of individual homeowners to carry out these improvements. Local authorities, housing associations and private landlords also need to (and have in many instances) recognise the vital role they play, particularly in relation to more vulnerable customers who are at increased risk of falling into fuel poverty. Retrofitting has been increasingly popular in other parts of Europe, as these case study examples show.

The issue of fuel poverty in the UK does not appear to be going anywhere fast. Despite the attempts of governments across the UK to reduce the figure, in many areas the number of people falling into fuel poverty continues to rise. While there are individual areas of good practice aiming to help some of the UK’s most vulnerable families to heat their homes, it is clear that a wider commitment to combat the underlying causes of fuel poverty is needed, along with a recognition that there is a responsibility across the board to provide help and information to families suffering as a result of fuel poverty.


If you found this article interesting, you may also like to read our blog on the Dutch Energiesprong model and our research briefing on retrofitting (member access only).

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From data to intelligence and improvement – what cutting edge councils are doing in the UK

Group of workers having a meeting

By Steven McGinty

Data has the potential to revolutionise the delivery of local services. Just like the private sector – where organisations such as Amazon and Facebook have leveraged user data – local councils have the opportunity to reap significant benefits from analysing their vast silos of data. Improving efficiencies, increasing levels of transparency, and providing services which better meet people’s needs, are just some of the potential benefits.

Although many councils are still at the early stages of utilising their data, some are innovating and introducing successful data initiatives.

Wise Councils

In November 2016, the charity NESTA published a report highlighting the most ‘pioneering’ uses of data in local government. The report emphasised that most local services would benefit from data analysis and that a ‘problem-oriented’ approach is required to generate insights that have an impact on services. The case studies included:

Kent County Council

Kent County Council (KCC), alongside Kent’s seven Clinical Commissioning Groups (CCGs), have created the Kent Integrated Dataset (KID) – one of the largest health and care databases in the UK, covering the records of 1.5 million people. The core requirement of the dataset was to link data from multiple sources to a particular individual, i.e. that information held about a person in hospital, should also be linked to records held by other public bodies such as GPs or the police.

This integrated dataset has enabled the council to run sophisticated data analysis, helping them to evaluate the effectiveness of services and to inform decisions on where to locate services. For example, Kent’s Public Health team investigated the impact of home safety visits by Kent Fire and Rescue Service (KFRS) on attendances at accident and emergency services (A&E). The data suggested that home safety visits did not have a significant impact on an individual’s attendance at A&E.

Leeds City Council

Leeds City Council have focused their efforts on supporting open innovation – the concept that good ideas may come from outside an organisation. This involved the initiatives:

  • Data Mill North (DMN) – this collaborative project between the city council and private sector is the city’s open data portal (growing from 50 datasets in 2014 to over 300 data sets, in over 40 different organisations). To encourage a culture change, Leeds City Council introduced an ‘open by default’ policy in November 2015, requiring all employees to make data available to the public. A number of products have been developed from data published on DMN, including StreetWise.life, which provides local information online, such as hospital locations, road accidents, and incidents of crime.
  • Innovation Labs – the city has introduced a series of events that bring together local developers and ‘civic enthusiasts’ to tackle public policy problems. Leeds City Council has also provided funding, allowing some ideas to be developed into prototypes. For example, the waste innovation lab created the app, Leeds Bins, which informs residents which days their bins should be put out for collection.

Newcastle City Council

Newcastle City Council have taken a data-led approach to the redesign of their children’s services. The Family Insights Programme (FIP) used data analysis to better understand the demand and expenditure patterns in the children’s social care system. Its aim was to use this insight to support the redesign of services and to reduce the city’s high re-referrals and the number of children becoming looked-after.

The FIP uses data in three different ways:

  • Grouping families by need – The council have undertaken cluster analysis to identify common grouping of concerning behaviours, such as a child’s challenging behaviour or risk of physical abuse. When a child is referred to long term social work, senior social workers analyse the concerning behaviours of the case, and then make a referral to a specialist social work unit. Since introducing this data-led approach, social work units have been organised based on needs and concerning behaviours. This has resulted in social workers becoming specialists in supporting particular needs and behaviours, providing greater expertise in the management of cases.
  • Embedding data analysts – Each social work unit has an embedded data analyst, who works alongside social workers. Their role is to test what works, as well as providing insights into common patterns for families.
  • Enabling intelligent case management – Social workers have access to ChildSat, a tool which social workers use to help manage their cases. It also has the capability to monitor the performance of individual social work units.

