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Maximising independence in adult social care - London Borough of Ealing

Published on 22/02/2019

The Requirement

iMPOWER was commissioned to work with the London Borough of Ealing to transform adult social care. This has involved reducing spend and improving outcomes for the people of Ealing by using a strength-based approach to maximise the independence of service users. When iMPOWER started this work with the council, they had exhausted traditional supply-side cost reduction approaches.
In order for the council to refocus on demand management, it was essential for the following activities to be carried out:
  • An Avoidable Demand Analysis to understand how demand could be reduced and establish the impact on spend (using case reviews, data analysis, benchmarking and observations).
  • Trialling new approaches with teams.
  • Delivery of the council’s Better Lives transformation programme.

As a result of iMPOWER’s work, we have seen change across the service. Spend has stabilised, we have improved understanding and grip on activity, and a consistent way of delivering social care. My high expectations have been met, and my directorate is in a far stronger position than 18 months ago.
Judith Finlay, Executive Director for Children, Adults & Public Health, Ealing Council

The Solution

iMPOWER enabled the council to refocus on managing demand, in large part by reframing their approach to social work by adopting a strength-based approach. The suppliers working hypothesis was that they could reduce cost and improve outcomes by changing the behaviours of staff and service users.
The case reviews were critical. Ealing’s social workers looked at a sample of cases from across the service, focusing on whether care packages could have been reduced, delayed or even prevented from entering social care. Key findings included:
  • 65% of cases in Older Adults could have been prevented
  • 64% of packages in Learning Disabilities could have been reduced
  • 55% of cases in Physical Disabilities could have been delayed
This clearly evidenced that there was avoidable demand within adult social care.
iMPOWER used a strength-based practice approach with three teams (an older adult’s locality team, the Independent Living Team and the Contact Centre) to trial a new practice approach. They provided materials, training and coaching to change the behaviours of both staff and service users, in order to maximise the independence of service users. Care was taken to refine an approach that worked for Ealing – a distinct ‘Ealing
To embed the approach with other teams, they involved team managers and senior social workers using a ‘train the trainer’ model. They ran sessions with them so they understood both the approach and how to manage change in their teams, and then supported them to roll this out. They supported the approach in various ways, including by developing a new set of forms for social workers that have radically changed the way they operate. The forms promote strength-based working and are significantly shorter than previous versions.
One of the programme’s work streams focussed on the interface between the adult social care service and its health partners. iMPOWER undertook a project to understand how demand was driven across health and social are – from people entering Accident & Emergency all the way through to requiring a social care package. This helped create a shared view of the challenges and opportunities.
The success of a programme like Better Lives is dependent on making sure the front-line staff, understand ‘the small decisions that will affect the big numbers.’ Trajectory Management is key to this and helped the client in two ways:
  • It put in place a management-level finance and performance reporting cycle that enabled key decisions to be made based on information about Ealing’s adult social care system as a whole.
  • Through the use of a Primed Performance Management system, it enabled the council to drill right down to understand how teams and team members are performing, what is working and what needs to change.
The critical activity has been working with people across the service to analyse, communicate and act upon the data.

The Results

As of November 2018, there has been a significant shift across several key performance indicators:
  • The Better Lives programme has directly saved £4 million through review programmes and reducing placement spend, and indirectly helped to save a further £6 million through management actions such as securing funding from partners, increasing income from service users eligible to pay and reclaiming payments that had not been used.
  • 40% reduction in contacts to the front door over the last 12 months through more effective contact routes.
  • 54% reduction in referrals from the contact centre to the service over the last 12 months due to more effective signposting and use of strength-based conversations.
  • 13% increase in service user reviews, meaning that more people are receiving support relevant to their current needs. On average there were 349 such reviews per month in 2017/18, and this increased by 12% in the first four months of 2018/19 (to an average of 392 per month).

The difference when working with iMPOWER is that they genuinely work with you, seeking solutions that work with current systems and using the skills of the staff delivering the business. They don’t set themselves up as experts, but encourage others to develop solutions. If they spot something wrong, they challenge in a constructive way. Their inheritance will live on, and I have really enjoyed my time working with them to deliver real and sustainable change.
Kim Carey, Interim Director of Adult Services, Ealing Council


To download a printable version of the case study, please click here.
For more information, please contact the Managing People and Professional Services team:
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