Customer Led Transformation Programme Case Study – Chorley Council Meeting the Critical Needs of Older People Project 19/58 Contents

LGDC local government delivery council Improvement

Customer led transformation programme Case study – Chorley Council Meeting the critical needs of older people project 19/58 Contents

About Chorley 3

Background 4

Objective 6

Approach 7

Findings 16

Outputs 22

Outcomes 26

Governance and resourcing 30

Challenges and lessons learnt 31

Next steps 33

2 Case study – ‘Measure-Up’ About Chorley The Customer Led Transformation Programme Chorley is a borough in central Lancashire to the south of Preston. Chorley has a Chorley Council’s “Meeting the Critical population of 104,100 in 2008, which is Needs of Older People” Project has estimated to grow to 115,700 by 2020. been funded under the Customer Led Chorley is predicted to have one of the Transformation programme. The fund biggest increases in over 65s in Lancashire aims to embed the use of Customer by 2020. Insight and Social Media tools and techniques as strategic management The borough is relatively affluent, but some capabilities across the public sector pockets of deprivation exist. Unemployment family in order to support Place-Based is lower than the Lancashire, national and working. regional averages, but about an eighth of the borough’s areas are amongst the The Customer Led Transformation most disadvantaged 20 per cent nationally. programme is overseen by the Local Seventy-five per cent of residents live in Government Delivery Council (supported urban areas, and twenty-five per cent live in by the Local Government Association). rural areas.

The fund was established specifically to support collaborative working between local authorities and their partners focused on using customer insight and social media tools and techniques to improve service outcomes. These approaches offer public services bodies the opportunity to engage customers and gather insight into their preferences and needs, and thereby provide the evidence and intelligence needed to redesign services to be more targeted, effective and efficient.

Case study – ‘Measure-Up’ 3 Background as hospitalisation or residential care – and Chorley has the most rapidly ageing thereby reduce the financial cost to the wider population of any borough in the North West public sector. of England with 20.6 per cent of residents estimated to be aged 54 or over by 2020. The Help the Aged estimates that nationally ‘Meeting the Critical Needs of Older People’ nearly three million pensioners in the UK project was initiated to address some of the are living in fuel poverty with many forced issues highlighted by Chorley Partnership’s to choose between heating their home and Health and Equality Strategy 2009 to 2012. eating. Several other projects in the North The strategy highlights the specific health West region had conducted research and needs associated with ageing, namely: analysis into fuel poverty among older people, including Salford in 2005 and Blackpool in • In ten years’ time, since a greater percentage 2009, and had concluded that it was not of the population will be older than today, feasible for a single agency to tackle the wide approximately 37 per cent more people over range of factors that contribute to fuel poverty. 65 will have dementia than at 2009 levels. Therefore this project focussed on taking a • Older people are much more likely to suffer holistic approach to both understanding and from strokes than younger people. By 2020, it addressing fuel poverty locally. is predicted that 38 per cent more people over 65 will have a long standing health condition Chorley Council became aware they were caused by a stroke, than at 2009 levels. not reaching all older residents with needs following discussions with their partners at • Older people are also much more likely to be the LSP’s Health and Well-being meetings. admitted to hospital with injuries sustained by For example the Fire and Rescue Service accidental falls than the rest of the population. raised concerns that they were delivering By 2020, 38 per cent more people over 65 will Home Fire Safety checks to residents who be admitted to hospital through unintentional could benefit from other services such as a falls than at 2009 levels. health check. Through their participation in local networks such as the Older People’s Forum, Chorley Total number of older people in 20,700 Council began to suspect that there were older Chorley (based on women over people suffering from fuel poverty in the borough 60, men over 65 (ONS Estimate that local services were not yet reaching. 2009)) Total number of people from this 9,601 Fuel poverty occurs where households group contacting the council during need to spend more than 10 per cent of 2009-2010 (based on Chorley their income on maintaining a minimum CRM data) level of heat, and hence is a marker of Percentage of older persons in 46 per cent health and social deprivation. Chorley contact with the council Council hypothesised that by identifying and Percentage of all residents in 63 per cent addressing these needs through preventive contact with the council 2009-2010 interventions they could reduce the incidence Source: Estimates from ONS and Chorley Council CRM system of more costly outcomes such

4 Case study – ‘Measure-Up’ Chorley Council also participates in a range This project has developed the concept of of local networks and community groups and, Customer Centric Service Provision and based on interaction with older residents applied it to a local area and the community and their representatives at meetings of that it serves. It started with the viewpoint these groups, they hypothesised that many that ‘’fuel poverty’ is a complex issue and vulnerable elderly are unaware of available therefore would benefit from a ‘systems’ services and sources of financial support, based approach to working with customers. It increasing the risk of serious illness and used and further developed three main tools: death. • a knowledge architecture of customer This project built on the previous initiative needs “Circle of Need®”1) referred to as CN in this • a front-line interview template Case Study. CN was led by Chorley Council. • an area-wide learning process which can be used in an evolutionary way to achieve “Part of solving a problem is being aware a radically different approach, based on of it, so the more people that I, in my role Customer Centric Service Provision. as Older People’s Champion can make aware, the better” Cllr Rosemary Russell, Chorley BC

The CN project developed a depiction of all types of local authority customers and their needs (and the inter-relationships between these needs), through workshops involving experienced front line local authority staff from all types of authority, as well as fire and accident service staff, police, primary care trust and the Chorley citizens’ panel.

