Author Archives: Good Practice Exchange

About Good Practice Exchange

Good Practice Exchange at the Wales Audit Office - encouraging public service improvement through shared learning and knowledge exchange. Y Gyfnewidfa Arfer Dda yn Swyddfa Archwilio Cymru – annog gwelliant yng ngwasanaethau cyhoeddus trwy rannu dysgu.

I’m a patient, get me out of here

Our seminars on hospital discharge planning are coming up on March 14th and 22nd.  The Good Practice Exchange has worked together on this one with the Health team at the Wales Audit Office.  Sara sat down with Anne to talk about why this seminar is happening now.

If you only had 1,000 days left to live,

how many of them would you choose to spend in hospital? (#last1000days)

Discharge planning is an ongoing process for identifying the services and support a person may need when leaving hospital (or moving between hospitals).  The Wales Audit Office has recently completed reviews of the discharge planning arrangements across all the health boards.  The reviews showed that whilst health boards have the frameworks in place to support discharge planning, there were a number of reasons that were preventing discharge from being as effective as it could be.

The majority of hospital discharges are relatively straightforward, but for approximately 20% of patients, discharge is much more complex for a variety of different reasons.  The number of delayed transfers of care has been steadily increasing during 2017 and the number of patients delayed 13 weeks or more is rising.  These delays in discharge lead to poorer outcomes for people through the loss of independence and mobility.

For every 10 days of bed-rest in hospital, the equivalent of 10 years of muscle ageing occurs in people over 80-years old, and reconditioning takes twice as long as this de-conditioning. One week of bedrest equates to 10% loss in strength, and for an older person who is at threshold strength for climbing the stairs at home, getting out of bed or even standing up from the toilet, a 10% loss of strength may make the difference between dependence and independence. [Professor Brian Dolan, more info can be found at this website.]

One of the common themes coming out of the reviews was that there was opportunity to have greater integrated working throughout the discharge process, including stronger links to services in the community, to make sure the patients are receiving the right care, in the right place, at the right time.

We felt that this theme, in line with the Well-being for Future Generations (Wales) Act 2015 and the Social Services and Well-being (Wales) Act 2014, was tackling a key part of discharge planning – putting the patient at the centre.  Patients are not concerned with who is providing which service, they just want to be assisted to achieve the best possible individual outcomes.

In essence, patient time as the key metric of performance and quality is best measured from the perspective of the person and is a journey not an event. [#last1000 days]

So at this seminar, you will find projects that are working across the sectors, navigating links to services in the community, showcasing truly integrated partnerships and joint working throughout the discharge planning processes and, most importantly, keeping the individual at the centre of the service.  They are finding solutions to the variety of reasons which cause the delays in complex discharges, whether they are related to transfers of care, safety, homelessness, mental health, housing, assessments, or all of the above.

These projects are looking to provide you with food for thought, ideas you may be able to adapt to your own environment, or to spark new ideas.  See what you can take back to your organisation or working environment which will help your patients to have better outcomes.

 

We would like to note that our background research also highlighted all the work that is going on to prevent admissions in the first place.  In fact, there were so many that we decided that this area deserved a seminar all to itself, so that one will be coming up in February 2019.

Painting by Numbers: how to understand and use data effectively

Focusing on our upcoming event on scrutiny and governance, we understand that the scrutiny process involves dealing with a lot of data. Our chat with Suzanne Draper from Data Unit Wales highlighted a key question – how can we get data to work for you? In this blog Suzanne gives some tips on how to understand and use data effectively.

“Lies, damned lies and statistics”

Benjamin Disraeli’s famous quote suggests that all statistics and data are questionable. And, indeed, they are – you simply need to make sure you are asking the right questions.

Here are our top 10 questions to help you better understand and use data:

Is the data relevant?

Is the data reliable?

Is the definition clear?

Are the units clear?

How current is the data?

How robust is the data?

Are the comparisons valid?

Are the graphics clear?

Do you have the complete picture?

Are there any other factors that need to be taken into consideration?

 Is the data relevant?

