Three Conversations with the Department of Health

'I have become convinced that the only way to make change really happen is to get to the heart of what people think they do when they turn up to work.'

It was great to spend time with Lyn Romeo form the Department for Health, talking about the Partners for Change three conversations model and how it can contribute to a blueprint for adult social care. A blueprint that delivers on the promises of personalisation and is practised in a context of community and asset building, local area co-ordination, restorative practice and similar approaches. In my opinion, unless we collaborate together to build a sustainable and compelling story about social care and how social work can deliver value, and really add to people’s independent lives, we face a future that is distinctly uncertain.

Throughout my career, I have lived through a series of paradigms, world views and approaches in adult social care that have all ended with a system that is process led, bureaucratic, and - despite many fine words - in constant danger of losing the person at the heart of it all. 

One director recently said, ‘we have built a system based on queues and waits’. You could go so far as to say that it is a sorting office, which works for letters and parcels, but not for people. It may sound simple but queues and waits are really bad for people – particularly those who have probably spent many weeks trying to find other ways of creating solutions for themselves. This can be all the more awful if they are waiting for an answer for a member of their family and they’ve had to fight their way through the system to arrive at their own particular queue or ‘wait’.

The current way of working measures a social worker’s quality, performance and productivity in terms of forms completed per hour/day/week. By their own admission adult social care systems, have become ‘assessment for services’ factories.

Person-Centred Planning

Came (and went) – and didn’t change any of these things. Why? Who decided that direct payment processes must become so onerous, so bureaucratic, and so self-defeating that people with direct payments would often wonder why they bothered. People going through these processes often end up with the same things they would have received but have expanded more time and effort to get them. (This is not to deny that for some, a direct payment has been a lifeline to choice, and to quality of life). Where did the half a billion pounds of reform grant to support personalisation go. What return did we get for that?

Strategies that prevent this such as those I participated in creating may have had many fine words in them but have largely not influenced the core experience of those who need support to get on with life. Commitments to dignity, respect, autonomy and citizens’ rights have left us with practice that is largely governed by the requirement to complete assessment forms. These forms have become the end in itself, rather than the means.

It was really refreshing to talk with Lyn about the requirement for really deep listening – and how we can re-introduce it as a default activity. For me, I have become  convinced that the only way to make change really happen is to get to the heart of what people think they do when they turn up to work. Look at what practice they display, what behaviours characterise their work, and ultimately the detail of the conversations they have with people and families.

The Partners for Change ‘three conversations model’ provides a set of tools to enable our committed, principled and skilled workforce to have conversations based on what people want to tell us, not what we want to ask them. The model provides the opportunity to see them as people (not clients, service users or even customers), reminding us they are often part of a family neighbourhood and community. In my experience, I have seen how, if you dynamically and intensively replace our ‘assessment for services’ culture with a commitment to proper conversations, we can really listen and begin to deliver the holy grail of better lives for people and families. This approach delivers a reduction in the consumption of health and social care resources, matched with a liberated, productive and inspired workforce.

About Sam Newman

Sam Newman is an experienced health and social care professional who caught the personalisation bug and has, for the past 7 years, provided change management support to more than 75 councils in the UK through OLM's specialist transformation division Partners for Change (P4C).

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