CN evolved over three project phases: proof of concept, full architecture of customer need and training materials to support experimentation. This further Circle of Customer Need project is an initial front line implementation of this earlier more theoretical work.

1 Circle of Need is a trademark of Aperia Government Services

Case study – ‘Measure-Up’ 5 Objective

The overarching objective of the project was • understand the services available to meet to understand the causes of fuel poverty in these needs, eligibility requirements and the borough and to reach those people in the potential providers established through area the borough had little or no contact with. engaging with local organisations To these ends, Chorley Council sought to: • deliver a programme of activity to raise • identify and engage with older people, awareness of the issue and increase take- aged 60+ in order to broaden their up of relevant services understanding of the behaviours and • develop mechanism to capture insight in needs of this group in relation to fuel the longer term to provide an evidence poverty as well as investigating wider base to feed into Council and LSP strategy related needs, how needs are linked and • influence and enable effective policy and the opportunities this may present. strategy in this area.

6 Case study – ‘Measure-Up’ Approach

The project took the following series of Socio-demographic data steps to delivery against these objectives: The project team profiled socio demographic • reviewing social demographic data data for the key variables associated with fuel • drafting and testing a Circle of Need poverty and older people such as age, marital • conducting workshops with customers status, type of housing and level of income and from this were able to identify groups and • conducting workshops with partners types most at risk from fuel poverty. • promoting information, advice and support to residents • developing tools for practitioners.

The socio-demographic groups identified were based on Experian’s Mosaic data.

per cent of Socio-demographic group based on mosaic profiles households M57 – Older people in flats subsisting on welfare payments 1.90 per cent M56 – Older people living on social housing estates with limited 1.87 per cent budgets M59 – People living in social accommodation designed for older 1 per cent people O67 – Older tenants on low rise social housing estates where 1.40 per cent jobs are scarce K49 – Low income older couples long established in former 0.83 per cent council estates M58 – Less mobile older people requiring a degree of care 0.09 per cent L54 – Retired people of modest means commonly living in 1.73 per cent seaside bungalows

The groups M57 and M56 occurred most frequently and made up almost 4 per cent of Chorley’s population.

Case study – ‘Measure-Up’ 7 The groups were mapped using GIS to build Customer workshop up a visual representation of fuel poverty across the borough using colour coding to The next step was to test the content and indicate level of risk. The maps provided a assumptions of the draft Circle of Customer very effective ‘snap shot’ of the issue locally Need with customers. To this end, the project and a quick and simple way to identify held two formal workshops with customer hot spots and areas that may benefit from groups across the borough. The location of targeted activity. The geographic analysis these workshops was partly informed by the was used in the planning of the outreach geographical analysis of the Mosaic data exercises later in the project. – which indicated where those residents most at risk lived – and partly by customer Draft circle of need outreach initiatives that partners such as the Older People’s forum, Chorley Pensioners, The project team created a first cut Circle of Active Generation were already planning or Need based on their desk research into the were underway. three main causes of fuel poverty i.e. Approximately 50 Chorley residents attended • energy inefficient housing these in-depth workshops, which served three purposes: • low household income • fuel prices. • to engage citizens and collect anecdotal evidence of fuel poverty and related needs This was a fairly quick and simple process, using structured questions and facilitation using the base model to identify needs that techniques customers would likely present initially: • to establish levels of awareness around • in need of improved accommodation the issue and access to services • having communication issues and barriers • to begin to raise resident awareness to accessing services around the services that were available. • being in need of financial assistance or Feedback from these customer workshops is having problems with debt outlined in section ‘Findings’ below. • having perceived or actual inability to access rights – people not getting what Partner workshops they’re entitled to. The project team then convened workshops The needs related to each of the presenting with a range of partners to test and improve needs were then identified which started to their initial Circle of Need. Two workshops build up a holistic picture. This Circle of Need were held during early autumn 2010, with the provided a framework for gathering customer following organisations participating: anecdotal stories and evidence around their experience of fuel property. The Circle would • Citizens Advice Bureau be refined and enhanced in the light of the • Lancashire Fire and Rescue Service feedback gathered. • Brothers of Charity • Help Direct

8 Case study – ‘Measure-Up’ • Primary Care Trust Based on customer insight gathered through • Chorley Community Housing customer engagement and Circles’ of Need analysis of related services, the project team • Chorley Council Home Improvement Team. was able to design and deliver a coordinated programme of marketing and promotional The purpose of these partner workshops activities with their partners under the was twofold. The first was to match up and campaign name, ‘Think keeping warmer this map services to the target group’s needs, as winter’ campaign. This included: part of the Circle of Need methodology. The • co-ordinated communications plan with project team worked with partners to verify related services the assumptions they had made in creating their draft Circle of Need, and to ensure that • developing promotional materials they had identified all the potential linkages • in-house surgeries and service delivery across the public sector. days The second purpose of these workshops • rural outreach sessions was to start to encourage partners to think • attending relevant partner events outside of their individual service focus.