 Data is everywhere. We are bombarded daily with facts and figures. It can be overwhelming, confusing even. How do you know what is important?

The trick is to focus on what you are trying to achieve and ask yourself: does this data help me understand more about the topic? Will I be able to make better, more informed decisions as a result?

If not, move on.

Is the data reliable?

In the same way, it can be difficult to know who or what to believe – will that face cream really reduce my wrinkles in just 7 days?

When using data, you need to be able to trust it. To do this, you need to understand where the data comes from and how it was produced.

There are many credible organisations who produce and publish quality data, including Data Unit Wales! These organisations will all have robust methods of collecting, verifying and publishing data to make sure it is as accurate and reliable as possible.

Is the definition clear?

Definitions are often simplified to make data more accessible. However, this can be misleading. Take, for example, a headline which appeared in a British newspaper in 2013:

“1,200 killed by mental patients”

However, if you look more closely at the underlying data you’d see that around half of those that committed the reported homicides had symptoms of mental illness at the time of the homicide, but were not, in fact, ‘mental patients’. What’s more, the study noted that it is unclear whether these symptoms led to the homicides.

While misrepresentation of the facts is usually unintentional, it can have a big impact on how you perceive the data and what you do with it.

Are the units clear?

Data is presented in a variety of formats, each with its own purpose.

Numbers, or counts, help you to understand the quantity or amount of something e.g. 151,000 tonnes of waste was sent to landfill in 2016-17.

I don’t know about you, but I wouldn’t know whether this is a lot or not. Percentages and rates are, therefore, used to make the data more meaningful and accessible:

e.g. 10% of waste was sent to landfill in 2016-17
e.g. 0.05 tonnes of waste per person was sent to landfill in 2016-17

When using percentages it is important to understand the underlying data. For instance, if two local planning authorities both decided 50% of their planning applications in 8 weeks you’d say that they were performing at the same level. However, if you knew that Authority A had decided 100 applications (50 of which were in 8 weeks) and Authority B just four applications (two in 8 weeks) would you still say they were performing at the same level?

How current is the data?

It is important to be clear about what time period the data relates to – is it this month, last month, this year, last year?

Most good quality data takes some time to produce. Usually, annual data will take between 6 and 12 months to be published, but some larger datasets may take longer.

Data shouldn’t be disregarded simply because it is ‘old’ – there are many valid reasons why we might use such data. For instance, it may be collected infrequently (such as Census data) or it may simply be the best estimate available.

How robust is the data?

Most data has a degree of unknown error – it is almost impossible to guarantee that a piece of data is 100% accurate. However, some data is likely to be more robust than others due to the way in which it was collected. Counts and estimates are likely to be very robust. Survey data may be less so due to sample sizes and the subjectivity of the data.

Are the comparisons valid?

Comparisons are very useful in helping put data into perspective, but only if the data is comparable. This may seem obvious, but it is very easy to make a mistake. There are two key things to consider when comparing data:

Has the data been produced to the same definition? For instance, have you included and excluded the same things, does it cover the same period, etc.

Has the data been standardised to take account of other factors that might influence differences in the data? For instance, if you were comparing staff age profiles across organisations you would expect a bigger organisation to have more staff in each age bracket. Comparing whole numbers wouldn’t therefore tell you anything you didn’t already know. If, however, you compared the percentage of staff within each age bracket (thus removing the impact of the size of the organisation) you’d quickly see how your age profiles compared.

So, if you answer ‘no’ to either of these questions, chances are the comparisons aren’t valid.

Are the graphics clear?

In addition to the above considerations, when looking at data in charts or graphs there are a couple more things you should look out for:

  • Always check the axis – if the data doesn’t start from zero your perspective may be distorted;
  • Beware of 3D charts – they do not give an accurate representation of the data;

A graphic should have one clear message. If you can’t find it quickly don’t waste your time and find another way to look the data.

Do you have the complete picture?

So often, particularly in the media, you are presented with one, lone figure on which to form an opinion.

