A design-led approach to transforming adult services

The UK’s ageing population is a growing concern for local authorities. Currently, services are not coping with demand, and this set to be exacerbated by further cuts to health and social care funding. Between 2015-16, four councils applied to the Design Council and Local Government Association public sector accelerator programme, Design in the Public Sector, to help them re-evaluate how to tackle the challenges specific to adult services and deliver better design-led solutions. 

The types of challenges these four councils faced included housing vulnerable adults, reducing falls among over-85s, home improvements for disabled residents and raising awareness of dementia within an organisation. Here, we speak to those councils and discover how their time on the programme helped them to solve their various policy issues.

Reducing falls in the home with a design-led campaign

Every day, eight people in England die from a fall. In the small town of East Teignmouth in Teignbridge, where 7% of residents are aged over 85, trips and falls are the most common cause of death in over-65s. In a drive to reduce hospital admissions and lower the demand on its Disabled Facility Grant budget, Teignbridge Council asked Design Council and the LGA to help them develop a new programme of support and advice to deliver the tangible and lasting results needed in the community.

In the small town of East Teignmouth in Teignbridge where 7% of residents are aged over 85, trips and falls are the most common cause of death in over-65s.

“By working together with experienced designers we hoped to give staff permission to think differently, and to be more innovative to solve problems,” said Amanda Pujol, Teignbridge Council’s Business Manager for Housing and Health.

After learning new interview techniques through the programme workshops, Teignbridge surveyed older residents who had already experienced falls. Their stories helped them to better understand why they happen, what happens after a fall and the emotional and mental impact of experiencing one. These testimonials were evidence that even smaller falls can be life-changing, and the council decided to undertake a radical new approach to prevent them.

Having decided that the previous method of leafleting was largely being ignored, more striking campaigns were trialled in GP surgeries across the area to raise awareness of the impact of falls and increase patient requests for further advice. The solutions were very creative, including an LP player installation with information about falls on the record sleeves called Sound Information, a mock crime scene with hard-hitting statistics about falls, and a more light-hearted campaign jokingly suggesting people apply bubble wrap to their homes, but having serious messages within the detail of the materials. 

The next stage of the transformation process was prototyping some of the service changes, which was carried out under the name Fall Proof. Three areas were identified, including an online photo submission service which identifies hazards in users’ homes, and a physical home assessment package which can recommend how to make homes safer. You can read more about Fall Proof here.

Teignbridge Council’s Amanda Pujol explained the project’s success: “Audiences are more likely to engage if we use emotion and make it personal. The relationships we have with the various health agencies had resulted in much greater collaborative working and we have put in bids for funding to carry on the work we started with Design Council.”

A reflexive service geared to support staff as well as users

Occasionally the Design in the Public Sector programme sheds light on an issue the council didn’t even know existed. This turned out to be the case with a council in Somerset. 

Mendip District Council was dealing with an increasing number of adults with complex issues, such as homelessness, alcoholism and substance abuse. It was clear that it needed to collectively address the support in order to stop individual problems spiralling out of control – which would have corresponding cost implications for the council. However, through the course of the programme, they also discovered that it wasn’t only vulnerable adults who required some support. 

The system had had hundreds of thousands of pounds taken out of it. What the Design in the Public Sector work did was show the need to – rather than replace the money – try different ways of working.

Tracy Aarons, Mendip District Council

Using the design training from the Design in the Public Sector programme, the council carried out targeted work with service users to gain insight into the way they perceive their treatment by the system, their aspirations and the tensions that existed between service delivery and user expectation.

Tracy Aarons, Deputy Chief Executive, Mendip District Council, said: “The system had had hundreds of thousands of pounds taken out of it. What the Design in the Public Sector work did was show the need to – rather than replace the money – try different ways of working.” 

Through interviews with service users they discovered a worrying trend of users arriving at the hostel system with a particular issue and, in an effort to fit and blend in with other service users, falling into another set of problems while there. The result of which created more challenges for them to face. 

This new information suggested that the best support possible would concentrate on individual concerns, and a move towards smaller units of housing rather than larger hostels. This policy has already shown to lessen the effects of people becoming institutionalised by the supported housing system. 

The ethnographic research also identified something that the council had not fully considered. While there was now acknowledgment of the physical and mental state of the service user, there was less recognition of the emotional strain put on the staff dealing with them. Interviews with staff showed that in an attempt to protect themselves, they were putting up an emotional barrier and becoming slightly desensitised to service users’ experiences. The service providers had not previously taken into account the impact on the highly stressed support staff. 

We hope that once new activities start these numbers will begin to reduce and, just as importantly, there will be evidence that people are not returning repeatedly to the system.

Tracy Aarons, Mendip District Council

As such, the partners are now prototyping a specialist reflective system, where staff can talk about third-party trauma experienced when helping the user – in essence supporting the supporter.

