The Skills for Care New Types of Worker Programme: Stage 1 Evaluation Report … · · 2014-04-174.2.4 Boundary-spanning roles ... The Skills for Care New Types of Worker Programme:

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NEW TYPES OF WORKER

kills for Care r Programme: uation Report

Ian Kessler leton College, University of Oxford

Stephen Bach

ng’s College, University of London

New Types of Worker programme

January2007

Foreword The New Types of Worker (NToW) programme is about innovative work redesign in adult social care. It uses action research and action learning to build the evidence base for new types of worker and new types of working in adult social care in order to show how workforce development needs to adapt to meet the challenges of the next ten years.

The work is funded by the Department of Health, to help meet three of their targets: • “Identify and trial additional innovative types of working that are central to the white paper

vision of a service-user commissioned service.” • “Embed sustainable new types of working in the sector through informing the

development of career pathways, performance management, NOS and qualifications.” • “Ensure that new types of working in social care make a full contribution to community

regeneration.”

In view of this, the NToW programme aims to: • give clear guidance and examples of how the social care workforce can be redesigned

to move from what people do now to what the sector needs people to do in the future • demonstrate the workforce changes required to implement new service models • show what those changes will mean for all aspects of adult social care workforce

development • be an exemplar of best practice in people and carer engagement.

These aims have been specified for the second stage of the NToW programme, which is now well under way. But this vision has been reached on the basis of the work undertaken in stage 1 of the programme, which ran from 2003–2006 and on which this report gives the detailed overview and evaluation.

The executive summary and conclusions sections of this report were first published early in 2007, but this publication is the full report. Skills for Care is grateful to Ian Kessler and Stephen Bach, of the universities of Oxford and London respectively, for their work in researching and collating this report. But social care as a whole owes a debt of gratitude to all the care workers and managers, people who use services, and carers who were involved in all the 28 pilot projects whose work features in this report. Not all of the things that were tried will be taken forward, but none of the pilot projects was a failure – deciding not to pursue an idea is just as valid an instance of action learning as deciding to roll an idea on to a further stage.

The New Types of Worker programme is part of Skills for Care’s business plan objective to ‘identify the future workforce’. We are doing this by maintaining NToW activity across the regions and by developing the social care role framework which provides the principles for the development of new roles in social care. Our approach requires that the development of new types of work, which must centre on people who use services, must precede consideration of new roles. We are planning the continuation of this work across the next three years, to include social care employers of all types as well as the people they serve.

Andrea Rowe Chief Executive, Skills for Care. June 2007

Contents 1 Executive summary Introduction 1.1 Context

1.1.1 Organisational and service setting

1.1.2 Path dependency 1.2 Objectives

1.2.1 Aims 1.2.2 New roles

1.3 Processes 1.3.1 Managing the project 1.3.2 Managing stakeholders

1.4 Outcomes 1.4.1 Approaches to evaluation 1.4.2 Organisational outcomes 1.4.3 Employee outcomes 1.4.4 Outcomes for people who

use services

2 Introduction 2.1 Origins 2.2 The New Types of Worker

programme 2.2.1 Aims 2.2.2 Accountability versus

Flexibility 2.2.3 Present versus Future 2.2.4 Ways of Working versus

Types of Worker 2.3 The pilot sites

2.3.1 Managing the programme 2.3.2 The current study

3 Context 3.1 Organisational and service setting

3.1.1 The service 3.1.2 The organisation

3.2 Path dependency

4 Objectives 4.1 Pilot aims 4.2 New roles

4.2.1 Specialist roles 4.2.2 Person-based roles 4.2.3 Co-ordinator roles 4.2.4 Boundary-spanning roles

4.3 Relating pilot objectives and roles

5 Processes 5.1 Managing the project

5.1.1 Steering groups 5.1.2 Project managers

5.2 Managing the stakeholders 5.2.1 Internal stakeholders 5.2.2 External stakeholders

5.3 Managing the relationship with Skills for Care

6 Outcomes 6.1 Approaches to evaluation 6.2 Organisational value and

‘sustainability’ 6.2.1 Sustainable roles 6.2.2 Vulnerable roles 6.2.3 Transitory roles 6.2.4 Evolving roles

6.3 Employee value 6.3.1 Recruitment and retention 6.3.2 The treatment of post-holders

6.4 Value for people who use services

7 Summary and conclusions 7.1 Overview 7.2 Tensions

7.2.1 Ways of Working versus Type of Worker

7.2.2 Accountability versus Flexibility

7.3 Learning points 7.3.1 Context 7.3.2 Objectives 7.3.3 Processes 7.3.4 Outcomes

The Skills for Care New Types of Worker Programme: Stage 1 evaluation report. Ian Kessler & Stephen Bach Published by Skills for Care, the strategic body for workforce development in adult social care in England. © Skills for Care, 2007. Albion Court, 5 Albion Place, Leeds LS1 6JL www.skillsforcare.org.uk Not for commercial distribution. This publication may be copied for social care workforce development purposes.

New Types of Worker stage 1 evaluation report, p.1

1.0 Executive summaryIntroduction The report sets out the findings from an evaluation of the first phase of the Skills for Care (SfC) New Types of Worker programme, 2003–6. This first phase comprised twenty eight pilots covering different parts of social care sector, set up with the aim of developing new work roles and new approaches to service delivery.

The evaluation was carried out over the last three months of 2006. It drew upon documentary material from the pilots, telephone interviews with 25 project managers and follow up in a selection of cases. The evaluation was based on a ‘systems model’ which explored:

• context

• inputs, in terms of pilot objectives

• processes

• outcomes for key stakeholders including the organisation, employees, people who use services, and carers.

The report is divided into these four parts.

1.1 Context 1.1.1 Organisational and service setting

The service setting, whether the pilot was located in physical disability, sensory impairment, mental health, learning disability, older people or children’s services, had implications for funding and partnership working. Organisational settings also varied with potentially important consequences for processes and outcomes. Pilots were located in the statutory sector and the voluntary sector, and in large and small organisations.

1.1.2 Path dependency

All pilots were path dependent in that they had been shaped by a range of factors over an extended period of time. There were, however, important differences according to whether the pilot had:

• emerged from the recent or distant past

• been driven by an individual ‘champion’ or institutional need

• been located in a niche or the mainstream of the organisation.

1.2 Objectives 1.2.1 Aims

Pilots were seeking to develop:

• person-centred services

• voices of people using the services, and of carers

• independence of people using the services, and of carers


• prevention or early intervention

• access for people using the services, and for carers

• workforce capacity

• a skilled workforce

• joined-up services.

Pilots invariably had multiple aims, but there were clusters of pilots which concentrated on skills, voice, early intervention and independence.

1.2.2 New roles

Most pilots involved the development of a new role; in only four was it difficult to identify the emergence of such a role.

Four types of role were distinguished:

Specialist role: a role which breaks away from a general occupation to focus in a deeper and more concentrated way on a task and/or user group.

Person-based role: a role which is performed by a person who also uses the service.

Co-ordinating role: a role which organises activities involving different parties.

Boundary-spanning role: a role which operates across traditional organisational, client or service ‘jurisdictions’.

In most cases these roles were based not on a re-labelling of old roles or even a re-packaging of established tasks, but on the generation of new activities. However, these roles covered a relatively modest number of employees, less than a hundred across all pilots, including two which employed almost half of this number. While not detracting from the impact of these new roles, the scale of change was limited.

1.3 Processes 1.3.1 Managing the project

Steering groups were a common feature. Such groups could become:

• an effective means of achieving buy-in to the project from various internal and external stakeholders

• a meaningful way of involving people using the service

• an important forum for dealing with substantive issues, contingent on those involved having the necessary authority and decision-making power.

• It was found that project managers within pilots:

• came and went during the course of projects, which could disrupt work

• could be difficult to recruit

• sometimes had responsibilities beyond the pilot which added to the pressure on them.


1.3.2 Managing stakeholders

New roles involved managing internal stakeholders: Such roles:

• often required broader culture changes, especially when linked to new ways of working

• could challenge co-workers and especially professionals

• could be perceived as generating ‘disruption’ in organisations already suffering from ‘change fatigue’

• provoke sometimes unexpected responses of a positive or negative kind from co-workers.

Organisations managed internal stakeholders by organising early stakeholder events, seeking to inform and generate buy-in to the pilot. They also fostered local ‘champions’ to spread ‘good practice’ and knowledge.

New roles also involved managing external stakeholders. Such roles required:

• agreed pathways and common referral and assessment procedures, particularly in a partnership context

• shared workplace procedures, again especially where pilots cut across different parts of public services

• sensitivity to statutory regulations which might shape the scope to develop a new post.

Finally the relationship with Skills for Care had to be managed. Some concerns were expressed about delayed funding and administrative procedures associated with the programme. The learning sets were generally seen to be of value and use. Criticisms were voiced about the national and regional ownership of the pilots displayed by Skills for Care.

1.4 Outcomes 1.4.1 Approaches to evaluation

It was a milestone for projects to self-evaluate, with discretion as to how this was carried out:

• The majority of pilots generated primary data on outcomes associated with the pilot.

• This was normally undertaken in-house with only six pilots seeking independent evaluation.

• Those pilots with a significant training component relied on training evaluation sheets.

• Many pilots sought feedback from people who used the service.

• A number of pilots deployed people who used the services to evaluate projects.

1.4.2 Organisational outcomes

In all but three of the pilots a new role or way of working continued in some form. However, a number of questions remained about the ongoing viability of these continuing roles:


• The future of roles in the continuation sites after funding ceased was uncertain.

• In certain cases new roles were seen as transitory, disappearing or assuming very different forms after they had achieved their goals.

• In other instances, roles had been ‘swallowed-up’ in broader initiatives and again had taken on very different characters.

• Those roles which appeared to be the most vulnerable were found in the voluntary sector where contingent forms of funding often made it difficult to provide ongoing financial support for them.

1.4.3 Employee outcomes

Projects often faced difficulties in recruiting people to new roles; this reflected more general skills shortages but, more specifically, related to the unusual requirements and uncertainties associated with the new posts. Retention was less of an issue, post holders showing a strong commitment to their roles.

The treatment of those in roles based on people who use services, that is those undertaken by the people themselves, was distinctive in requiring sensitivity to those people’s condition and circumstances. More generally:

• in workload terms, the new roles were often demanding, requiring post holders to set up new systems and develop new networks. These demands were exacerbated by the fact that they often had to deal with co-workers and professionals who were also facing considerable workload pressures.

• as new and unusual roles, there was also a requirements to develop training programmes for them

• there was a need in some cases to protect terms and conditions of employment, particularly where the worker came from another part of the public services, but more pressing was the need to provide career opportunities for those in the new roles to avoid them becoming seen as ‘dead end jobs’.

1.4.4 Outcomes for people who use services

There were important differences in the new roles in terms of how directly they impacted upon people who used the services. A number of the roles involved the provision of frontline services directly benefiting people. Other roles had less direct consequences for people who use the services, operating at some remove from them.


2.0 Introduction 2.1 Origins

In early 2003 Skills for Care1 launched a programme entitled New Types of Worker that the chief executive described as ‘contributing to the modernisation of the public services’ by helping to develop a social care workforce ‘that is fit to meet future needs’.2 Funded by the Department of Health, the programme comprised two phases. The first, lasting three years, took the form of twenty-eight pilot projects from different parts of the social care sector and across a variety of user groups. The second, commencing in April, 2006, provides further support for six ‘continuation sites’ and implements plans formulated by the Skills for Care regions to take forward and further develop the work and learning emerging from phase one.

This report sets out the findings from an evaluation of the first phase of the Skills for Care (SfC) New Types of Worker (NToW) programme. It has the following objectives:

• To provide an independent assessment of the pilots.

• To review the complete range of projects in a structured and systematic way.

• To characterise the pilots, so developing a fuller appreciation of the form taken by them.

• To understand how the projects were conducted and with what consequences.

• To draw out learning points for practitioners and policymakers.

This report is divided into four main parts:

• Context: the circumstances in which the pilots were established.

• Objectives: the aims underpinning the respective projects.

• Process: the operation of the pilots.

• Outcomes: the consequences for various stakeholders.

These core sections are followed by a discussion of the findings and preceded, in the remainder of this introduction, by an overview of the NToW programme and a description of how our evaluation was carried out.

2.2 The New Types of Worker programme 2.2.1 Aims

The New Types of Worker programme emerged from the Government’s public service ‘modernisation’ agenda. This is an agenda founded upon a range of related principles, but which has the person using the service at its heart. This focus has encouraged national 1 At the time the project was launched Skills of Care was operating as Topss England. The title Skills for Care is used throughout this report. 2 Waddilove D, Case Notes (Skills for Care, Leeds, 2006), Foreword.


policymakers to challenge traditional relationships between public service providers, in some instances stimulating an emphasis on partnership working and leading to an examination of whether working practices are ‘best’ structured and organised to meet client needs and circumstances. However, the development of new roles within the social care workforce presents distinctive challenges:

• It is a workforce which services a variety of groups with very particular needs and, at times, subject to discrete public policy initiatives:

o older people

o children in need

o people with mental disabilities

o people with learning disabilities

o people with physical disabilities including sensory impairment.

• The provision of services for these groups extends well beyond the public service sector, creating a workforce which straddles the public, private and voluntary sectors; indeed almost two thirds of the 1.2 million social care workforce lies outside the public sector (www.prospect.ac.uk).

• It is a workforce which typically interacts with agencies from a wide range of services, depending on the group, involving housing, education, the health service (primary and secondary care), and the police.

The NToW programme’s objectives were broadly drawn (Topss England August 2003 discussion paper for Task and Finish Group meeting 8 Sept. 2003) with phase one seeking to support pilots which could contribute to:

• the development of service provision in a ‘person-centred’ way

• the generation of new work roles

• the creation of new (inter) organisational relationships

• the formulation of management systems to support these relationships

• the stimulation of learning at different levels.

At the same time, there were tensions in the programme along the following lines:


The project needed to account for the expenditure of public money, in the case of phase one £6 million, by reference to the achievement of clearly stated goals. However, for a project that had at its core the pursuit of new approaches to work and employment, there was a risk that tightly drawn objectives might undermine the flexibility needed to deal with uncertainties and required to innovate. It is perhaps an inevitable feature of a programme dealing with the ‘new’ that uncertainties will exist and unexpected outcomes will emerge. In particular, the inherent unpredictably of projects involving the ‘new’ becomes an even


more potent consideration where projects are required to conclude within a finite funding period.

