A Project To Support More Effective Involvement Of Service Users in Adult Support and Protection Activity

Chapter 5: Conclusions

Introduction

5.1 This project has demonstrated the value of a co-production approach to explore how service user involvement in ASP work might be improved. It has produced new tools and adapted existing ones which are ready to pilot and can then hopefully be put to use. This chapter draws the findings together and makes recommendations for taking the work further.

Project overview

5.2 The project approach has required more intensive team work than conventional research approaches. Data gathering and data analysis have not been discretely separate activities but have informed each other over successive cycles of learning and tool development, requiring reflection in action as well as reflection on action (Schðn 1983). The project approach in this respect has similarities to the collaborative approach developed within Scottish health policy on patient safety and now being trialled by Scottish Government across a number of key sites of policy intervention (NHS Quality Improvement Scotland 2010). The collaborative approach sequences sessions for sharing learning with periods of action across a number of teams. Our project has entailed a similar sequencing and distribution of learning across teams, albeit on a smaller scale. Like the collaborative approach, lessons learned by one team have been picked up by other teams and adapted to suit differing contexts, such as use of the evaluation diaries for service users and practitioners first developed in East Ayrshire and subsequently adapted by North Lanarkshire and Perth teams.

5.3 The project has set in motion a process of change. Whilst the pilots will gain evaluative feedback from both practitioners and service users who use the tools, meaningful measurements of change if the tools are formally adopted within services have yet to be developed. However our literature review suggests several possible measurements would be useful:

• Increase in those who have experienced ASP services willing to participate in evaluation
• Service users participating in evaluation reporting better understanding of the process and better experience of case conference meetings and subsequent support and protection plans
• Increases in people self-referring for help from services
• A reduction in the same people repeatedly being referred under the ASPA.

5.4 This interactive approach is complex and has challenges as well as value. In reflecting on the process we have identified considerations applicable to co-production of policy implementation more generally.

Flexibility for service users

5.5 For a variety of reasons service users did not always want to commit to a formal group process, or could not attend every meeting throughout the design process. Different teams developed different ways to involve service users in incremental steps that suited the level of participation the service user indicated they wanted.

Flexibility for social work teams

5.6 A different set of pressures and dynamics also meant that social work services themselves faced challenges to participating in the process in the time frame designated. These included staffing changes and whether the timeframe clashed with other project work that was being undertaken.

5.7 A particular challenge for one team that did not progress was that the local advocacy project felt there was no scope within the contract with the local authority to release an advocacy worker from their caseload to undertake non-statutory work.

5.8 Flexibility also allowed one team to gain benefit from partial participation by joining the national network of the three teams who had participated in the project from the start. They were able to benefit from comparing practice with the other teams in a proactive problem solving context and identify strategies that could be taken up in the future. Teams further on in their process were able to pass on knowledge to those coming after them in what we hope can be sustained as an on-going learning and development chain.

Learning outcomes

5.9 This project has demonstrated the value of a co-production approach to explore how service user involvement in ASP work might be improved. It has produced new tools and adapted existing ones which are ready to pilot and can then hopefully be put to use. There is a real appetite amongst local authorities to do this type of developmental work but for some work pressures prevented them from taking part. Whilst practitioners and managers are aware of the need to improve service user participation they do need time to step back from day to day work to fully appreciate the barriers.

Learning from developing the tools

5.10 Ways of working that enable collaboration between practitioners and service users are:

• Expect to consider a range of options before picking one
• Choose a discrete aspect of ASP work and be realistic
• Devise tools that are simple to use
• Change is achieved through the process of using the tool
• Provide guidance and support about how they are to be used
• Use symbols and pictures that are commonly understood
• Paperwork is for service users too
• Think about transferability of formats: converting a paper-based tool to an electronic format can be complex
• Organisational change takes time: share the vision and its potential with practitioners as well as management.

Learning from doing co-production

5.11 In the process teams also identified a number of important points about
co-production as a service development approach:

• Flexibility is required about how service users wish to work on projects: no one model fits, find out how they want to get involved
• Relationships take time to build and for everyone to feel comfortable about working in a different way with each other
• A 'nothing's off limits' approach helps to build trust and openness
• Acknowledge you can't fix it all and find a realistic starting point
• Co-production working develops practitioners' skills and knowledge that can then be used more widely
• Deadlines provide a helpful framework for pacing work
• Humour is key: being able to laugh and relax together
• This local model of policy and practice development does take time as it is more of a journey of joint discovery but it sets the seeds for change in situ, and creates alliances and ways of working that can be built upon

Project Outcomes

5.12 In particular the project demonstrated:

• Co-production with service users and advocacy workers has helped local authority staff to see their work through each other's eyes and experiences
• Small locality teams proved a good model because relationships could be developed in ways that are not possible within more formal working parties
• It was important to find a range of ways service users could participate enabling choice and dialogue about what suits them best
• The teams demonstrated what might be described as a re-balancing of power between the practitioners and service users. modelling best practice
• Bottom-up ideas and potential solutions were worth cultivating
• This type of work takes time and may require creative adaptation to respond to changes in circumstances that impact on service users' participation
• Having a national network was effective is promoting learning between the teams, acting as a catalyst for moving the work forward

Recommendations

5.13 In light of these conclusions we have the following recommendations. Consideration should be given to:

• Piloting and evaluating the tools developed in this project
• Capturing the learning from the pilots through a range of media
• Disseminating findings from the project more widely through structured events and use of digital media platforms. Publishing the results of the pilots will provide practitioners with more detail about the outcomes the tools have achieved.
• Encouraging local authority ASP committees to explore how the co-production could contribute to their work
• Pursuing further exploration of flexible support to encourage the contributions service users want to make and to enable them to network and compare experiences with each other across localities, which is crucial to the capacity building of co-production on a strategic national basis.

At a national level

5.14 There are a range of actions that could be taken on a national level, utilising existing ASP and other more general networks and agencies:

• Disseminate findings through the established ASP forum
• Establish a shared learning web presence, such as the one planned by With Scotland
• Consider how this type of front-line co-production work might be promoted more generally within the local social care and health workforce.
• Take the report's findings into account in the review of the draft amendments to ASPA Code of Practice