Tracy Aarons explained the long-term value of what the council learned on the programme: “Benefits of the approaches we learned about will now be a part of our long-term, rolling strategic programme. It is early days for the approach but the monitoring of temporary accommodation and rough sleeping since the main funding stream was cut is currently showing numbers to be stable. We hope that once new activities start these numbers will begin to reduce and, just as importantly, there will be evidence that people are not returning repeatedly to the system.”

Using awareness to improve services for people with dementia 

Design in the Public Sector doesn’t always work directly with local authorities, organisations that work together with councils to deliver services have also learned valuable new skills through the programme.

One instance of this is the Hanover Housing Association, which took part in the programme in 2015. Hanover manages homes for older people in more than 175 local authorities. They were keen to use the programme as an opportunity to improve their services. After analysing what they believed the main challenges they faced were, they decided to focus on raising awareness and understanding of dementia in the organisation.

One of the first processes Hanover took on was detailed background research with more than 200 of its staff. This revealed something they were not previously aware of – that in general their staff demonstrated a limited awareness of dementia. They also found that interviewed residents displayed very little empathy or patience for dementia sufferers. This insight set Hanover on a new path and helped them to develop a range of solutions to improve their services, including awareness campaigns for residents in the form of physical and mental exercises.

Jaysen Chapman, Project Team Leader at Hanover Housing Association, explained their thoughts: “We defined the challenge right down to how we can maintain or increase the wellbeing of residents who have dementia and then through our work – through research – it became clear that actually what we really need to focus on is awareness and the training of our own staff.”

We defined the challenge right down to how we can maintain or increase the wellbeing of residents who have dementia and then through our work – through research – it became clear that actually what we really need to focus on is awareness and the training of our own staff.

Jaysen Chapman, Hanover Housing Association

Training was organised for 132 staff, 89 residents and 291 external helpers in the ‘Dementia Friends’ scheme, and targeted support to improve links between estates and existing local support networks. Meanwhile, Hanover developed new facilities that included a bus service where there is extra help for those with dementia, and a special provision by local libraries, where people with dementia are not charged for late returns.

Chapman explained: “I think that the programme helped us to focus on the right things and the right areas and do stuff at the right time. It’s probably been the most enjoyable project any of us have worked on – and probably one of the most effective, as well.”

Linking up services to improve adult housing 

In 2015 Braintree District Council, working with Essex County Council and Greenfields Community Housing Association, took part in the east of England DiPS programme. Braintree was trying to find a way to improve home adaptations for disabled residents. Working with Greenfields, they hoped design-led thinking and planning could hold the key to improving their services, while also reducing costs.

When they joined the programme in July 2015, the council’s system involved several agencies who worked independently, making it an extremely fragmented experience for the customer. This resulted in stress and frustration for both users and staff. At the same time, referrals had increased significantly between 2012 and 2015 – with an average waiting time of three months – while funding was insufficient to meet demand for the service.

Placing the customer at the heart of the project – and utilising Design Council’s processes – has led to greater partnership working which has delivered real benefits for our current and future customers.

Andy Wright, Braintree District Council

Future funding was also uncertain with each of the organisations facing financial constraints, and the Disabled Facilities Grant (DFG) remaining a statutory responsibility of the councils, the challenge was one of efficiency – they needed to better understand the customer experience, make the process of applying for adaptations easier and get the works carried out more proficiently.

Through guidance and training on the DiPS programme, the council commenced a fundamental review of the whole system, with the aim of having a more customer-centric process, making the application for aids and adaptations easier and more efficient.

The team soon realised the service they were providing was responsive, rather than proactive, and therefore difficult to target customers in actual need of adaptations. Through user research, the team’s review showed that it is possible to have a joined-up service that is more efficient and provide value for money.

Changes to the service planning included the prioritisation of stair lifts to reduce slips, trips and falls, more information to customers at the beginning and through key stages of the process, and improving the customer-facing facets of the service thoroughly.

Andy Wright, Corporate Director, Braintree District Council, said: “Placing the customer at the heart of the project – and utilising Design Council’s processes – has led to greater partnership working which has delivered real benefits for our current and future customers. We’re interested in the possibilities of taking this one step further and providing a fully integrated service at Clinical Commissioning Group (CCG) level, bringing together assessments and budgets while reducing paperwork and governance.”

Having witnessed its success, other authorities across Essex have become increasingly interested in the work that Braintree has been carrying out and are looking to emulate the changes into their own processes. 

Futureproofing services for generations to come

Today, for the first time in history, Britain’s over-65s outnumber people under the age of 16. By 2020, the Office for National Statistics (ONS) predicts that people aged over 50 will make up nearly half (47%) of the adult population.

We are already seeing the warning signs of an overstretched health and social care services, and demand will only grow in the years to come. Using design-oriented thinking can help councils, businesses and other service providers to create effective services which meet the wants and needs of the population.

Design in the Public Sector, and most recently our new Transform Ageing programme, are just some of the ways Design Council is helping the delivery of new, innovative and efficient user-led services come to fruition. Our belief is that collaborative, preventative and personalised approaches can create transformative results, for many generations to come.