In no other aspect of our lives would we expect this to happen. For instance, we wouldn’t expect a doctor to make a diagnosis based on our blood pressure reading alone.

And so it follows that the data you are using should provide you with a balanced picture – it should allow you to answer both ‘what?’ and ‘why?’.

Are there any other factors that need to be taken into consideration?

It’s important to make sure you have all the information to help you understand the data. For instance, is the data rounded? Has some of the data been ‘hidden’ in order to protect individuals? Is there any national (or local) legislation that has a direct bearing on the data and its use?

Most organisations publish metadata alongside their data. Metadata is “data about data” and is designed to provide you with all the necessary information about the data that you are looking at, including any ‘special instructions’.

So, to summarise, in order to use data effectively you need to understand what you are looking at. If in doubt, ask!

Come along to our Good Practice Exchange seminar in January on the role of scrutiny in relation to future generations.

Scrutiny for the well-being of future generations – more questions than answers?

In January, we are holding a seminar which is going to challenge how public services in wales need to rethink how they hold members and officers to account in relation to future generations. We recognise that this is a step change for public services and we caught up with our colleague Tim Buckle who has a foot in both camps – working on a Wales Audit Office review of local authority scrutiny arrangements during 2017-18, and helping shape this seminar.

There have been numerous conversations about the term ‘scrutiny’, we thought it would be helpful to clarify how this fits with the seminar in January.

The Well-being of Future Generations (Wales) Act (WFG Act) challenges public services in Wales to work differently. So what does this mean for scrutiny? That’s what we’ll be discussing and working through in the seminar in January 2018. But before we start talking about that, in this blog I wanted to talk about another question, what do we mean by ‘scrutiny’?

My initial reaction to this question is….well more questions! It depends who you ask? It depends who’s doing the scrutinising? It depends who’s being scrutinised? Do we mean local government overview and scrutiny because that has specific roles set out in legislation? Do we mean the process or function or scrutiny more broadly across the 44 public bodies covered by the WFG Act? But then in trying to work differently I’ll ask another question – does it really matter that we don’t have a succinct definition? Maybe not, as long as we are all talking about broadly the same type of activity then we can still discuss what might work, what doesn’t work and what might need to change including possibly the behaviours of the scrutineers and the scrutinised. Maybe one of the things we all need to come to terms with is that in a complex, fast moving world where change is constant we have to accept that not everything can be neatly defined and compartmentalised?

The term scrutiny is commonly used in local government because Councils in Wales have at least one ‘overview and scrutiny committee’. But the process of ‘scrutiny’ also takes place in councils in many different forums and processes – officers ‘scrutinise’ performance information, as do Cabinet Members. In any public body there will be some ‘scrutiny’ of performance, budgets and policies. To keep things simple what we are really talking about is holding decision-makers to account, challenging performance, policies and ways of working, reviewing outcomes and so on and so on…. There are probably quite a few other words that we could use to describe what we mean by the process of ‘scrutiny.’

If we follow this logic this also means that simple designations of the ‘scrutineers’ and the ‘scrutinised’ are also too simplistic. There are some obvious groups who will probably see themselves as part of the ‘scrutiny community’ – scrutiny committee members and scrutiny officers in local government, non-executive board members and so on, but cabinet members and executive board members may also find themselves scrutinising the way in which their own organisations have acted in accordance with the sustainable development principle. Crucially they may also be holding partner organisations collectively to account on Public Service Boards – accountability isn’t always vertical it can be horizontal too….

So what does this mean for delegates attending the event in January 2018? It means we want them to bring their knowledge and experiences of scrutiny – whether as a ‘scrutineer’, as the ‘scrutinised’, or as someone who’s observed scrutiny in action – and to share this with people from other organisations and sectors. It means we hope that delegates learn from each other and can work through solutions to common (or not so common) barriers to effective scrutiny to help improve the wellbeing of future generations and to find solutions that will work in their organisations. To help do this, at the event, delegates will be challenged to think differently about scrutiny, about what effective scrutiny means and about why they think it’s important for the wellbeing of future generations?

