The Conversation focuses on what people want to tell us and what they want us to know, not just about what we want to ask them, which is why there are no service or needs-led questions. By listening to what's working and what's not from the patient’s view we can help people find out what might best support them.
Lincolnshire County Council introduced the Initial Conversation in 2018. This approach reduces the need to complete a more in-depth assessment and financial assessment that may be unnecessary and delay the person getting the support they need. We still record conversations and a plan of action of who will do what and when, as this is a proportionate assessment. We contact people again within two weeks to see how things are going and give further advice and support if needed. The conversations consider what people can do themselves and all of the resources and support that we can connect the person to, within their community and networks, in order to help them live their lives independently.
We will continue to work together with colleagues and partners around how we share experiences, learning and are reflective about how this will help us to do better for people and their families, as well as for ourselves.
We will work together with people and communities to make visible the values, skills and knowledge that they have.
Lincolnshire County Council piloted the Initial Conversation in 2018 with our Social Care teams in the east of the county, which presented the opportunity to co-design the system and processes, and think about how this was supporting practice, as well as considering the impact this was having on people contacting Adult Care.
In August 2020 we rolled the Initial Conversation out across other adult social care teams and we continue to learn and develop, and we are committed to embedding this process and strength asset-based practice.
We have seen a positive impact with the reduction of the number of people that require a more in-depth needs assessment, staff have reduced case loads, and people are supported to get the right support much sooner. We have also seen the number of complaints about waiting times reduce by 50%.
We have worked with the Lincolnshire Co-production Network to developed guidance for staff at Lincolnshire County Council - this has been important, in particular around the language used and how we ask questions that can lead to a considerable impact.
Colleagues in Adult Social Care and Health have worked closely together to share learning around the Initial Conversation, the processes and to support the development of this in health. The Initial Conversation is being tested and developed in community nursing, cancer care and maternity with real and positive outcomes for people and staff. The Mental Health Transformation programme will also be testing the Initial Conversation in Gainsborough.
Give it a go - have a different conversation with people, you can be creative, and there is no single way of doing it but the outcome should be a positive for the person. The type of conversation may differ dependent on the situation. So it's important to be flexible!
It's also important to review and change processes alongside practice these need to support what we do.
The principles of the Lincolnshire Initial Conversation
The conversation is a proportionate assessment which should be built on these key principles:
1. It’s about people’s lives, not just their needs
It provides a platform for people to talk about their whole lives and not just the areas which they need support.
2. It recognises that people are experts in their own lives
It encourages people to use their expertise, skills and experience in their own care and support.
3. It’s founded on trust, honesty and openness
It requires a relationship of two or more equals, recognising each person’s contribution and understanding the concerns they might have.
4. It starts with a blank sheet
The conversation should be led by what’s important to the person, but care workers can prompt and shape the discussion.
5. It needs sufficient time and resources
The person may need time to feel confident and comfortable to participate. But getting it right means that people are offered the care and support they want and need.
6. It takes place within the context of the person’s whole life and their community
It will cross organisational boundaries. Some things might be better supported by other services.
“When people are referred to adult social care they are very keen on talking about the negatives and the things they can no longer do. We now have the confidence to have different conversations with people, look at the things they can do and what is important to them."
"You get to know a lot from the person during that initial conversation.”
“The IC worker role has helped me to build up very good working relationships with other professionals. It now feels that we are working with health colleagues more closely and it no longer feels like us and them.”
“People are very surprised how quickly we get in touch with them, they often say “I was not expecting you to contact me for a few months.”
"Daughter expressed thanks for the support, kindness and for linking with support so quickly through."
"It was so helpful speaking with you today and I no longer feel my sister has been ‘abandoned."