The discussions of the customers Circle of • holding awareness days with local groups. Need helped partners to see things from the As part of their ‘Think keeping warm this customer’s perspective, and to think beyond winter’ campaign, the project attended and their own service offering, and laterally in presented at meetings of local groups such terms of what services may be relevant and as Chorley’s Older People’s, and also held relate to particular customer needs. events on International Older People’s Day. The project convened a second-round of workshops aimed at gathering accurate and The Chorley Service Catalogue complete contact information and eligibility criteria from each service to publish in the Consultation with partners revealed that practitioner tools developed later. few practitioners were aware of what services were available, and from which Delivering information, agency. In response, the project mapped all the services to specific customer needs, advice and support and distributed the catalogue, complete with up-to-date contact details, to 70 local Chorley Council were keen that, as partners. For further information, see well as increasing their knowledge and ‘Outputs’. understanding of the customer group, the project should also deliver some practical outcomes for older people suffering from fuel poverty in time for winter 2010. With this objective, the project uses the findings of the Circle of Customer Need analysis to inform a range of promotional and outreach work during autumn 2010.

Case study – ‘Measure-Up’ 9 Chorley Council also employed their ‘Smile’ Developing delivery tools community trailer - a mobile venue to bring the Council out into the community. The for practitioners ‘Smile’ trailer supported the project’s rural Based on the findings from the research outreach sessions, including a series of and development of the Circle of Customer event where the mobile venue provided Needs the project worked with teams from free health checks conducted by healthcare the Home Improvement Agency and housing professionals from NHS Central Lancashire. standards department to co-design a The locations that the ‘Smile’ trailer visited process and some supporting tools to enable as part of these rural outreach activities frontline staff to apply needs led working at were partly determined by the geographical the frontline. The objective was to support “hotspot” analysis of the segmentation data frontline practitioners to, effectively and which indicated areas with greatest needs. accurately capture and diagnose need and As well as promoting the range of services as a result offer the most appropriate service provided by the public sector partners, the or services to meet that need (based on outreach work and the marketing campaign customer insight). Home Improvement and promoted and facilitated: Housing Standards Teams were selected for the pilot because they had access to • flu vaccinations provided by Central customer’s homes. Being able to see the Lancashire NHS visible signs of fuel poverty, such as rotten • electric blanket testing in partnership windows and rising damp was an important with Lancashire County Council Trading part of the diagnosis which enabled the Standards frontline staff to go beyond any ‘presenting’ problems to the fundamental needs. • fire safety checks and smoke alarm installation, in partnership with Lancashire Cases are recorded and captured in a Circle Fire and Rescue Service. of Need format, generating additional insight that can then be used as part of a structured For further details, see ‘Outcomes’ below. approach to learning over time, informing The outreach work took place between strategy and improving services. Combined September and November 2010, the project with other critical issues and needs, applying made contact with an estimated 400 older this approach overtime creates a holistic residents. view of the needs of customers, enabling the most effective allocation of public sector resources. The stages in the practical process developed by this project are “The tools for front line use have been outlined in more detail below. specifically designed in a way that

we can improve them and feed them back into circle of need, so everything can be improved on a kind of learning loop” Victoria Witts, Project manager, Chorley BC

10 Case study – ‘Measure-Up’ Prototyping/implementing If they are and some new intelligence about the topic has been recognised, they highlight the new process this for later analysis. The steps outlined below describe the needs assessment process that the project Examining related needs has developed based on the research, engagement, and analysis through a The staff then widen the scope of the system of prototyping. By prototyping these conversation to find out if the customer also frontline tools the project produced a ‘proof has any of the related needs shown on the of concept’ set of outputs outlined here. The second circle of the topic template (see prototyping process was paper based to figure 3 under ‘Outputs’) and again tick those allow for refinements and updates. that are relevant. The process and tools should not require frontline staff to have an in-depth knowledge Where there are obvious cause and effect of Circle of Need and are also re-usable relationships between needs these are across a range of complex issues. shown as arrows. Where there are cycles occurring arrows are shown in both directions Following the success of the pilot this or a cycle including a number of needs (see process is now being used by Chorley figure 1 below). Council’s Housing Department, the Home Improvement Agency with Lancashire Fire These forms foster a sense of partnership & Rescue Service’s local Community Safety working with the customer and how some Team for Chorley also using and developing needs can interact with other stakeholder the Service Directory. viewpoints, such as the wider community. Staff tick and again draw cause and effect arrows between the related needs and any Diagnosing needs other stakeholder needs ( the outer circle e.g. the environment’s need for reduced On visiting a customer, the case workers carbon emissions) which will be affected by review their customer information; they listen meeting the customer’s need. actively and get a good understanding of the customers presenting needs, regardless of whether their organisation is the one best placed to help. If the customer has a simple request for an available service to which they are entitled and have no related issues, the staff fast-track the request.