Investing in data

Tom Symons, principal researcher in government innovation at Nesta, has suggested that councils need support from central government if they are to accelerate their use of data. He’s suggested that £4 million – just £1% of the Government Digital Service (GDS) budget – is spent on pilot schemes to embed data specialists into councils.

Mr Symons has also proposed that all combined authorities should develop Offices of Data Analytics, to support data analysis across counties. Over the past few months, Nesta has been working on this idea with the Greater London Authority, and a number of London boroughs, to tackle the problem of unlicensed HMOs (Houses in Multiple Occupation). Early insights highlight that data analytics could be used to show that new services would provide value for money.

Final thoughts  

After successive years of cuts, there has never been a greater need for adopting a data-led approach. Although there are undoubtedly challenges in using council data – including changing a culture where data sharing is not the norm, and data protection – the above examples highlight that overcoming these challenges is achievable, and that data analysis can be used to bring benefits to local councils.


Follow us on Twitter to see what developments in public and social policy are interesting our research team. If you found this article interesting, you may also like to read our other digital articles. 

Beating the back to work blues

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The first journey into work after the Christmas break has to be one of the most painful journeys of the year. Overfed, possibly hungover, still angry at that sly comment your distant relative made across the dinner table a week ago, you and many others return to work at the start of January with the glow of the next set of bank holidays seeming very far in the distance (FYI the next bank holiday is Good Friday on 14th April – yes, APRIL *sobs*).

It’s no surprise then, that January is the time of the year that sees the highest rates of divorce. This is the month heralding some of the highest stress rates of the year, and is the lowest point in the calendar for many people who face daily battles with mental health. A researcher at Cardiff University, Dr Cliff Arnall has even created a formula to work out that 24th January is the “most depressing day of the year”.

Mental health takes centre stage at work

It’s therefore apt that as many of us spend much of our time at work, there has been an increasing recognition of the role of employers in supporting mental health.

In October 2016, Business in the Community published its 2016 Mental Health at Work report, which included a toolkit for employers. The report highlights the damage that concealing their condition can do to people with mental health problems, as well as the level of support that should be made available to employees to help promote positive mental health and wellbeing in the workplace.

Recommendations made in the report include:

  • Talk – Organisations and employers should break the culture of silence that surrounds mental health, particularly in the workplace by talking the Time to change employers pledge
  • Train – Organisations and employers should invest in training to ensure basic mental health literacy for all employees in all areas of the business
  • Take action – Organisations and employers should “close the gap” by asking all staff about their experiences of their own mental health at work and how any issues have been dealt with. Understanding the perceptions that staff have of how the company supports mental health generally across the organisation, can help identify steps to improve/ change practice if necessary.

Employers role in removing stigma

Ensuring good mental health in the workplace affects all levels of staff, from senior management to the newest members of staff who are still training or serving a probationary period. Multiple reports, including those by ACAS, CIPD, MIND and The Work Foundation, have stressed the importance of employers setting an example to their staff. That includes senior staff recognising when they need to take time to support their mental wellbeing too.

The Chartered Institute of Personnel and Development’s (CIPD) Absence Management Report for 2013, showed that stress is one of the biggest causes of long-term absence in the workplace. The report also showed that it impacts staff at all levels:

  • 40% of respondents said that stress-related absence increased over the past year for the workforce as a whole
  • 20% said it increased for managers
  • 1 in 8 reported a rise for senior managers
  • Only 44% would feel confident enough to disclose unmanageable stress or mental health problems to their current employer or manager.

The report suggested that if senior managers acknowledged their own mental health issues, it would remove some of the stigma associated with asking for help with mental health in the workplace. However, doing this requires a significant culture shift in how many organisations are run – which could take years. The Work Foundation, commenting on the 2016 version of the CIPD report, found that:

“Effective management of mental health in the workplace can save around 30% of costs felt by employers.  Line managers have a really important role to play in creating an environment where employees feel safe to disclose with the knowledge that the organisation will do something to help them.  Managers need to have a positive employment relationship where open and honest conversations can be had to discuss any required adjustments and provide that supportive environment.”

