This is the story of how Bristol City Council is changing its approach to delivering care to vulnerable people. Presented by Amy McGuinness of cxpartners alongside Tracy Dodds and Sonia Moore of Bristol City Council at Service Design in Government 2016.

1. Transforming care
services in Bristol

2. 2
189m 106m 40m c.
Diminishing LA budgets Life expectancy
Connectivity
6% above the national average
6%
Care Act
Better Care
New legislation
Partnership working group
65%
35%
Adult social care cost
35% of BCC total budget spend
Care Direct
Increase calls to care direct
50%
2011/12 2015/16 2019/20
Funding split central vs local gov Increasing
Tracy Dodds, Digital Services Manager talked through BCC’s service change programme
Why are we doing all this service redesign?
Diminishing budgets from central Gov alongside an increased demand for services such as Care and
higher expectations from citizens about how they engage with BCC has led to a complete rethink about
how we shape and deliver services.

3. Bristol’s vision for a Citizen Platform
“Give me the information I
need to help me deal with
events in my life”
“Enable me to apply, report and
pay for things online 24/7/365”
“Remember me and relate to
me intelligently as a single
organisation”
“Let me progress openly
online”
“Give me the tools that enable
me to assess my own needs”
“Let me tell you what services are
performing well and how they
can be improved”
“Connect me to people who
have similar needs and engage
with us to help
re-design services”
This is our journey. Starting with making sure people can access information and guidance
wherever they are and building our capabilities service by service, working towards a truly digital
platform where people can assess their own needs and connect to others with similar needs.
BCC is trying to remove the silos so that the citizens of Bristol can engage with us as one council.

4. Improved IAG on new
website
Digital services
Citizens account Waste tracking Homelessness self
assessment
Feedback online
User centred design
approach
Bristol’s vision for a Citizen Platform
We’ve made the greatest progress on simplifying our info and guidance on the new website as
well as delivering a whole range of end to end services. We’ve also delivered some basic
assessment tools around rehoming and homelessness and have plans to build on these in the
future. Now our focus is on delivering a citizen account. All of these changes have been driven
by user need.

5. January 2015
Residents Parking Concessionary Travel
Complaints
Registra7ons
March 2015
Taxi Licencing
June 2015
Response Repairs
Pest Control
September
2015
Local Tax
Moving Home Waste Cancel a Job
New Web Site Housing Bens
Evidence Upload
New end to end digital services
delivered 2015
We’ve delivered more than 10 digital services delivered in as many months focussing initially
on those services used by most by residents (parking) and then looking at services needed by
more specific groups such as older people, taxi drivers, tenants, benefits claimants and so on.
We’ve involved real people, built reusable digital patterns and plan to build even
further on what we’ve learnt so far in 2016.

6. June 2016
Further Ci*zen A/C work Residents Parking
Verifica*on Concessionary Travel
Verifica*on Cohort 4 –
Internal Support
Processes
Sept 2016
Landlord A/C
January 2017
January 2016
Repairs –
communal jobs
Local Tax A/C
Transac*on
Rent A/C
Transac*on
Benefits A/C
Transac*on
Waste forms
Local Tax –
General Form,
Student Discounts
Mayoral
Correspondence
Evidence upload
Cohort 4 –
Internal support
processes
March 2016
Loca*on Based
Repor*ng
C/A Further
Transac*ons
Govtech –
automa*on Local Tax
Enforcement
Repor*ng
Online Feedback
Cohort 3 – IAG,
Self assessment
Cohort 4 –
Internal Support
Processes
End to end digital service pipeline
planned for delivery Jan ’16 – Mar ‘17
Our ambition for 2016
Many more digital services – reusing and exploiting what real people have told us so far,
reusing the lego bricks to expand our digital offer. A focus on a citizen account which will
allow people to log in and see all of their services in one place.

7. Context
Our role is to put customers at the centre of the design
Designing digital services so good people prefer to use them
Whether we are rewriting a piece of website content or rebuilding a digital transaction we
ask Who is the user here? What do they want to find out or do? How can we best meet their
needs and what might get in the way? We then solve it and check back – does that work?
Did we get it right?