If the customer has complex needs including those indicating fuel poverty, the case workers use their topic template and tick those core needs associated with this topic (see Figures 4 and 5) that are present for this customer. If this is a new customer, they ask them if they are willing for their case to be used anonymously for statistical purposes.

Case study – ‘Measure-Up’ 11 Producing an individual Identifying delivery partners service plan If the customer was ready to go ahead, the The case workers access the service member of staff would take responsibility directory of local area services for fuel for handing the case over to a nominated poverty in older people and related needs, delivery team leader to assemble the by selecting needs. This catalogue has required package of services and to arrange been produced by the project. They identify to have this delivered. and recommended possible services with eligibility criteria and contact information. Delivery and learning The understanding of needs developed The member of staff attending would through the earlier conversation, enables the mark-up the template with the case notes. staff to identify what sort of change would Conversations with customers sometimes be the most effective for this customers produced ideas for innovation in service specific circumstances. They discuss what design, and when this occurred the member the customer plans to do themselves and of staff – whether they be from the Housing discuss service options arriving at an agreed Department or Fire & Rescue Service – would individual plan covering all initiatives for include these in the customer plan (figure 6) for all involved. They also discuss with the later analysis. They update the summary topic customer their concerns for the future, if information (figure 7) with respect to any new appropriate, and identify possible future initial symptoms of the needs in the template. needs e.g. vulnerability to fuel cost increases These summary notes are also feeding a new and possible future solutions for the lower level of the Circles of Need Knowledge customer to consider. Architecture. All information captured would be fed back through to the project team at regular review sessions for analysis of learning, improvement and development of method and tools.

12 Case study – ‘Measure-Up’ Figure 1. Circle of Need Older Lady Living in Poor Quality Housing Stock

A A B Poor Has issue A A causes B quality housing stock

Affected HIA1/OCT/PR60AL by crime Case outline: Older lady, over 80, lives alone but has support Socially of a son who lives in Yorkshire. Medical isolated – in treatment / need of a Presenting need – home improvement. assistance / supportive Home community Technical officers visit to asses for damp and advicePresenting issue improvement new windows. Eligible for grant but customer financially unable to meet required shortfall. Receiving full Won’t Access to Son Barriers rights entitlement of benefit leave to service signposted property Customer doesn’t want to move out for works to be completed due to upheaval Climate change Customer receives WarmFront grant for central Financial heating assistance Social Home/ care/ Customer happy with improvement and doesn’t support want to proceed with large works due to scale of neighbourhood security & safety upheaval. Can’t Property afford Case worker suspects lack of finance is not the looks short fall main issue, rather reluctance to leave the vulnerable property – long term family home due to disrepair Property still damp and under occupied Expending excess natural resources

Figure 2. Older Lady Living Alone in One Room

A A B Poor Has issue A A causes B quality housing stock

Affected by HIA2/OCT/PR60LU crime Case outline: Large terrace, Yarrow Road Socially Medical isolated – in Older lady living alone treatment / need of a assistance / supportive Living in one room as back room too cold due to Home community damp, mould on the walls, rotten fittings. advicePresenting issue improvement Receiving full benefit, simply unable to maintain house Access to Damp proof course failed Barriers to rights service One room with gas fire Happy with living situation Climate change Financial assistance Social Outcome: care/ Council offered grant Home/ neighbourhood support Proceeding with work. security & safety No smoke alarms/incorrectly fitted alarms

Expending excess natural resources

Case study – ‘Measure-Up’ 13 Findings

The desk research, socio-demographic • Given these issues, agencies that make profile, and customer and partner workshops home visits (e.g. Case workers, home generated substantial findings. The top-line fire safety checks, Home Improvement findings are that: Agency) are best placed to identify the visible signs of fuel poverty like rotten • The people most at risk are those windows, damp patches on walls, use of ‘unknown’ to the system – residents unconventional heating methods. They who are isolated because of their living must then have an awareness of the wider conditions. Furthermore, these residents needs and appropriate services to meet often do not realise there is an issue these needs. themselves. • Co-designing solutions with customers can • Compounding this fact is the stigma encourage customers to take-up the help attached to fuel poverty, which is by and support being offered. For example, definition behind closed doors - making the an older lady living alone had been burgled symptoms less visible several times and was in contact with • As the diagrams below illustrate, fuel the Home Improvement Agency to make poverty raises complex issues that her property more secure. She also took customers – not least that of making sense measures to increase her own security by of the public sector. Residents have to installing a barking dog alarm at her front understand: door and making a list of security checks. º the availability and eligibility criteria of • Older customers prefer receiving the services information face-to-face and word of mouth and generally like something written down º which organisation provides which that they can refer to. service (even though practitioners present at the workshops were not aware which services were offered by other partners)

“It just makes sense to think about any “It‘s easier for me because I don’t have to try other needs at the same time rather than and explain what I mean – they (the outreach/ waiting until it’s a real problem’” home visit worker) ask the right questions” Comment from a resident during a Comment from a resident during a Citizen Workshop Citizen Workshop

