Working with people
Improving outcomes and tackling inequalities within our communities
This theme covers how we work with people, assessing their needs, maximising their independence, supporting people to live healthier lives ensuring a focus on those who may experience more inequality.
Assessing needs
Afsaneh’s story – A journey to safety
What was the situation?
Afsaneh is a 42-year-old woman who was living in temporary accommodation. Afsaneh is from the Middle East and was a victim of domestic abuse from her ex-husband before being able to move to the UK using an illegal route to safety from the trauma she experienced from domestic abuse.
Afsaneh has a big family and is degree educated but had a serious accident which led to her having difficulty in walking and standing and had many corrective surgeries but was still not able to walk and uses crutches. She is prone to falls due to the muscle and bone weaknesses in both legs. Her physical disability was as a result of road accident a long time ago which needed a number of surgeries. Afsaneh was in serious pain through the entire process of moving to the UK and she lost a significant amount of weight, and this affected her mood. Afsaneh had no savings; she was an asylum seeker with no current legal status to remain in the UK. Afsaneh stated she has had a difficult life and moving to the UK was the only surviving option she could think of. Afsaneh was receiving asylum support from the Home Office weekly to buy food and other essentials. Afsaneh was unable to claim any benefit unless she received a positive outcome from the Home Office in terms of an application for asylum.
What did we do?
When Afsaneh was referred to Adult Social Care for support for her care needs, the assessment process was undertaken using an interpreter. Once there is an appearance of needs, the Local Authority has a responsibility to assess and meet the needs as appropriate. A ‘no recourse to public funds’ status does not prevent an individual from accessing other publicly funded services, such as social care or NHS treatment. Services must not be denied to a person solely because they have no recourse to public funds. However, a person’s immigration status (or lack of status) may be a factor that determines whether they can access some services. When assessing need and providing care and support to an adult with no recourse to public funds, the local authority must apply the Care Act 2014 in the usual way. When a person who is ‘in breach of immigration laws’ qualifies for care and support, Schedule 3 of Nationality, Immigration and Asylum Act 2002 requires the Local Authority to determine whether the person can be reasonably expected to return to their country of origin to avoid a breach of human rights arising from their destitution in the UK. In practice, this means that the Local Authority will need to undertake a human rights assessment to identify whether there are any barriers preventing the person from being able to return. When a barrier to return is identified and the person qualifies for care and support, the bar on providing support can be lifted and the person's care and support needs can be met. A Human Rights Assessment was undertaken which identified that Afsaneh had a barrier preventing her from returning to the Middle East and she et the eligibility threshold for support from the Local Authority.
Support provided included:
- Afsaneh received a short-term service to promote independence, as needed help with washing, dressing and to establish if needed any ongoing care and support.
- Liaison took place with the Coventry Refugee and Migrant Centre,
- Afsaneh required an Occupational Therapy assessment to help reduce her risks of falls during personal care and was also provided with equipment.
- A referral was also made to the housing ream to provide support around her accommodation needs.
Bukola the social worker involved said:
I was happy to provide support to Afsaneh, it was my first experience of working with someone who was asylum seeking and needed to get to know the person, their journey, work with a multidisciplinary team and recognise the benefits of having good support network.
What happened and how are things now?
Afsaneh following a successful period of short-term support only needed a small package of care and support and this was arranged. Afsaneh was also granted her asylum to remain in the UK. She needed to quickly move out of her accommodation and also needed assistance with applying for benefits. Support was provided by the Coventry Refugee and Migrant Centre. Afsaneh had a friend living outside of Coventry who was very supportive and subsequently moved to live near so could have an improved support system. Afsaneh is looking to have reconstructive surgery in the UK to improve her quality of life. Afsaneh was appreciative of the support provided by the entire Adult Social Care team.
Aideen Staunton Head of Service, partnerships and Social Care Operations said:
We recognise the key role we play as a Local Authority in supporting people who are seeking asylum, it's great to see how we supported Afsaneh working closely with migration colleagues.
Coventry has been an asylum dispersal city for asylum seekers and more latterly a "city of sanctuary" in respect of migrant populations. Coventry's Council webpages offer useful information to newly arrived communities including people who are seeking asylum, have been granted refugee status by the Home Office, or come into the city through other routes (such as students, overseas skilled workers or EU migrants). coventry.gov.uk/immigration-asylum/newly-arrived-communities
Supporting people to live healthier lives
Val and Mike - Our experience
What was the situation?
