Buurtzorg: reinventing district nursing in Scotland

Buurtzorg roughly translates from its native Dutch as “neighbourhood care”. The model, used extensively in the Netherlands, has attracted international attention as a novel way to deliver community based nursing programmes. Its positive reputation and recorded successes in areas of Holland are attributed to its innovative use of locally-based and locally-aware nursing teams to deliver high-quality person-centred, but low-cost, care.

Seeking to improve core health outcomes

In the Netherlands, Buurtzorg was designed to engage three key health priorities:

  • Health promotion
  • Effective management of conditions (in a community setting)
  • Disease prevention

It focused particularly on the elderly, those who move regularly between hospital and home, and those with long term, constant care illnesses. It has also been used with patients with progressive illnesses such as dementia, with some nurses within the teams being given training to become dementia specialists where appropriate.

The model includes the following key elements:

  1. Holistic and personalised care – where assessments of need are integrated into and form the foundation of agreed care plans
  2. Mapping networks of informal care, and assessing ways to involve these networks in treatment plans
  3. Identifying other formal carers and organisations who provide care services and coordinate their input
  4. Taking steps to support the client in his/her own environment
  5. Promoting self-care and independence on the part of patients.

A number of studies of pilot sites across the UK and beyond have identified the positives and some challenges of applying the Buurtzorg model in different contexts. Some of these are outlined in the table below.

Applying the model in Scotland

In a Scottish context, the model has been applied in a number of areas, with the initial pilots making way for a wider roll out of adaptations of the model. In March 2017, as part of a wider research project, nurses and management staff from NHS boards across Scotland met in Perth to discuss learning and exchange best practice around how the model could be adapted and further rolled out in the future.

It highlighted the different stages that many Buurtzorg areas were at in their roll out, with some like Aberdeen and the Borders far more established than Argyll, who were at the time only in the earliest stages of their Buurtzorg journey. The research and learning event gave practitioners the opportunity to engage and further cement both formal and informal learning networks, which have been identified as key to the success of the Buurtzorg model both in the UK and elsewhere.

The importance of information sharing and informal learning

Rolling out the model in test sites highlighted the importance of planning and learning, and of creating a strong sense of trust between practitioners and NHS management, but also between the Buurtzorg nurses and their service users and other professionals. This change in mindset regarding ways of working, and a change in the chain of accountability was something, which, according to those practitioners who attended the Perth event, many sites have found to be a significant barrier to effective implementation.

However it was also highlighted that promoting and facilitating the creation of formal and informal learning networks and learning spaces can be an effective way to generate conversation about best practice as well as allaying some fears that may persist regarding working culture and approaches, including partnership working with other agencies and understanding risk in the working environment.

In Scotland, approaches have varied, from encouraging nursing teams to create videos and then post them to an online forum, employing more formal training plans to incorporate multiple agencies and ensure that everyone is “singing from the same hymn sheet”, or holding informal drop-in or open space events where staff are supported in their role and given advice to alleviate and find potential solutions to issues.

Practitioners also highlighted that it is important to provide a space where teams can examine what did not work well, and why. Learning from mistakes can often be as beneficial as learning from good practice, as these can provide insights into issue management and resolution as well as how to implement the programme effectively.

It is also clear from feedback, that while a strong core network of nurses and other community based practitioners is vital to the success of Buurtzorg care models, the back team support is also just as important. Creating efficient and streamlined processes leaves nursing teams free to care for patients and allows them more time to develop and deliver the person-centred care which is a key element of the Buurtzorg model.

Final thoughts

Learning from the experiences of the trial projects in Scotland has provided invaluable insights on how the model can be applied and some of the challenges that can be encountered because of the differing context. This knowledge can then be used to shelter and steer newer projects away from danger areas toward best practice and innovative collaborative working. Applying Buurtzorg in Scotland gives the potential to create and implement new models of holistic person-centred care, where practitioners with local and specialist knowledge interact at a local level with other care providers, join up approaches and create a better care experience for service users.

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Community planning in the devolved UK

Community planning is all about how public bodies and other partners work with local communities to design and deliver services that suitably reflect the needs and priorities or a local area. Effective community planning incorporates strong partnership working and a shared vision which has been created especially to fit a set of local circumstances.

Providing effective and efficient services, promoting community engagement and enterprise and engaging the third sector are all things that could now be considered part of “community planning”. It is founded on the idea that communities know best; they know what they need, they know how it can be delivered and how they will use services in the most effective way to get the most value from them. With an increase in political devolution we have seen different approaches to delivering community planning emerge in England, Scotland, Wales and Northern Ireland. Some nations embraced it from a very early stage, others less so. However, it has become an increasingly popular model over recent years, with all four administrations now using some form of community planning model.

England

In England, the focus has largely been on housing and land use and the relationship between community plans (which consider services and public engagement) and local development plans (which focus more on the physical aspects of planning in the community, such as land use). Neighbourhood plans give communities the opportunity to develop a shared vision for and shape the development and growth of their local area. Neighbourhood plans are not a legal requirement, but a right which communities can evoke if they wish to. They are designed to fit alongside local authority produced “local plans” and provide an opportunity for communities to set out a long term vision for their area in terms of development, and “may encourage them to consider ways to improve their neighbourhood other than through the development and use of land.”