14 Case study – ‘Measure-Up’ The following pages (Findings and Needs) ‘Related’ needs are grouped under the provide a tabular summary of the findings following headers: generated by the research and engagement, and give examples of customers presenting • day-to-day support and related needs. The primary or • medical assistance ‘presenting’ needs are grouped under the • active, supportive community headers: • home/neighbourhood security and safety. • financial assistance: Issues related to low income and cost of fuel • home improvement: Issues related to the property which may cause it to be energy “Mum doesn’t know where to look (for inefficient/cold information about Council grants) and if it’s • access to services: Barriers to accessing hard to find, she wouldn’t go to the trouble– available services this way she is getting what she’s entitled • advice about entitlement: Issues around to” Comment from a resident during a awareness and availability of services. Citizen Workshop

Case study – ‘Measure-Up’ 15 Findings and Needs Need Findings Example customer need Related needs Financial • fuel bills unaffordable and • information on how to • home Assistance increasing switch tariffs improvement Issues related – financial • low income – pension • sources of financial to low income support doesn’t cover the cost of support – grants/benefits/ and cost of towards cost living pension credits fuel. of home • fear of using central • support with debt relief improvements heating and resulting high • advice about disconnection • advice about bills • information/tips about entitlement – is • using unconventional more efficient heating the customer heating methods. methods. receiving Examples: what they are º older person living in entitled to? one room because they • home/ can’t afford to heat the neighbourhood whole property security and º only turning on the safety heating an hour before • medical bed time to warm up the assistance – house nutrition. º older couple sitting watching TV in sleeping bags to keep warm • electricity cut off to vulnerable households due to missed payments • older person not on the right energy tariff • customer can’t afford to make home improvements to improve home energy efficiency.

16 Case study – ‘Measure-Up’ Findings and Needs Need Findings Example customer need Related needs Home • older property in need • information about minor • home/ Improvement of maintenance – rotting home improvement neighbourhood Issues related window frames, no central services e.g. handyman security and to the property heating service safety – poorly which may maintained • property under occupied • home improvement cause it to property can due to family moving on grants and schemes e.g. be energy indicate a or death of a partner – WarmFront. inefficient/cold. vulnerable property unsuitable. person living • deterioration of neglected there and may rooms that are not being be a target for heated crime • timely home • advice about improvements needed entitlement to enable independent • access to living following hospital services – fear discharge of upheaval. • home improvements must be suitable for partially sighted, blind, hearing impaired. e.g. bigger dials on thermostat.

Case study – ‘Measure-Up’ 17 Findings and Needs Need Findings Example customer need Related needs Access to • mobility problems prevent • information about transport • active, services customer accessing services such as dial-a supportive, Barriers to services – customer may ride community – accessing not have regular access isolation • local services in walking available to a car or other transport, distance or town centre services walking difficulties, falls. • internet skills for older • rural isolation – customers people in order to access unable to access services services online in town centre location • opportunities for translation • language barriers - older services and literature in members of BME (black/ different language. minority ethnic) groups unable to communicate • help completing application with service providers forms or contacting service providers. • older people concerned about intrusion and upheaval, therefore may choose not to access support. • issues with trust • embarrassed about situation, too proud to ask for support • difficulty completing application forms and contacting organisations. Advice about • lack of awareness around • information about available • access to entitlement available services and services and eligibility services Issues around entitlement • advice on welfare rights • day to day awareness and • complex services – support – availability of • benefits entitlement many different services completing services check e.g. cold weather available, hard to find application payments correct contact details forms. and contact the right • consumer advice department. the customer • advice on how to make has to know where to look a complaint to trading • complex eligibility criteria standards or energy and application process. ombudsman.

18 Case study – ‘Measure-Up’ Findings and Needs Need Findings Example customer need Related needs Day to day • skills lost due to • advice about financial • access to support bereavement of a partner support services (e.g. traditionally men • information about social • advice about dealt with finances and services entitlement. women looked after the home/cooking etc.) • education and skills courses around basic • customer needs support skills with day to day tasks such as maintaining the house • budgeting workshops and garden • home help services • help completing • information about application forms or personal alarms. contacting service providers.

Medical • mental health issues such • need for regular medical • active, assistance as dementia or depression check ups supportive due to social isolation community • need for prevention i.e. • poor nutrition due to low flu vaccinations • home/ income. for example, older neighbourhood • luncheon clubs where man living on Iceland £1 safety free hot meal is provided ready meals • access to • meals on wheels • emergency treatment due services services to trip or fall • financial • social services support • respiratory problems due assistance. for mental health issues to living in cold/damp environment. • physical activities for older people e.g. • arthritis and joint pain walking groups, active due to living in cold/damp generation conditions. • support groups e.g. • risk of hyperthermia due to Alzheimer’s Society. living in cold conditions • health issues due to lack of physical activity • A&E and rehabilitation services following a trip or fall.