2.2.3 Present versus Future

The NToW programme unfolded against a shifting public policy backdrop. For example, during phase one major government statements were published on health and social care including the Green Paper Independence, Wellbeing and Choice (DH, 2005) on adult social care services and the White Paper Our Health, Our Care, Our Say (DH) on community services. The pilots were often not only ‘in tune’ but in some cases well ahead of the proposed developments; indeed there were instances of early project findings feeding into these government papers. However as a consequence of this shifting backdrop, the NToW programme constantly had to re-frame itself to ensure alignment with ongoing public policy developments.

2.2.4 Ways of Working versus Types of Worker

The SfC programme was ostensibly concerned with establishing new work roles; it was, after all, entitled the ‘New Types of Worker’ project rather than the ‘New Ways of Working’ programme. In an important sense, any attempt to develop new worker roles is inextricably linked to new ways of working: if ways of working change, it is likely that work roles will alter accordingly. Nonetheless, a new work role implies a more radical unpacking of existing tasks and responsibilities (or the generation of new ones), and then a repackaging of them in a new way. The SfC objectives quoted above lack precision, often conflating the link between new work roles and new ways of working, and leading to some uncertainty about the focus of the programme. It is striking that even at the end of phase one this uncertainty remained.

2.3 The pilot sites Table 1 below sets out the pilot sites finally selected, highlighting the breakdown by region and user group as well as by the length of the project. It can be seen that the programme achieved a good balance between projects covering different user groups. The priority given to sensory impairment services is reflected in the fact that five of the pilots covered this activity; nonetheless, a similar number of projects involved children, learning disability, and mental health. Older people were somewhat under represented, although Table 1 is slightly misleading in this respect with projects such as those run by Jewish Care and Leeds City Council mainly focusing on older people. It is also striking that six of the pilots sought to embrace multiple user groups, a reflection perhaps of the programme’s attempt to explore roles that extended across traditional user ‘silos’.

The regional distribution of pilots saw a concentration of projects in the south (10), but this did not greatly undermine the regional balance with a significant number of projects to be found in the north (6) and south-west (8); only the east (2) had a shortfall of pilots. In terms of funding, only a small number of the pilots (6) were funded for the full three years; eleven were funded for two years and eleven for a year.

2.3.1 Managing the programme. A number of systems were established at national level to support the phase one pilot projects:


Action learning sets: Organised on a regional basis and using facilitators, these met on a regular basis and provided opportunities for pilots to share ideas and experiences.

A website: allowing for the posting of and ongoing access to key documents.

Milestones: a combination of standard and bespoke milestones was established for each project. One of these milestones was the need for pilots to provide an evaluation of their work. This combination of milestones and self-evaluation ensured that the processes and outcomes from the project could be monitored. However it was the absence of an independent, overview evaluation that prompted this current study.

Table 1: Phase 1 pilot projects by region, user group and length

North South South-West East Nationwide Older People

The Laurels (2004-6)+# Bath/Somerset Partnership (2003-6)+

Mental Health

-Association of Social Workers and Allied Professionals: Rendezvous for Justice & Equality (2005-6)*+< -Hants. Person’s Individual Plans*+ -Jewish Care Dementia (2003-6)+< -Hants Partnership/ HAPUN Service User Engagement (2004-6)+

- Taunton MIND Skills and Opportunity Centre (2004-6)+<

Children -SW Surrey Team Around the Child (2003-6)+ -Greenwich SSD and Primary Care Trust (2003-4)

Devon Children’s Trust (2003-6)

Suffolk CC Looked After Children (2003-4)+

Barnardo’s Arts & Creative Ways of working (2004-6)+<

Learning Disability

-Blackpool Learning Disability Partnership (2004-6)+ -County Durham Care (2003-6)+

United Response (2004-5)+< New Dimensions/ New Ways of Working (2003-6)*+<

Sensory Impairm’tor Physical Condit’n

-Salford Sensory Services (2004-6)+ -Gateshead Community Based Services (2004-6)*+

-Hampshire County Sensory Early Intervention (2005-6)+ -Northants CC SI Unit (2005-6)

-Devon SSD: ROVICs (children & SI) (2005-6)+

Multiple - Leeds City council Community Support Asst. (2003-6)+

-Sutton Children’s Trust Transition Unit (Children/LD/PC) (2005-6)+

-WHERE: Community Enabling Service ((2003-6)+< - No Limits Training Group*+< -Pathfinder training (2004-6) - SUCH Project(2004-6)*+<

Norfolk SSD- Assistive Technology (2005-6)+

*Phase 2 Continuation Site +Project Manager interviewed as part of this study < Voluntary sector organisation

# private sector

2.3.2 The current study

Set out below is the systems model used to evaluate the phase one pilot projects. Its four main elements – context, inputs, process and outputs- correspond to the structure of the report.

Figure 1: Evaluation model

Pilot Focus & Context

NewTypes ofWorkers

New Ways ofWorkingNational Policy

Objectives:

Pilot Inputs

-Person centred services(Voice/dignity/well being/Independence)-Prevention/ early intervention-Access-Support for long term needs-Workforce Capacity building-Skills mix-Skilled/competent workforce

-More care at home-Better joined up services atthe local level

- Innovation-Allowing different providers

Pilot Processes

Pilot Outcomes

Objectives Resources

Design/Implementation

Operation

Service Users Professional/Employees Organisation

Costs Benefits

Success Factors

Objectives m

et?

Both

Sustainability/Mainstreamed

Who was involved?(agencies & users)What prompted theInitiative?What service isInvolved?

Carers

The evaluation was carried out over the final three months of 2006, a tight timescale, not least given the significant number of pilot projects to be covered. The methodologies used needed to be sensitive to this timescale and included the following:

Documentary material related to the projects was reviewed including original pilot proposals, milestone and final reports.

Telephone interviews and in some cases face-to-face interviews were conducted with as many project managers as possible. In the event twenty five of the twenty eight project managers were interviewed. The only project managers not interviewed were from the Devon Children’s Trust, 3Northamptonshire and Greenwich SSD project.

Follow-up work was carried out in a selection of cases. The nature of this work varied, but tended to involve: interviews with at least one other person linked to the project-these interviews were usually with a worker in the new role and people who use services; focus groups, typically with people who use services; and occasionally observation, for instance, through attendance at a Steering Group meeting. The choice of follow-up sites sought to reflect the distribution of the pilots by region and user group. It can be seen from Table 2


3 Two projects were located in Devon CC and focused on children. The ROVICs project was covered in this evaluation; it was the project involving the development of a ‘training travel agent role’ which chose not co-operate.


below that at least one project from each of the four regions was included with a concentration of projects in the south and south-west. The projects covered included physical disability and sensory impairment, mental health and children. Older people were involved, in part, by the follow-up work in the Jewish Care project, which dealt with dementia. Unfortunately there was no follow-up work in a learning disability pilot. In total fifty-one people were interviewed during the fieldwork.4

Table 2: Follow-up work

North South South-West East Older People

Mental Health

Association of Social Workers and Allied Professionals: Rendezvous for Justice & Equality: - interview with project worker -interviews with three service users/new workers Hampshire Person’s Individual Plans: - observation of Steering Group meeting -Focus group with four users/workers - Interview with new role holder Jewish Care Dementia project: - Interviews with two trainers

Taunton MIND Skills and Opportunity Centre: -Focus group involving one worker and five service users

Children SW Surrey Team Around the Child - interview with new role holder

Suffolk CC new role for Looked After Children - interview with Head of Fostering service

Learning Disability

Sensory Impairment/Physical Condition

Gateshead Community Based Services: -interview with two managers and three service users

Hampshire County Sensory Early Intervention -interview with new role holder and one service user

Devon SSD: ROVICs (children & SI) -Interview with new role holder

Multiple WHERE: Community Enabling Service (PC & MH) -visit to site and meeting with six users and worker SUCH Project (MH&PC) -Interviews with two new role holders

4 The authors would like to express their thanks to those in the pilots who helped with and co-operated in carrying out this study. We are grateful to Ellie Sheehan for her assistance with this report


3. Context While the New Types of Worker programme focused on exploring new worker roles, it was rarely if ever the case that a role emerged from ‘out of the blue’ or developed in a ‘vacuum.’ Every pilot had a particular organisational and service setting and its own history. This section explores two contextual features in greater detail:

• the pilots’ organisational and service setting

• the evolution of the projects.

3.1 Organisational and service setting 3.1.1 The service

The comprehensive range of user groups covered by the programme, clearly placed the pilots in discrete public policy settings related to children, older people, mental health, physical and learning disability, governed by a particular a configuration of initiatives and institutional arrangements. In brief, those pilots in children services were embedded in changes stimulated by the Every Child Matters (2003) agenda with the creation of integrated children’s services and more recently Children’s Trusts; those in learning disabilities were driven by the agenda set out in Valuing People: A New Strategy for Learning Disability for the 21st Century (2001 DH); while those in mental health were influenced by one of the earliest National Service Frameworks, introduced in 1999, although such frameworks have since been introduced for older people (2001), children and for those with long term neurological conditions.

These discrete policy tracks and supportive structures had implications for the pilots in a number of respects:

• Funding: There was some unevenness by user group in the availability of alternative and ‘ring fenced’ funding to support the pilots at various times. For example, the Norfolk assistive technology pilot, focusing in large part on older people, had been able to draw upon almost £1.5 million from the government’s £80 million Preventative Technology Grant to support ongoing work.

• Partnership working: This form of service delivery had emerged across all of the service groups covered by the pilots, but there were important differences in its pace of development and character. In an institutional sense, partnership working was most developed in mental health and learning disability, with progress much more uneven across the other groups. In those mental health and learning disability pilots located within the statutory sector, such as the Havant and Petersfield User Network (HAPUN) project, the Hampshire person individual planning (PIP) project and the Blackpool Learning Disability project, employees were working in and with the Mental and Learning Disability Trust. Projects involving other groups of people who use services, such as children and those with physical disabilities and sensory impairments, joint working between education, health and social care was common, but relationships and systems in these sub-sectors were sometimes less formalised.


• People who use services, and carers: The nature of the client-worker interface varied by service groups. In pilots involving children and those with learning disabilities, workers were typically dealing with carers, often parents, while amongst those projects covering older people, adults with physical and mental disabilities employees were much more likely (depending on the condition) to be interacting directly with people who use services. This difference permeated the pilots in various ways. Those projects seeking to develop and engage with user networks focused on people with physical and mental disabilities such as the HAPUN and Gateshead projects. It was these groups who were also often at the centre of projects which sought to develop work roles undertaken by people who use services, like the Association of Black Social Workers and Allied Professionals (ABSWAP), Hampshire PIP, MIND and SUCH pilots.

3.1.2 The organisation

The NToW programme covered a diverse range of organisations, particularly in terms of their sector, size and structure. The most fundamental divide between the pilots was between those in the voluntary sector and those in the statutory sector. It can be seen from Table 1 above that a third of the pilots (9) were from the voluntary sector, sensory impairment being the only user group without an organisation specifically from this sector. The sector status of the pilots might be viewed as having somewhat contradictory implications for the well-being of the individual pilots:

• On the ‘positive’ side, voluntary sector organisations might be seen as generally more flexible and less bureaucratic. As a consequence decision-making might be quicker and the scope for innovation greater. It is, for example, no coincidence that over half of the projects (see Table 1) which attempted to reach out to multiple user groups, including the Wellington Health Education Resource Enterprise (WHERE), No Limits, and SUCH projects, were from the voluntary sector.

• On the ‘negative’ side, some voluntary sector organisations function on a less secure basis than statutory organisations, with more contingent sources of income and fewer supportive internal structures and systems. This was not invariably the case: a number of well established voluntary sector organisations such as MIND, Barnado’s and Jewish Care with more secure funding, figured in the programme, but there were other pilots from this sector such as the ABSWAP, the SUCH and WHERE projects, which were highly dependent on time-limited grants to carry out their work.

The statutory-voluntary sector divide has some bearing on the size and structure of the organisations involved in the programme. The smaller and larger organisations were drawn from the voluntary sector. The smallest organisations involved in the programme were from the voluntary sector: the SUCH project, for example, involved only around half a dozen people. However, those nationwide organisations involved in the programme were also from the voluntary sector including United Response employing 2,000 employees, Jewish Care with 1,200 workers and 2,500 volunteers and New Dimensions with 1,800 staff. The statutory organisations were naturally confined to the geographical boundaries associated with the local authority, although even here there were size differences between the sprawling shire counties such as Suffolk and Norfolk and the


more compact metropolitan districts of Leeds, Salford and Gateshead. Indeed, within the statutory sector, there was also considerable variation in the scale of projects: for example, the Leeds domiciliary service project covered around 1400 employees; but there were instances where the pilot was confined to a single, area based team as in the Team Around the Child (TAC) project in South West Surrey and the user engagement project in Havant and Petersfield in Hampshire.5 Clearly the size and coverage of the pilot organisation might be expected to have a significant affect on the objectives of the project as well as the associated processes and outcomes.

3.2 Path dependency All of the pilots were path dependent, in other words they had emerged and been shaped over a given timeframe. However, there were important differences in this process:

Recent or distant past: A number of pilots had arisen from a relatively recent stimulus or initiative such a ‘Best Value’ report, but more typically had emerged over an extended period in response to:

• the direction of national policy

• a longstanding internal service need

• a continuous process of service development.

Individual or institutional: Dedicated, enthusiastic and energetic individuals often drove projects. However others were deeply rooted in ongoing institutional needs and developments.

Niche or mainstream: Some projects were mainstream, service-wide initiatives, which sought to introduce roles or ways of working across the organisation. Others were more modest, attempting to alter an aspect of service provision in one part of the organisation. The niche and mainstream options were not mutually exclusive, with a couple of projects (see below, Norfolk and Leeds) starting out as pilots, before the SfC programme provided an opportunity to extend the work.

A number of examples can be highlighted to illustrate how these dimensions combined in different projects:

Jewish Care

The Jewish Care dementia project emerged from an ongoing stream of activity over many years that addressed a mainstream institutional need. Thus, the organisation ran a number of residential care homes for older people, at least 60% of whom would be suffering from dementia (Jewish Care Application for Pilot site status udated:1). The pilot could be traced back to 1999 when Jewish Care began research in collaboration with Middlesex University on dementia patient-carer interaction. This work recommended further staff training. In 2003, the Oxford Dementia Development Centre carried out an audit of practice in Jewish Care using standards developed by the Alzheimer Society. In general this revealed ‘high standards of care’ but highlighted a number of areas for

5 This should not detract from the fact that these teams covered broad geographical areas with significant client bases. The Havant and Petersfield area, for instance, was 25 miles long and 10 miles wide and comprised 650 people suffering ‘severe and enduring’ mental health problems.


potential improvement, again reiterating the need for staff training (Jewish care, 2006 final report).