Scotland

The introduction of the 2015 Community Empowerment (Scotland) Act is a clear indication of the stance of the Scottish Government with regards to community planning. As well as statutory rights being strengthened with regards to consultation and community consultation, the legislation also places statutory requirements on public bodies with regards to supporting local community based service delivery, and actively engaging local people in decision making processes. As a result of the legislation 32 Community Planning Partnerships (CPPs) now exist in Scotland and they are responsible for developing and delivering community plans. These can take two forms:

  • a larger plan, which takes account of the whole CPP area (Local Outcomes Improvement Plan)
  • a smaller plan, which focuses on a smaller geographic area which has been identified as being in need of improvement (locality plan)

There is no limit to the number of plans CPP’s can create in a year, but the views of local communities are particularly important in creating these as that is the way to best reflect local needs and priorities.

In Scotland a consultation is also currently underway to consider ways to align community and spatial planning more closely, as it was recognised that planning for services should also be mapped along with physical development.

Wales

In a Welsh context the use of community planning focuses on resource allocation and the direction of resource to where it is needed. Promoting community cohesion and well-being through community planning is also something which can be seen in both Wales and Scotland. Increasingly, plans have attempted to incorporate a “place-centred”, “service focused”, “partnership led” approach, with the emphasis on individual need. It is hoped that by bringing service providers and other partners back in touch with the people who use their services that their views can be taken on in future planning projects. As in all community planning projects, partnerships are key; however in Wales one of the biggest challenges has been forming these partnerships and getting buy-in from local businesses. A similar challenge has also been seen with national level bodies.

This challenge of engaging national bodies in community planning has also been seen in Scotland. National bodies are expected to engage with rural and urban CPP’s in ways which reflect individual community need, something they had not been used to doing previously. As a result, promoting flexibility and adaptability and encouraging participation from a range of stakeholders in order to support the creation and delivery of community plans has been high on the agenda across the UK.

Northern Ireland

The situation in Northern Ireland is, to a large extent, still evolving. Executives at Stormont, as well as planners and developers, see engaging local people as important but they are also trying to find a model which works best for a Northern Irish context. Potential options for integrating community based models have included adopting models from England or Scotland respectively; creating their own model which takes elements from a number of different models; or making attempts to align the Northern Irish model closer to that of the Republic of Ireland.

Currently the legislative basis for community planning in Northern Ireland is set out in the Local Government Act (Northern Ireland) 2014. The Act makes a statutory link between community plans and local land use development plans, and makes the link between community planning for a district and well-being more explicit.

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Engaging difficult to reach communities in community planning

The views of local communities are particularly important when creating community plans, as their fundamental principle is to reflect service and resource need more effectively in order to benefit communities. As a result community planners across the UK face the unilateral challenge of getting people to engage. Different groups within a community may have different capacity and ability to engage. ‘Hard to reach’ groups are particularly important to the consultation process as it is often they who make the most use of services or have the greatest need for specific service provision. People in this group may include young people, older people, ethnic minorities or other socially excluded groups, and small businesses. They are also sometimes referred to as ‘seldom heard’ groups.

Methods to improve communication and consultation with hard to reach groups vary, but some potential barriers and solutions to engagement include:

  • Jargon and technical language – Policy and planning documents can be very long, and very dense, with lots of planning specific technical jargon, create an easy access version so that everyone can be engaged in discussions and not feel intimidated by “high level” documents.
  • Digital illiteracy – Increasingly consultation documents, some forums and copies of the plans themselves are held online, and improving access to these would help to encourage more people to participate.
  • Awareness and accessibility – Promoting consultations or community planning events, and holding them at a variety of times and in a variety of settings to allow people from different groups to attend. In addition providing them in multiple languages, using language that is more accessible for young people, or in a larger type size may also help to encourage people to participate.
  • Showing impact – Create follow up documents so that people can see how their input has made a difference. Even if the plan won’t be implemented for a number of months, let people know how what they said influenced or changed the decisions that were made.

It is clear that England, Wales, Scotland and Northern Ireland are at different stages in their community planning journey. However, they have all, in one way or another recognised the importance of engaging communities to identify needs and attempt to allocate resources accordingly. In many instances, these community agendas have not just been linked to spatial, or even service planning, but also to wider issues around inequality and well-being and how resources and planning across all areas can best be directed to tackle this. It may be that we see this reflected further in future legislation.


This blog reflects on a recent paper by Deborah Peel and Simon Pemberton “Exploring New Models of Community based Planning in the Devolved UK” a study funded by the Planning Exchange Foundation.

Idox Information Service members can access our research briefing on engaging communities in planning.

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Mobilising healthy communities: Bromley by Bow Health Partnership

Ian Jackson of the Bromley by Bow Health Partnership was the guest speaker at the first Glasgow Centre for Population Health (GCPH) seminar series of the year.

The Bromley by Bow Health Partnership (BBBHP) is a collaboration between three health centres and other non-primary care partners in the Tower Hamlets area of London. The aim of the partnership and the new primary care delivery model which comes with it is to transform the relationship between the public and primary health care. This means considering the wider determinants of health when the partners plan and deliver care, rather than treating healthcare in a purely biomedical way.

