Working Together for Change in a Day
One day consultation process
Helen Sanderson, Kim Haworth and Jaimee Lewis
Not all people who receive services in the community go through social
services. Often there are people who require low level support and are not
using adult social care, or have gone through a period of ill health and are
using re-ablement services. They may not be subject to an annual review
process, or eligible for longer term support. So how can commissioners,
providers and health professionals check effectiveness and find out whether
the services and supports on offer are meeting peoples’ needs?
Using the Working Together for Change (WTFC) model, we have developed a
one-day consultation process to capture people’s feedback in a focused and
concise way. This information can then be used to inform business planning
and commissioning cycles so organisations can make strategic changes and
personalise the services and supports they offer to ultimately improve the
outcomes for people who use them.
About Working Together for Change
Working together for change (WTFC) is a way of taking information from
people’s outcome-focused reviews about what is working and not working for
them, and what is important to them in the future. This information is then
clustered and themed with people and their families to co-produce change.
This results in change at an individual level through the reviews process, but
then also contributes to an organisation’s change at a strategic level. This is
because the information can be used by providers to inform their business
planning and development, and by commissioners to inform their strategic
commissioning plans or build up a business case for work in a particular area.
The WTFC in one day approach
The full WTFC process generally involves taking information from the
outcome-focused reviews of people who are being care managed. However,
when there are instances where people don’t have an outcome-focused
review - for example someone who may only need care and support for a
short while - then WTFC can be adapted for use over one day to obtain “live”
feedback and check the effectiveness of the services on offer.
Kim said that from her commissioner’s point of view, the WTFC in one day
process can give a more universal overview of how a service or supports are
working in the community:
“You can use the process of Working Together for Change to review a service
or supports to get a view from a whole range of people who may not be
eligible under the Fair Access to Care criteria. This process tells you so much
more about the wider community, identifies its strengths, where it needs to
1
develop in order to ensure its inclusiveness, often to a diverse group of people
with a wide spectrum of needs. For example, this approach is really useful
when evaluating the validity of low level preventative services and supports.
Often anecdotal information is used to help shape a view on their
effectiveness. However, this process enables me as a commissioner to
gather information directly from people who use the service and supports to
really find out if it makes a difference.
“I really saw this as an opportunity for me to understand if something is
working or not working without having to rely on aggregating information from
reviews or relying on other colleagues having to undertake those reviews.
This is massively powerful. For example, when we were looking at the stroke
pathway, a lot of the feedback we received indicated where supports that
weren’t commissioned by social services or health weren’t appropriate to
peoples’ needs. For example, people who couldn’t get access to parking
bays or where there weren’t any dropped kerbs in a town centre – that kind of
information may not come through an outcome focused review.
"If we are to effectively commission across a community then Working
Together for Change massively assists with this task."
Working in this way involves finding out from people what worked and what
did not work from their experience, and what changes they recommend. This
approach can be used:
 With groups of people who experience a particular service (for example
people who have experienced a stroke, or people who have dementia).
 To explore people’s experience of a process, for example
safeguarding.
 From one perspective (the person using the service) or from multiple
perspectives (carers, provider staff, professional staff, commissioners).
The principles that underpin this approach include:
 People share their story, from their perspective (there is no ‘best
guessing’ other peoples perspectives).
 People work in small groups and are supported by a facilitator to
identify and record what worked and did not work from their
experience.
 This can be structured across a customer journey or their use of
different services.
 People generate recommendations that build on their experience of
what worked, and would change what did not work for them.
This process has been pioneered in Lancashire, and in the last six months
has been used with various groups of people including those who:
 have experienced a stroke and their carers (this is written up in the
paper Using Coproduction to Personalise Stroke Services by Kim
Haworth and Helen Sanderson)
 have dementia, their carers and staff providing a range of services and
supports at Charnley Fold – a dementia-specific day service centre.
2



are involved in safeguarding across Lancashire.
are from black and minority ethnic communities.
have used the local re-ablement service.
What happens – the process
This section outlines the steps you can take to consult with people using the
Working Together for Change in a Day process. Two examples of where the
process has been used help to illustrate the points below.
1) The scope of the process is agreed.
 What do we want to learn about – how people experience one
particular service or their journey which may include several services?
 How many perspectives do you want to include? Just the people
experiencing the service, and their family, or from the providers and
professional staff experiences too?
 How will the information be used, and feedback given to the people
involved?
 Who will organise the process, and make sure the ‘right’ people are
supported to attend? This version of Working Together for Change has
been used with up to 25 people at one time, or through the separate
events that captured the perspectives of people using services, and a
second event to capture the views of staff and providers.
 Who will facilitate the process, and who will be the neutral table
facilitators?
For example, Charnley Fold, a dementia-specific day service in Lancashire,
has been open for almost three years. Whilst it appeared to be successful and
valued by a range of stakeholders, it was agreed that the best way to find out
if this was an accurate assumption was to undertake a review of the services
and supports on offer. This was especially important as further dementia
supports are being developed in Central Lancashire and it was essential to
understand where we needed to develop or change.
As another example, and this time in the case of Lancashire’s Adult and
Community Services Directorate, a recent Care Quality Commission
inspection had rated the council as “performing well” and “excellent capacity
for improvement” in terms of safeguarding. They decided to use the Working
Together for Change in a Day process so they could find ways of improving
their safeguarding service.
2) Sharing stories, and learning about what worked and did not work


