To deliver what the people of Derbyshire need we need to adapt quicker, embrace change, and ensure that the right networks of support – often not the council – are available.
Our county has an aging population. By 2043 the population aged 90 and over will more than double. This will inevitably increase the demand for our support.
This means the way we work now in some areas of our service will not be sustainable, nor is it what local people want or need from us. Local government spending is under pressure more now than ever before, and we need to make sure that we spend the money we have wisely to provide the right level of support for those who need it most.
People want to live at home as independently as possible for as long as possible. We recognise that the way we've worked up until now hasn't always resulted in that happening. You have also shared your views on different and better ways of doing things. By taking a 'strength based' approach we can make a positive difference with local people and achieve better outcomes.
About 'Better Lives'
The Better Lives programme was set up so people can lead the most independent and fulfilling life possible, enabling them to get the support they need in the best place and in the best way, and to look at how we can make make this a reality more of the time.
We are doing this by:
- engaging and empowering frontline practitioners in creating new ways of working
- working with a 'one council' approach, supporting the programme from all angles and noting when Better Lives can benefit other initiatives
- basing the work on evidence to ensure we have the right impact on people
- fostering a culture of promoting independence in our staff, leaving a lasting impact
- knowing that we won't get it right on day one - we'll trial new things, build on what works and fix what doesn't - we'll learn as we go
If you have any questions or suggestions please email better.lives@derbyshire.gov.uk
Our areas of focus
Following a review of our services in 2019 by our staff and Newton Europe we identified a number of areas where we could make a big difference by changing the way we work:
- hospital discharges
- working age adults
- prevention and personalisation
- short term services
- managing resources using data and information
Hospital discharges
We know that what happens immediately after someone is discharged from hospital can have a positive or negative effect on their chance of long-term independence. Practitioners found:
- 70% of discharges to short term care beds were not the most independent discharge and resulted in an increased likelihood of people remaining in residential care
- 87% of those receiving home care would have benefitted from short-term services but only 18% get access to those services
As you'll know, when someone is discharged from hospital it's important to get the right package of care in place as soon as possible. When we initially reviewed our cases before the programme started, 70% of people discharged into short-term care beds could have gone straight home. Many of these people went into long-term residential care instead.
We've now adopted a 'home first' approach and work to overcome the barriers to returning home. Sharing knowledge and expertise with colleagues in peer group discussions creates an opportunity to explore new ideas, share best practice and make consistent decisions about the right level of care.
Working age adults
Practitioners discovered that there are up to 500 people with disabilities in Derbyshire who could be living more independently:
- 67% of those living in residential settings could be living more independently
- 740 people attended day services across Derbyshire - some of these people could be supported in a different way to maximise their independence
- there is an opportunity to improve and embed the progression model in the provision of day and night-time support within supported living
Our goal is to maximise the independence for those aged 18 to 64 with disabilities that are receiving social care support. We're working with people who use day services, those in supported living, and those in residential settings. There have been some very positive success stories coming out of the work which we'll be sharing.
Prevention and personalisation
Case reviews by practitioners this year showed that only 1 in 3 people were in the ideal setting and had the ideal package to achieve their most independent outcome.
- 9 out of 10 people in long-term residential care are not in the best place for their needs - more than half of these started as short-term care placements
- 7 out of 10 people that would benefit from short-term services don't currently get access to them
- in half of the cases where we weren't achieving the most independent outcomes, access to a multi-discipline team was identified as a blocker
Our aim is to support people to be as independent as possible for as long as possible in their own community.
Our prototype team was set up in Erewash. They were asked to identify barriers and look at where we can make the biggest positive difference to the greatest number of people. These colleagues have been shaping the way the prevention and personalisation team will work across the county. We're now rolling out training to everyone who will be using these new ways of working.
Short-term services
We found that up to 60% of clients are rejected from Short-Term Services (STS) due to capacity each week:
- discharges from the service do not take place in a timely manner resulting in clients spending on average 40% longer in STS than needed
- the diagnostic indicated clients could be leaving STS 38% more independent than they currently do
- effective short term interventions require input from multiple disciplines where each member of staff is valued for their contribution
Our goal with short-term services is simple – to ensure that every individual can benefit from short-term enabling help in their own home, when they need it. That is why we want to free up care workers by moving towards offering a short-term service and an interim-care service which will enable local people to get back to doing things for themselves.
We're also redesigning our processes and giving practitioners new tools. For example, by enabling people to be independent at home by setting SMART (specific, measurable, achievable, relevant, and time-bound) goals that reflect their desires, and establishing multi-disciplinary teams to speed up the process, giving direct care teams dedicated support from our social workers and occupational therapists.
Managing resources using data and information
Currently there's no single place to go to that tells us how our services are running. Data and information are held in different places by different people.
The 'Data Dock' is a dashboard pulling together all our information into a single place for the first time. It means that managers will be able to use it to make decisions based on data and evidence.
The Data Dock is being designed in collaboration with practitioners so that it's easy and intuitive to use and interpret. It supports the delivery of all the other programme strands. More information and guidance on how to use the Data Dock will be made available.
Learning and development
We've been building training packages and delivering sessions for those working in prevention and personalisation (P&P), and short-term services (STS), and they are now rolling out across the county. We’ve also been showing people how to use the Data Dock dashboard of management information during these sessions. The following learning packages are on Derbyshire Learning Online:
- P&P training package
- STS training package