Edited image by Rebecca Jackson. Map via Google Earth

Edited image by Rebecca Jackson map via Google Earth

Effect of social determinants on health

In the 1890s Charles Booth created a map of London which categorized areas of the city of London depending on their levels of deprivation. The most recent Indices of Multiple Deprivation Report showed that those same areas considered deprived in the1890s are still facing the highest levels of multiple social deprivation and health inequality today. It is no secret that disadvantage has a negative impact on people’s ability to make the best choices when it comes to health. And disadvantage at a social level can have a significant influence on poor physical and mental health across a range of conditions.

More recent research conducted by Michael Marmot looked more closely at what determines health outcomes in populations, and the extent to which other factors influence people’s health, or rather their ability to be well.

He produced what is known as the 30/70 model: 30% of what determines your health is your genetics and improvements in pharmacology, the other 70% is related to other “external factors” including poverty, environment, culture, employment and housing. BBBHP has used this as the foundation for their primary care model, arguing that primary care providers are not just dispensers of medical products, but have a responsibility to contribute to people living healthier lives in their community.homeless

Social prescribing

One issue highlighted by the BBBHP was the significant number of people presenting at GP surgeries with “non-medical” ailments, or medical ailments triggered by “non-medical stimulus”. People were arriving at the practices and booking appointments because they were lonely and it gave them somewhere to go. Others were presenting with symptoms of depression, which on further investigation were found to have stemmed from issues around debt or domestic violence. A social prescribing service was set up by the partnership to try to tackle some of these non-medical conditions and improve the health of the general population by non-pharmacological means.

The social prescribing service, where GPs refer people to other local services for help, can be used as a replacement for pharmaceutical interventions, or be supplementary to them. GPs, or other primary care staff, may refer any adults over the age of 18 to one of over 40 partnership organisations. These range from walking groups to formal sessions with advisors in debt or domestic violence agencies, as well as art classes, community gardens and companionship services to combat loneliness. The organisations can provide help and advice on issues such as employment and training, emotional well being and mental health.Ölfarbe

The challenges of quality and funding

Maintaining quality in the provision of social prescribing is a particular challenge for BBBHP. They work regularly with trusted partners, particularly the Bromley by Bow Centre. However, there is no consistent quality check for many of the services from the health partners themselves. Evaluative studies and feedback sessions are used to assess quality and impact, and consider the scale of demand. And while it is acknowledged that more formal frameworks for assessing quality and impact of social prescribing services are preferred in formal assessments, in reality, word of mouth, participant feedback and uptake rates are used as a standard for quality as much as official feedback in a localised community setting.

A second issue is funding. BBBHP identified that finding long term funding was their main issue in providing security for providers and service users, as well as for GPs referring to services. Funding is vital not only to ensure the survival of the community groups who provide some of the referred services, but also to allow them to develop longer term partnerships and build capacity within the social prescribing service. The BBBHP works closely with the Bromley by Bow Centre, a key provider of support services for the local community, but like many services which rely on funding, they increasingly have to plan for tighter budgets.

blue toned, focus point on metal part of stethoscope

A final challenge for the staff at BBBHP was changing people’s expectations of primary care, and what it means to live well. Some patients were suspicious and reluctant to be recipients of “social prescription”, as this did not fit with the traditional expectation of what GPs should do to make people well. This can be a big change in mindset for some people, according to Ian Jackson, when people come expecting to be prescribed antidepressants but are instead “prescribed” a walking club or a debt advice service. He noted that the reaction from patients can sometimes be confused or hostile, and some patients do not even turn up for referrals.

Improving patients’ understanding of the benefits of social prescription, ensuring people attend referral appointments, and that social prescriptions have a long term impact is something which BBBHP are hoping to research further. They feel that looking at the long term impact of non-pharmaceutical interventions and how these feed back into the wider agenda of tackling inequalities is important to allow the partnership to continue to build healthy communities and save on primary care costs in the long term.

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Creating positive social connections to improve community health

Social prescribing and other associated projects have sparked new social connections. Members of the community have come together to form their own support groups. The Children’s Eczema support group run by local GPs and the DIY health scheme, which sought to educate and support parents who were anxious about minor ailments in children, have helped parents in the area to set up WhatsApp groups, organise coffee mornings and go to one another for support. Such initiatives are regarded by BBBHP as important in tackling wider, systemic social inequality in the area.

Currently, primary health care in communities is focused on illness. This needs to change, according to BBBHP, with local community-based health delivery based as much around social health as biomedical issues. Through its social prescribing and other services BBBHP has aimed to focus on supporting people in a holistic way, tackling health inequalities as well as biomedical illness, to allow them to make good choices to improve their health.


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Single sector Business Improvement Districts: the future of BIDS in Scotland?

As a model to promote economic development, Business Improvement Districts (BIDs) have been a success in Scotland. Under the watchful eye and guidance of the umbrella body BIDS Scotland, the framework has grown and in many ways looks very different from the 5 initial ‘pathfinder BIDs in 2006 (the first being Bathgate BID). However, the underlying principles, values and aims remain constant.