The room is set up for people to sit in small groups of 5 (including the
facilitator).
If the process is going to be focused on a customer journey (for
example, people's experience of stroke) then the steps in the journey
are introduced at the beginning of the day.
3




There is a clear explanation of the process and ‘guides’ about
capturing the information, recording it on cards, and roles on the table.
The facilitator has a pile of green and red cards, and black marker pen,
and is responsible for drawing out information and recording it.
The facilitator supports each person in turn to tell their story, using the
customer journey as a guide. At the end of the story, the facilitator
supports the person to reflect on what worked and did not work from
their experience, and records this on the relevant green or red cards.
The cards are written using the person’s words, and checking this back
with the person.
Once the red and green cards are written for someone, they are given
‘their’ cards (to be put on the wall later).
This can be adapted depending on what is trying to be achieved.
In the case of Charnley Fold, rather than using a customer journey, the group
looked at the services that each person had used, and what worked and did
not work about each service. Charnley Fold’s services were listed at the
beginning of the day and there was a piece of sprayed paper for each service,
with space to put up working and not working cards.
In Lancashire’s safeguarding team, the original plan was to have people who
use services, providers and safeguarding professionals together for the day,
to look at safeguarding practices from different perspectives. However, staff
were anxious about how people who use services could be included, and
ultimately the process was held in two sessions, a session with safeguarding
professionals and providers, and a separate session for people who use
services. Once safeguarding professionals had experienced the process, they
then felt more confident in identifying and supporting people who use services
to attend a session.
They also customised the headings used so they could better reflect the
safeguarding process. Instead of what’s working, not working and what needs
to be changed or improved, they had:
 Before (Pre-alert)
 During (from alert to investigation)
 After (post investigation)
3) Sharing and clustering the information



Once all the story telling has been done, and the cards written, people
put them on sprayed paper, under the relevant customer journey
heading. Ideally, people put their own cards up so that they are
responsible for putting them under the relevant heading.
These are clustered by the facilitator where possible.
These are read back to the whole group by the facilitator, so that
people can hear everyone’s contribution and perspectives.
4
At Charnley Fold, they found that one of the challenges they had was that
some people had used almost all of the services and supports they had listed,
while other only just one or two. This was addressed by having ‘self
managing’ groups, so that the facilitator worked at the pace of the people
sharing their stories, and adjusting the time for each person based on the
number of people sharing stories at a table, and the number of services (and
therefore length) of their story. The facilitator also had to note on the back of
the cards which service it related to, so that it would be posted on the relevant
paper.
Because Lancashire held two sessions when reviewing their safeguarding
service, they used information from both sessions to produce the
recommendations.
4) Using the information to develop recommendations





Once the whole group has looked at, and commented on the cards,
people go back to their group to think about recommendations. The
questions is, what needs to happen to build on what is working (as
described on the green cards) and change what is not working (as
described on the red cards)?
This can be done at table groups or in pairs. People are given another
coloured card (blue) to record these.
These are then shared at the table, and each table asked to look at all
of them, and choose their top 3 (or 5) recommendations.
The recommendations on the cards are then all put together (from all
the different tables) on another board. The facilitator reads them out,
and looks with the group at how well they directly relate to what people
said is working and not working.
People are then asked to vote on their top 10 (or whatever number has
been decided) recommendation's, and the 10 with the most votes are
the ones that are taken forward.
This is an example of some of the feedback from Charnley Fold’s work. It is
just a small part of the information collected on the day and refers specifically
to the caring café service:
Service
Caring
Cafe
What’s working

Good
Information
Service
available.

Thursday night
carers meetings
work.

Food very good
& reasonably
priced.

Use the Cafe –
can just pop in
for a break.
What’s not working





Friendship cafe
oversubscribed.
Provide support
for service users
attending groups
in the cafe.
Caring Cafe title
confusing.
Information
service needs
promoting.
Poor sign on main
What needs to develop or change?
 Member of staff for front of
house. Would help with
signposting/advice/queries/infor
mal referrals.
 Timetable of events/facilitators.
 Person-centeredness – mixing
people/sharing experiences.
'Anyone can come'. Rename the
cafe.
 Needs to be opened during the
hours as advertised.
 Needs to be better advertised –
5




Enjoy fish & chip
Friday.
Good Access
Point.
Thursday
support group
has good
speakers.
road.