8. We’ve been inspired by GDS, and have followed several of their guiding principles
Bristol City Councils digital design principles Feb 2014
Look for ways to
delight people
Use familiar patterns Create accessible
services
Don’t just design a
pretty front door
Measure and
improve
Free data from
its silos
Look for
relationships
Strive for
consistency and
efficiency
Create simple,
clear
experiences
Digital services so good people
prefer to use them

9. The new Agile
The old Waterfall
We’ve significantly changed our approach to projects and delivery.
The Old Waterfall - gathering requirements, a long time building specifications with the
risk that the end result wasn’t quite right.
The new Agile - getting user feedback upfront and building minimal viable services then
getting them out there and improving them based on feedback.

10. Developing a clearer picture service by service
by sharing and building on insights
January 2015
Residents Parking Concessionary Travel
Complaints
Registra7ons
March 2015
Taxi Licencing
June 2015
Response Repairs
Pest Control
September
2015
Local Tax
Moving Home Waste Cancel a Job
New Web Site Housing Bens
Evidence Upload
=
It hasn’t been an easy ride BUT…
We are seeing a benefit to our approach. The more we learn from our user engagement the
more patterns we spot and the more we can draw and learn from the things we have done
so far. Building up a picture of the Citizens of Bristol and their needs.

11. Infrequent engagement
Low need
High propensity to self-serve
Frequent engagement
High need
Low propensity to self-serve
‘Universal citizen’ ‘Group 1’
‘Stable’ ‘Precarious’
Universal
citizen
Higher
need
Higher needs describes citizens with a tendency
towards higher engagement, complex needs and multiple service use
One council,
differing levels of engagement
It helps when we visualise who we are dealing with on a scale of need and vulnerability.
This came out of a piece of research with benefits customers and homelessness. We found
out that people moved up and down this scale (they wanted to be stable and in control of
their lives, didn’t necessarily trust the council to get things right but wanted to use digital
services to save themselves time and money)

12. Martha is a mixed-race woman, 45 years old and with physical and cognitive disabilities. She has a daughter, who lives with her
on and off. He life is intricately entwined with BCC: housing benefit, council tax, concessionary travel, and previous experience
of Home Choice and homelessness. She lives in social housing and works as a receptionist. Martha has lived just above the
breadline for years, and is regularly in and out of debt to payday lenders. Her attitude to BCC arrears is both fearful and
resigned - it’s happened before and it’ll happen again. She is quick to admit that she makes bad choices, particularly when in a
panic, but feels that the council could do more to understand her circumstances. At the same time, she feels that she knows a
few workarounds - helpful individuals, ways to get attention - although she doesn’t like having to do it. ‘I don’t want to be that
angry person’, she says, of turning up at the CSP and making a fuss. At the same time, she’s found that it’s worked in the past.
Anything that happens to Martha has a knock on effect on her other services: a missed Housing Benefit payment uses up her
council tax money, which means she has nothing for food. She can’t understand why different departments don’t communicate
with each other ‘it’s just the council owning the council money, at the end of the day’. At its worst, letters from BCC just get
thrown in the bin - she panics, and buries her head in the sand
* All citizen stories are composites based on several interviews. Real names have not been used.
Citizen story: Martha *
“I don’t want to have to be that angry person”
‘Stable’ ‘Precarious’
We also found the concept of a compound profile really helpful. Here we have collated the
features and views from a range of individuals into a single profile which we have used as a
persona against which we can build a service (both digital and non digital).

13. 1313
Redefining
Adult Care Services
So that was all going swimmingly and then we turned our attention to services in adult social
care. Bristol had completed some immediate and important work to ensure we had responded
to our duties of the care act by April 2015 but we knew we needed to look beyond that.

14. Test and refine the three tier model
Help to Help yourself
Accessible, friendly, quick, information, advice, advocacy,
universal services to the whole community, prevention
Help when you need it
Immediate short term help, reablement, intensive support to
regain independence, minimal delays, no presumption
about long-term support, goal focussed, integrated
Help to live your life
Self directed, personal budget based,
choice and control, highly individualised
Safeguarding
Rightskills,rightpeople
Promoting wellbeing
Early help and prevention, enabling
people to live more independently
for longer
Directing people to
lower cost options
and solutions
Delaying or avoiding
the needs for more intensive,
higher cost care and support
The team wanted to test Bristol’s version of the three tier model of care and support.
A major concern: how do we do all of that? Would our Bristol approach (which was
quite a well oiled machine for some fairly transactional services) really work here?
These are potentially quite vulnerable people with a complex set of needs.