Single sector BIDs

The traditional model sees businesses within a local area enter into a financial partnership, with each member paying a levy towards improving and promoting economic development within a community, in partnership with local authorities and other bodies. By working together businesses can reduce costs, share risks and create new platforms for growth, while for local authorities the benefits include the potential to drive growth and investment in the local area and to obtain help in raising additional funds to do this.

However, the flexibility of the model and the way it fits it with both local and national agendas has been a big part of its success, and groups are now trying to apply the framework to new contexts in alternative and innovative ways. One of these new style frameworks is the idea of single sector BIDs. Their role was part of the discussion at the BIDS Scotland 10 year anniversary conference held in Perth last month.

Image via Rebecca Jackson

Image via Rebecca Jackson

Single sector BIDs, as supporters have pointed out, come with their own unique sets of challenges and benefits compared to the traditional BID model, but they are no less effective. They allow groups of businesses with common interests and common agendas to come together, cooperate, organise and collectively promote their goods and services with a view to develop not only their own businesses but those of others in their area and the local community as a whole.

A BID for food and drink

Within East Lothian plans are currently under way, and awaiting ballot, to officially form what is thought to be the world’s first ‘food and drinks BID’. They have adapted the BID model to cover a wider geographic area than the original BIDs model intended, as it was initially focussed around town and city centres and encompassed a number of different types of business.

Instead the single sector BID model encompasses businesses which sit within the food and drink industry, with a view to promoting East Lothian food and drink, support local business and create a unified voice and brand to market themselves and East Lothian as a quality provider of exquisite produce. They have had strong support from their local authority as well as from national bodies like Scotland Food and Drink. Together, local producers and sellers have been working with these statutory bodies to form their BID partnership. In May 2015 the partnership was awarded a seedcorn grant to develop their Food and Drink BID in East Lothian.

Because the businesses within the proposed BID are varied in terms of size and scope, it was decided to create levy bands relating to the number of employees, rather than rateable value, as had previously been the traditional model. The BID group also introduced a voluntary levy scheme for businesses such as farmers, who wanted to be included in the BID group as producers but were not eligible to under the current BID legislation.

The issue with legislation regarding urban and rural BIDs and the increased difficulty rural businesses have in joining BIDS, (both because of their geographic isolation and their size and categorisation within current legislation) is something which the BID group in East Lothian have stated they are trying to address and mitigate as best they can.

Rural_Urban Landscape_iStock_000004526499Medium

Many observers are watching keenly to see if the single sector BID model could be applied across a wider geographical area, or across additional sectors. Suggestions have already been put forward for a canals BID within Scotland, a universities BID, as well as potentially creating food and drink BIDS in other areas such as Ayrshire and Perthshire. These could potentially form a network of BIDS across the food and drink sector, enabling individual businesses to create a stronger lobbying voice.

The future of BIDs in Scotland?

It is now the case that BIDs in Scotland are not restricted to town and city centres and can be developed in areas such as the tourism and visitor sector, commercial or industrial districts areas, rural areas, agriculture or, as this blog has highlighted, single sector business groups. The flexibility of the model and the increased levels of partnership working act as ways to spread accountability, create legitimacy through collective action and generate additional funding for a local area.

Together these elements make BIDs an interesting proposition for many businesses in Scotland and it is this flexibility, legitimacy and promotion of partnership which has driven the BID model into new and innovative areas, transforming the nature of the relationship between local businesses and statutory bodies within communities and transforming the nature of economic development and community resilience agendas.


Our popular Ask-a-Researcher enquiry service is one aspect of the Idox Information Service, which we provide to members in organisations across the UK to keep them informed on the latest research and evidence on public and social policy issues. To find out more on how to become a member, get in touch.

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Telecare in the UK: lessons from Barcelona

By Rebecca Jackson

Telecare is technology to help people live independently, usually in their own homes, for longer. Usually delivered as part of a package of care, telecare devices can include things like: bed sensors, to detect if someone is out of bed at an unusual time; fall sensors; medication reminders; and alerts on screens or over loudspeakers. Such devices have led telecare to be heralded as a new dawn in patient-centred, independent living.  However, despite initiatives  to drive its application forward, not everyone in the UK is convinced about the benefits of telecare.

Practitioners and carers are sceptical about the potential of replacing traditional care with digital models to save money and the impact that this could have on standards of care. In addition, many patients themselves are uncertain about the use of telecare and digital health solutions, with many who have telecare systems within their homes choosing to continue to interact with primary and home care services in the same way as before. Much of the academic and expert-led research and evaluation of telecare programmes in the UK by organisations such as the Nuffield Trust and the Kings Fund has found little to no improvement in service, reduction in cost or reduction in workload for care teams in areas where telecare has been deployed.

While telecare in the UK appears to have stalled, elsewhere digital health solutions are not only successfully integrated into traditional care models, but are having a positive impact on the people in receipt of care, and reducing the burden of work on care providers.

Lessons from Barcelona

In Spain, the law has guaranteed access to telecare since 2006. Economic austerity has led to individual local authorities in Spain being given control over their budgets and therefore their provision of telecare. The approach in Barcelona has been highlighted as an example of best practice in telecare.

