8. Efficient and effective systems and processes

Efficient and effective structures, systems and processes are important as they can either underpin and align with the good practices outlined in Systems leadership, governance and management arrangements or they can be a barrier that people work around.


8.1 Introduction

Efficient and effective structures, systems and processes are important as they can either underpin and align with the good practices outlined in Systems leadership, governance and management arrangements (3.1 to 3.5) or they can be a barrier that people work around. For example, robust strategic (e.g. research, planning and monitoring) and operational (e.g. care management, contracting and quality assurance) processes are needed to:

8.2 What good looks like

The best councils have robust performance and budget planning and monitoring processes and use them to:

  • Ensure plans to support adults with LD&A are realistic and resource requirements are sustainable underpinned by the understanding of current and future demand as outlined in Understanding demand, prevention and early intervention
  • Understand the impact it is making on care and support quality, costs, and individual outcomes of adults with LD&A and their carers. This includes the use of key indicators, and benchmarking, to track whether things are improving or not and to inform learning/improvement processes.

They have access arrangements that respond to adults with LD&A who contact them with information that is suitable and adapted to their specific needs at every point in the customer journey. Staff working in the access function (see also Developing the care and support workforce) understand the likely issues adults with LD&A will encounter when seeking support. If initial enquiries are handled by staff who work with a range of enquiries, for example in a call centre that receives all calls to the council, they should have undertaken autism and learning disability awareness training and be competent in the requisite communication skills. If enquiries are received directly by a specialist service or routed there from a generic access point staff should have more in depth training and possess suitable communication skills. Where enquirers are offered information and advice this should be provided in ways that are suitable for adults with LD&A and include details of resources more general community resources as well as those that are specific to their individual needs.

They have LD&A operating procedures that support staff to use strengths-based and outcome focused approaches (See Developing the care and support workforce) that ensure adults with LD&A are supported to: live their lives, stay healthy and keep themselves safe (see Supporting adults with learning disabilities and/or autism to stay safe) and to achieve their full potential.

They have systems and process that fully support personalisation and use of innovative support arrangements.

They have a care management system that is an enabler of strengths based and person centred assessment, care and support in line with the local vision for how adults with LD&A will be supported by an efficient, effective and joined up System of care and support.

They design and operate business processes/systems to be accessible for adults with LD&A by allowing flexibility in how systems and processes can be used and by making skilled support available to people who need support to use systems and processes. They enable reasonable adjustments to be made to enable adults with LD&A (and their carers) to benefit from systems and processes that can be tailored to their individual characteristics and circumstances.

They have effective communications processes within the council so support to adults with LD&A can be co-ordinated and feel joined up to the people being supported, bottom up so leaders hear and consider the views of front line staff and between the council and others e.g. partners and the local community to enable co-production.

They use technology when they can to enable more efficient working practices including self-service by the people being supported, carers and suppliers of care and support and so contract management and payments processes can be streamlined

They have robust business continuity plans in place so vital core care and support can continue for adults with LD&A if uncontrollable external events make the normal operation of services impossible. Separate plans exist for services for adults with LD and for services for autistic adults.

They have systems in place to capture learning to support continuous improvement. This includes learning reviews when things go wrong and systematically learn from things that go well.

 

8.3 Expected outcomes

In terms of outcomes councils that are implementing good practice should find that:

  • Adults with LD&A and their carers should have a better experience when they deal with the council. This should be reflected in their feedback to the council.
  • Suppliers of care and support should find it is easier to work efficiently and effectively with the council when supporting adults with LD&A. This should be reflected in their feedback to the council and in their willingness be a supplier to council funded adults with LD&A
    • The efficiency/effectiveness of professional practice should improve. This may be evident if:
    • Social workers release time from travel, case recording and attending internal meetings to use on planned, pro-active social work with the people they support and their families
  • The percentage of social worker time that is on direct client focused work will increases over time while time on indirect client work and on administrative and back office duties should decrease
  • Overhead and other on costs reduce over time as a percentage of overall expenditure on support for adults with LD&A.
  • The time lag between a referral being received and an assessment/or a review being carried out should bec ome shorter
  • Assessment and support for adults with LD&A should be more integrated and the people being supported, and their carers should experience a more joined up process and more joined up support.
  • There are less interruptions to service continuity due to unforeseen external events that make the normal operation of services difficult e.g. extreme weather, power cuts, public health crisis.