Association of Black Social Workers and Allied Professionals

The pilot was driven by an ‘individual champion’ with a long track record of community work in south east London. This work had mainly focused on housing projects but the SfC project was sharply focused on the need to address the care requirements of those from the local black community with mental health needs. As the rationale for the project noted:

‘Black and Minority Ethnic users and carers groups are sometimes isolated and unsupported by family members. In the absence of provisions, users are vulnerable and often become the scapegoats when things go wrong...There is a need to provide appropriate support to (BME) service users who experience discrimination, exclusion and scapegoating.’(Milestone report, 2005:4)’

Blackpool Learning Disabilities Partnership

This project was an institutional response to a perceived organisational need driven by public policy developments. The 2001 White Paper on learning disabilities, Valuing People, had placed considerably emphasis on person-centred planning. As the project manager noted:

‘There was a need to develop something in this area anyway. We were required to set up a steering group on person-centred planning and there was the push from Valuing People. Then there was the push from other areas so certain types of planning are ‘performance indicatored’, particularly with young people in transition from children’s to adult services and we had to give information on this to the Department of Health.’

Norfolk Assistive Technology

The Norfolk pilot emerged from a continuous stream of activity undertaken by a service development officer with a particular interest in assistive technology. This interest overlapped with a range of public policy initiatives and pronouncements stressing the importance of assistive technology in the home for older people and those with learning disabilities including the NHS Plan, 2000, Valuing People and various Audit Commission reports (Application). Moreover, it was a project that built-on earlier initiatives: a Smart home in Norwich had already been developed in partnership with Norwich City Council, their Alarm Service and Tunstall Telecom.

Leeds Domiciliary Services

The Leeds project was associated with a sustained institutional attempt by the council to restructure a major council service: domiciliary care. A review had split the service, one part focusing on personal care and the other on more routine household duties. A small pilot in west Leeds, focusing on those employed in personal care and founded upon the NHS Accelerated Development Programme, was then set-up, with the SfC project designed to roll this work out across the whole of the city’s service.


Hampshire PIP

The Hampshire PIP pilot covering mental health was an example of a project ‘kick started’ by an external stimulus, taken forward by dedicated individuals, but with a view to mainstreaming a practice: the drafting of Person Individual Plans. The external stimulus was exposure to the Wellness Recovery Action Plan (WRAP) developed in the US by Mary Ellen Copeland, following attendance by a nominated individual on related training provided by the National Institute of Mental Health. It prompted an attempt to offer those with mental health problems throughout Hampshire the chance to draft a plan.

SUCH

The SUCH pilot was developed by an ‘individual champion’ keen to provide holistic therapies (e.g. aromatherapy) to people not normally in a position to access them. Furthermore, it emerged to provide employment opportunities for people in recovery. SUCH has also drawn upon the WRAP approach.

Hampshire Early Intervention Sensory Service

This project was an instance of an organisation responding to a recently identified service need. It followed a Best Value 2003 review of the sensory service, which revealed extremely high levels of user satisfaction in general, but concerns ‘about the length of time that elapsed between sensory needs being identified and assessment of need being offered.’ (HCC Final report, 2006, p8).

The WHERE Community Enabler

This project emerged after many years work by WHERE in facilitating the re-engagement of isolated individuals into the community. As an internal report noted ‘The role of the Community Enable has evolved from ten years experience in running a Community Access Service for people who have physical disability or long term mental health distress.’ (Hill, 2004,New Social Care Roles- Community Enabling p1)

No Limits Training Group

This project focused on building a carers’ community in Somerset. The impetus arose from local champions who believed that carers needed to be engaged with in a different manner than in the past. In particular it was felt that statutory agencies had a tendency to maintain carers as ‘carers’ rather than encourage their own empowerment. To address these issues the project had reached out across Somerset to carers, running events to bring carers together, to form a carers’ community. This had provided a platform to develop an independent voice for carers in the county and a mechanism to establish a pathway for carers to become carer representatives. Carers were therefore partners in service provision and could access employment and learning, increasing workforce capacity.

Bath and North East Somerset Partnership Project

This project stemmed from a recognition that residential care was increasingly caring for people who were older, living longer and would previously have expected to receive nursing and hospital care. The project, a multi-agency partnership between statutory and


independent sector employers in conjunction with PCTs from Bath, Bristol and South Gloucestershire, had enabled older people in care homes to receive nursing support without having to move when their needs increased. It had also prevented hospital admissions and facilitated early discharge from hospital. This had occurred by training social care and health support workers in selected clinical procedures, challenging the tradition that this type of nursing support is provided only by GPs and district nurses.

County Durham Care

Drivers for this project included national policy to shift learning disability services into the community and the inclusion agenda. A key feature of the project had been the development of community project workers working in a person-centred manner with people who use learning disability services. Occupational standards had been developed for this workforce. The development of new workers had contributed to service redesign and had formed part of wider changes in management structures and working practices in County Durham.

Sutton Children’s Trust

This project focused on the difficulties that young adults with disabilities confront in transition. The aim was to support young people in transition to navigate the network of agencies involved in the provision of adult services. The project had brought together a number of partners in children’s social services, adult social services and Connexions to ease the transition via new ways of working.


4. Objectives This section seeks to classify projects by their objectives and, in particular, considers whether and how pilot aims were linked to the development of new work roles. More specifically, the section first reviews the project objectives; it then identifies the emerging work roles and concludes with a consideration of the relationship between pilot goals and types of worker.

4.1 Pilot aims The pilots might have been expected to pursue the kinds of objectives already summarised in the introduction as underpinning the NToW project. These objectives, reflecting Skills for Care priorities and broader national public policy concerns, can briefly be re-stated as seeking to develop:

• person-centred services

• voice of people who use services and of carers

• independence for people who use services and for carers

• prevention/early intervention

• service access for people who use services and for carers

• workforce capacity

• skilled/competent workforce

• joined-up services.

Table 3 below seeks to capture this mosaic of objectives, distinguishing pilots by the range of aims involved and, in each case, highlighting the primary goal.

Table 3 indicates that there were certain goals that informed most of the projects. For example, there were few projects not seeking to develop accessible, person-centred services. More unexpected perhaps was the prevalence of voice as an objective, with many of the pilots seeking to create a greater inclusiveness in service design and delivery. The table also highlights the multiple objectives underpinning the projects and a few of those projects ‘ticking’ a particularly significant number of ‘boxes’ are worth further consideration:

• In setting up an Early Intervention Service for those with sensory impairments, the Hampshire project confronted the interface between health and social care and sought a ‘joined-up’ or integrated relationship. Closely related was a requirement to train especially social care staff employees at this interface who needed to know more about the health side of sensory impairment. Moreover the project sought to provide a voice for people using the service by deploying them in the training and service evaluation; they interviewed people on the impact of the service and were encouraged to help run an Information Resource Centre.

New Types of Wo

• By developing the Rehabilitation Officer for Visually Impaired Children (ROVIC) role, Devon ensured early intervention for children with visual impairment and access to a dedicated service. In addition, by placing the ROVIC in joint agency teams an integrated service was created, while the emergence of a new specialist deepened workforce skills

• In focusing upon assistive technologies, the Norfolk project provided people who use the service with greater independence in their homes. But the creation of the support worker role facilitated access to this service and again created new skills within the workforce.

• The MIND project had a number of activity streams. In creating a centre in a high street location it was providing ready access to advice and information for a ramade available therapy serviclisteners built workforce capacthose in the statutory sector.

• The Leeds domiciliary pilot wcommunity support assistant rprofessionals. However, it is wwho highlighted the project’s v

‘This service user wanted toin and wait for different profpeople, and they (the servicerelationship with the homec

Table 3: Project objectives

Pers

on-c

entre

d

Voice

Inde

pend

ence

Prev

entio

n/

Early

In

terv

entio

n Ac

cess

Wor

kfor

ce

capa

city

build

ing

Skille

d W

orkf

orce

Join

ed u

p se

rvice

ABSWAP X + X X Barnardo’s X + Blackpool + X WHERE + X X ROVICs + X X X X Gateshead + X X Hants Early Intervention

X + X X X X

PIPs + X X X HAPUN + X X Jewish Care X X + Leeds X X X + X X MIND X + X X New Dimensions

X +

Norfolk X + X X X X Salford X X + Team Around the Child

X X X +

SUCH X X + Laurels X + United Response

X + X

CHI Health Miles + X Suffolk X X + X No Limits X + X X Bath and NE Somerset

X X X + X X X

County Durham + X X X Sutton X X + + The key objective X Other objectives

rker stage 1 evaluation report, p.18

nge of people who use the service. In addition, it es on the same site and by training buddies and ity and generated skills which were complementary to

as focused on workforce capacity in developing the ole to take on certain tasks delegated by orth quoting the observations of the project manager oice and independence dimensions:

go out and have a life but she was having to stay essionals, different interventions from different users) were saying look I’ve got a trusting, good

are assistant; I’ve got her in the morning and the


evening can’t they (the home help) do some of these duties which then allow me to go out and work or whatever.’

• While mainly concerned with developing a person-centred recovery plan for those with mental disabilities, the PIP project revolved around establishing staff skills to help people draft a plan and also provided an opportunity for their voice in seeking to involve them in the delivery of this training.

Although the pilots were invariably pursuing a range of objectives, it was equally apparent that they could be distinguished according to their primary purpose. Table 4 classifies the projects in these terms, suggesting a spread of projects according to their key goal. It can be seen that each of the core objectives was being taken up by at least one of the projects. At the same time ‘skill’ and ‘voice’ were most likely to be at the fore, respectively underpinning five projects. Indeed, while the PIP and Blackpool projects explicitly sought to develop person-centred services, in so doing they were mainly concerned with staff skills in delivering such services, with the Leeds project also heavily concentrated on employee development. A fuller appreciation of how different objectives informed the pilots is provided by considering the main project clusters as highlighted in table 4.

Table 4: Types of project

Person-centred

Skills Early Intervention

Joined up

Voice Access Workforce Capacity

Independence

Blackpool Barnardo’s Hants Early Intervention service

Team Around the Child

ABSWAP MIND Leeds WHERE

PIP Jewish Care

ROVICs Sutton Gateshead SUCH Norfolk

CHI New Dimensions

Salford HAPUN Suffolk

County Durham

Laurels Bath United Response

No Limits

Voice projects

These projects were designed to facilitate more effective service user engagement in the development and delivery of services. They were fairly widely dispersed across different user groups, covering those with mental health difficulties (ABSWAP & HAPUN), learning disabilities (United Response) and those with physical disabilities (Gateshead). People who use services were given a voice in three main ways:

• by developing and strengthening their own networks (HAPUN, No Limits & Gateshead)

• by engaging them ininteraction in various capacities with other people who use the service (ABSWAP)

• by involving them in different management processes such as recruitment and selection, induction and training (HAPUN & United Response).


Skills projects

These were projects with a strong training component designed to prepare staff for new ways of working. Again they covered various groups of people who use services: children (Barnardo’s); older people in homes often with mental health problems (Jewish Care and the Laurels); and learning disabilities (New Dimensions). They were, however, projects that often went beyond simple training, attempting to embed new practice in the organisation through culture change (Jewish Care) and creating ‘communities of practice’ (Barnardo’s). Given the importance attached to ‘accelerated development’ in the Leeds project as the basis for delegating tasks to community support workers, there is a strong case for including Leeds as a ‘skills project’ as well.

Person-centred projects

These projects introduced person-centred forms of care planning in mental health (PIP) and learning disability (Blackpool) or the development of an assessment tool particularly sensitive to the needs and wishes of people who use services (CHI). They also had a strong skills component, training staff up to pursue person-centred approaches and in this sense had much in common with the Jewish Care and United Response projects.

Early intervention projects

These projects were mainly found in sensory impairment services, in two cases related to adults (Salford and Hampshire) and in another to children (ROVICs). There appeared to be an institutional disconnect between diagnosis (health) and social support (social services), which these projects sought to address. Indeed in this sense they had a strong ‘joined-up service’ element with much therefore in common with the Surrey Team Around the Child project and the Bath project.

Access projects

The access projects shared an attempt to reach those individuals often by-passed by mainstream services: in the case of the MIND pilot, those with mental health problems in the community beyond the statutory sector and needing a normalised, readily accessible point of information and support; in the case of SUCH pilot, people not able to access holistic therapies; and in the case of the Suffolk project, difficult to place older children denied the chance of a ‘normal’ family life.

Independence projects

These pilots sought to facilitate independent living in the home and the community, either through the provision of assistive technology (Norfolk) or guidance on social integration (WHERE).

4.2 New roles Having explored the objectives underpinning the projects, attention can now turn to whether the pilots involved the development of a new work role and, if so, what form it took. In considering whether a new worker role emerged, a relatively simple test is used:


whether the project explicitly sought to establish a new role in the organisation.6 Using this measure, new roles were apparent in all but the following five projects.

• The New Dimensions project principally was concerned with the development of two products: a recruitment and selection toolkit and a competence framework for workers in learning disability services.

• The Barnardo’s project was essentially seeking to make mainstream the use of the creative arts as a means of dealing with the mental and emotional well-being of children. It was acknowledged that this project was about new ways of working rather than a new role. As the project manager acknowledged:

‘I felt the whole situation (the NToW programme) was set up for people who said something like ‘let’s create a new post’; we didn’t have that; we were doing something quite different.’

• The Jewish Care project was mainly training staff in the ‘Yesterday, Today, Tomorrow’ programme, seeking to make them more sensitive to the needs of those with dementia, while also dealing with the broader culture change issues that went along with embedding such an approach.

• The No Limits project was mainly concerned with developing carer networks.

• In seeking to support young people with disabilities in transition from children’s to adult services, the Sutton project sought to bring together various relevant agencies.

While new roles emerged in the other projects, the character of these roles varied. These variations emerged along two dimensions:

1. Role purpose: Looking at purpose, four roles emerged:

Specialist role: a role which breaks away from a general occupation to focus in a deeper and more concentrated way on a task and/or user group.

Person-based role: a role which is performed by a person who uses the service.

Co-ordinating role: a role which organizes activities involving different parties.

Boundary spanning role: a role which operates across traditional organisational, client or service ‘jurisdictions’.

2. Role design: Roles could also be distinguished according to how novel they were within the organisation. Thus, in design terms, they could take the form of:

A re-labelled role: a new name but no significant change in job content.