The system there – a cooperative venture between an independent provider and the local authority – sees carers take a proactive approach to telecare. The system does not just monitor and provide assistance in times of distress, but proactively engages with service users at regular intervals to help carers provide reassurance and build relationships.

As well as the emergency measures, such as fall sensors (typically the primary use of telecare in the UK), calls are made to check up on service users, provide reassurance, deliver general public health information and to mark important occasions, like birthdays. This can help to reduce feelings of isolation and loneliness, which in turn can lead to better general health and wellbeing.

Calls can also be made to highlight important information, such  as weather warnings; safety alerts and local events which the service users may wish to attend. These calls are backed up by visits from the care team, who work for the telecare provider. These visits supplement visits from municipal care and social workers and the two teams communicate and share information via digital platforms.

Digital healthcare as an enabler

The case of Barcelona shows us how digital healthcare solutions, and more specifically telecare, can be used as an enabler – a tool to allow the local authority to pursue a joined up and preventative approach to healthcare which has positive benefits for recipients.

Such approaches could also have a significant impact on the UK’s 3.8 million unpaid carers. Telecare has the potential to reduce some of the burden and stress of caring for a relative, which in turn can have positive effects on the health of the person in receipt of care. It can also  form an effective part of reablement programmes – supporting people as they leave hospital or return to independent living.

However the approach to delivering telecare in Britain is as much about culture as it is about the technological infrastructure. Using telecare as part of a preventative, person-centred approach should produce better outcomes. In this sense, implementation of telecare in the UK still lags behind other countries. Key lessons could also be learnt from programmes in Norway and the Netherlands in relation to telecare in dementia settings.

Generally, the targeting of telecare services also differs – in the UK it tends to be aimed at elderly people with complex and diverse needs, while in Norway and the Netherlands the focus has shifted to those suffering from chronic illnesses.

Local solutions

In the UK, some local authorities have been experimenting with digital healthcare, although local authority budget cuts have meant that in many cases these have been cut back to focus delivery on the most vulnerable clients.

The lessons in digital healthcare that Britain can learn from places like Barcelona could be key to the successful roll out of digital healthcare solutions in the future. The Barcelona example highlights the enabling role that telecare can play in joining up health and social care and promoting a more preventative approach to healthcare.

Opportunities to develop telecare strategies and deliver them in partnership, as in the Barcelona model, show that it cannot be delivered in isolation, or be used as a replacement for existing carer-led services. Instead telecare has the potential to be a supporting tool to ensure effective care outcomes. It could also help care services in Britain to tackle the increasing demand of an ageing population.


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Digital technology in social work practice

Using social media in social work practice was the topic of conversation at a recent conference, held at the University of Stirling. With a delegate list including academics, researchers, practitioners and representatives from the public and private sectors the conversation topics were broad and wide ranging from how to use social media, what to avoid doing and how to integrate digital technologies and systems into everyday practice for social workers.

social media infographic photoPartnerships to deliver digital solutions

In March last year we told you about the partnership between a local authority and Idox who teamed up to deliver a digital case management tool to support the council social workers in their day to day practice. The ideas that were promoted during the conference not only emphasises the innovative nature of that partnership when it was developed, but also the continuing possibilities to pursue innovative digital solutions within local government to allow Idox to continue deliver efficient and positive outcomes for service users.

Avoiding social media pitfalls

Aside from poor infrastructure, like a lack of wifi, and seemingly impenetrable work computer firewalls, both of which came up regularly in discussions, one of the main reasons social workers did not use social media was fear, uncertainty and worry of the repercussions should something be posted or liked which was deemed inappropriate.

Rachel Wardell, the director of Services at Warwickshire council gave a talk on utilising Twitter in an appropriate way and outlined the “7 stages of Twitter” for new and advanced users. She suggested that Twitter was actually a great way for social workers, teams and managers to make connections and share best practice across the profession. She discussed how links initially forged on twitter by a follow or the sharing of an article developed into partnerships and trips to visit areas of best practice to observe and learn from fellow professionals.picjumbo.com_HNCK1814

However for many social workers, and their management teams, social media use can still be problematic, with the BBC reporting earlier in the year that there had been a rise in the number of council workers being punished for misconduct relating to social media. For social work teams the pressures and implications are even more significant. In discussion with Birmingham University’s Dr Tarsem Singh Cooner some of the delegates highlighted examples of colleagues who had been accused of bringing the profession into disrepute and some extreme instances where they had been removed from cases at the request of service users who had seen a post on their social media account which was not secured with privacy settings.

While most were keen to stress that these were individual mistakes and misjudgements there was still anxiety about the increasingly blurred boundaries between public and private, the importance of relationship building and personal experience for social workers interacting with service users, but the necessity to remain professional. The phrase ‘social workers are human too’ was used regularly by those advocating the use of social media and that councils should use a level of common sense and discretion when dealing with incidents involving staff and social media. However, the general consensus appeared to be that social media should be treated with caution:

  • use a separate work and personal account
  • use an alias
  • employ maximum privacy settings
  • don’t post anything that could potentially bring the profession or your conduct into disrepute
An example (from my own Twitter) of how Twitter can be used to document conferences and interact with professionals

An example (from my own Twitter) of how Twitter can be used to document conferences and interact with professionals

Making social work ‘appier

One of the big developments which has become increasingly popular as a tool to engage social work in digital technology is the creation of apps. Many of the conference discussions were on the benefits of using an app, how they can be utilised fully in their roles as training tools and information providers or how they can be used to encourage participation and communication in aspects such as feedback.