Valerie known as 'Val' is married to Mike and they have two daughters; she married Mike when we was 21 after meeting at 16 when they both worked at the General Electric Company (GEC) and after 5 years of courtship. Val worked as a coil maker at the GEC and enjoyed the banter she had with her colleagues. They would have married sooner but her parents made them wait because of her young age. Val is now 82 years of age and had some falls recently and a hospital admission due to reduced mobility. Val also has physical health problems and was experiencing problems with her memory.
What did we do?
Val was discharged home with short term support to promote her independence. A plan was put in place to improve her mobility by walking with a frame and being able to 'transfer' safely for example getting out of bed. It was assessed that Val needed help from 1 person, Mike or a carer to help her manage her transfers and walk short distances with a walking frame. Mike or a carer would walk behind Val with a mobility aid, so that if she tired she could sit and rest. A hospital bed was provided which was adjustable and this went downstairs to make life easier. Val was referred for community physiotherapy to strengthen her leg muscles and improve her confidence when she walks. The support was gradually reduced over a period of weeks following conversations with Val and Mike, as Val wanted to be as independent as possible. Chloe, occupational therapy assistant who provided support said;
Working with Val embodies the whole reason as to why we do what we do. Seeing her smile when she was able to take her first couple of steps showed that the reablement process works.
This support was provided by a new integrated team, this was a pilot as part of a programme of work called 'Improving Lives'. The 'Improving Lives' Programme is about fundamentally changing the way we support people in Coventry with urgent need. People's experience of health and social care won't be dictated by the services we have, but rather by what they need, Improving Lives is a collaborative programme delivered in partnership between Coventry City Council, University Hospital Coventry and Warwickshire, Coventry and Warwickshire Partnership Trust and other health and social care partners in Coventry.
How do we want our services to be arranged?
Sally Caren Head of Adult Social Care and Support said:
The Improving Lives programme of work has been very exciting and we have moved all relevant services into 3 geographically based teams that were established following on from the successful pilot. This means that more residents across Coventry will be able to receive the seamless service Val did with a multidisciplinary team wrapped round them supporting their recovery and independence.
How are things now?
Val needed some ongoing care and support and a care package consisting of 3 calls a day was arranged. This provides support for Val but also helps Mike in his caring role. Mike supports Val with all her other needs, he buys their grocery shopping, and he prepares their meals, and they always eat together. Val and Mike have had a really happy married life, they just want life to be as normal as possible, being at home where they have lived and raised their children and being close to local facilities such as the library and easy access into town. Val has access to assistive technology including a ‘lifeline’, which she can use if needs to call for support. Val and Mike’s daughter and two grandchildren, continue to provide substantial support acting as carers in their own rights. Mike said:
Everyone we encountered face to face from the hospital up until those involved today has been supportive, pleasant, helpful and put Val at ease.
Jo, community case worker, said:
It was good to see Val getting involved in the support and staff building a relationship and getting to know her, respecting their privacy, autonomy and listening to what mattered to her and her husband.
Val is self-funding her care. You will be considered a self-funder if you are eligible to pay or are already paying the full cost of your care and support. Anyone who appears to have care and support needs is entitled to an assessment of their needs under the Care Act 2014 regardless of their financial circumstances. If your request is to meet needs by care and support other than a request of a care home. Then the local authority has a duty to meet your needs even if your resources are above the upper capital limit (£23,250) and you are not entitled to financial support. You will though need to pay an arrangement fee and an annual charge.
More information on self-funding and support available.
Carers Action Plan
We recognise the important role carers play in supporting people and have developed a 2-year action plan for 2024-26 launched in December 2023. The plan was developed after extensive engagement with carers. We heard from 166 people with caring responsibilities, completing surveys, attending groups, forums and engaging with our own caring workforce, which involved establishing a Carer staff network which is going strong. Carers told us about their experiences of having a carers’ assessments, their access to breaks, where they would find information if they needed to. We also heard about people’s experiences of caring through the pandemic. Carers also told us about how they wanted systems to work together, to reduce repetition and telling their story multiple times.