A re-packaged role: combining established tasks and responsibilities in a new a way either by taking on some of those formerly undertaken by higher (occasionally lower) level roles (vertical re-design) or by embracing those performed by roles at a similar level (horizontal re-design).

A re-created role: based on newly generated tasks and responsibilities.

6 It is beyond the scope of this paper to consider whether the role is unique beyond the organisation.

Table 5 below sets out the new roles identified along these two dimensions in each of the pilot projects covered, along with the number of employees in these posts. The table suggests that in terms of the numbers affected, the scale of change was quite modest. Indeed, it is apparent that fewer than 100 workers were involved in the new roles, and this includes the 20 or so found in just one project—the Laurels. In only three of the projects did the numbers in post reach double figures: in the Laurels residential home with its social care workers; in the Hampshire Early Intervention Service with its Sight Loss Advisers and Communication Rehabilitation Officers and in MIND, Taunton with its Listeners and Buddies, who were after all volunteers. Indeed, in the case of all the co-ordinator roles highlighted in table 2, we are dealing with a single post holder.

At the same time, it is striking that most of the roles to emerge were ‘re-created’ rather than simply being ‘re-labelled’ or ‘re-packaged’, in other words they were roles structured around new activities and responsibilities within the organisation. The relative absence of roles based upon a re-packaging of tasks is particularly noteworthy given public policy debates and broader developments which have tended to concentrate on this sort of re-design.7 It suggests that these roles were contributing towards a service rather than a workforce capacity agenda, extending the range of available services rather than the capacity of the current workforce to deliver current services.

Role development in each of the NToW pilots is now considered, drawing upon the four purpose-based role types distinguished: specialist, person-based, boundary spanner and co-ordinator.

Table 5: Types of Worker: Rationale and Design ( ) = numbers of workers in post

PURPOSE DESIGN Specialist Person-Based Boundary-Spanner Co-ordinator

Re-label -Laurels Social Care Worker (21)

-Hants. Sight Loss Adviser (7) & Communications Rehab Officer (7) - Salford Community Assessment Officers (4)

Re-package -Devon ROVIC (3) -Bath/Somerset

-Leeds Community Support Assistant

Re-create -Assistive Technology Support Worker(6)

-ABSWAP Research Assistant (8) - Hants. PIP Co-facilitator (2) -Taunton MIND Listener & Buddy(20) -SUCH Holistic carer (3)

-Suffolk Employed foster careers (8) - WHERE Community Enabler (8) - County Durham - SW Surrey Team Around the Child Service Co-ordinator (1)

-Blackpool Person-centred Planning co-ordinator (1)& Mentors(2) -Hants PIP Co-ordinator (1) - Gateshead Service Dev. Manager (1) -HAPUN Service User Development Worker (1) - United Response Inclusion Training Co-ordinator (1)


7 For example in the NHS interest has focused on the delegation of more routine tasks from junior doctors to nurse and from nurses to health care assistants can be seen as a form of vertical re- packaging or re design, as can the delegation of administrative tasks from teachers to teaching assistants under the Workload Agreement in education.


4.2.1 Specialist roles

Laurel’s Social Care Worker. While the social care worker role in the Laurel’s residential care home came the closest of any of the roles to a re-labelling, it was not a pure example. Certainly the former care assistants on becoming social care workers remained responsible for providing the mainstream caring activities for residents, but there were some important shifts in the role. These involved a sharpening and a re- focusing of the work of the former care assistants, hence the classification of this role as specialist. The care assistants as social care workers moved away from dealing with routine personal tasks for residents like mending clothes and taking them to hospital appointments, which might be done by family members. Instead they were encouraged and trained to concentrate on activities that more directly related to the residents’ emotional well being such as organising social events. As the home manager noted:

‘Rather than assisting people with their hygiene and the meals, we felt it (the care assistant role) should be a lot more than that, more about what this resident likes to do, looking at what the person’s history is, about how can we make the (residents) stay more enjoyable.’

Devon’s Rehabilitation Officers for Visually Impaired Children (ROVIC). The ROVIC role could plausibly have been classified as a boundary spanner, hence the arrow across to this category in Figure 2. It had much in common with the roles developed on the Hants Early Intervention Service for those with sensory impairment, and with the Co-ordinator role on the ‘Team Around the Child’. As in the case of the former (see below), it sits within a joint team covering education and health, and as with the latter it can be found in hospital clinics providing an early awareness of the service. However, it is presented as a specialist role because it emerged from the ‘cradle to the grave’ sensory impairment team to focus specifically on children’s visual impairment needs. Indeed, it is a specialist form of the rehabilitation officer role, which more typically focuses on the needs of adults. As noted:

‘There were a lot of non-specialist workers, care managing children with visual impairment with little understanding of the implications of congenital sight loss.’

Norfolk’s Assistive Technology Support Worker. This was a newly-created specialist role designed to facilitate the provision of assistive technology to a range of people using services in the county. It was initially concerned with communicating about and raising awareness of the availability of this kind of technology as well as with the assessment of need and, over time, with the actual installation of certain devices. It was this project manager who also articulated the value of a specialist role:

‘If you want busy staff to take on new ideas and new ways of working you really need to try to facilitate that to happen and that can very often be by developing initially a new kind of role, as a specialist, a dedicated person who becomes the consultant with a small ‘c’ and they become the informal expert and we can then cascade the knowledge and skills.’

Since 2003 the Bath and North East Somerset Partnership has selected care home sites in which to train social care and health support workers to carry out selected clinical


procedures. It is therefore a specialist role because these are activities that in the past would have been undertaken by GPs and district nurses.

4.2.2 Person-based roles

The ABSWAP project trained-up around eight black people who use mental health services as researchers. They were then able to talk to other people who use services about their experiences of the relevant services with a view to highlighting past problems and future needs.

The MIND project trained mainly, but not exclusively, people who use the service on a programme, ‘Supporting People with Emotional Distress’, to become listeners and buddies.

The SUCH project developed a holistic carer role which involved reception and support work for those coming for holistic therapies.

The PIP project had two co-facilitator roles, filled by people who use the service, to help deliver PIP training.

4.2.3 Co-ordinator roles

Hampshire’s PIP co-ordinator. This role was established to help develop and implement Person Individual Plans across the county. In fact, the role went beyond co-ordination in that the post-holder also delivered much of the necessary training associated with the PIP scheme.

Blackpool’s Person-centred Planning Co-ordinator. This role similarly sought to facilitate the introduction of person-centred planning, in this case, for those with learning disabilities. But it also included the introduction of a Person-centred Planning Mentor role, to work alongside staff to help in the development of these plans.

United Response’s Inclusion Co-ordinator. This role sought to co-ordinate the greater involvement of people who use the service, again people with learning disabilities, in the development and operation of various internal procedures. United Response was seeking their greater involvement in the induction, recruitment and selection of its staff and in training for the prevention of harm to people using the service and in the development of the organisation’s general values training.

Hampshire’s (HAPUN) Service User Development Worker. This role was similarly involved in encouraging higher levels of involvement of people who use the service in a range of organisational procedures, in this case those with mental health problems in a particular part of the county; here the procedures in question were those relating to recruitment, planning, training and contract monitoring. At the same time, this role extended beyond co-ordinating such involvement to developing and strengthening networks of people who use the service.

Gateshead Service Development Manager. Similar to the HAPUN Service User Development Officer, this role focused on those with physical disabilities rather than


mental health problems. It sought to strengthen the service user structures underpinning the Physical Disabilities and Sensory Impairment Partnership Board and bolster engagement of people who use the service with service delivery.8

4.2.4 Boundary-spanning roles

South West Surrey’s Team Around the Child Service’s Co-ordinator for the ‘Team Around’. This was a role, which as the title suggests, could also have been placed in the ‘co-ordinator’ category. However, in contrast to the other co-ordinator roles, its primary purpose was to sit within the Team Around the Child, liaising with health and education as well as with social care agencies. In this capacity the role-holder ensured that information was shared between agencies, that the primary case worker had some support in managing the case and that the family was aware of the developments and had an advocate in dealing with various professionals.

Hampshire’s Sight Loss Adviser and Communication Rehabilitation Officer. The sight loss adviser was another example of a role that involved an element of re-labelling; thus, a similar role could be found prior to the project, known as the Eye Clinical Liaison Officer. Again, however, it would be a mistake to view this is a straightforward re-labelling exercise. The Sight Loss Adviser, along with the Communication Rehabilitation Officer, had emerged as part of a major organisational change with the development of an Early Intervention Service. This was a service requiring a role that sat both procedurally and indeed physically at the interface between health and social care. The national institutional framework for dealing with sensory impairment created a disconnection between diagnosis (health) and social support for the consequences of impairment (social services). These roles were developed to sit alongside clinicians and through the formulation of a new referral process, generate awareness of and access to social care support.9

Leeds Community Support Assistant. The Leeds domiciliary project provided the only clear example of re-packaging along the lines of professionals delegating more ‘routine’ tasks to support workers. In contrast to such delegation in education between teacher and teaching assistant and in health between nurse and healthcare assistant, this delegation was across different parts of the public services. Thus one of the key purposes of the Accelerated Development Programme was to enable local authority community support assistants to deliver ‘low level’ nursing and therapy tasks such as changing dressings and routine administration of medication formerly performed by qualified health service workers.

WHERE’s Community Enabler. While on a slightly smaller scale, WHERE’s community enabler role also sought to bridge different parts of the public service or more specifically different groups of people who use the service. It was a role that engaged those with mental health and physical disabilities, as well as some older people, with a view to

8 In taking forward its work as a continuation site, Gateshead is now looking to develop a rehabilitation officer assistant role 9 These two roles were essentially in place before the NToW project started and the pilot was explicitly seen as a way providing training associated with the new service and evaluating its impact. As a consequence, a tighter interpretation might place this project along with the three others which did not directly leading to a development of a new role under the auspices of the NToW programme.

facilitating great social involvement. Referrals came from various sources and assessment took place within the project to establish whether and how the individual might be helped in this respect. Community enablers were then deployed in various ways, signposting people to relevant services and more proactively organising activities. In particular, community enablers played a key role in running a regular gathering of people in a local café where social activities were organised within this ‘normalised’ environment. A time bank scheme was also set up by community enablers which acted as kind of ‘clearing house’ for activities, with people identifying tasks that they needed doing and others volunteering to do them.

Suffolk’s Foster Parent Employees. This role sought to span a somewhat different set of boundaries: those between paid employment and a fee-based service. Typically, local authority foster parents are not council employees; they receive fees to cover their expenses when they take in one or more children. In seeking to boost the number of foster care placements for difficult-to-place older children aged 11–17, Suffolk sought to move to an employment relationship with a group of foster parents who would be expected to take in these children. As one of those involved in the project noted, these children ‘had as much right to a family life as any other children’ and in the absence of a placement would end up in a home or in an expensive, often out-of-county, private sector placement.

County Durham’s Community Project Worker. This role has been used to ensure that rather than people having to come to services provided by the county, the service could be tailored to the people, spanning spatial and organisational boundaries.

4.3 Relating pilot objectives and roles

N

Figure 2: Types of Role and Project

In the final part of this section consideration is given to the relationship between the objectives underpinning the pilot projects and the emerging types of role. Is it the case, for example, that a specific kind of role is associated with projects driven by particular goals? Or is any given role compatible with projects having a variety of aims?

Figure 2 and table 6 below present similar data in slightly different ways as a means of highlighting the link between roles and pilot objectives. It can be seen that in terms of objectives, the

ew Types of Worker stage 1 evaluation report, p.26

Skills/Capacity/Person Centred

Co-ordinator:-Blackpool-PIP(Jewish Care)(Barnardo’s)

Specialist:-Laurels-Durham

Voice

User:-ABSWAP-MIND

User:PIP Co-facilitator

Co-ordinator:-United Response-Gateshead-HAPUN

Joined-up/Early Intervention

BoundarySpanner:- TAC-Hants.Early-Salford

Specialist:-ROVIC-Bath

Independence/Access

BoundarySpanner:-WHERE-Suffolk

Specialist:Norfolk

BoundarySpanner- Leeds

User:SUCH


pilots have been bundled together as a means of rationalising the analysis. Thus, as already noted, pilots concerned with skills, workforce capacity and person-centred services had much in common in focusing on employee training and development; those pilots dealing with early intervention invariably involved seeking to develop a joined up service; while access to new services was often a means of generating greater independence for people using the service.

Table 6: Roles and Project Objectives

Voice Skills/ Capacity/ Person-centred

Independence/Access Joined-up/ Early Intervention

User: ABSWAP Co-ordinator: PIP Specialist: Norfolk Boundary Spanner: TAC

User: MIND Co-ordinator: Blackpool

Boundary Spanner: WHERE

Boundary Spanner: Hants.

Co-ordinator: United Response

User: PIP Boundary Spanner: Suffolk

Boundary Spanner: Salford

Co-ordinator: Gateshead

Specialist: Laurels

User: SUCH Specialist: ROVIC

Co-ordinator: HAPUN

Boundary Spanner: Leeds

Specialist: Bath

Specialist: Durham’s Community project worker

A number of points arise from Figure 2 and table 6:

There were differences in the number of roles associated with different types of project. Skills projects generated all four of the roles distinguished – person-based, co-ordinator, boundary spanning and specialist – while independence and joined-up projects generated only two role types.

Types of new role were not exclusively tied to projects with particular objectives: the person-based role was found in skills and independence projects; the co-ordinator role in skills and voice projects; the specialist and boundary spanning roles in independence, skills and joined up projects.

Identifying generically labelled roles in projects driven by different objectives, suggests that the precise form taken by that role varies. For example, the co-ordinator role could be found in skills projects co-ordinating staff training; in voice projects it could be seen co-ordinating people who use services and their networks; similarly in early intervention projects boundary spanning roles were spanning service boundaries; in independence/access projects client groups (WHERE) or employment (Suffolk) boundaries were being spanned.


5. Processes The evaluation revealed that there were three partly related but analytically distinct processes that needed to be managed in each of the pilots:10

• Managing the project: the largely internal processes associated with the organisation and administration of the pilot

• Managing stakeholders: the processes related to dealing with external and internal stakeholders

• Managing the relationship with Skills for Care: the processes involved in addressing the interface between the pilot and Skills for Care.

Each of these different management processes is considered in turn.