The WFG Act requires public bodies to challenge themselves to reconsider what they do and how they do it. This challenge is not limited to a single policy area, team or function and it is recognised that the change won’t happen overnight. Scrutiny, in all its forms, could potentially play a key role in driving that change by ensuring the right questions are asked, at the right time.

Wales Co-Operative

Casey Edwards @casey_walescoop from the Wales Co-Operative Centre @WalesCoOpCentre has blogged for us about how housing co-operatives are helping to build resilient communities.  The North Wales leg of our #WAOADM event is next week.

No two housing co-operatives are the same; it’s not a one size fits all approach. Co-operative housing is about communities having democratic control over decision-making about their homes, neighbourhoods and communities. It is a flexible and innovative approach to ways in which we meet the housing needs and the aspirations of local neighbourhoods. Co-operatives can be developed in either new or existing housing and can cover a range of tenancies.

The Co-Operative Housing Project was established in 2011 and is managed by the Wales Co-Operative Centre, and supported by the Confederation of Co-Operative Housing. The project has helped to deliver over 130 homes across Wales and is supporting the delivery of many more by developing expertise in different co-operative models and providing advice to developers and co-operative groups.

I joined the Wales Co-Operative Centre in May 2017 as the project advisor and have realised it takes a lot of hard work from a lot of people to get these schemes ‘shovel ready’. All of the housing schemes have developed in contrasting ways and adopted different models, from the different ways in which schemes were instigated and funded; how individuals came to be involved; to the size, nature and tenure of the housing co-operative. So does all of this hard work actually pay off?

Being part of a housing co-op is about more than just having an affordable roof over your head. It is about being part of a support system, helping yourself but also taking the responsibility to help others in the wider community. Read about how Luana, at Loftus Village Association, is helping to bring the community together through organising events and social activities.

Examples like this also show how living in a housing co-op can also help to tackle isolation and loneliness, especially amongst the vulnerable and the elderly. Co-operative communities form close bonds and look after one another; that feeling of being part of a community which is hard to come by in the 21st century. Haydn from Old Oak Co-Operative shows how being involved in the co-op has helped him grow in confidence and take on responsibility within the community.

Living in a diverse, supportive community also gives people the chance to share knowledge and skills with each other, that maybe they wouldn’t have had the opportunity to learn living in more traditional environments. As part of the development of the co-op, tenants are involved in a rigorous training programme which includes topics such as co-operative principles, governance and housing management. They learn new transferrable skills which can help them improve their employment status or give them the confidence to change career. Our scheme Ty Cyfle is empowering young people to manage their housing independently, learning new skills along the way.

This self-help and self-responsibility approach to addressing housing need is having a much bigger impact than just providing affordable homes, it is creating self-sufficient, resilient and healthy communities, which can reduce the demand on wider support services.

Living in a community-led housing scheme can offer the kind of support that public services are increasingly finding it difficult to provide, often in a more personal and cost-efficient way. The Well-being of Future Generations (Wales) Act has now placed a duty on public bodies to think more about the long-term; to work better with people, communities and each other; to prevent problems and to take a more joined up approach. Co-operative housing is doing so already.

The seven wellbeing goals compliment the seven co-operative principles developed by the International Co-Operative Alliance, which all co-operatives should adhere to. They both emphasize the importance of developing attractive, viable, healthy and sustainable communities, that maintain, even enhance the natural environment. A democratic and fair society with an economy that generates wealth, without discrimination. A society that enables people to fulfil their potential no matter their background or circumstances. A society that provides employment opportunities and education and training for a skilled workforce. A co-operative society that highlights the importance of social and cultural wellbeing.

Co-operative and community-led housing can be a part of the solution to the housing crisis in the UK. But more than just a quick fix, it can be a part of a long term sustainable option to providing affordable homes and creating resilient communities.

The Wales Co-Operative centre offers support and advice to any new or existing organisation wishing to develop co-operative housing. We can provide access to experts’ advice about co-operative housing and we can provide skills and development training for members of a co-operative. We have recently developed a Co-operative Housing Pilot Toolkit, developed to help community groups, housing associations, co-ops, local authorities and others in the initial stages of considering how to develop new co-operative & community-led homes. Take a look.