Using “blue Monday” to initiate conversations on mental health

This year “Blue Monday” falls on the 16th January. It may be called the worst Monday of the year, but employers are being encouraged to use the publicity around it to create opportunities for employees to discuss mental health in the workplace.

Questions to ask could be: what makes them stressed, what makes them anxious, how can the office environment be changed to improve the wellbeing of employees? There are also ideas for activities to help staff “beat the blues”, including lunchtime exercise, healthy eating and talking to colleagues about things other than work.

Specific sectors have also begun to initiate schemes to try to improve mental health and well being. Mates in Mind is a programme to be launched in early 2017 by the Health in Construction Leadership Group with the support of the British Safety Council. Modelled on an Australian programme, it is a sector-wide programme intended to help improve and promote positive mental health across the construction industry in the UK.

In social work, too, informal peer mentoring schemes have sprung up organically in many offices, with co-workers giving each other support when they need it, often in an informal capacity. More formal schemes have been set up to help social workers monitor and feel safe when talking about their mental health to colleagues and superiors. Feedback indicates that the low rate of retention of social workers is, in part, due to stress caused by secondary trauma or excessive caseloads.

 

So, as we trudge back to our desks for the first working days after Christmas, it is perhaps worth keeping some of these ideas in mind. Employers are keen to talk about mental health, but they also need the input of staff in order for them to work.

Putting some of these ideas into practice, may also go some way to improving the situation of many with hidden mental health conditions in the workplace who don’t feel confident enough to speak openly about it. We needn’t wait for the next bank holiday to improve our mood, small changes can make a big difference to wellbeing in the workplace!


Follow us on Twitter to see what developments in public and social policy are interesting our research team. If you found this article interesting, you may also like to read our other workplace mental health articles: 

Managing mental ill health in the workplace

Ending the stigma around anxiety

Focusing on the end result: outcomes based commissioning in health and social care

In March 2016, the government announced that it was pairing up with the Blavatnik School of Government at the University of Oxford to create the Government Outcomes Lab (GOL). The aim of this partnership was to create a centre for excellence in commissioning research and practice – to find new and innovative ways for the public sector to commission projects, provide on the ground support to local commissioning teams and become a world class research centre on effective models of commissioning.

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Payment by service vs payment by results

Traditionally, governments contract third-party service providers on a ‘fee for service’ basis – so commissioners prescribe and pay for a particular service that they believe will lead to a desired outcome. More recently however, commissioning teams have started to introduce elements of ‘payment by results’ or ‘pay for success’ when commissioning services – so providers only get paid in full if they deliver the desired outcomes.

Social impact bonds

Social impact bonds (SIBs) are a tool to help outcomes-driven providers deliver on their projects, by giving them access to financing and management support from “socially-minded investors”. The idea being that this will broaden the pool of skilled providers, encourage smaller more locally based providers to tender for projects (who may have been reluctant to previously because of cost and lack of support) and, potentially, increase the chances of the service being successful.

One of the primary aims of the Government Outcomes Lab is to consolidate and promote as far as possible the use of social impact bonds to align social value based commissioning with commissioning for measurable outcomes – to promote a social value as well as an economic value in the way providers deliver on contracts. There are now 32 Social Impact Bonds across the UK, supporting beneficiaries in areas like youth unemployment, mental health and homelessness.

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Benefits and challenges to outcome based commissioning

While to many people it may seem almost impossible to question the principle of outcomes based commissioning (to move from a system focused on process measures and targets to a system that is focused on improving the outcomes that matters to citizens and patients) the reality for commissioning teams, providers and service users is, in some cases, very far removed from this ideal.

In April 2012, the Audit Commission published its guidance on Payment by Results (PbR). This generated fairly positive messages around PbR but also advised commissioners to be aware of the risks:

“At its best, PbR can deliver savings and bring in new resources at a time when budgets are under great pressure. It also defers costs to commissioners to allow time to realise the benefits of change and preventative work….. However, PbR carries extra risks to securing value for money and requires higher level commissioning skills than more traditional approaches”- Audit Commission (2012)

Much of the literature on outcomes based commissioning models emphasises the importance of:

  • transparency;
  • agreed objectives;
  • agreed measurable outcomes;
  • communication and clear definitions of accountability between commissioners;
  • any social investors or third sector bodies with input;
  • providers;
  • and any secondary providers who may be awarded subsequent sub contracts

A more comprehensive list of pros and cons to outcomes based commissioning can be found here.