5.1 Managing the project 5.1.1 Steering groups

Although a few of the pilots did not have a steering group, for example, the ROVICs and the Laurels projects, most had set up a committee to oversee and guide the work. However, there was considerable variation in how these steering groups were structured and operated. For example, in Norfolk six steering groups were established, one for each PCT, comprising a wide range of stakeholders, while in Barnardo’s a single group was set up involving representatives from the Human Resources department, the Children’s Services manager, someone from the research team and the project manager’s line manager. The regularity of meetings also varied with some convening as often as once a month and others on a quarterly basis. A number of important points emerged about the character of steering groups:

• The steering group could become an effective means of achieving ‘buy-in’ to the project from a wide range of internal stakeholders. The Jewish Care pilot, for example, was keen to involve senior managers from different parts of the organisation as a means of embedding change in approaches to people with dementia. The Dementia Care Steering Group was, therefore, fairly inclusive, involving managers from different parts of the organisation including from care homes and the day centres.

• The steering group could become a powerful way of involving people who use services in the project. A considerable number of projects included people who used the services on their steering groups. However, this was not always a straightforward process. In Gateshead, for example, it became clear (not least to the person herself) that a particular person who used the service did not have the ‘right’ skills or carry the necessary authority to chair the steering group.

• The steering group could become an important forum for dealing with the substantive issues needed to take a project forward. However, its effectiveness

10 A fourth management process could be added to this list related to the management of the role itself. Role management is covered in the next section looking at the impact on employees.


in this sense was crucially dependent on the involvement of managers and other actors with the authority to make key decisions. This was illustrated in the Leeds domiciliary project. The need to develop agreed health and social care procedures on a range of issues across no less than five primary care trusts rendered the steering group central to the operation of the project. Yet, those present from the PCTs were just ‘not senior enough to take decisions that would stick’ or were simply the ‘wrong people’, slowing down the rate of progress. A similar problem was faced in the HAPUN project where the failure of ‘strategic managers with the powers of authorisation’ to turn up to meetings led to the break-up the steering committee.

The changing membership of a steering group could also slow down progress. As noted in the TAC project: ‘Each time we had a change of personnel on the steering group we had to persuade them all over again about what we were doing. It has always been a battle.’

5.1.2 Project managers

Naturally each of the projects had a manager, but the circumstances surrounding the appointment and tenure of the managers varied with consequences for the organisation and administration of the pilot.

• Project managers differed in terms of knowledge about and involvement in the pilot. In a number of instances, such as the Hampshire PIP project and the Norfolk assistive technology project, the project managers had been involved in earlier related work, and were therefore able to ‘hit the ground running’. Others in, for example, the Gateshead and Barnardo’s projects were appointed without this legacy of participation and consequently needed to ‘climb a steep learning curve.’

• Project managers sometimes came and went over the course of the pilots. This was not a frequent occurrence but arose in at least three cases with significant consequences in each: in Jewish Care the project manager changed with the individual taking up the post finding it difficult as a ‘newcomer’ to engage with the established Skills for Care Learning Sets; in the Early Intervention Service project the original project manager moved creating uncertainty for the post holders in the new roles who reported to this manager; in Salford the project manager moved towards the end of the project and, with major difficulties finding a replacement, caused some delay in its completion.

• Project managers could be difficult to recruit not least because these were fixed term appointments. In at least one case, the difficulties led an overseeing manager to suggest that compromises were made on the quality of the person appointed to the role. Indeed, these compromises were later reflected in what this overseeing manager saw as problems in taking forward the project and leading her to conclude that a project manager ‘should never be appointed unless you are certain that they are the right person.’

• In the main, project managers focused exclusively on the pilot, but in a few instances they held an additional professional or managerial role. This was the


case in the Blackpool and ROVIC projects, putting considerable pressure on the individuals involved. Similarly the project manager in Gateshead was on the senior management team and, as a consequence, asked to do work falling beyond this role. In one case, the HAPUN project, the new worker had to take on the role of project manager when she left.

• The project manager needed to be at the ‘right’ grade. Just as difficulties were created when representatives on the steering group did not have the necessary decision-making authority, so problems emerged if the project manager was not senior enough within the organisation. Highlighted as a concern by the project manager in Leeds, the seniority of the project manager raised issues of credibility with internal and external stakeholders, with implications for how efficiently and effectively decisions could be made.

• The support of the project manager’s line manager could be important to the wellbeing of the project. In the case of the Team Around the Child (TAC) pilot, for instance, this line management changed on a number occasions; indeed sometimes this brought in a line manager who was not particularly supportive of the project, ‘putting it at risk’.

5.2 Managing the stakeholders The management of project stakeholders has already been touched upon in highlighting the importance of steering groups and will be considered further in the next major section of the report dealing with the impact of the pilots on employees and people who use services. There are, however, a number of process issues related to internal and external stakeholders worthy of consideration.

5.2.1 Internal stakeholders

The pilots almost invariably had significant consequences for those well beyond the project itself, in general affecting managers, professionals and other employees in the organisation. These were consequences that needed to be managed, although their scale and nature varied. There were a small number of projects which were relatively discrete and sharply focused, whether in geographical terms, as with the TAC and HAPUN projects, or in terms of the organisational unit, as with the Laurels and the ABSWAP projects. This is not to suggest an absence of issues related to internal stakeholders; in the TAC project, there were certain ‘jealousies’ amongst professionals created with the emergence of what was seen as a ‘gold star’ service for the children disability team in South West Surrey. However, the management of internal stakeholders arguably assumed an increased scale where the pilot was operating across the whole of a large organisation.

A number of process challenges were highlighted in this context:

• Culture change: As already suggested, new roles and ways of working were typically seen to require a broader change of culture to embed these developments and ensure that they were implemented effectively. This need was apparent among the person-centred and skills projects covering nationwide organisations, such as


Jewish Care, County Durham, and Barnardo’s, and those projects covering a significant swathe of the workforce as with the Blackpool and Hampshire PIP projects. In such pilots there was a danger that, in the words of a Jewish Care manager, training would be seen as a ‘quick fix’; meaningful change needed to be reflected in a new and widely accepted organisational values and routines. Of course, it is a dilemma that ‘culture change’ takes time, a commodity in short supply in the time-limited NToW projects.

• Challenging professionals: Closely related, a number of the pilots had important implications for professionals and the ways they worked. This was most obviously the case with the person-centred projects that challenged the authority of the professional to make decisions. It was a point highlighted by one project manager who noted that ‘professionals unsurprisingly don’t like to be told they aren’t doing things right’. As one of those involved in the PIP project more explicitly stated:

‘Amongst the medical group there’s an expectation they’re going to find it hard to adjust because it is challenging the medical model; it’s [PIP] not about expertise, it’s about the individual being the expert and things like working together. Some medics have taken to it really well and for others the control thing is more challenging.’

In the No Limits project, approaching carers direct also initially led to an unfavourable response from statutory services.

• Workload pressures and initiative fatigue: The projects operated within organisational contexts characterised by ongoing change and, partly related, significant workload pressures. This created difficulties in establishing wider workforce engagement with yet another change initiative. As a participant in the PIP project noted, ‘staff have enough essential training to attend without having to go to the PIP training as well.’

• Unpredictable responses: It was not always easy to predict the response of internal stakeholders. Thus, while workplace pressure created difficulties in engaging the wider workforce, an initiative could ‘strike a chord’ prompting higher than expected enthusiasm for it. For example, there was high demand for the training on the health aspects of sensory impairment instituted in setting up the Hampshire Early Intervention Service. As the final report from the project noted:

‘Although the training was targeted at a group of nine unqualified early intervention staff, spare places on courses were offered to the wider sensory team in order to maximize the benefit of the programme. The response was overwhelming with most courses being vastly oversubscribed and the project team being swamped with requests for inclusion.’ (D. Hallmann and S. Butcher, 2006 Hampshire CC Sensory Intervention Service.)

Moreover, some of the new roles, particularly the ROVICs and TAC co-ordinator, were seized upon with alacrity by professionals and people who used services, raising issues about referral procedures and caseload management.

In addressing these challenges, the pilot projects adopted a range of techniques and approaches, including:


• Local champions and examples of ‘good practice’

Jewish Care developed a network of local champions who could both spread and sustain ‘good practice’ in addressing the needs of people with dementia. As the project manager noted:

‘We’ve tried to bring together a ‘champions’ group, identified staff who are models of good practice in person-centred practice; representatives from each of the homes who get together at bi-monthly meetings and do some training and then the idea is they go back to their homes and keep best practice going. It is important that they continue to feel supported and motivated but also that they try to increase the skills of the staff in the homes.’

• Stakeholder events and learning processes

Many of the pilots held early events that brought internal as well as external stakeholders together. These served to provide information on the project but also encouraged buy-in and involvement from the outset. Indeed the value of an early stakeholder event was reflected in the comments of the Leeds project manager who indicated that she wished she had held such an event at the beginning of her pilot. Stressing a slightly broader point on the importance of internal and external stakeholders knowing about and understanding a new role and service, it was noted in the Norfolk case that:

‘Staff won’t refer to a service if they don’t know it exists and users won’t ask for it if they don’t know about it. To empower individuals you need to let them know. So in the early days we spent a lot of time going out to talk to carer groups and multi agency groups, voluntary organisations, making people aware.’

Less common were internal attempts to institutionalise learning. Drawing upon the NToW learning set model, the Gateshead project manager unsuccessfully attempted to introduce a similar approach. More effective were the ‘communities of practice’ developed in the Barnardo’s project. These were ‘kick started’ by a national event bringing together practitioners from across the organisation, who worked with young people, to share practices on the use of the arts in dealing with the emotional needs of children. They were then taken forward on the basis of a network of tightly defined communities, with some being based on locality, others on themes, such as the use of music, and yet others on schools, using the arts to deal with such issues as bullying. The communities were given discretion as to how they used their time, but in general they provided an opportunity for practitioners to discuss and explore related ideas and approaches.

• Planned and targeted approaches

In organisations subject to change and workload pressure, a considered approach was needed to taking forward the project, which often involved seeking out those interested in the pilots’ work and then using those examples to encourage others to participate; in effect this was an incremental, cascading approach to change. This tactic was highlighted by the project manager in the Hampshire Early Intervention service, where those hospitals particularly keen or willing to accept a joint heath and social care appointment system were targeted first and then used as a showcase for more reluctant trusts.


5.2.2 External stakeholders

The need to manage external stakeholders was particularly acute in projects involving boundary spanning roles and the pursuit of joint working. By definition these were projects requiring the engagement of various external partners and in the process certain tensions emerged:

• Care pathways and common referral and assessment criteria: Considerable time and effort was expended on trying to develop shared referral and assessment criteria, particularly in those joined-up projects involving health and social care. In the Salford project, for instance, there was some discussion about a care pathway and the development of a system which ensured the communication of information from audiology in health to social care in the local authority on people’s residual needs over and above what a hearing aid could address. Similarly in the Team Around the Child project initial difficulties were faced in agreeing referral criteria:

‘We did try to get one set of referral criteria for social care, health and education, but we found that we couldn’t, it just wasn’t workable; so what we said in the end was if the child’s situation met the referral criteria for any of those three services they could be referred to Team Around the Child.’

• Shared workplace procedures: This was a major concern in the Leeds domiciliary project where the delegation of tasks from health care professionals to local authority community support workers required the harmonization of various workplace procedures. This need brought to the fore considerable differences in policies, for example, related to the lifting of clients and dealing with ‘needle stick’ injuries. Indeed, the scale of the challenge in this respect was retrospectively acknowledged in the internal evaluation report on this project which noted ‘new roles mean changes across all the services, and that was not fully understood by everyone at the outset.’ (Quoted from the undated minutes of a steering group meeting.)

• Clarifying regulatory requirements: Some of the new roles challenged statutory regulations governing working practices. This was particularly the case in the Suffolk project where the authority’s attempt to employ foster carers raised largely unforeseen concerns about the interpretation of the Fostering Service Regulations (2002). These regulations, inter alia seeking to avoid any conflict of interest between carers and care professionals, raised some doubts about the legitimacy of the new role. One of the managers involved in the project calculated that six months had been taken up in discussion with the Commission for Social Care Inspection on whether the new role was acceptable within the context of these regulations.

5.3 Managing the relationship with Skills for Care The relationship between Skills for Care and the pilots was considered along a number of dimensions—administrative support, learning sets, regional and national links. The pilots varied in their views on the quality of this relationship depending on the dimension in question.


Administrative support

There were some contractual difficulties, which affected a number of the early contracts. These led to some delays in the start of projects, affecting timetables. Participants understood the need for regular milestone reports, but in some instances expressed concerns at the burden they represented in the context of a heavy workload, while others expressed frustration at the absence of any SfC feedback on them.

The Learning Sets

In general, the learning sets were viewed positively as ‘useful’ places to share ideas and indeed in some cases, particularly in the North, assumed the status of a mutual support group. Only four of the interviewees highlighted their limited value, raising the following concerns:

• The issues raised and discussed were not relevant to small, independent organisations.

• They involved set piece presentations rather than providing a genuine opportunity to share ideas and learn.

• They were time consuming.

• They were not readily accessible to later starting project managers.

More broadly it is worth raising a possible tension between a learning set approach which, by definition, encouraged ongoing sharing and development, and a milestone approach firmly locking the projects into a set of objectives to be met.

National and regional relations

The relationship with Skills for Care at the national and regional levels was generally seen in less positive terms. At least three interviewees felt that Skills for Care displayed a ‘lack of ownership’ of the programme and certainly their projects. As a project manager stated, ‘Skills for Care as a whole organisation didn’t appear to be terribly interested.’ This was particularly felt towards the end of the programme when there was considerable uncertainty about how the first phase project work would be used and carried forward into phase two. These concerns were reinforced by the general lack of contact between the pilots and the Skills for Care regions. Thus, some project holders were worried about their involvement in the roll-out, and the loss of learning, given that their projects were winding-up. Skills for Care is fully aware of this concern and it has significantly strengthened links with phase two of the programme.


6. Outcomes This section reviews how the different projects evaluated their work and then considers outcomes from the perspectives of organisations, post-holders and people who use services.

6.1 Approaches to evaluation There was a standard requirement on the pilots to undertake a final project evaluation, with discretion as to how this was conducted. Table 7 below sets out the approaches taken and highlights a number of patterns:

• The majority of the projects sought to generate primary data on activities related to the project.

• This was normally undertaken in-house, by team members; in seven instances it was undertaken by an outside organisation (the Norfolk, MIND, Bath, Hants, Early Intervention, County Durham, Jewish Care and SUCH projects).

• A number of those projects with a significant training component relied principally on evaluation sheets from training courses (No Limits, Blackpool and United Response), while the PIP project adopted a more novel approach in following-up trainees six months after the course to see how ‘useful’ the training had been.