More information on co-operative housing and what support is available can be obtained from the Wales Co-operative Centre on 0300 111 5050 or at co-op.housing@wales.coop.

Faster closing – it’s good to talk

Following on from our recent event on ‘Early closure of local government accounts’, Matthew Coe, Financial Audit Manager at the Wales Audit Office, talks about his experience of the day and the important discussions he encountered with delegates…

On 10 October 2017 I attended the latest Good Practice Exchange shared learning seminar in Cardiff on the Early closure of local government accounts. Alongside many representatives from local authorities, there were a large number of staff from the Wales Audit Office, all keen to understand lessons from those already piloting faster closing timetables.

In the first plenary session there was a lot of audience participation with table groups considering a number of mini scenarios on how not to manage the accounts closure and audit processes. Even with some of the Wales Audit Office “actors” hamming it up for all they were worth, it was clear that everyone in the room recognised we need teamwork and regular communication to make a success of this transition.

As is usual at Good Practice Exchange events, we then broke into smaller workshop groups covering three particular aspects:

  • Making Assets Early Closure Friendly – ensuring the streamlining of asset valuations and capital accounting;
  • Knowing why we want what we want! – what is needed in terms of working paper requirements; and
  • The importance of Internal Quality Assurance on your Financial Statements – highlighting why internal quality assurance checks are critical to a successful audit.

These workshops looked at practical actions that we could take. It was particularly useful having a trained – tamed? – valuer present in the asset valuation workshop to explain his work and give his perspective on how to give valuations sooner.

The big learning points for me from these workshops were:

  1. Everyone agreed but more importantly accepted that there will be more estimates in the accounts.
  2. In addition it is likely there will be more uncorrected misstatements noted in the auditor’s reports (ISA260 reports) – BUT this is not necessarily a bad thing: a key message to relay to those charged with governance.
  3. You can actually do things earlier on non-current assets – it is not solely a year-end exercise after all – and together we just need to think creatively about it.
  4. Finally, auditors need to be clearer on working papers they need – not want, but actually need – and in what format with finance staff. On the flip side, finance staff also need to change the way they prepare and provide the working papers.

In the final plenary session I was struck most with just how long I had spent discussing the detailed arrangements with the finance staff from Cardiff Council. While we do cover this in our work as an audit team, as a Client Manager, I personally seldom get a chance to discuss the detailed approach to working papers with the finance team preparing them. For me, to have nearly four hours to go through the practicalities and challenges of changing both Council and Wales Audit Office approaches and ways of doing things, was incredibly valuable.

There and then we were able to agree a number of key principles such as early engagement on changes, quick resolutions to queries by both sides, and further meetings to improve supporting documentation for the 2017-18 accounts (meetings we have already starting arranging).

Also not only did I find that we agreed on the need to change both our approaches (and were positive about doing something about it for 2017-18) but I could communicate the collegiate way of working that sets the tone of our audit work first hand.

Finally I would say that communication really is the key – preferably by just talking to the right people face to face – so that you can talk around the implications of potential problems early on makes a big difference to how smooth an accounts/audit process can be. Early engagement on changes in accounting policies, methodologies and potential issues, as well as carrying out earlier testing, will certainly smooth the way to a faster closing Nirvana!

10 Steps School Project

Georgina James, Melin Homes

As I’m writing this, I’m sat at my desk working towards developing our offer for Melin’s schools program over the next 5 years, a schools program that didn’t exist 4 years ago.