One high-profile intitiative which has faced more challenges than it has produced benefits is the “troubled families” programme. which aimed to support families with long-standing problems. The programme was heavily criticised for its payment by number (number of clients processed) rather than payment by specific outcome. The issue here appeared to be the lack of definition of outcomes and what was going to be expected of the provider in terms of service before they could be paid.

In this instance the organisations delivering the “troubled families” programme in some areas were being paid for the number of people who went through the service, rather than the number of people who completed the programme successfully, or saw notable improvement as a direct result of the input of the programme, and without taking note of the professional view of the quality of the service being provided (which was considered in some areas to be poor). This resulted in providers being paid for a service which, while many people used, did not actually achieve the expected outcomes. This is something which future commissioning bodies must take note of and act upon to ensure that any future agreements do not contain such massive loopholes with regards to payment.

Outcome Flow Chart

Outcome Flow Chart via Roma Learning Leaders

Outcomes based commissioning in health and social care

A number of different policy areas have begun to use outcomes based commissioning models with varied success (although as we have seen this can be as much to do with the quality of the provider and the transparency of the contract as it is about the implementation of an outcomes based model). Rather than focusing on inputs (e.g. number of doctors) or outputs (e.g. number of operations conducted, or amount of drugs administered), these commissioning models are based on achieving specific, predefined and measurable ‘outcomes’ (e.g. improved health).

In a specific health and social care context, outcomes based commissioning can, if done well, form a key part of a wider prevention agenda, as well as helping to improve personalisation of services. In Wiltshire for example, the council has employed outcomes based commissioning techniques in relation to its domiciliary social care teams. This example shows that when the right providers are selected and clear outcome measures are defined, the impact for service users can be significant, in a positive way: there is a strong focus on getting the best possible result for the customer in the way that suits them; with every visit having a clear purpose and a focus on achieving greater independence for the older person wherever that is possible (which is the overall wider outcome the commissioning teams were hoping to achieve – greater independence of service users and less reliance on the social care teams in the long term).

Some specific challenges in a health and social care context include coordinating payment for outcomes with direct (or personal) payment schemes and agreeing on realistic and well defined outcomes and time frames with service users (which if done well can have a very positive impact on the personalisation agenda of services) Attributing outcomes specifically to one set of interventions in health and social care can also be difficult, particularly if a service user is in receipt of a number of different strands of care, for example, primary care and domiciliary social care as well as having access to some remote telehealth facilities.

Commissioning for long term outcomes

If the issue of defining or attributing outcomes is a challenge for outcomes based commissioners, then the issue of planning for long term outcomes is even more difficult. This approach requires commissioners to have a long term view of the strategic aims of a programme, as well as requiring them to consider any factors which may influence or change these aims, and additionally to consider the scope of need in the future if other preventative measures are successful.

Advice for councils

The LGiU and academics at Oxford Brookes University, as well as many others, have published guidance for local authority commissioning teams, giving them some direction in relation to best practice in outcomes based commissioning. Some of the key “pointers” for councillors include:

  • Take time to get the right set of providers in place to deliver the new model and collaborate with them to get the best possible system in place – be thorough in research and consideration of tenders.
  • Be very clear what the likely outcomes are that any specific service is being asked to deliver.
  • Make the payment mechanism as simple as possible. Consider whether any rewards will be paid for good performance in delivering outcomes. Consider if payments should be made on each individual outcome achieved or for outcomes for sub-sets of the population e.g. hospital discharges.
  • Make use of the public, their opinions and data collected about them to assess the needs of the population and reflect this in the agreed outcomes.
  • Try to implement outcomes based commissioning as part of wider transformation within the organisation – in order to improve quality, reduce costs and improve efficiency (particularly in health and social care) other infrastructure and practices (such as IT systems and skills development in staff) need to be addressed in addition to commissioning models in order to bring about change.

Further reading about health and social care on our blog

Co-production in social care … a need for systems change

Why a holistic approach to public health and social care needs a wider evidence base … and how Social Policy and Practice can help

What’s happening to make big data use a reality in health and social care?