• Many of the projects sought the views of people who use services and, to a lesser extent, of staff and professionals involved in the pilot through surveys and interviews. The response rates on surveys, however, remained fairy low. A couple of the projects (MIND and Blackpool) used ‘case studies’, which provided a more detailed insight into the experiences of individuals engaged with the pilot. The Jewish Care project attempted to provide a voice for the individuals by deploying ‘dementia care mapping’.

• A few projects drew upon people who used the service to help in carrying out the evaluation (PIP and Hants Early Intervention).

Table 7: Approaches to evaluation

Outside Organisation

Survey Interviews Other Comments

WHERE Community Enabling

No Yes Profiling service users

No Narrative review

Narrative review of outcomes. The survey was a descriptive providing a profile of those using the service by gender, age, location and source of referral

Blackpool No Yes 71 participants on 6 training courses

No Case studies of service users

Barnardo’s No Yes – On the use of arts&skills of workforce

No Narrative This survey was used to scope issues

Norfolk Yes University of East Anglia

No Yes (14) Focus groups (8)

Evaluation explored such issues as experiences of users, impact of the role on staff and future challenges


Hants. Early Intervention

Yes HCC Performance Management Unit & Southampton University

Yes – data from various surveys

Yes (11) Focus groups Evaluation of secondary data on service use

-Evaluation of professional development using staff focus groups and analysis of training evaluation sheets - feedback form of those using service over a 10 week period -follow up interviews with 11 users. Service users involved in latter two pieces

PIP project No No Yes Semi structured telephone interviews with sample of those receiving PIP training 6 months after training. Interviews conducted by service users.

Leeds No Yes Survey District nurse teams in two PCTs covering 1,455 patients

Yes (10) Survey mainly descriptive - skills levels and home carers in place Structured interview with 10 stakeholders

Jewish care Yes External facilitator

Yes – survey of resource managers, champions and social care co-ordinators

No Use of Dementia Care Mapping for voice of user

Evaluation forms by trainnees. Used external facilitator to evaluate work in July 2006

HAPUN No Yes No Narrative Survey of user mailing list asking for views in this list- 6 out of 60 responded

Gateshead No Yes of service users in network

Yes (2 with service users)

Discourse analysis

Small survey of service users: 11 respondents .Data related mainly to the way the PDSI Partnership Board worked

ROVICs No No No Quote, letters and emails from users

United Response

No No No 35 training evaluation sheets analysed

Evaluation covers the quality and value of training

Laurels No Yes Staff and User survey

No 6 out of 22 service users responded 4 out of 6 case staff given questionnaire responded

SUCH Yes Yes users survey: MeasureYourself Concerns Wellbeing

No Service user evaluation sought through the independently validated MYCAW form

Team Around the Child

No Yes of professionals /parents

No No 27 responses to the survey which covered quality of service using TAC

Salford No No No Mainly narrative report MIND Yes

Consultants Yes User survey

No Case studies of users (14) Professional Case studies

34 items user questionnaire dealing with views on the services with 45 respondents User and professional cases on individual experiences of services

ABSWAP No No No Mainly narrative report


Table continues No Limits No Yes of attendees

at conferences and training

Bath Yes Evaluation conduced by University of west of England and Joseph Rowntree Foundation

Durham Separate evaluation unit within Durham used

Yes Observation Feedback from independent user/carer forum and learning disability partnership forum

6.2 Organisational value and ‘sustainability’ There were very few instances of project managers doubting the organisational value of participating in the NToW programme. However, in assessing the organisational consequences of the pilot projects a number of difficulties had to be confronted.

• First, it was intrinsically problematic to measure the outcomes of time-limited projects. It is often the case that the full consequences of a pilot take some time to emerge, particularly where, as with the NToW programme, the projects involved new and potentially innovative developments. As one of the project managers noted, ‘This is where the frustration comes in, because for effective development work and sustainable outcomes you need at least three years to the lay foundations.’ Or as another project manager put it, ‘You end up (at the conclusion of a project) with a greater understanding of what you need to do.’

• Second, given the diversity of projects in terms of their contexts and objectives, it remained difficult to identify generally applicable outcome measures. It was temping to draw upon a cost-benefit model, but the application of such an approach was less than straightforward. Leaving aside the fact that this model is often reduced to financial costs and benefits, it is often difficult to weigh up such outcomes, with clear financial benefits sometimes being offset by unseen costs. In the Suffolk project, for example, employing a new local authority professional foster care ‘saved the authority £250,000’ on just one difficult to place child who would otherwise have had to be passed on to a private agency. But this saving was more than offset by the loss of goodwill amongst non-professional foster carers who were disaffected by what was perceived as the privileged treatment of those in the new role. The situation is further complicated by the fact that the benefits realised may not be to the organisations actually funding the new role. The TAC project implied real savings as the creation of a ‘team around the child’ care package at home allowed for early hospital discharge. But these were savings which accrued to the hospital rather than to the PCT funding the new role. Similar issues arose in the Bath and NE Somerset case. Finally, it is also worth noting that self-evident benefits are not always enough to overcome institutional barriers to new roles and ways on working. As the Leeds project manager noted:

‘We did a ‘Needs Analysis’ and worked out that if district nurses delegated routine task they would save 400 hours a week, and that didn’t take into account travel; that would have freed these nurses up to do higher level stuff in the home.’


Yet, despite these potential gains, delegating these tasks to community support workers in the city proved an extremely difficult and protracted process (see below).

• Third, as already implied, with organisational goals often shifting and being modified over the course of the project, outcomes were often elusive and unexpected.

Given these observations, this part of the report first adopts a modest but viable generic measure of organisational outcome by considering the sustainability of the new role (or way of working). It could plausibly be argued that the ‘success’ of a new role lies in whether it continues after the completion of the pilot. Moreover, this measure has added value in being one of the key concerns highlighted by SfC in taking forward the NToW programme.

Table 8: The Sustainability of New Roles and Ways of Working

Pilot Role/ Working Continues (Yes/No/In Part)

Comment

Voice Projects ABSWAP (User Role) In part As continuation site focus has shifted from research role to

user involvement in the management of mental health services MIND (User Role) In part Much activity wound-up by end of 2006 United Response (Co-ordinator role)

No Inclusion Co-ordinator role gone

Gateshead (Co-ordinator role) In part As a continuation site work to strength user networks continues, but more explicit focus on developing new Rehab asst. role

HAPUN (Co-ordinator role) Yes Service User Devel. role continues Jewish Care Yes Internal funding to continue. External funds also sought Skills/Capacity/Person-centred Projects

Hants. PIP (User and Co-ordinator roles)

In part As a continuation site co-ordinator role continues and co-facilitators roles established. Longer term need still open to debate

Blackpool (Co-ordinator) In part Still unclear what will happen to co-co-ordinator and mentor roles

Laurels (specialist role) Yes New re-focused role continues Leeds Domiciliary(Boundary spanner role )

In part Project manager role continues until March 2008 with broader brief. Work with CSA continues as part of initiative ‘Making Leeds Better’.

Barnardo’s In part Strategy developed to take forward the work but uncertain about progress on implementation

New Dimensions In part Continuation site. County Durham Yes The role is being rolled out across County Durham as part of

the modernisation agenda as posts become vacant. Independence/Access Norfolk Assistive Technology (Specialist role)

In part Debate on whether it is a permanent or transitory role but agreed funding until March 2008

WHERE (Boundary spanner role) No The community enabler role has gone with the SfC funding. The Café concept continues in CHI

Suffolk (Boundary Spanner role) No Role seen as precursor of skill based system for foster carers SUCH In part Continuation site: role of holistic carer continues Joined-up/Early Intervention Salford (Boundary spanner role) Yes Community Assessment Officer role continues SW Surrey Team Around the Child (Boundary Spanner role)

Yes Co-ordinator joint funded on a permanent basis

Hants Early Intervention (Boundary spanner role)

Yes Sight Loss Adviser & Comm. Rehab. Posts still in place


Devon ROVICs (Boundary spanner role)

Yes Two out three ROVIC posts now funded by Children’s Trust on a permanent basis

Bath Yes Additional funding from ODPM enabled continued funding for the In-Reach nursing team in Bath

Table 8 above sets out whether the new role or way of working continued after the NToW funding. In general terms and on initial reading a fairly positive picture of outcomes emerges: in only three of the 19 listed projects – United Response, WHERE and Suffolk – did the respective roles disappear at the end of the project, while in nine of the projects the role continued on a permanent basis.

On closer consideration, however, the situation is at best mixed:

• Almost half of the roles/ways of working were continuing only ‘in part’.

• In five of these cases this was because they were continuation sites – they may be vulnerable when the funding ends.

• The MIND project could easily be classified as a ‘no’ with much of the activity winding up at the end of 2006.

• Debate was ongoing in two cases (Norfolk and PIP) as to whether the new role would be needed in the future.

More specifically, in looking at sustainability by role type, no obvious pattern emerged. So for example, there were instances where boundary-spanning roles and co-ordinator roles were sustained and cases where they disappeared, suggesting the importance of context as an influence on the future of a role type. In the main, the nature of the project similarly did not appear as a major factor in explaining sustainability; for instance, there were voice projects in which roles continued and discontinued. However, it is noteworthy that joined-up/early intervention projects did generate sustainable roles; indeed four of the sustainable roles came from these kinds of a project. A more detailed consideration of table 8 allows for a more detailed discussion of this and other findings:

6.2.1 Sustainable roles

Three of the pilots (Devon ROVICs, Hants Early Intervention and Salford) with sustainable roles were located in sensory impairment. This perhaps suggests that the institutional setting in this service area was not only ‘ripe’ for new roles and ways of working but susceptible to lasting change. Given that these projects typically involved the development of joint working between health and social care, it also implies that shared activities and systems in this service area could be developed. The contrast with the difficulties faced in developing joint working in the Leeds domiciliary service (see below) is striking. The continuation of the TAC co-ordinator is a further example of a service area receptive to a new role. Indeed, the effectiveness of this new role during the pilot was reflected in the fact that despite financial pressures funding was found for the post:

‘We did succeed in as much as we got agreement on joint funding for the co-ordinator’s post on an ongoing basis from the area manager for social care at South West Surrey and from the new PCT…We had a lot of problems with the PCT and a lot of information had to go to their board – it is one of the very overspent PCTs – but we managed to get it through.


A similar pattern of events was apparent with the Devon ROVICs:

‘The opportunity to run the pilot got off the ground because we wouldn’t be funded by the Children’s Service until we had proved the need…We are so strapped for cash as a local authority, that the fact the Children’s Service is willing to put its hand in its pocket is evidence of success.’

As well as highlighting the scope for developing sustainable roles in particular service areas, these two examples highlight how the NToW programme provided an opportunity to demonstrate the value of new roles and generate a strong evidence base which could overcome barriers even in the most financially constrained of circumstances.

6.2.2 Vulnerable roles

Vulnerable roles were found in vulnerable organisations and these tended to be located in the voluntary or private sectors. It is, for example, noteworthy that most of the sustainable roles and ways of working were in the statutory sector. This was not invariably the case, however. In Jewish Care the project had proved its worth to the extent that the organisation was prepared to internally fund ongoing activities related to working with dementia sufferers. But this case highlights the limiting circumstances in which such innovations might succeed in the voluntary sector: Jewish Care was a large, robust organisation, the project touched on a key client group and was located at the heart of the organisation.

Two of the three roles which unambiguously disappeared were from the voluntary sector (WHERE and United Response) and, as noted, a third (MIND) might easily have been added to list; the vulnerability of the voluntary sector roles was also masked by the fact that two of the continuation sites were located in this sector, raising questions about ongoing viability. These vulnerable voluntary sector roles were typically in small organisations (SUCH and ABSWAP) or at the margins of a large organisation (MIND, Taunton) and reliant on contingent forms of funding. Even in larger voluntary organisation such as United Response there could be acute problems in sustaining a new role:

‘The organisation being a charity runs on the minimum that it can do and doesn’t have the money for a post (Inclusion Co-ordinator) that is seen as not essential; it would be nice to do but it’s not essential. So internally we don’t have the funding and externally there doesn’t seem to be a category for funding new roles; you can get funding for things like hoists and wheelchairs but not new roles.’

6.2.3 Transitory roles

Table 8 indicates that around half of the pilot projects developed roles or ways or working which were ‘in part’ sustainable. The phrase ‘in part’ has been applied to continuation sites because, as implied, the ‘jury remains out’ on sustainability after the SfC programme has finished. The term also relates to projects where some doubts remain and ongoing debate continues on whether the new role is required in the future. Such uncertainty brought the fore the possibility that there may be new roles in social care which have a transitory function; they fulfil a purpose and then go or perhaps assume a very different form. This was apparent in at least three of the projects. Two were co-ordinator roles in skills pilots—the Blackpool and PIPs projects. Here the role revolved around training up


staff to deliver certain procedures – in both cases person-centred planning – with the possibility that it would disappear when that training had been delivered. As noted in the PIP case:

‘I would envisage the aim of the project as being that it (PIP) was embedded, so it wouldn’t have a team ongoing. Certainly we would need a team for another few years but long term I’d like to see it as something that has say a lead and someone to co-ordinate things but that it was submerged in the service and the service user networks.’

However, the notion of a transitory role was not confined to co-ordinators in skills project. Similar views were expressed in relation to a specialist role in an independence project, the Norfolk assistive technology support worker:

‘The ultimate aim from the beginning when I set up the new roles was always that this was a skills and knowledge base which needed to permeate a whole range of staff and that it wouldn’t remain as a specialist stand-alone role. It needed to be part of everything else that was going on.’

6.2.4 Evolving roles

The term ‘in part’ was also attached to a small cluster of projects where the new role or way of working was not the final ‘resting place’, but contributed more to the ongoing development of the service; in other words it represented a ‘step on the way’, but not the ‘destination’. Certainly the Suffolk project went through this process of evolution. While a couple of residual, employed foster carers remained, the authority had categorically turned its back on this role. However, equally apparent was a direct link between the professional foster carer and the ‘skills level scheme’, which was introduced from April 2006. While not paying a salary to foster carers, a fee structure was designed to encourage them to acquire the skills needed to take on difficult to place children; in this sense the scheme became a functional equivalent to the employed foster carer. As noted:

‘It (The 11 to 17 project on professional foster carers) served its purpose. It re-confirmed a concentration on tackling the problem of the difficult to place children at the heaviest end.’