As a result of the engagement we developed three key priorities within the plan:
- Empower carers with flexible respite options ensuring they can take breaks
- Deliver the right support at the right time and in the right place
- Maximise the reach of carers assessments to benefit more carers
We continue to work towards the outlined actions in the plan, have established several working groups and an overall steering group to oversee the plan. As the plan progresses we will continue to engage with people with caring responsibilities to make sure we are on track. Read the plan.
Equity in experiences and outcomes
Phil’s Story – expanding his horizons
What was the situation?
Phil is a 48-year-old man who was born blind and with good hearing, he attended a specialist school for children who are blind. Phil also has a history of low mood and self-harm which included him hitting his ears which he has done since being a child which is a coping mechanism, but which unfortunately caused permanent hearing loss and he now wears bilateral hearing aids. Phil is therefore deafblind. Deafblindness is a combination of sight and hearing loss that affects a person’s ability to communicate, access information and get around.
What did we do?
Phil was subject to a safeguarding enquiry as he was being emotionally and financially abused by someone who had befriended him this led to great anxiety for Phil and him having arrears for his rent. Ceri a social worker supported Phil to identify what he wanted to happen. Phil said he wanted the abuse to stop and would like to be more independent and access the community as easily as sighted people do. Phil feels that being blind holds him back from being able to live life how he would like to. Phil’s social worker was a qualified deafblind assessor having received specialist training to assess the needs of deafblind people. So, a safeguarding plan was put in place, which included the support of the police and we agreed to gradually transfer his package of care to a specialist support agency, Deafblind Enablement, where all support workers are qualified deafblind Communicator-Guides. These are highly trained staff to be the eyes and ears of people living with dual sensory issues.
What difference did it make and how are things now?
Phil’s Communicator Guide, Laura told us how things are now:
Since Phil has had his Communicator Guides his world and confidence is expanding. Phil was in a strict routine of going places only he knew about, eating the same foods and visiting the same places. He didn't have the confidence to integrate new ideas or places. After having conversations with Phil, we discovered lots of things we could give him access to information on. He is a lover of cats, so we went to the cat cafe in the city, he didn't know places like that existed. We explained the many restaurants in the city and now Turtle Bay and the Rosebud Cafe are a favourite of his. We arranged meetings at the job shop, as Phil was discussing he wants to find purpose in his life, he is enjoying the confidence course that was offered and potential volunteer opportunities. Phil is a fantastic musician and we have been supporting getting him voluntary 'gigs' at care homes in Rugby and Coventry. We found standalone pianos in Leamington at the train station where he now likes to play, and he's enjoyed members of the public coming across to sing whilst he plays. The Lief cafe is a new discovery for him, and the managers asked him to play on a Saturday. The team work together to make sure that he is well supported in his endeavours, He loves to spread joy through music, and it is in his words “his therapy”. The best thing I have witnessed with Phil is when we were able to support him to go to Theatre as he hadn't been, there was an audio described performance and he was very excited and dressed in his suit. As we were waiting, there was another blind man from Nuneaton sitting next to him and I was able to introduce them. They arranged drinks after the show and the audio describer of the performance joined us for a drink in the bar after. Phil was so happy. Phil's new friend called to arrange Christmas drinks. Phil’s world has expanded so much that interaction with others and feeling part of the community enables him to have wonderful memories. It was a pleasure to have worked with Phil and seeing how much his situation has transformed with the appropriate support, is the cherry on the cake! If you know of any places Phil could play his music to entertain people, please get in touch!
Phil’s social worker Ceri said:
Working with Phil initially was daunting as he had been living for many years without the appropriate level of support and this directly led him to make many unsafe/risky decisions. Working together with Phil we were then able to create a package of care that worked with him.
Coventry Adult Social Care for a number of years have been developing our practice and support for people who are deafblind being committed to ensuring we meet requirement of Care Act 2014 and separate policy guidance for Deafblind Children and Adults.
Phil said:
It’s great to know that I am stable and doing the best I can, being independent as possible. Although there are still challenges, I can face them better. I am more in control and in charge of my emotions, so I can tackle issues sensibly rather than in a dangerous way. I enjoy working with Deafblind Enablement (DBE), there is more time, I really enjoyed going on DBE’s holiday and going on the fairground rides. The boat trip was especially good, and I also had the opportunity to go and audition on the piano. I feel more normal, not different to society and feel like a human being.