Case study – ‘Measure-Up’ 19 Findings and Needs Need Findings Example customer need Related needs Active, • social isolation – older • information about social • access to supportive people who are isolated groups, clubs, forums, services – community and unknown to public interest groups. e.g. mobility services are most at risk. network 50+, active • home/ generation, library • changes in culture – loss neighbourhood services. of community feeling security and e.g. checking in on older safety. neighbours • older people reluctant to leave the house due to safety concerns e.g. older lady who went to the hairdressers once a week and had her property broken into whilst out. • a solution for those in fuel poverty is to go out a lot and leave the heating off but then return to freezing houses.

20 Case study – ‘Measure-Up’ Findings and Needs Need Findings Example customer need Related needs Home/ • risks associated with using • home safety checks by • home neighbourhood unconventional heating fire and rescue improvement methods. for example, security and • installation of smoke/ • financial using multiple electric safety deaf alarms assistance – to heaters, putting the cooker make property or to heat the house, • community police – safer cooking on a camp fire raising awareness of and throwing the fat back current scams and fraud • day to day onto the open fire. campaigns. support • risks from poorly • information about trading maintained electric standards. blankets • trips/falls from trailing wires on heaters • fire/flood risks in neglected rooms • fraud – older person a victim of doorstep fraud. e.g. doorstep cold callers offering cheap insulation, suggesting that guidelines have changed and the home owner needs more insulation or charging the home owner for insulation and not fitting any at all (older person unable to go into the loft and check) • scam mail - older person struggling financially may also be susceptible to scam mail offering large monetary rewards • poorly maintained property can indicate a vulnerable person living there and may be a target for crime.

Case study – ‘Measure-Up’ 21 Outputs

The Services Directory

A key finding of the research and consultation was that partners generally were unaware of what services were provided by each agency. In response to this, one of the key outputs of the project was the Services Directory, which was based on discussions held at the partner workshops.

Figure 3. Services Directory

22 Case study – ‘Measure-Up’ The directory is structured by need and Customer need template lists all of the services available to meet that need along with a list of providers and The Circle of Customer Need template their contact details. It also has some more (figure below) is a quick capture system for general information to support partners such an interview. Needs identified are ticked and as library opening times, local GPs etc. cause and effect relationships are recorded by drawing arrows and making notes if The guide was compiled based on insight necessary. Examples these recording gathered from partner workshops and template in use are included as part of the information provided by the relevant ‘Approach’ section as figures 1 and 2. organisations. It is designed as a starting point to encourage needs led thinking as Figure 4. The Circle of Customer Need a document that will hopefully evolve and Front-Line Prompt / Recording Template develop. The service directory has since been distributed to around 70 front-line staff

Poor working for over a dozen local partners quality housing and service delivery organisations for older stock Affected by people. Including: crime

Socially Medical isolated – in treatment / need of a assistance / supportive • Chorley Active Generation Home community advice improvement

• Help Direct Access to Barriers to rights service

• Lancashire Fire and Rescue Climate change Financial assistance Social Home/ care/ The Service Directory is also being used neighbourhood support security & safety as a template for similar projects involving

complex needs including the Council’s recent Expending excess natural Total Alcohol programme. resources

Feedback on the Service Directory

“This document is really useful to us as it will really help us to signpost people when we are The template filled in to accompany these carrying out Home Fire Safety Checks. Quite notes is shown in figure below. This is an often we come across people that we know example of a customer plan developed need additional support and we don’t know following an interview. where to signpost them to, this will be useful as all the agencies are listed.

There are needs on that (Circle of Need) diagram that perhaps we would never have thought about. We would think of the obvious ones around benefits, repairs etc however issues like isolation wouldn’t be something we would particularly focus on.”

Feedback on directory from Rachel Walker, Community Fire Safety Team Leader, Lancashire Fire and Rescue

Case study – ‘Measure-Up’ 23 Figure 5. Capture of customer plans for update and learning

CUSTOMER PLAN Case ref: ABC Brief Description: 90 year old lady, living alone, very vulnerable Services to be delivered: Organisation: Any eligibility issues? Assessed for home improvement grant Council MRA grant Eligible for grant

Garden to be tidied and maintained TBC

Smoke alarms and deaf alarm Fire and Rescue

Referred for benefits check Customer initiatives: Customer has bought barking dog device as deterrence Outcomes: Customer now in process to receive services

Future Concerns: Disruption caused by potential home improvements

Comments/feedback: Customer previously unknown to public service organisations – one visit uncovered a range of issues that can now be addressed

The learning points are collected by need, so that learning for the topic can be added to learning about the need from the perspective of other topics. The table below shows example learning for the ‘Need for Medical Treatment Assistance or Advice’, collated from the information contained in completed customer service plans.

24 Case study – ‘Measure-Up’ Figure 6. Extract from cause and effect summary

MEDICAL TREATMENT ASSISTANCE OR ADVICE

Symptoms Causes

Ill health - lung disease, heart and circulatory Cold damp accommodation disease, viruses, joint movement, stress and high blood pressure Ill health - poor mental health, depression, Deteriorating health dementia Issues with nutrition Isolation Lack of information/support to cope with illness Slow recovery Not hot meals Can’t open tins, turn locks Hyperthermia Inability to maintain house

Socio-demographic data maps

The maps produced as part of this process are now available to inform future strategy and are used by Chorley’s policy team to identify areas where there is high risk or need some targeted action such as outreach work. The hotspot mapping will also be used to monitor performance improvement over time.

