New Developments in Adult Social Care

Further consideration for developing a Six Steps Approach to delivering effective outcomes and managing demand.

Professor Bolton has attempted to draw out from his observations, transferable principles so that we can better understand what may need to be developed and what may need to change to achieve similar outcomes to the organisations he visited. Their attention and common practices he observed in these organisations typically fall into the following categories:

• Assest-based or Strengths-based Practice
• Promoting Independence
• Outcome-based Commissioning

Amongst the many illustrations in the paper of “what works”, Professor Bolton shares his own comments and conclusions of “why it works‘ which range from serendipity to the conscious decisions to set a clear strategic direction, re-model and truly engage, empower and support their staff to innovate.

This paper suggests that the three categories are key practice and organisational considerations in the pursuit of delivering outcomes effectively and managing demand and notes Professor Bolton's conclusions in summary:

Strength-Based Assessments offer a more positive and constructive relationship with customers to share possible solutions. However important these assessments are, the really significant way in which people's lives are transformed is through the help they receive.

The models based on strengths-based assessments does depend on a parallel approach in relation to community development which focuses on the inclusion of people who may have care needs. This is particularly important if those who have learning disabilities are to gain from the approach. It is important though that councils look to ensure that their approach is having the desired impact on their finances and on their communities. This is often missing as Councils say it is difficult.

If considering which model for prevention is right for your council, it is clear that in designing a “promoting independence model” that is right for your locality is probably is worth exploring, however you would want to ensure that the investment of such a model is likely to deliver positive outcomes and a financial return.

The focus on outcomes can be positive but, don't limit your ambitions to levels of satisfied customers – look at interventions that make a difference to people and their lives – promoting independence. Don’t make the outcomes so complicated that you can't measure them. Don't dive into payment by results as it is both complicated and likely to be bureaucratic (costly) to administer. Get the right cultural focuses first working in partnership between commissioners, providers and assessors. Only explore further options when the approach is stabilised and working.

The paper provides, alongside a narrative and a list of “questions and considerations for organisations” for each of these categories, full case study details can also be seen of the work being undertaken in the five organisations Professor Bolton visited.