NHS Learning from Excellence Programme

To understand how continuous improvement can be promoted by systematically learning from what goes well (as opposed to only investigating and learning when things go wrong see the materials from the NHS Learning from Excellence Programme.

8.4 Efficient and effective structures, systems, and business processes performance indicators

Outcome indicators

Aim

National/Local

The time lag between a referral being received and an assessment/or a review being carried should become becomes shorter year on year

Decreasing trend

National data

CLDT Staff time recording shows the percentage of their time spent on:  Direct client work, Indirect client work and Other non-client related work

Balance shifts to “Direct” client work

Local data

Monitor the number of interruptions to service continuity due to unforeseen external events each year

Decreasing trend

Local data

 

Individual experience indicators

Aim

National/Local

Proportion of adults with LD&A and their carers who report, when asked, that they have a positive experience when they deal with the council

Increasing percentage

Local data

Proportion of suppliers of care and support who report, when asked, that they find arrangements to work with the council to support adults with LD&A are easy/efficient and effective

Increasing percentage

Local data

Proportion of adults with LD&A, carers, suppliers, and frontline staff who report, when asked, that communications with the council are effective

Increasing percentage

Local data

Proportion of adults with LD&A and carers who report, when asked, that their care and support was integrated and felt joined up

Increasing percentage

Local data

 

Financial/value for money indicators

Aim

National/Local

Calculate and benchmark SSMSS costs in ASC FR on adults with LD&A: Per head of adult population, Per adult with LD&A with support, Per employee on LD&A team/service

Aim for lower quartile

National data

Split out gross current expenditure on LD&A social care activities (this includes the cost of the Commissioning function) in ASC FR005 - Calculate and benchmark:

  • LD&A social care activities exp per head of adult population
  • LD&A social care activities exp per adult with LD&A supported by the council

Progress towards local target

National data

Calculate and benchmark overhead and other “on costs” as a percentage of overall expenditure on support for adults with LD&A.

Aim for lower quartile

National data

 

8.5 Self-evaluation questions

How to rate yourselves against the self-evaluation questions: For each chosen section the DASS should consider each statement about good practice that follows and work with their senior management team, representatives of key partner organisations and local experts by experience to rate how close the councils approach to supporting adults with LD&A is to the best practice described using the following five-point scale, where one means it is far away from best practice and five means it is already using best practice.

The scale to be used is as follows:

1. Commitment

The importance of this best practice has been recognised. Conversations are taking place internally or with partners including experts by experience, but work has yet to begin.

2. Developing

Work on this best practice has commenced internally or with partners including experts by experience, but it has yet to be signed off, is only in the planning stages and with resource identification is still in progress.

3. Implementation

An agreed fully resourced and commissioned (where relevant) plan is in place. Implementation has started, but best practice is not yet fully operational.

4. Operational

Best practice is in place and is being used, albeit implementation is at an early stage, and further refinements in line with the learning from implementation may be needed before expected benefits are fully realised.

5. Sustainable Delivery

Best practice is in place and is working well. Long-term funding, resources and structures are in place i.e. best practice now represents “business as usual” and continuous improvement processes are in place.

Efficient and effective structures, systems, and business processes

Score 1 - 5

Basis of score

1 The council has robust performance and budget planning and monitoring processes based on a robust evidence of current/future need/demand (Also see part 4) including the use of:

  • Activity/financial models so plans/budgets are realistic.
  • Key performance indicators so plans/budgets can be monitored including: Aggregated data on the proportion of individual outcomes achieved and measures of inequality. experienced by adults with LD&A, so the extent of the challenge faced is understood.
  • Benchmark with comparable councils to assess relative performance enable learning.

 

 

2 Access arrangements ensure adults with LD&A who contact them receive suitable inform-ation adapted to their specific needs at each point in the care and support journey. They ensure that:

  • Staff working in the access function understand the likely issues adults with LD&A will encounter when seeking support.
  • Where initial enquiries that are handled by staff who work with a range of enquiries, for example in a call centre that receives all calls to the council, they have undertaken specialist autism and learning disability awareness training and are competent in the requisite communication skills.
  • Where enquiries are received directly by a specialist service or sent to it by a generic access point, staff have more in depth training and suitable communication skills.

 

 

3 The council LD&A operating procedures help staff use a strengths-based and outcome focused approach to support adults with LD&A to live the lives they choose, stay healthy and safe including guidance on:

  • Monitoring progress against individual’s agreed outcomes so the effectiveness of individual support can be checked and adjusted if needed.
  • Co-ordinating care and support if delivered by multiple support providers or an MDT.
  • Using review resources proportionately.

