“We decided to do something radical, not just another year tinkering around the edges”

June 27, 2019

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by Edel Harris, Chief Executive of Cornerstone

Since 2016, Cornerstone has been developing and implementing an ambitious new strategy – ‘Local Cornerstone’ – which aims to challenge the traditional model of providing social care, and put the people they support at the heart of what they do. The Carnegie UK Trust has been supporting Local Cornerstone as part of its Enabling State programme. Here, we talk to Edel Harris about the learning and challenges of moving towards more enabling ways of working.

What inspired you to think about transforming the Cornerstone model?

The drivers at the start of this process were the challenges facing the social care sector in the UK. Everyone was talking about the crisis in social care, but no-one was actually doing anything about it. We were also going through our own internal business planning process, where our Board were discussing whether we could afford to pay a living wage – and if you’re having that conversation, you have to realise that something needs to change.

Cornerstone had suffered from the effects of austerity with all the public spending cuts, and we wanted a sustainable future, and at the same time to try and transform the social care sector in the UK. So we decided to do something radical, rather than have just another year of tinkering around the edges.

What did you do?

Myself and two colleagues took three months out of the business, and we went on study visits around the world – visiting all sorts of organisations, not just in our sector – to find out what works well. Our core objectives were to put the people we support at the heart of what we do; to do more than we are contractually obliged to do; to genuinely value social care as a profession; to raise funds to transform lives; and to enable the people we support to live a valued life.

Our learning about what works well led us to move away from a traditional centralised system of delivery to local control. We set up self-managing Local Care and Support Teams – investing in an up-skilled workforce and shifting autonomy and decision-making to the frontline. A big part of the change involved introducing new technologies to make cost savings and to free up staff time to spend it on delivering person-centred services rather than on paperwork and processes.

We launched Local Cornerstone in October 2016. The first year focused primarily on structural reorganisation and in setting up the Cornerstone Foundation.  Year one also included work that we had to do to inform and involve health and social care partnerships and regulators.  Local Cornerstone has been up and running for over two years and we now have over 70 Local Care and Support Teams operating across the country.

It’s still voluntary to join a team as we didn’t want to force colleagues into this new way of working.  We wanted them to be inspired by the experiences of their colleagues and the evident benefits of the new way of working on the lives of the people we support. We are now recruiting directly into the team member role which is having a positive impact on the organisation. The evidence available to date suggests that the model is working and we plan, over  the next 6 months or so that we will shift from a ‘test phase’ to Local Care and Support Teams just being the way that we operate.

What challenges have you faced along the way?

Change is difficult

We have a workforce of nearly 2,200 people, so managing change has probably been the hardest part: convincing people that this was the way to go, dealing with their fears and concerns, capturing their hearts and minds. Generally people don’t care about ‘strategy’ – what they want to know is ‘what does this mean for me?’ When you’re removing layers of management, which we did quite drastically, you can understand why colleagues looking at the new organisational chart are thinking, ‘where’s my job?’

That, of course, was challenging. But what we’re finding now is that our new culture is working in our favour: we are recruiting people into the charity who are very excited about working in a self-managed way – they are coming to work with us because we are doing something pioneering.

Technology

An important part of Local Cornerstone involves the use of technology. Improved business processes play a big part in generating the efficiency savings required. Using technology saves thousands of man hours which can be spent with the people we support.

There are two uses for the new technology: improved business systems and the increased use of technology enabled care. Introducing tech-enabled care has been fairly straightforward. But the changes to our business systems and the introduction of a fully integrated system has been a massive undertaking: we’re integrating everything from rota management through to payroll and invoicing; we’re giving everyone mobile devices, we have shut down our intranet and all communication is now channelled through Apps on mobile devices.  In some ways it’s probably not a surprise that it’s been a little bit challenging! But we are almost there: we’ve gone live with some of the products, we’ve distributed over 1,000 mobile devices to our colleagues, and we are undertaking our first integrated payroll run in the next few weeks.

Resources

And of course, it’s been quite difficult to do the everyday stuff, to keep the show on the road while this big change has been going on. We have worked out that the additional, non-recurring costs of Local Cornerstone, over three years, will be about £1.2 million. We have managed to secure some grants and investment from a range of sources, and this has allowed us to resource most of the additional costs of change.

How have other partners responded?

One of the things we realised at the start of the process was that we couldn’t do this on our own. We spent a lot of time working with our partners including the regulators and commissioners.  We have received great high level engagement, encouragement and support, but sometimes we have faced resistance to change, in practice. For example, a chief officer might say, ‘absolutely, we’re supporting innovation, we want to make it happen’; but then when you have a contract discussion with a commissioner they’ll be saying, ‘oh, but the contract says you’ve got to deliver so many management hours, and you don’t have any managers?’.

We are working with partners, through a series of commissioning tests, to try to change practice and thinking. We currently have six commissioning tests looking at alternatives to purchasing hours of care, looking at different ways of genuinely commissioning for outcomes. We’re obviously doing this in the context of our own contracts and relationships, but we are hoping that the evaluation of Local Cornerstone will result in systems change and have a wider impact.

What advice would you give to others thinking about developing a more enabling way of working?

The first thing is to have absolute clarity of vision. You have to be absolutely clear why you’re making changes and paint a picture of what the future looks like – and never deviate from that. So that everyone understands the destination, and although the journey itself might be a bit challenging at times, everyone is absolutely on board with the vision.

The second thing is that you have to be brave. There have been lots of times when we’ve thought, ‘oh my god, what are we doing?’ because it’s pretty big stuff. So you have to believe in your vision and stay brave and have very supportive people around you. Strong strategic partnerships are key: you cannot do something like this on your own. So you need to understand who your key stakeholders are, and not take it for granted that they’ll work with you, you have to really work hard on those relationships.

And I think the final thing is to be agile enough to adapt and change if you need to, as you go along.

We still have some way to go before we can say everything is completely done and dusted, but the strategy has a life of its own now. We have so many Local Cornerstone champions, and so many people whom we support, their families and our colleagues, who are saying that they would never want to go back to the old way of working. Our storyteller in residence has an abundance of stories that demonstrate so clearly how Local Cornerstone is transforming lives.

It hasn’t been easy. There are still challenges ahead. Adopting this new model was pretty radical and not without risk. But it’s been worth it.