Figure 7. socio-demographic map

Case study – ‘Measure-Up’ 25 Outcomes

The projects generated benefits both through Energy Efficiency the engagement and outreach work which • Promoted Chorley Energy Efficiency was undertaken to inform the approach to Raising Scheme – which ran from the Circle of Need Pilot, and the Pilot itself. September 2010 to March 2011 and offered 130 loft insulations and 155 cavity Benefits from wall insulations, saving local residents an estimated total of £22,250 on their fuel engagement phase bills or an estimated average saving per household of approximately £140 per year. The awareness raising campaign including rural outreach events, participation in • Ninety-nine of these measures (35 per International Older Peoples Day, Chorley cent of the total) were carried out for Council’s ‘Smile Magazine’ articles marketing residents that the Council had defined as and project outreach work achieved the ‘’priority’’ customers i.e. those over 70 or following outcomes during October and on low incomes (benefits claimants). The November 2010: project’s outreach work helped the scheme to reach this group. Health • These calculations are based on Energy

• vaccinated 30 people against seasonal Saving Trust figures for typical savings winter flu at the OSS in partnership with for a gas heated three bedroom semi- NHS Central Lancashire detached home – with a loft insulation average saving of £40 and cavity wall Fire Safety • Worked in partnership with Lancashire Fire average £110. Savings could potentially and Rescue service to increase referrals be more dependent on current level of for their free home fire safety checks and insulation). installation of 10 year smoke alarms. The Benefits from the Circle of Need Pilot outreach work generated approximately 50 Whilst there is an up-front cost for front line referrals. A single home fire safety check needs identification and capture, it only which prevents an accidental fire can save applies to customers with complex related LFRS £20,000 as well as an estimated needs and it can create the opportunity for £26,043 in property damage, not least the significant downstream efficiency savings in cost of life. the following ways : • tested 200 electric blankets as part of a Lancashire wide initiative. Preventative Strategies Nipping issues in the bud leads to less total resource to resolve: e.g. hospitalisation costs

26 Case study – ‘Measure-Up’ three services with an average of one follow up visit and one follow up telephone call. This represents an estimated potential saving of £39.12/75 per cent per customer. • If 15 case workers/home visitors/home workers from across the LSP visit two customers per month with complex needs and offer on average three additional services, this will be a total saving of £14,083 per annum in avoidable contact alone. avoided by early action to resolve damp and cold living conditions For example, of the • Alternatively, the two most frequently pilot cases: occurring Mosaic groups M56 and M57 (identified previously) constitute a total of • 71 per cent were referred onto the Fire 1,713 households, representing a potential and Rescue service for home fire Safety saving of £67,012.56 to the Council. checks Benefits from becoming more effective • a further 43 per cent were signposted As a systems thinking based approach, Circle and guided through the Council’s Energy of Need enables front line staff to look for Efficiency grants application the most effective solution for the individual • 42 per cent were also signposted onto customer. Broadening the enquiry from a other charity or voluntary services such presenting need to a pattern of related needs as Dial-a-Ride, Active Generation leisure enables them to discuss the best place to start activities and Help Direct. to resolve the issue. On average, a resident • referrals were also made to Social who goes through the Circle of Need process Services, NHS falls team (falls among over receives three new services. 65’s are estimated to cost the NHS £4.6m However, over and above delivering a higher a day) as well as other services such as ‘volume’ of services, the Circle of Need electric blanket testing. approach ensures that customers receive Avoidable Contact the most appropriate services according to • Resolution at first point of contact avoiding their need. So some older people may be later repetitious interviews with different signposted to a range of services, whereas front line staff, or different organisations others may learn of a specific service that results in operational efficiency savings to directly addresses their needs e.g. cookery the participating organisations. For example classes or luncheon clubs which helps to previously, it is estimated that to identify and resolve a range of issues relating to health, access a single complex service (such as nutrition, cost of living (food costs). Similarly, a grant) a customer would require two face support for independent living may be best to face interactions and three telephone supported through a mobility service. The conversations at a cost of £17.32. insight learning that Circle of Need generates helps to identify specific solutions to specific • Following the Circles of Customer Need needs – which helps drive the efficient use process, the case worker was able to offer of resources overall. to work together to develop innovative approaches. The resulting customer plans include elements of the customer’s own initiatives with public and voluntary sector contributions. For example, an old lady prone to falls was visited by Home Improvement Agency to complete a DFG assessment. In the meantime, she left a key with a trusted neighbour so that they could get in to check on her if they were concerned she had fallen.

