
Newham Council’s innovative approach to home care
Sevice Area:
adult social care
Sevice Area:
adult social care
Background
In 2017, Newham Council was experiencing issues with the quality and cost of its home care provision. Over half of care packages were purchased outside the council’s framework agreement and above the agreed hourly rate. There were also many quality and safeguarding concerns, largely from within the providers contracted by the council. A ‘time and task’ culture and commissioning approach resulted in a lack of job satisfaction for care workers, and sub-optimal outcomes for residents. Subsequently, the council grew interested in the Buurtzorg model – an approach pioneered with community nurses in the Netherlands. The key principles of the model are:
A neighbourhood-based structure: reducing travel time and enabling workers to become embedded in their local community infrastructure.
Outcome, rather than time and task focussed: recognising that residents’ needs are not static, so care should be accordingly adaptive and flexible.
Self-management: reducing bureaucracy and giving workers the professional freedom to take decisions about working in partnership with residents to deliver care in a way that works best for both parties. Within the model, there is no hierarchy – workers do not have a line manager, but have access to a coach to help resolve issuesand to a support centre for support with administrative tasks.
Local Action
In 2017/18, the council piloted a new model of home care based on Buurtzorg principles: Living Well Local. It aimed to provide a viable alternative by improving outcomes and satisfaction for residents and care workers. Another priority was to achieve long term savings by reducing a layer of management and better meeting residents’ needs (with bespoke care that improves independence, resilience and health). The pilot did not fully deliver its desired outcomes but provided key insights to help redesign Newham’s services.
Drawing on the pilot, in 2019/20, the council remodelled and re-procured its home care service. It introduced a ‘patch-based’ model that not only reduced care worker travel but also embedded a neighbourhood model: maximising connections with professional and community networks to benefit residents’ experience. The council also stipulated that providers appointed to the framework agreement pay their care workers the London Living Wage and sign up to the UNISON Ethical Care Charter.
Care workers are typically the professionals who know residents best. In the pilot they reported knowing what is needed to increase independence but often lacked the time, authority or contacts required to effect meaningful change (leading to reduced job satisfaction). From this premise, the ‘Trusted Assessor’ approach was born. A Trusted Assessor is an enhanced role seeking to improve care practice and enable career progression by expanding the role of care worker to include ongoing observation, risk assessment and monitoring of residents. The role seeks to empower workers by teaching them strengths-based, person-centred planning and risk enablement to build ‘enabling’ relationships with the local community; improving their knowledge of activities and services within the local area; and training them to assess and prescribe non-complex items of community equipment without the need for a separate occupational health referral.
The practical implementation of the model has required significant system and cultural change. Newham has worked in partnership with providers and its partners in health to ‘test and learn’ and refine the model over the last three years. Implementing these changes has proved challenging at times. For example, an initial training course for Trusted Assessors was too academic, requiring lengthy coursework submissions that placed unrealistic demands on busy frontline care staff. A new training course, accredited by the Disability Living Foundation, and with direct supervision and support from the local community health provider (East London Foundation Trust) is more practical.
Another challenge has been providing sufficient support for Trusted Assessors. Initial quarterly peer support sessions proved inadequate – sessions are now monthly. The new enhanced roles of provider staff risked confusing or alarming care recipients, their families and other professionals, so a clear communication plan was put in place.
A further challenge has been to ensure that providers themselves give the Trusted Assessor role enough attention and credit. In the next stage of the programme, the council is therefore seeking to change the selection procedure to ensure that those considered for the role are fully committed and given the time and influence that they need within their organisation to effectively deliver the role. The council is also working with health partners and Care City Community Interest Company to further evolve the role by developing apprenticeship level training to provider staff to qualify them as nursing associates/AHP assistant practitioners so they can perform delegated health functions and embed additional skills and knowledge within provider organisations. This work is enabled by innovation funding from the Rayne Foundation.
Impact on local residents
98% of new Care Packages are now purchased via the council’s framework agreement, enabling commissioners to build meaningful provider relationships, better manage cost and improve quality.
Too often initiatives are developed to benefit one party – or, in the current climate, focus solely on savings.
The Trusted Assessor approach found to benefit residents, workers and the council. Residents receive higher quality, personalised support from better qualified staff to build their independence. Three years on, the council has 37 Trusted Assessors across 22 Providers. Trusted Assessors have prescribed 74 items of equipment directly from the Community Equipment Service – swiftly giving 41 residents access to what they need, and freeing up occupational therapy resource.
Residents who have worked with Trusted Assessors have seen direct benefits and speak positively of the approach. One described how a Truster assessor worked in partnership with her to prepare her own lunch, which helped improve her strength to walk around her home. This enabled her care package to reduce from 12.25 hours per week to 8.75.
Workers report a greater sense of job satisfaction and have access to career progression in a traditionally ‘flat’ structure. Trusted Assessors now feel recognised in their role and empowered to make a difference for residents. Three have ‘moved on’ to other roles: one is training to be an occupational therapist; another, a social worker; and one has become a registered manager in another provider organisation.
The council generates immediate and longer-term savings by genuinely making residents more independent and reducing care packages. In 2021/22, the council saved £60,000. Then, £82,000 was saved in 2022/23 and £139,000 in 2023/24. Savings of £300,000 are forecast for 2024/25. (These figures do not include cumulative savings from previous year/s.)
In 2024, the council won an LGC Award for this work, in recognition of ‘exceptional creativity and commissioning and partnership collaboration’ and for ‘elevating the status of care workers and providing a clear pathway for their professional development.’
Environmental Impact
The hyper local nature of the new care model is designed to contribute towards the council’s decarbonisation efforts by reducing travelling distances.
What's next?
The council is currently further evolving and re-procuring its home care framework to:
Deliver an all-age approach, introducing the model to home care for under 18s.
Work with health and education partners to develop a bespoke apprenticeship route; upskilling care workersto deliver additional integrated functions (i.e. low level ‘health’ functions in nursing and physiotherapy) and support the delivery of innovative care tech solutions.
Co-design a video for residents explaining the Trusted Assessor role and process.
Review the gain share arrangements to ensure the financial benefits filter down to the Trusted Assessors themselves.
Set the foundations to ‘future-proof’ the workforce – growing the skills required to fill existing workforce gaps (i.e. within occupational therapy and other allied health professions).