Anne Campbell from Queens University Belfast discussed the development of a series of information-based apps which focused on child development. Another app covered the knowledge of social workers and social care teams of drug and alcohol in substance misuse cases, including symptoms, street names for abused substances and the studies which use examples of substance misuse in social work and adult and child protection cases. She discussed the importance of using practitioners and service users to develop the app, to ensure it was fit for purpose and easy to use. She also highlighted the potential for her apps, which currently operate in a Northern Irish context, to be developed and diversified to account for differences in policy in Scotland, the Republic of Ireland and England and Wales.

Screenshot images of the apps

Screenshot images of the apps

There is a potential for software development in the future which would see more secure data files more easily accessible via personalised secure apps and document drop apps, which could be shared across a number of sectors, including health, social care and education. Delivering the digital infrastructure platforms to develop and successfully run integrated systems and sharing platforms such as these would require huge investment from local authorities, and would potentially provide the opportunity to work in conjunction with specialists, such as Idox, to develop software which is supportive, flexible and fit for purpose.

Apps

Iphone apps. Image by Daniel Go via Creative Commons

Using social media to create connections

The final part of the afternoon was characterised by case study style discussions, where speakers presented their own experiences, both positive and negative of using social media and stressed the importance of social media as a way to create connections. The connections spoken about included connections between practitioners, to create a more extensive community of best practice within the social work profession, connections between service users and social workers, many of whom feel more comfortable communicating via social media, and finally creating connections between service users to help them provide support to each other. This was something specifically highlighted by the team from Lothian Villas in East Lothian.

Lothian Villas have been using a closed, invite only Facebook group as a forum to interact with young people staying with them during a period in residential care. Members can post on the page, while others respond giving advice and reminiscing, much like a traditional family would do. That, according to Ewan McKay, is vital for allowing children who have come from care to build and maintain relationships and have happy memories of their childhood which can go on to shape how they behave as adults in the future. They can also then pass their memories and advice onto the children who are coming through the system after them.

Other groups spoke about the use of document sharing sites, digital presentation sites and networking sites like LinkedIn to create and document continuing professional development (CPD), a core part of social workers’ continuing improvement and the maintenance of standards.

 

The conference highlighted the massive steps forward which have been taken and the desire for drive and innovation in digital infrastructure to take public services, and their delivery onto digital platforms. This would allow for greater connectivity between professions such as social work and other service providers in health and education resulting in more efficient services, producing better outcomes for service users. Using digital platforms well, including apps, sharing websites and personal social networking sites such as Twitter will allow practitioners and local authorities to ‘join up’ services to promote more holistic, person-centred care at a local level while allowing professionals to build a network of best practice and document their own CPD. Digital media in social work practice could potentially be a key enabler in improving practice and generating positive outcomes for service users.


Our popular Ask-a-Researcher enquiry service is one aspect of the Idox Information Service, which we provide to members in organisations across the UK to keep them informed on the latest research and evidence on public and social policy issues. To find out more on how to become a member, get in touch.

Follow us on Twitter to see what developments in public and social policy are interesting our research team.

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

meeting

By Rebecca Jackson

One of our most popular member briefings has been our 2014 introduction to co-production in public services. In fact, it was so popular that we made it freely available to download from our website. For those who don’t know, co-production is an approach to improving or developing services by working collaboratively with the people who use those services. It has become increasingly popular within many types of public services in the UK, but especially in health and social care.

The components of co-production

But what does co-production actually mean in practice? Although every case is different, generally it can be broken down into several processes:

  • Co-design – the planning of services
  • Co-decision making – with regards to the distribution of resources and the allocation of services
  • Co-delivery (of services) – including outlining the role of volunteers and the third sector, and including them in the process if necessary
  • Co-evaluation (of services) – assessment of the outcomes and whether they have been successful for all parties involved.

Legislation and implementation

The 2014 Care Act was one of the first pieces of UK legislation to include co-production as a concept in its statutory guidance, stating that:

‘Local authorities should, where possible, actively promote participation in providing interventions that are co-produced with individuals, families, friends, carers and the community. ”Co-production” is when an individual influences the support and services received, or when groups of people get together to influence the way that services are designed, commissioned and delivered.’

Co-production is now a key part of the implementation of health and social care strategy across the UK. It provides service users with an input on which elements of services are of most use, and which could be altered to make them more effective – particularly important at a time when local authorities are under pressure to deliver more efficient and cost-effective services.

Co-production relates to other strategic priorities such as prevention, wellbeing, a focus on outcomes and the personalisation agenda. It allows people who use services to have a direct input into the design of care services and care plans, so as to create more effective programmes of care.