The Leeds project might also be classified as one which was necessary but not sufficient to generate the hoped-for changes in workforce structure. This project was ‘successful’ in terms of a number of tangible outcomes; thus it managed to accelerate the development of 368 community support workers up to NVQ level 2, well beyond the target of 200. But moving these workers on to NVQ 3, the level necessary for them take on low-level professional tasks proved difficult. Indeed it was acknowledged that community support workers were taking on delegated tasks only in small pockets: ‘We’ve not cracked the large scale roll out.’ The work was continuing as part of a broader initiative, ‘Making Leeds Better’, a 10 year plan which included ‘taking domiciliary services closer to home’. It reflected a re-configuration of services involving the closure of one of the city’s hospitals and the building of a new children’s hospital, moves which would require much greater adult care at home.


‘This fitted very well with what the New Type of Worker programme was trying to achieve but the work continues not as a separate project but as part of the mainstream.’

In a slightly different sense, there were examples of roles developing as new and sometimes unforeseen needs emerged. This was certainly the case in the PIPs project, where a role initially viewed as co-ordinating and delivering training evolved into one concerned with post-training support and monitoring:

‘As time went on things really snowballed and we’ve got involved in all sorts of related things. You realise once you‘ve trained people you’ve got to support them afterwards and ensure fidelity to the model.’

6.3 Employee value The new work roles have important consequences for the employees who fill them and for other employees, typically professionals, who work with them. For post holders the nature of the roles, in terms of how they are structured, rewarded and managed, will have a profound impact on the nature and quality of working life, and indeed more general well-being. For co-workers the roles will have no less significant, if perhaps less direct, consequences; as we have seen, a number of the new roles involve supporting professionals and in some instances even taking on some of their work. The employee consequences of new work roles also represent a key outcome from the perspective of the other two stakeholders under consideration: the organisation and the people using the service. The organisational sustainability of such roles and their ability to deliver quality services to the individuals and carers will be crucially linked to an ability to recruit, retain and motivate post holders.

This section mainly focuses on the consequences of the new roles for those who performed them, although brief mention is made of the implications for co-workers. Consideration is first given to the issues of recruitment and retention, before looking at employee motivation which naturally requires a broader look at how those in the roles are treated in terms of workload, pay, training and development.

6.3.1 Recruitment and retention

Many of the projects were able to recruit suitable individuals to the new roles. As already suggested, in a number of instances the appointment was after all being made to a single post, while in the case of a project such as the Laurels, employees were already in post. However, a noteworthy number of the pilot projects did experience recruiting difficulties:

• The Blackpool project had problems recruiting to its two mentor roles.

• The appointment of the HAPUN Service User Development Worker took longer than expected.

• Only 4.5 of the six Norfolk assistive technology support workers were appointed during the first round of recruiting: ‘I didn’t appoint to all of the posts at first because I wasn’t satisfied with the calibre of people applying.’

• Just nine applications were received for the three Devon ROVIC posts. Of these ‘only four were appointable’, many of the applicants not having the requisite


experience in working with children. Two ROVICs were initially appointed and a third six months later.

• The Hampshire Early Intervention Service had difficulties recruiting to qualified posts.

• Despite strong expressions of interest from a range of social care workers in Suffolk to take on the role of professional foster carer, very few of these converted into firm applications. Indeed, in the light of these difficulties the project was forced to seek the involvement of the authority’s Youth Offending Service. Professionals from this service were seen as particularly well qualified to take up this role, routinely caring for older children on bail or remand.

• There were only two applicants for the co-ordinator job in the TAC project.

These problems were related to a variety of factors, ranging from narrow administrative difficulties to more fundamental structural and institutional concerns:

• As in the case of the project manager, some of the difficulties were associated with the fact that these were pilot roles on a short term contract with consequent uncertainty about the future. As a means of dealing with this issue, there were instances where new roles were filled on a seconded basis, such as the PIP, TAC and United Response co-ordinators.

• Secondments could still cause problems and delays. The delay in appointing the HAPUN Service User Development Worker arose from difficulties in finding a replacement for the post vacated by the person keen to take up the role. This not only points to unexpected blockages but suggests the importance of planning and sequencing. Aware of the time taken to recruit, the Norfolk project sought to recruit well before the pilot date to ensure that project time was not ‘eaten-up’ by the process.

• It was striking that there were recruitment difficulties in two of the sensory impairment projects, where there were general shortages in qualified staff. Where roles did not require a professional qualification recruitment pressures were eased. As noted in the Norfolk project:

‘My experience has always been that if we advertise interesting jobs in social care that don’t require a professional qualification, we’ve always a lot of applicants, and good applicants.’

However, more profoundly it was perhaps intrinsic to projects concerned with new roles, combining tasks in unusual and perhaps unique ways, that people with an appropriate skill set were unlikely to be readily available. It was a point again highlighted in the Norfolk project, with suggestions that this may have implications for the kind of competences being sought:

‘If you are developing a new role, you know from the beginning it’s not going to be totally straightforward. Although I’ve got an idea and a vision, I couldn’t know exactly how it was going to work out. I did know there would be hiccups


and there would be things that I wouldn’t get quite right. So you do need people really who are quite adaptable and flexible.’

• Closely related, new roles generated uncertainties about the demands and requirement to be placed on post holders, which when fully realised dissuaded some from applying. Certainly, this was the case in Suffolk, where the initial interest failed to translate into applications as social workers and children’s homes workers began to appreciate the wider implications for family life of assuming the role of professional foster carer.

The impact of these uncertainties might have been expected to impact more forcefully on retention than recruitment; after all, the difficulties associated with a new role might only fully emerge when the post-holder performs it. There were isolated instances where this was indeed the case. For example, one of the ROVICs left before the end of the pilot, although this had as much to do with the fact that she came from the voluntary sector and was not used to systems in the statutory sector as with the fact that the role was new. There were also cases of what might be viewed as a more positive form of turnover, where staff had developed in the role to the extent that they were looking to further advance their careers; certainly this was the case with one of the mentors in Blackpool.

However, in general, and where roles had been sustained, high turnover rates were not a concern. In some cases, such as the Laurels, the new more focused role was actually seen to have encouraged employees to stay ‘by making work more enjoyable.’ In a broader sense, low turnover might be explained by an element of self selection in those who took up the new roles. Those attracted to such challenging and perhaps uncertain roles might well have been the kinds of people likely to stay with a role through ‘thick or thin’. Indeed, at an impressionistic level those post-holders interviewed appeared to have a strong commitment to their roles and the benefits they generated for the organisation and the people who used the service.

This self selection should not detract from the care taken in some of the projects to ensure that individuals remained in their roles. This was particularly the case in pilots involving roles for people who use services; here sensitivity to the post holders’ conditions was crucial to them remaining in the role. For example, where post holders had mental health difficulties, a relapse could force withdrawal from a role, a situation which emerged in the ABSWAP project. In fact the ABSWAP pilot was an instance where arrangements were made to help maintain involvement of people who used the service in the research assistant’s role: training for the role was organised at a familiar, local venue rather than at the more distinct college site, so ensuring regular attendance and high completion rates on the course. Similarly, the hours worked by the holistic carers in the SUCH project were tailored to the demands of those in the role.

6.3.2 The treatment of post-holders

There was some variation in the treatment of employees according to the nature of the role. Thus, a distinction could be made in this respect between roles for people who use services and the other types of role.


The management of roles for people who use services

We have seen that these roles have taken different forms—as holistic carers in SUCH, researchers in the ABSWAP and the Hants Early Intervention projects, buddies and listeners in MIND, co-facilitators in the PIP pilot and participants in training delivery in a number of the skills projects. But they did have similar employment status: they were not waged or salaried employees. In the main, they were volunteers or paid on the basis of fees for work undertaken and travel costs. In a number of cases, concern was expressed that payment for work might affect welfare benefits, with suggestions that such payment may have been lowered to avoid any loss of benefit. Similar issues arose in the No Limits in terms of benefit payments and carer involvement.

It is open to debate whether this sort of involvement represents a form of ‘low cost’ labour, but certainly there was a universal enthusiasm for their work among those people who use services interviewed, and a feeling that they had benefited in various ways. These benefits assumed a number of forms:

• While often not a permanent paid post, the role nonetheless represented a first step back into employment, especially among those with mental health difficulties, as in PIP co-facilitators, SUCH holistic carers and ABSWAP participants.

• In all of these instances the roles also facilitated re-integration into the community and had positive therapeutic effects.

• Less expected outcomes included those emerging from the ABSWAP project where the group of researchers evolved into a support network, reflected in the help provided for one of their number who had a relapse.

Other roles

Those in the other types of role – co-ordinator, boundary spanner and specialist – were salaried employees on contracts of employment. In considering their treatment, the following points were highlighted:

• Workload: Job descriptions were developed for most of these roles, although there was a ‘catch-22’ in that the novelty of the job bred some uncertainty as to how it might unfold in terms of tasks and responsibilities. In the case of the community enabler, a definitive job description was seen as an outcome of the project, being devised in the light of practical experience. In other projects, such as the Norfolk pilot, the job description was broadly drawn to cater for this uncertainly. As already, noted this required flexibility on the part of the post holder and indeed the emphasis of the job did change over time.

To the challenge of uncertainty were added difficulties in dealing with co-workers. These were especially acute in the co-ordinator role. This role not only had organisation-wide responsibilities, but also focused on person-centred plans challenging traditional professional approaches. As noted in the ABSWAP project:

‘This (person-centred) way of working sometimes doesn’t go down too well with professionals. When you have a user saying ‘I don’t want an injection in


my bum’ and the consultants have to think about an alternative, it creates a resentment some of the professionals haven’t quite worked through.’

Moreover, we have already seen that dealing with busy professionals was no easy task. However, alongside a degree of professional resistance, there were instances of professional enthusiasm for the new role, such as the TAC co-ordinator and especially the ROVIC roles, which involved some support for the professional. Indeed, as stressed, the sustainability of a new role was often crucially related to the value placed on it by professionals. This professional, and indeed wider organisational, support grew as the project went forward and as ‘successes’ became visible. As highlighted in Barnardo’s:

‘As the project built momentum, more and more people got involved, for example to plan events. It was really quite an organic process and it was something we were testing out and it really did get momentum with staff. So in the end we had a lot of people on board who wanted to take the work forward.’

This need to highlight ‘success’ as a means of bringing other staff on board was stressed in TAC project:

‘You require a great deal of energy from people who are very busy and you are asking them to do something else, so you have to make it worthwhile; you have to make it effective’

A similar point was made at the Laurels:

‘There was reluctance to accept the new roles and it wasn’t until the staff saw the effect of new ways of working on residents that they embraced them.’

More prosaically, further workload pressures were sometimes generated by an absence of administrative support for the new role, a point highlighted in the TAC, Hants. PIP, Gateshead and Leeds projects. It was perhaps unsurprising that at the outset a new role involved a heavy administrative workload as, say, new systems were set up. However, the administrative burden was often overlooked in preparation for the role, detracting from the time available for substantive service-related activities. In isolated cases, such as the HAPUN project, these problems were compounded with the post holder assuming the project manager role. As the final report of this project (T. Thomas, 2006, A Couple of Steps Up From Basket Weaving) noted:

‘Probably the hardest circumstance to hit the project saw the departure of the Project Manager, one month before the final appointment of the Service User Development Worker which resulted in the SUDW having to manage as well as run the project, increasing the workload and taking away the opportunity to share hopes, dreams and ideas with any others directly responsible for it.’

• Training and development: As might have been expected, training emerged as a concern in many projects; after all, a new role often requires new skills and little time to develop them. In the Suffolk project, for example, the development of the


professional foster carer raised concerns not only about the capabilities of the direct carer but also the carer’s family:

‘You would expect residential workers to know all there was to know about bringing up children in the home environment. They knew what they were getting into, but their families didn’t.’

Training was also an important issue in the ROVIC project, where rehabilitation officers were more typically working with adults than children and required new capabilities and skills when they switched:

‘ROVISs (Rehabilitation Officers for Visually Impaired Adults) are people working with adults with acquired sight loss and there’s a huge difference in working with children with congenital sight loss. We needed to put in place child development stuff, the legislative framework that they would have to be working in, the national assessment framework for children; we needed that stuff putting in place, as well as child protection and child assessment skills.’

Indeed, striking in this case was the authority’s sensitivity to training needs as expressed by the ROVICs themselves:

‘We were particularly looking at where ROVICs themselves felt they had a need and we’d then meet that either internally or by buying-in an outside training package.’

In other projects training was less of an issue. Some projects, such as Laurels and Salford, were anyway heavily focused on training those in the new roles. In others staff preparation was seen more in terms of management style than formal training, as stressed in the Barnardo’s case:

‘There were a lot of things about developing staff confidence; often staff don’t try things because they don’t feel they have permission to do them. Sometimes if you want people to work in different ways you don’t really need some jazzy training programmes, just something about supporting staff confidence and encouraging them to share.’

At the same time, it is important to recall that the pilots were not generating a large number of people who needed training; as we have seen many roles, such as the co-ordinator, involved just one person.

Equally to the fore were issues associated with employee development and especially career progression. There were instances where a new role contributed to personal development and career opportunities. This was stressed in the Blackpool case:

‘I get the impression that they (the two mentors) have got a huge amount out of it. In fact both have had a huge shift: one is now part time training to be a social worker and she is very conscious it has changed her perspective on her role and the kind of things she would challenge; she has a greater awareness of what is not okay.’


But there were cases where a new role created uncertainty in career development. The TAC co-ordinator, for example, was employed on secondment from the PCT in part to protect pay and other conditions, including pensionable service. But she still had limited if any opportunities for career advancement within the new role:

‘There doesn’t seem to be an opportunity for me to advance and that is the source of frustration. I haven’t got anywhere to go; I hope there will be when the children’s trust starts to develop.’

This was an issue which the Hampshire Early Intervention Service pilot had been forced to confront. It had sought to deal with it by creating two grades for the role—qualified and unqualified. The intention was for each hospital to have a qualified and an unqualified worker located within it and working together, but the authority had also devised a training scheme, which allowed those in unqualified posts to move to the qualified level.

• Line management: Reporting relationships and where the new role sat within the organisation emerged as an important influence of the efficiency and effectiveness of the post, especially in the statutory sector. The more the role could be fully integrated into the organisation, the more likely it was to be accepted. In the Norfolk project, for example, one assistive technology support worker (ATSW) was to be found in each of the six PCT districts, each with their own local line manager. As the project manager noted:

‘I have regular monthly meetings (with the ATSWs) but operationally it was important, in terms of embedding the role, that they were seen to belong to the district staff.’

A similar if slightly broader point was made in the case of the Hampshire Early Intervention Service project:

‘We made sure that everything we did fitted in with the department’s infrastructures. So although the training was a stand alone project, we worked with our learning and development professionals, we used their evaluation and kept them informed throughout.’