'drop in'.
Drop in Centre' instead of caring
cafe.
Change the name of the caring
cafe.
Friendship cafe
over subscribed.
5) Taking the recommendations forward and feeding back to the group


The person who commissioned the process tells people what will be
happening next with the information, and how she/he will be sharing
back with the participants what has happened as a result of what they
shared.
Once all the information has been typed up this is shared with the
participants.
At Charnley Ford, a further half day workshop is being arranged to share a
draft action plan based on the 'what needs to develop or change' to decide
who will take forward the points in the action plan with clear timescales
agreed and reporting mechanisms. Quarterly meetings will then take place to
ensure the action plan is kept live.
In both instances, the recommendations are being used to inform a variety of
business plans and strategies including dementia strategy, day supports etc.
In Central Lancashire there is also extensive work taking place in developing
the Transitional Care Pathway. It is essential that commissioners are able to
use the information gathered, the recommendations made and feed them into
the commissioning cycle .
It is also essential that time is set aside to share the action plans with
participants following an event and that this becomes part of an ongoing
process. An example of this is the recommendations that formed the action
plan following the event with people who had suffered a stroke. There was
two follow up events, with further one being planned to include people who
have recently suffered a stroke. This will enable commissioners from the local
authority, the primary care trust and the acute trust to ensure that the changes
and developments that have taken place are effective and are ensuring better
outcomes to people who have had recent experiences.
Lessons Learned
As the process was adapted to the different circumstances in which it was
being used, including at the dementia day service and when reviewing
safeguarding practices, a number of important lessons were learnt along the
way.
6
1) The facilitator has a crucial role
The quality of the information is influenced by the quality of the facilitation. It is
vital that facilitators are seen as neutral to the area being explored, and are
chosen for their facilitation ability. The guides for the facilitators, which should
be shared with the whole group as part of the process, are to:





Encourage people to talk from their experience and use ‘I’ statements.
Capture as much detail as possible.
Write one ‘thought’ per card, using bullet statements.
Don’t worry about spelling.
Revisit the cards with the group at the end of each stage to check that
the facilitator has accurately recorded what individuals have said. This
also acts as a prompt to record further thoughts/ideas.
Separating the roles of facilitator and recorder was tried, but this was
ultimately unhelpful unless the recorder was skilled at capturing things in the
person’s own words once the facilitator and the person had agreed what
should go on the card. It is important to brief facilitators well through a
meeting and briefing sheet.
2) Set up self managing tables that set their own pace
As well as a facilitator, each small table group needs to have a timekeeper to
help the facilitator hear from everyone and manage the time. Bigger table
groups did not work as well, as it took longer for everyone to share their story,
and it was harder to hear across a larger table and keep everyone engaged.
Hearing four stories at a table was the maximum.
Setting a time (for example for four people – 2 hours and 15 mins for a break)
is a good rule of thumb, but let the groups manage the time themselves rather
than instructions from the front to move onto the next person.
3) Keep different perspectives separate until generating
recommendations
The process can be used in one day even when you are looking at the same
issue from a range or perspectives. If you want to hear the perspectives of
people who use the service, providers, professionals and commissioners,
then ensure that you have enough tables for each group (or more than one
table per group) and a neutral facilitator for each table. You can use either
different sheets of paper to put up the different perspectives, or vary the
colour of the cards to identify the different groups. In the large group
facilitation it is important to recognize the similarities and different views from
the different perspectives, without people becoming defensive or need to
justify their position.
Kim said this was especially important so people can see the contribution they
have made.
“Try and get the action plan written up as quickly as possible, or at least when
you do the working and not working process, get that typed up and out to
people as soon as possible. A lot of times people are invited to events, which
ticks boxes, but then they say they feel nothing comes of it. People then say
7
they have felt they’ve given a day of their time but “so what?”. So it’s really
important they can see their contributions.”
Conclusion
The full Working Together for Change process involves taking information
from people’s outcome-focused reviews and using that information to inform
business planning and development and strategic commissioning plans. This
results in individual and strategic change. When people don’t have access to
reviews, then Working Together for Change in a Day can still provide a way
for providers and commissioners to consult with people about what is working
well and what needs to change so services and supports better meet peoples’
needs.
“It provides an evidence base of what people say about a service and
supports, when there may have not been a way of capturing that information
before. This is a great and focused way of getting good information and
feedback when people use services or supports but don’t have an outcomefocused review. It really helps commissioners to get a wider picture not just
about health and social care, but about the other universal services being
offered in their communities.”
For further information on Working Together for Change, please visit the HSA
website www.helensandersonassociates.co.uk
8