In a similar vein, the co-design element of the Circle of Need enables customers to contribute to the resolution of their issues, reducing their dependence on external services. For example, during a Circle of Need evaluation one older person suggested “My daughter will take me to the day centre on way to work, if you can arrange transport home for me.” The approach also produces potential wins for a range of stakeholders from a single Governance and resourcing action: e.g. insulating a house results in:

• improved housing stock for the community The project was allocated a dedicated project manager who managed the day to • warmer living conditions for the customer day running of the project using Chorley • reduction in their carbon footprint. Council’s formal project management method which is based on a cut down version of Support for collaboration PRINCE2 project management methodology. Understanding the needs and their This ensured that expenditure was carefully relationships at first point of contact can managed, risks identified and mitigated enable the most effective services to be against early and that key deliverables for selected, regardless of service provider. the project were met. The customer and the service providers can avoid repetitive explanations and The project team comprised of members multiple visits making it more effective for or the Council’s transformation department the customer, while the service providers including the Head of Transformation as can streamline their delivery of services project sponsor, with representation from for efficiency gains (by eliminating common other key departments including Housing and steps and, optimising use of scarce Environmental Health along with the Fire and resources). Rescue as a key partner.

Innovation and co-design A consultant was engaged to support the An understanding of a customer’s needs and application and development of Circles of the relationships between different needs can Need in line with project objectives. empower front-line staff and their customers

28 Case study – ‘Measure-Up’ A range of local partners also participated Challenges and lessons learnt in the project, contributing: Partnership working • their experience of working with Older Workshops with partners showed that there People and their understanding of the is still very much an organisation focus rather issues than a focus on the needs of the customer. • their participation in (and organisation of) Customer-centre partnership working outreach events requires a change of culture and of mind-set. • detailed service information for inclusion The experience of the project suggests that in the Service Directory. this is best achieved through small steps e.g. structuring the service directory by need. These partners included: Partnership working requires broad • Lancashire Help Direct timescales due to the nature and structure • Lancashire County Council Trading of other public organisations. Commitment Standards to innovative projects such as this often requires approval from senior levels for

• Lancashire Fire and Rescue allocation of time and resources and this can • Chorley Citizens Advice Bureau take time. The task is to find a way to align priorities or exploit specific organisational • Chorley Council information team priorities for the benefit of the customer. • Central Lancashire Primary Care Trust For complex issues and innovative projects, • Chorley Council Housing, Housing it’s crucial to be able to react to project standards and Home Improvement Agency developments by thinking creatively to • Chorley Community Police pursue the best possible outcomes. • Age UK A project needs to be flexible and able to react to project developments and change • Brothers of Charity. direction if necessary. This illustrates the The project produced monthly reports as importance of high level planning and regular part of this mechanism which then fed into reviews, engagement via formal governance, key project updates for LSP and Council and monitoring by the project board. members. The final report from the project was presented to the Executive Member for Health and Older People. The project manager also regularly attended specific meetings of all relevant organisations and groups to give updates which also served to enhance partner engagement and facilitate opportunities for knowledge sharing.

Case study – ‘Measure-Up’ 29 Pilot learning collaboration demonstrates the value of a • Short term concerns and fear of the wide variety of talents and experience. unknown often meant that partners were unable to see potential longer term benefits The Services Directory has met with a of a needs based joined up approach. very positive response, equipping service Once a few cases had been generated it providers with a single, simple reference for became easier to persuade others of the all information related to older people and benefits and get them involved in the pilot. fuel poverty. Its clear structure also provides a valuable next step into needs-led working. • Identifying a key individual within each partner organisation to lead is important. However, its current format as a hard copy The individual must buy-in to the approach directory and paper based tools, maintained and be open to innovative ways of working locally by the Council means that its use if they are to fully apply the tools and is limited as inevitably the information will techniques and sell the ideas on to their quickly become out of date as information colleagues. changes and new services are added. • The knowledge generated from interviews Developing effective IT support for customer and distilled through the learning process centric working is essential to achieve the can be used to create more effective large and long term benefits of this approach. tools to aid swift and reliable diagnosis To ensure the on-going value of the Services and service selection. Thus the cost of Directory, the resource must now be moved diagnosis can be reduced and more online into a dynamic document that can partners attracted to join in, growing the be updated and maintained by all partners scope of the pilot. and service providers. This will also present the opportunity to potentially incorporate

• Although the project has generated a customer insight for other issues for older positive response from customers it’s people, building a single resource for any difficult for staff to adopt a new mind set need an older person may have. which is at odds with their current tools and easy for them to slip back into service As with the Service Directory, the Circle of centric and organisationally limited thinking. Need tools also need to be translated into a more user-friendly format to make their Next steps day to day use sustainable. The project is currently seeking further support and funding Though the practitioner tools currently focus from Chorley Council to implement the Circle on fuel poverty, topics can be based on the of Need approach demonstrated by this proof related needs of other topics e.g. the security of concept. needs of older people. They are much less costly to introduce as much of the work is already done. Furthermore, the addition of more partners will also lower the costs. This approach should provide an evolutionary route into radical change. It is based on and builds from effective teamwork, where the benefits of learning are shared and

30 Case study – ‘Measure-Up’

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