Barnet - Appreciative Inquiry to improve learning disabilities support
Background: In 2017, an external service and an external case review both identified significant potential to increase the independence and the quality of life outcomes for adults with learning disabilities in London Borough of Barnet (LBB), and to reduce the need for and overall cost of council funded care and support to meet the needs of adults with learning disabilities.
As a result, the Barnet Integrated Learning Disabilities Service (BLDS) undertook a series of initiatives to deliver the benefits identified. Two years into this programme Barnet wanted to assess its progress? and identify how it could do even better?
It commissioned Alder Advice to help it with this task. Task: Right from the start the progress that Barnet had already made was recognised. The ethos was to seek to build on this progress and the council’s undoubted strengths and other assets in order to get even better.
We worked closely with management, staff and other stakeholders to explore seven key lines of inquiry that asked do we have:
- A clear well communicated strategy consistent with "Progression“ that staff/other stakeholders buy in to it?
- The right structures to support progression?
- Systems and processes that fit with and promote progression?
- The right mix of staff/right skills to use to ensure prof practice is progressive?
- The right leadership and supervision inn place to promote progression?
- Progression focused support services in the local market?
- A culture (values, beliefs, attitude to risk) consistent with progression?
For each key line of inquiry we used SOAR analysis. This helped us to ensure that existing Strengths were used to identify Opportunities to get even better that aligned with the council’s future Aspirations and where we could be clear what improvement in Results could be expected.
The assessment highlighted numerous strengths to build on to deliver the local vision and aspirations. For example, it highlighted a wide range of recent improvements in the previous two years. Each was good, in its own right, and collectively they demonstrated a core ability to deliver change. Recognition of this strength led to the identification of an opportunity to join up some of the different improvements to deliver a fuller range of benefits that could help improve quality of life outcomes and lower the costs of support in the short, medium and long term.
Another key strength identified was informal multi-disciplinary working and the co-location of NHS and council staff really helped with this. There was an opportunity for MDT working to be systematically co-ordinated so that the best of the current "informal" work became the norm. This would ensure more timely interventions and improve efficiency and effectiveness. This is very important as the local vision is underpinned by an assumption about MDT collaboration at senior and at practitioner levels.
Whilst there is evidence of short-term cost consciousness the mainly responsive nature of work and some inefficient work processes/practices was allowing some long-term "over-servicing" of individual clients to persist and was allowing service models that were increasingly dated and barely “fit for purpose” to continue.
The findings clearly highlighted several improvement themes which if were supported by 17 recommendations to ensure that each theme was tackled in a coherent, co-ordinated manner to deliver more positive, personalised outcomes, improved compliance with the Care Act and other legislative imperatives alongside demonstrable improvements in value for money. These recommendations were supported by evidence of areas where investment in a programme of change and improvement was required.