Flashback to our energy efficiency project, Powering Up Communities and we’re just entering schools doing a little energy program training Junior Green Energy Champions. Our street naming competitions with schools were a success and we were offering our Melin minibus to schools for educational trips. Overtime, the work we were doing in schools developed, with the eco program helping schools to achieve their ECO flags with Keep Wales Tidy and the groups were creating energy saving songs to well known tunes and performing them at our events. I’d say our first step in our recognition of the importance of working with schools, was deciding to do an end of project celebration event with the children we had worked with. We worked with partners such as ICE, Keep Wales Tidy, Constructing Excellence in Wales and Techniquest to deliver a carousel of workshops with over 100 children and teachers attending. The event was a massive success and it was there that we thought “WOW! These young people we are working with are our future residents, staff members, and local councillors or supporters” We need to make sure that our work encompasses the young people of our communities and what better way to do it than through schools. Now our journey on schools wasn’t an over night success, it took months if not years, of developing projects and relationships with schools and partners.

One of our partnerships was with Career Wales, who we had done ad hoc ambassador work for previously.  They approached us to see if we would like a business partnership with 2 secondary schools that were situated within our area. We have now signed up to a 3 year business partnership with the two schools and are focusing on a three-pronged approach between the pupils, staff and parents, to ensure we make an impact and difference to the people we work with.

And the best part, Melin have committed to a delivery of a schools program for the next 5 years. Had Melin not had the idea to do the little bits in schools then we wouldn’t have progressed to the stage we’re at now. New projects focusing on the health and wellbeing of pupils and teachers. Which leads us to the 10 Steps project… If you want to know about where we are now and what we’ve got coming up then come along to Wales’ Audit Offices seminar on Using Alternative Delivery Models to deliver public services.

Rural Skills

Working together since 2009, Gwalia (Pobl – @poblgroup) and the Brecon Beacons National Park Authority (@BreconBeaconsNP) have developed a series of outdoor projects which have enhanced the lives of those living in supported housing and outreach clients.

One of the first initiatives was Brecon Beacons Community Champions which, with funding from NRW (Natural Resources Wales @NatResWales), supported young people in outdoor activity training. Participants all achieved their Bronze National Navigation Scheme Award (@nass_office) and went on to independently arrange and take part in their own choice of activities.

The activity projects so inspired the service users from the Brecon Foyer (Gwalia) they formed a local committee and constituted themselves as a group. The aims of the group were to provide inclusive and accessible activities and learning opportunities through anti discriminatory practice, to improve the image of young people and to increase awareness of issues affecting them. The group has since successfully gone on to secure funding for projects including an educational trip to Auschwitz following a project on Jewish History; a residential outdoor activity trip to Devon; visits to London and Rome and a healthy living project.

Further joint projects have included Geocaching Development 2010-12, Rural Skills 2012- 2014, Park Pathways 2014, Mental Health and Wellbeing Day 2015 and most recently Awards for All funding which has enabled the 2016/17 Rural Skills training programme to go ahead. This project has been hugely successful with all participants successfully achieving Agored Cymru (@AgoredCymru) accreditation in Outdoor Skills, Cutting docks, brambles,hedges and Practical Woodland Skills.

The combination of training and increased confidence in participants has been inspirational and resulted in the following outcomes: 1 individual has gained full time employment;

4 individuals have engaged with and participated in the BBNPA/Princes Trust (@PrincesTrustWales) Get into the Brecon Beacons programme including a two-week “Get  Into” programme  and Explore Enterprise, 2 individuals successfully recruited onto the BBNPA/  Princes Trust partnership  Get Into the Brecon Beacons 3-months work programme as Trainee Rangers – see ITV Wales coverage of the trainees here.

Matt Baker and the team from BBC Countryfile (@BBCCountryfile) joined the group on a Geocaching activity day to discover how accessing the natural environment with a little bit of new technology can trigger new ways of keeping active and improve mental wellbeing.

Inside Housing (@insidehousing) followed on from the television coverage and produced this article highlighting how Housing Support can enrich lives beyond just tenancy support.

The enthusiasm, participation and progression of everyone engaged in these projects  demonstrates the potential this work has to make a significant difference to the ways in which socially excluded groups view, access and derive socio-economic benefit from the outdoor environment.

In summary these locally focused projects have been developed by both partners to give the best possible support to young disadvantaged people living in both urban and rural areas of the Brecon Beacons National Park to help increase their access to education, employment and training opportunities.

Rural Skills