 

 

4 The council’s care management system enables more efficient and effective working in line with the local vision by ensuring it supports its staff (and allied professionals) to adopt a strengths-based and outcome focused approach, enables accurate/efficient recording, and facilitates the appropriate sharing of data between different professions and organisations subject to appropriate data protection safeguards.    
5 Staff are regularly asked how the care management system and associated processes could be improved to better support their day to day work and the system is improved on an ongoing basis. Where the system used is also used by other council’s the council is an active member of the system providers user group where systems improvements are discussed and agreed.    

6 The council design and operate business processes and systems so they are accessible for adults with LD&A. The council:

  • Allows flexibility so Reasonable adjustments” can be made to systems and processes so their operation can be tailored to the individual needs of adults with LD&A/carers.
  • Ensure specialist support (staff and tools such as communications aids) are available for people who need support to use (and benefit from) systems and processes.
   

7 The council has effective communications processes:

  • Within the council so support to adults with LD&A can be co-ordinated and feels joined up to the end user.
  • Bottom up so leaders hear and consider the views of front-line staff.
  • Top down so key information/ decisions etc. can be disseminated to the staff who need to know in an effective and a timely manner.
  • Between the council and its partners/the local community to enable co-production.
   

8 The council makes optimum use of technology to support efficient working practices and self-service by the people supported, carers and suppliers. For example, to enable:

  • Agile working by staff, for example, minimise travel time, hold virtual meetings where this is more efficient and to minimise the time taken on case note recording.
  • Self-service by adults with LD&A and carers e.g. on-line: PA directory, E-market place, application processes for support with direct payments, easy read information, and advice etc.
  • The contract management burden on providers to be minimised incl. automated payment processes e.g. web enabled access to providers records on the progress of individuals against agreed outcomes in support plans.
  • Different councils who share the same providers e.g. share results of QA work so duplication between councils is minimised.
   
9 The council has up to date business continuity plans that include separate sections on how the continuity of vital core support for adults with LD and for autistic adults would be maintained if external events make the normal operation of services impossible e.g. extreme weather, power cuts, public health crisis.    

10 The council has robust systems and process in place to facilitate learning and continuous improvement and minimise the risk of the development of a blame culture. This includes processes:

  • For staff and the people who use services to reflect on and learn from things that go well. Examples of excellence are identified and reviewed so learning from what works well feeds into improvement planning, and
  • To investigate and learn lessons when things go wrong.
   

 

Who is good at this?

The London Borough of Hammersmith and Fulham

The London Borough of Hammersmith and Fulham redesigned its structure to improve transitions between Children’s and Adult Services. To do this they created of a specialist Adult Social Care/ Children’s Services transitions team which also has input from a health care professional to better link with NHS services. The transition team members:

  • Are jointly managed by Adult and Children’s Services though a “matrix” arrangement
  • Operate a case management model for individuals “in transition”, in which each young person has a named worker to co-ordinate support and provide continuity/ consistency for them, and their carers. This helps them to access pathways and services appropriate for their needs.
  • Different pathways now exist for young people with:
    • ASD only.
    • Complex support needs, including people covered by the transforming care partnership.
    • Moderate support needs.
    • Low level support needs.
  • Work with each individual (ideally from age 14, although often in practice it is 16) until they are ready to transition into adulthood with support from ASC. Support from the transitions team is not expected to continue after age 25

Leeds City Council

In Leeds City Council, the introduction of strengths-based working has changed the framework in which social services are delivered and has liberated social work. There has been a move away from the care management approach to one that enables social workers to build relationships and work directly with people.

Leeds has significantly adapted its systems and processes to enable the shift to strengths-based working and to reduce bureaucracy. These include major changes to recording of assessments, reviews, and risk assessments.

The PAMMS (Provider Assessment and Market Management Solution) system

The PAMMS (Provider Assessment and Market Management Solution) system was developed by HAS Technology with 11 Councils in ADASS East Region. The aim was to improve the management of provider quality, lower contract management costs and minimise the regulatory and contract compliance burden on providers. 

Guidance

To understand how continuous improvement can be promoted by systematically learning from what goes well (as opposed to only investigating and learning when things go wrong see the materials from the NHS Learning from Excellence Programme