Line management issues could occur, however, especially with boundary spanning roles. This was illustrated in a particularly dramatic way in the case of the TAC co-ordinator who was initially line-managed by the local authority project manger but received supervision from the children’s service manager in health, then when the project manager moved line management responsibility shifted to special needs education and now finally it came to the complex needs team in which she sat.

6.4 Value for people who use services In considering the consequences of new roles for people who use services, this report returns full circle to the key stakeholder underpinning the government modernisation programme and the Skills for Care project. Clearly, the new roles generated by the NToW project were designed to improve service provision from a user perspective, although it is equally apparent that they did so in different ways. In general terms, these differences


might be related to the closeness of the roles to the frontline; in other words, how directly they were involved in interaction with the person using the service or their carer. On this basis a threefold classification readily emerges: direct, indirect and conflated roles. The conflated heading covers those roles where interaction is a non-issue: the person who uses the service is the role-holder. Attention has already been given to the benefits for individuals generated by these roles in considering how they were managed.

Direct roles correspond to boundary spanning and specialist roles which almost invariably involved unmediated service delivery and contact with the person who used the service. Clearly it is these roles which might be expected to have had the most profound and certainly immediate effect on the people. As noted, many of the projects sought to evaluate this effect, highlighting some impressive outcomes. For example:

• The review of waiting time in the Hampshire Early Intervention Service found that with the new role 80% of referrals were seen immediately and most within two weeks; this compared to a waiting time of between 10 and 65 weeks under the previous system.

• The returns to a questionnaire revealed that 65.5% of those using the MIND centre reported ‘improved well being’.

• The ‘success’ of the Team Around the Child can be seen in the ‘ballooning number of referrals’ and the consequent need to change the age criterion for referral from 0–8 to 0–3.

Other projects had very clear benefits for people who used the services, such as the Norfolk project where assistive technology allowed people to stay in their homes longer with, say, dementia sufferers being much more easily monitored. (An outcome which also has cost benefits in keeping people out of full time residential care).

However, as we have seen, such diverse projects make it difficult to establish criteria by which to assess outcomes for people who use services, and projects varied markedly in their methodological approach to this issue

Indirect roles mainly equate to co-ordinator roles. A distinction does need to be made between those co-ordinator roles focused on engagement of people who use services and those concerned with employee training. Clearly, the former had greater contact with people who use services than the latter, their impact on those people being seen in the establishment of strengthened networks for them, for instance, a new Deaf Forum in Gateshead. In the case of training co-ordinators, outcomes were often measured by feedback sheets following a training programme, obviously at some remove from any impact of the role on people using the service. However, these different co-ordinator roles do share outcomes which are not directly linked to service delivery outcomes.

Any future evaluation of how new roles impact on people who use services might well benefit from taking into account the proximity of the role to the person who uses services.


7.0 Summary and conclusions 7.1 Overview

From this evaluation, it is clear that the first phase of the Skills for Care New Types of Worker programme has encouraged the development of a range of new roles across different parts of the social care sector. These roles have sought to take forward public policy objectives related to the establishment of services centred on people who use services including the provision of greater voice, access and independence for these people, the generation of a more highly skilled and flexible workforce and the creation of a more integrated set of organisational activities.

Four types of new roles have been identified:

• co-ordinators, organising activities and networks among staff and people who use services

• specialists, focusing in a dedicated way on a particular activity or services group

• boundary spanners, working across organisations or client groups

• people who use services performing the roles themselves.

These roles have been founded upon different sorts of interaction with service users: boundary spanners and specialists providing a frontline service and therefore in direct contact with the person; co-ordinators seeking to build systems and capabilities which involved less direct participation in service delivery; and people who use services in posts where the distinction between them and providers clearly dissolves. However, despite such differences, these roles have broadly been based upon newly generated or created activities rather than on a simple re-labelling of traditional jobs or a re-packaging of existing tasks. Moreover, in general these roles have been seen as contributing positively to different stakeholder outcomes, leading to the establishment of sustainable roles in some cases, providing enriching and worthwhile employment opportunities and enhancing service quality.

At the same time, this evaluation has highlighted the limited scale of the developments to emerge from the New Type of Worker programme. It has been seen that across 25 of the 28 pilots, fewer than one hundred employees have undertaken the new roles, and that includes two projects accounting for almost half of these employees (Laurels and the Hampshire Early Intervention Service). In the main, the roles have at best involved a handful of employees and more typically a single post holder. This is not to detract from the importance of these new roles to the delivery of improved services, but it is to highlight the modest nature of the changes in workforce structure fostered by the programme. More significant perhaps were the questions raised about the lasting legacy of the programme. There were some striking successes in terms of sustainable roles, the Rehabilitation Officers for Visually Impaired Children (ROVICs) and Team Around the Child Co-ordinator being the most noteworthy. But a number of roles were also lost at the end of the project, such as Community Enabler and Inclusion Co-ordinator, along with the considerable learning that arose during their development.


An overview judgement on the project’s legacy might conclude that its contribution to future workforce and service development has been significant but limited. In many instances, the new role represented a key stage on the road to service improvement but rarely the ‘final resting place’. Certain roles (in the Blackpool, PIPS and Norfolk pilots) might well have turned out to be transitory, crucial in generating certain activities and outcomes, but disappearing or transforming after they had done so. Other roles had been ‘swallowed-up’ by broader initiatives (Leeds and Suffolk) contributing but being taken in a new direction by them; while in yet other cases, particularly the continuation sites, the ongoing viability of the role remains an open issue.

The nature and fate of the roles distinguished was found to be sensitive to context. The service setting, in particular, was seen to have influenced various aspects of the pilot projects. Thus, it was clear that the need for joined-up services and, more significantly, the scope to develop a role able to facilitate their creation was especially marked in sensory impairment. The institutional disconnect between diagnosis in health and the provision of community support in social care for those with visual or hearing impairments ‘screamed out’ for an early intervention role for adults and children; it was successfully established in a number of instances. It proved less straightforward to establish new roles in other service settings, the case of the Leeds domiciliary service, seeking to bridge local authority home care and NHS health care being the most striking example.

Alongside service setting, the sector setting emerged as a key contextual factor. In the debate over whether the voluntary or statutory sector was the more conducive to the development of new roles, the evaluation largely leaned towards the statutory sector. Certainly, the relative freedom to act in flexible and innovative ways led to the emergence of novel roles in the voluntary sector; so, for example, roles based on people who use services were often located in the voluntary sector (MIND, SUCH and ABSWAP), while more radical attempts to cut across boundaries were also be found in it (Community Enablers). But, located in organisations with contingent forms of funding and other forms of uncertainty, these also proved to be the most vulnerable roles, most likely to fade as the NToW funding ended.

7.2 Tensions At the outset, it was suggested that a number of tensions ran through the NToW project, an inevitable consequences of its structure, character and context. This evaluation has highlighted the ways in which these tensions have played themselves out:

7.2.1 Ways of Working versus Type of Worker

Despite ongoing debate amongt key stakeholders in the NToW programme about whether it was principally concerned with new types of workers or new ways of working, our evaluation has established that in the main projects did establish a new role: in only four of the pilots covered was it difficult to identify a new role. Nonetheless this finding needs to be qualified in a number of ways:

• As already stressed, the scale of these developments was limited with very few employees performing in these new roles. The one programme where a potentially significant swathe of a workforce might have been affected, the Leeds domiciliary


project, had faced major difficulties in developing a community assistant role taking on tasks delegated by health professionals.

• Where new roles emerged, it was often the case that new ways of working had to be developed. This was illustrated in those projects where new care pathways, protocols, referral and assessment systems as well as workplace procedures had to be formulated, a requirement especially to the fore in pilots cutting across different parts of the public services.

• Although new roles emerged in most projects, there was little doubt that in some of these cases the project was essentially about new ways of working. The new role was often an important catalyst for and facilitator of this new way of working but the project was principally about embedding change and ‘doing things differently’. This was particularly apparent in skills projects, where the co-ordinator role was often designed to train up staff to work in new ways, but in other projects as well where a role was seen as transitory, generating skills which would become embedded over time, as in Norfolk.


The projects were seen often to unfold in unpredictable ways, requiring a flexibility which did not always sit easily with the SfC procedures understandably instituted to ensure accountability for the resource expended. Indeed, it is arguable that there was inherent tension between a system of milestones, locking projects into meeting stated objectives and a learning set approach, seeking an ongoing sharing of ideas and joint learning. Clearly there might still be scope for flexibility within a broad framework of milestones, but it is worth stressing that projects often took an ‘organic’ form, developing in an iterative way which required adaptability on the part of project managers, role holders and others. Unintended consequences and issues emerging from the projects included:

• The difficulties faced in recruiting people to new roles requiring an unusual configuration of skills and competences

• The administrative responsibilities or burdens placed on the post holder as a new role takes off

• The shifts in emphasis as the role unfolded and required the post holder to concentrate on different types of activities over time

• The responses of other internal and external stakeholders which might be of a positive kind, leading to unexpected demands, or a negative kind, requiring means to overcome resistance

• The problems confronted in dealing with multiple agencies from different parts of the public services, particularly in developing the work and employment system needed to underpin the new role or way of working

• The loss of key personnel – project managers or post holders – at crucial times.

Many of the learning points to emerge from this evaluation relate to these tensions and how they were managed.


7.3 Learning points The learning points are presented under the headings used to structure the report.

7.3.1 Context

• The development of a new role needs to be sensitive to context. This includes history, service and organisational setting.

• What is feasible and how the project unfolds will depend on the opportunities and support provided by the institutional infrastructure (funding, work, employment and service delivery systems). Full consideration should be given to this infrastructure before setting up the new role.

• A new role has a better chance of taking off where it has some momentum behind it. This may be provided by an ‘individual champion’∗ but more effective is a clear link between the new role and a continuous line of service development.

• The ‘success’ of a new role is related to the security and the level of resources provided by the organisation to support it.

• Consideration should be given to the different organisational implications of developing a new role across the whole of an organisation or in just one part, whether that be a particular functional team, activity or area.

7.3.2 Objectives

• Projects need to have a clear set of objectives to provide focus and to facilitate evaluation.

• Typically a project will have a number of objectives and as a consequence some consideration needs to be given to how the project will be ‘branded’ for both internal and external consumption.

• The emphasis given to different objectives is likely to shift over time while new objectives might emerge as the new role unfolds. This needs to be recognised in presenting the new role to stakeholders and in any evaluation of the role.

• Different objectives are better pursued by different types of new role. Consideration needs to be given to which role type best fits with the objectives being pursued. For example, the aim of training-up the workforce to administer new procedures suggests the value of a co-ordinator role to organise it.

7.3.3 Processes

• Consideration needs to be given to processes required to manage a ‘new role project’, to manage the internal and external stakeholders and to manage those filling the new post.

• Steering committees are a key mechanism for managing projects and the internal and external stakeholders involved, but care is needed to ensure that those on them have the necessary decision-making authority.

• The time needed to manage a steering committee should not be underestimated. ∗ See ‘Profiling the individual’ NToW paper on individual champions, www.skillsforcare.org.uk


• People who use the service are typically key members of a steering group.

• Project managers need to focus exclusively on the development of the new role; giving the project manager other responsibilities puts the well-being of the project manager and the new role at risk.

• Establishing a new role often involves changes in organisation or service culture, especially if the role is associated with new ways of working. The introduction of a new role needs to be accompanied by a broader review of organisational and/or service aims, values and practices.

• New roles are likely to interface with other workers and in particular with professionals. Some of this interaction may be perceived by these employees as challenging or as another ‘unnecessary’ burden. Other workers and professionals need to be prepared for new roles and their concerns addressed. This involves communicating with them about the new role or service: if they don’t know it exists they cannot use it.

• Local champions provide a means of disseminating and securing new ways of working at the workplace.

• Gaining acceptance of a new role from internal and external stakeholders may depend on establishing initial ‘successes’ and then ensuring that these ‘successes’ are widely publicised and appreciated.

• ‘Successes’ may be achieved where the new role is most wanted. Those in the new roles should gravitate towards those parts of the organisation where they are most likely to be embraced and supported.

• Attempts should be made to integrate new roles into established organisational structures and systems; a role which stands apart from these structures and systems is more readily seen as an anomaly and more easily removed.

• Large stakeholder events at the launch of a new role are a useful means of letting people know about the role and getting some ‘buy-in’ to it.

• Aligning service and workplace procedures (for example, those related to referral and assessment as well as working practices) is crucial in partnership projects, but this is a difficult process and the problems faced should not be underestimated.

• Attention should be given to how the development of new roles might be affected by statutory regulations underpinning service provision. Such regulations may facilitate or hinder the development of new roles.

7.3.4 Outcomes

• Evaluation is a difficult but essential part of establishing a new role; permanent funding for a new role is much more likely to be forthcoming if there is a strong evidence base for its need and effectiveness.

• It is therefore important to give careful consideration to evaluation as part of the preparation for the introduction of a new role.

• This preparation should include a consideration of the kind of measures to be used in the evaluation (e.g. waiting times, numbers of referrals, cases handled); the


evaluation methods to be used (surveys, case studies) and the stakeholders to be evaluated (people who use services, co-workers and professionals).

• People who use services are usefully involved in an evaluation, in terms of finding out their views on the new role but also as researchers in actually generating this information—they are better able to empathise and relate to other people using the service in gathering such data.

• The importance of co-workers should not be underestimated in any evaluation; roles, particularly professional support roles, often succeed or fail on how useful they are seen to be by co-workers.

• Any attempt to use cost-benefit analysis in evaluation should be sensitive to hidden and unintended costs or benefits.

• Difficulties may be encountered in recruiting to new roles, although these difficulties are likely to be less acute in the case of posts which do not require a professional qualification.

• Given the likely uncertainties associated with a new post, one of the key competences requited is flexibility or adaptability.

• Partly as a consequences of difficulties in finding people with the ‘right’ skills, training for post holders is a crucial consideration and needs to be devised and in place on appointment.

• Problems might be encountered in establishing the pay and other terms of conditions for a post holder, especially given differences in such terms between different parts of the public services. The use of secondments may be a way of protecting terms and conditions.

• Attention will also need to be given to the career and employee development opportunities provided by new posts; without such opportunities there is a danger that the new role will be perceived as a ‘dead end’ in career terms.

• Careful consideration needs to be given to line management and supervision.

• New roles can often be onerous in workload terms as new procedures have to be put in place and new networks established. Administrative support for new roles is an important but often overlooked requirement.

Documents

The Skills for Care New Types of Worker Programme: Stage 1 Evaluation Report … · · 2014-04-174.2.4 Boundary-spanning roles ... The Skills for Care New Types of Worker Programme: