Promoting Independence - our approach

Promoting independence - part of how we do things

A core principle underpinning the delivery of Adult Social Care in Coventry is that of promoting independence. This principle has, at its heart, an approach to social care that starts from the premise that everyone we work with has strengths that can be built on to promote recovery, enablement and the achievement of independent lives. This approach is long-standing and originates back to the establishment of Intermediate Care services in the early 2000s and the New Homes for Old policy which saw the development of Housing with Care as a means of enabling older people with care and support needs to remain living independently in their own flat within a supported environment. This approach progressed further with the development of supported living for adults with learning disabilities, Discharge to Assess pathways to support people to regain skills following a hospital stay, and home-based community promoting independence services all of which are embedded in our service offer today. Underpinning this is our utilisation of the skills of Occupational Therapist, Social Workers, Community Care Workers and support workers who work together with the person, their family and carers to achieve their optimum level of independence. Our approach to promoting independence is constantly evolving and improving as our understanding and technologies develop. This document sets our ambition and plans for the next stages of development and the benefits expected as a result of this.

Promoting independence within the wider health and care system

Our operating model is consistent with the requirement of Local Authorities to provide preventative services and promote wellbeing under the provisions of the Care Act 2014. Essentially, the introduction of the Care Act reinforced our approach.

This Promoting Independence ethos is also embodied in the Adult Social Care Vision, as below:

1. To enable people in most need to live independent and fulfilled lives with stronger networks and personalised support and
2. Effective enablement and prevention and wellbeing - we provide support to people in cost effective ways to enable them to reach or regain their maximum potential so that they can do as much as possible for themselves

Our approach also supports the overall health and social care system vision:

"We will do everything in our power to enable people across Coventry and Warwickshire to pursue happy, healthy lives and put people at the heart of everything we do" Coventry Health and Wellbeing Strategy 2019-23

In essence, a core objective of the health and care system, of which Adult Social Care has a key role, is to support adults to live independent lives within their communities. Our Promoting Independence approach works with people so that they have the skills to do this.

Promoting independence at the heart of how we do things for Adult Social Care

Our approach to Promoting Independence is incorporated into all elements of our operating model. This operating model has four key stages which, at each point aims to deliver good social care through enabling people to do more for themselves and use a strength based approach drawing on community assets and alternative means of support.

• Prevent - Includes accessibility of information, support to carers, voluntary sector effectiveness
• Enable - Includes promoting independence, DFGs, technology, intervention at crisis
• Support - Includes home as opposed to residential, process effectiveness
• Review - Includes review of key pathways, continuation of high cost services review, DFG review

For individuals and families, this means a coordinated approach to prevention will help realise these principles and prevent or delay the need for long term services.

The approach aims to:

• Have timely and appropriate involvement with individuals who, through disability or illness, need support to overcome barriers which prevent them from having independence in everyday tasks.
• Have in place primary prevention strategies that reduce the negative impacts of disability or mental ill health in society, improve people’s access to community and universal services, tackle disablist perspectives and prevent abuse.
• Work across the whole life course, and take family centred as well as person-centred approaches.
• Include secondary and tertiary strategies that prevent, delay or reduce the need for unnecessary specialist services.
• Reduce hospital admission and admissions to residential and nursing homes

How we work in practice

We work closely with the individual and family/carers to help them to achieve their goals of becoming more independent, by doing the following:

• On initial contact, we discuss with people how their concern might be resolved with information and advice, this could be signposting to another agency or providing some equipment.
• If further support is required following initial contact either an Occupational Therapist (OT) or Social Worker (SW) will complete an initial assessment of the individual’s strengths & needs and develop, with the individual, a plan that is meaningful for them. This plan will set out goals to be achieved, over a given time period, with the aim to increase independence and decrease the need for ongoing formal care support. Where the skills of both OT and SW are required they will work jointly.
• In situations that require a clinical oversight, the OT will be the lead practitioner. The OT will complete a full functional assessment of activities of daily living and provision of therapy interventions. This could result in no further on-going support or an intervention plan supported by a home support agency. In these situations the OT will work closely with the agency and provide ongoing therapy assessment and intervention as required.
• Before consideration is given to a potential requirement for ongoing care and support all social care staff will consider promoting independence interventions. These may include practice of tasks, employing alternative techniques, using assistive equipment/ technology and provision of home adaptations. Brokerage (brokerage is part of our service that finds out about support and available resources aside from formal care and support) will be utilised throughout the process to work creatively with the individual to find ways of supporting areas where rehabilitation is not the solution.
• Social care staff will work as part of the multi-disciplinary team utilising community resources, assistive technology and home adaptations to enable adults to remain at home and/or to live independently and engaged with their network and community.
• Social care staff will work across service boundaries and coordinate the response which includes liaison with other City Council Services (Housing, Revenue and Benefits, (General Practitioner (GP), District Nurse (DN), Community Psychiatric Nurse (CPN), Hospital Consultants)

The next stages in our development

In the context of continual improvement the next stages of our approach to promoting independence for 2020 include:

• In 2019, again based on a successful proof of concept we introduced a specific service for adults with learning disability – this will become more widely available
• Extend the principles to adults with mental health problems through working with our partners in Coventry and Warwickshire Partnership Trust, NHS and wider stakeholders to support peoples recovery and enable them to have a better life
• Developing and implementing a Promoting Independence toolkit for all providers following an initial project with Skills for Care. This toolkit, once implemented is expected to improve the extent to which a Promoting Independence approach is delivered in the future
• To create opportunities in community settings where people are able to talk to us about how they can maintain their independence without the need for direct social care support
• To ensure that health and social care staff work together more effectively in learning from people who have experienced support, to improve them and focus more on enabling people to live more independent lives
• Engage with organisations who are interested in developing Housing with Care and/or Supported Living in Coventry to ensure they are working in a manner that supports our objectives
• Work with the wider Council in other service areas in supporting people to be independent. This can include the role of housing, employment and skills and sport and leisure, all of which play an important role in supporting people to live independent and fulfilling lives