Implementing co-production can be a difficult transition and requires a whole system approach to change. This means that organisations, such as local authorities, must adopt change at every level to encourage meaningful participation and to embed co-production in day-to-day practices.

Managing change

The SCIE co-production guidance uses a jigsaw model for management of change which may be a helpful way to identify the elements of an organisation which must be altered to effectively incorporate co production.

jigsaw 3The guidance provided by the Social Care Institute for Excellence (SCIE) recommends that:

  • organisations must change at every level, from senior management to front-line staff,  if they want to achieve meaningful participation
  • participation should become part of daily practice – and not be a one-off activity
  • participation operates at different levels, as there are many ways to involve people who use services in different types of decisions

Social care co-production in practice

  • The project PRESENT is a joint initiative between East Dunbartonshire Council, the local Dementia Network, the Joint Improvement Team and Governance International, which uses co-production to engage people with dementia and enable dementia sufferers to make a positive contribution to their communities.
  • Islington Council has developed a Framework for Involvement in Adult Social Care to provide a solid base for co-production that is accessible, inclusive and has impact. The council worked with people who use services and carers to produce the Framework. Local statutory and voluntary sector organisations, including the Making it Real Experts by Experience and Project Team, and Healthwatch Islington, were also involved.
  • A report produced in 2013 by the Scottish Co-production Network, Governance International, the Scottish Joint Improvement Team and the Social Care Alliance,  also provided comparisons between the approaches to co-production in social care between Scotland and Sweden.

These are just a few examples of innovative practice, more of which can be found on the SCIE website.

The potential of co-production

Co-production has the potential to transform the way social care is delivered in the UK. However, implementing co-production approaches into existing organisations, with their own culture, structures and operating procedures, as well as their own expectations about services and how they should be created and delivered, remains a challenge for commissioners, the third and private sectors, politicians and the public.

In order to be successful and to produce sustainable and effective relationships, total change will be required and it will take a huge commitment and long term vision to ensure its success. Once implemented, though, it is clear that co-production has the potential to contribute greatly to prevention, personalisation and outcomes-focused service delivery – which are all key agendas in the current health and social care policy climate.


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Co-production in the criminal justice system

Community concept word cloud background

By Rebecca Jackson

Co-production in criminal justice was the core theme of a conference held last Wednesday by the Scottish Co-Production Network.

The speakers were invited to showcase their organisations as three examples of best practice. All the organisations have integrating partnerships and co-production at the heart of their values, and they spoke of the benefits and challenges they had faced, as three very different organisations, all looking to use co-production in the context of criminal justice.

Startup Stock Photos

Startup Stock Photos

Supporting vulnerable women

Tomorrow’s Women Glasgow, is part of a national pilot which aims to develop community- based justice options for people who are offenders. This specific pilot focuses on vulnerable women with complex needs who are in, or have recently been involved in, the criminal justice system.

The women-only centre offers a safe space for women to come and spend time and to work with mentors to address the barriers and issues which prevent them from leading positive, healthy lives. In addition to this, the women are invited to contribute ideas towards the running of the centre, planning activities, contributing to a newsletter and hosting open days.

“The scheme gives vulnerable women a choice, a voice, a direction and opportunities”

The project is run in association with the social enterprise Outside the Box. There are some examples of Outside the Box’s other projects here.

woman hands isolated on sky background

Improving transitions from prison

Pete from Positive Prison? Positive Futures… delivered an inspiring and thought-provoking presentation about his experiences as a person with a conviction who had served time in prison and how that drove him to help others upon their release from prison. He helped to set up the organisation Positive Prison? Positive Futures… (PP?PF) which seeks to “improve the effectiveness of Scotland’s criminal justice system so as to reduce the harms caused by crime and to support the reintegration of those who are or have been subject to punishment”.

He was keen to stress that the charity is not a service provider; rather it is an initial point of contact to help direct people with convictions to the available and relevant services which already exist.

“We’re kind of like in space when you use the gravitational pull of an object to slingshot you in the right direction (Apollo 13 reference anyone?!). People are coming to us going one way, we come into contact with them, build their speed and send them in another, safer, hopefully better direction!”

In addition to this, the charity engages regularly with the Scottish Government as part of committees looking into reform of the prison service, the redesign of community justice and have, among other things, influenced policy decisions around the release of individuals from prison including transitional care.

The charity works with recently released, or soon to be released people with convictions, looking at building relationships during the vulnerable first few weeks ‘on the outside’ where re-offending and suicide rates are high. They also offer mentoring to help prepare people for the transition from prison life.

Two adult education students studying together in class.

Co-production and young people

Space Unlimited is a social enterprise based in Glasgow, which offers a creative space for young people to become involved in the planning and review of the criminal youth justice system. It encourages young people from vulnerable backgrounds, as well as young people who have served time in prison, to use their experiences to change how offending and criminal justice is viewed by young people.

The scheme aims to provide a space to show how young people can use their views to influence how the system can work best for them, to avoid re-offending and help integrate them back into society. The young people interact with adult stakeholders from across the local authority and criminal justice sector, as well as charities and third sector organisations.

“We promote and encourage children and young people to view themselves as experts in their own right, using their own experiences to promote positive change in the youth criminal justice system”

Category Picture Community Development

Creating new spaces for dialogue

What all of the case studies sought to highlight were the key elements of co-production:

      • Assets
      • Capacity
      • Mutuality
      • Networks
      • Shared roles
      • Catalysts

The speakers discussed their learning and experiences, as well as the challenges they face, but all highlighted the fundamental belief underpinning co-production – that service users and service providers can learn from one another. We create better services by engaging service users – creating services with people, not for them.

Co-production is an approach which is widely spoken about in health and social care, but as the conference and its speakers highlighted, the application and remit of co-production could be rolled out over other areas of policy too. It is all about finding groups of people willing to engage and to listen – creating a space for an exchange of dialogue, knowledge and learning. And the results could potentially be hugely beneficial for both service users and service providers. This video from the New Economics Foundation (NEF) highlights some of the benefits of co-production in practice.


Co-producing Positive Futures learning event: how co-production, learning and partnership building can improve community experiences and engage people in the criminal justice system. Scottish Co-production Network, Glasgow, 28 October 2015.

‘High quality and equitable outcomes for all’ – highlights from the Scottish Learning Festival 2015

By Rebecca Jackson

“High quality and equitable outcomes for all”  – that was the theme of this year’s Scottish Learning Festival held last week at the SECC in Glasgow. A mix of academic and policy based seminars, converged with practitioner based learning during the session on Wednesday.

Out of a packed schedule we chose to attend the launch of a new initiative to encourage more STEM teachers; information on the Scottish Attainment Challenge, delivered by Education Scotland and the Scottish Government; and a promotion of employment partnership learning, showing how schools and colleges can engage more with local business to provide opportunities for students.

A fundamental commitment of the Scottish Government

The keynote speech on Wednesday was delivered by Angela Constance MSP, Minister for Education at the Scottish Government. In her address, she stressed the importance of the key themes of the conference, which were collaboration, best practice and ensuring that no child in Scotland should be unable to fulfil their potential at school because of their background or their ability to pay.

Scottish education she said, would be “driven by evidence of ‘what works’ “ and “education in Scotland must be about ability to learn, not ability to pay, at all levels” and that this was a fundamental commitment on the part of the Scottish Government.

She also launched a new initiative aimed at getting more STEM teachers into the teaching system in Scotland. Teachers, she said, were key not only to teaching but to inspiring students to pursue subjects to a higher level.

She awarded the Robert Owen Award for an Inspiring Educator to Professor Graham Donaldson, the man behind Teaching Scotland’s future report on the education of Scotland’s teachers.

Angela Constance MSP addresses the conference. Rebecca Jackson, 2015

Angela Constance MSP addresses the conference. Rebecca Jackson, 2015

Tackling the attainment gap: the Scottish Attainment Challenge           

The Scottish Attainment Challenge was promoted as an accelerator of change, building on what has already been done in Scotland and using core values and agreed outcomes to create a system which takes a uniquely Scottish approach. The focus is on 4 key areas, and is delivered by a three way framework which uses a national hub, inter authority collaboration and support and the Scottish Attainment Fund.

The four key areas are:

  • Collaboration for improvement
  • High quality teaching and learning
  • Linking with family and community
  • Supporting nurture and well-being.

Speakers in this seminar emphasised that in Scotland, policy needs to be driven by what works. The challenge, they said, could not be delivered in isolation. Kevin Helman from Stirling and Clackmannan provided a local authority perspective. He highlighted the role of head teachers sharing best practice among schools.

The Scottish Attaniment Challenge outlined in Stirling and Clackmannan. Rebecca Jackson, 2015

The Scottish Attaniment Challenge outlined in Stirling and Clackmannan. Rebecca Jackson, 2015

The Girls in Energy Programme

Employment partnerships between schools and businesses could be a key way to promote vocational learning and encourage STEM subjects in schools. We’ve written before on this blog about the need to build STEM skills in the UK and especialy the importance of providing girls with STEM role models.

It was encouraging therefore to hear in another seminar session about the Girls in Energy programme, an Aberdeenshire based project between Mintlaw Academy and Shell.

The project provides a useful blueprint which could be recreated across Scotland. The programme combines:

  • blended learning, of academic and vocational qualifications (2 HNC’s and 1SVQ level 2);
  • industrial visits;
  • a 2 week placement.
Girls in Energy programme. Rebecca Jackson, 2015

Girls in Energy programme. Rebecca Jackson, 2015

There was an emphasis on how the scheme boosted employability skills, including interview technique, presentation skills and communicating with others, equipping the girls involved with practical skills valued by employers.

Practitioners and students who have been through the scheme were keen to stress that the scheme could easily be recreated if strong relationships between education and industry/business are forged. They highlighted the potential in engineering, construction and other industries which could follow the same outline as their model.

All that is good about Scottish education

The conference highlighted all that is good about the Scottish education sector. The stalls and exhibition space were filled with people who are passionate about providing a better, more equal and well-rounded education for children in Scotland.

However the conference also emphasised the core values of what academics and practitioners feel  is needed to drive education forward in the future – an understanding and sharing of best practice and resources, and the ability to integrate multiple aspects of learning to create a better experience for teachers, local authorities and children alike.


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