15. How do we find people
who are seldom heard
and will they want to get
involved?
How should we engage
these service users (will
our current practices /
process work?)
There is so much
to find out and fix –
We don’t want to boil
the ocean
Will they worry that we
will take the opportunity to
cut their entitlements or
support ?
Is using partners who
are not subject matter
experts a good idea?
Can we do this in
project time scales and
how do we optimise use
of limited budget?
Initial concerns
We were convinced by our user centered, agile approach – it has worked so far
BUT… There were concerns about whether it would work for something as complex and
sensitive as Care Services.

16. Amy from cxpartners talks about how the approach was tailored
cxpartners have been working with Bristol City Council throughout their change programme
supporting them to become a people led organisation who do user centred service design.
This picture was taken from a customer vision workshop back in 2013.

17. We worked to deliver a number of services using a people led approach. This means
gathering insights about what services are currently like and then finding out how people
would like them to be in the future. We had a established process that had been used across
parking, council tax, waste…

18. ?Care Services
We knew that this approach had worked well for these other services but when it came to
care there were concerns about whether it would be appropriate to work in this way and the
Better care team had some concerns. So we needed to tailor our approach.

19. We don’t want to risk
upsetting a vulnerable
group of people

20. Organisation Customers
Promise
Value
Feedback
live|work
This is a promise value diagram. An organisation gives a promise to it’s customers and in
return the customer gives that organisation value .The whole thing is underpinned by a
feedback loop. In this case Bristol city council offer a promise of care to it’s citizens and the
citizens provide value in the form of taxes.

21. Organisation Customers
Promise
Value
live|work
But if we don’t have a feedback loop then we don’t know how effectively the promise is
being delivered or even if it’s the right one.
?

22. Organisation Customers
Promise
live|work
And if we don’t know that the promise is right then we risk disrupting the value.

23. 65%
35%
Total BCC budget spend on Adult Social Care which is spent on less
than 10% of Bristol’s population.
35%
It’s important that we understand the needs of people who are cared for and carers in order
to decide how we can make services fairer in the future.
So although there was a concern about involving a vulnerable group of people we knew it
was vital to do so. We were mindful of this when we went about recruiting who we were
going to speak to and how we would structure the research.

24. How do we avoid hearing
the same things from the
same people?

25. There were worries that only the same or loudest voices would be heard.
We needed to objectify what was being heard at support groups to see whether these views
represented those people who don’t normally have a voice.
We needed to distill the truth of people’s experience.

26. How do we avoid boiling
the ocean? There’s too
much to find out

27. 18 yrs +
When we talk about Adult Care Services typically this is delivered to people over 18yrs +.
That covers quite a large group of people with differing needs.
We didn’t want to risk diluting what we uncovered by trying to cover everything.

28. 55 yrs +
We narrowed the lens by focusing where there was the highest demand (the older
population). We decided to talk to Service users over 55 and Carers who look after people
who are over 55.

29. Infrequent engagement
Low need
High propensity to self-serve
Frequent engagement
High need
Low propensity to self-serve
‘Universal citizen’ ‘Group 1’
‘Stable’ ‘Precarious’
Universal
citizen
Higher need
Scale of vulnerability
We needed to make sure we were representing a broad spectrum of people.
Both those who are considered to be nearer the stable end of the scale - someone who has
MS, people who have had a stroke, People with early stage Dementia as well as those at the
other end of the scale who might be experiencing all these things coupled with a disability,
mental health issues or alcohol and drug issues. Within in the carers group we made sure we
spoke to younger carers (people in their 30’s) right up to older carers (people in their 70’s).

30. How do we find people
who are seldom heard
and will they want to
get involved?

31. Because of the nature of the research we recruited through social workers and community
organisations. We took a lot of time to find the right people and make sure they were both
happy to talk to us and aware that we were NOT reviewing their care package.

32. Is using partners who
are not subject matter
experts a good idea?
Shouldn’t we do it
ourselves?

33. We don’t need to be
subject experts we just need
to be able to ask the right
questions, listen and feedback
to the right people
We involved the whole team in creating the discussion guide so we knew we were asking the
right questions. Being from outside the adult social care team allowed us to assess what we
were hearing without bias and feed back the truth of peoples experience.

34. The research consisted of one-to-one sessions. No surveys, no shallow views but a deep dive
into how people felt. We carried out sessions both in our offices and peoples homes. The
wider team were able to view these sessions which was invaluable in helping them
understand peoples stories.

35. NowRecent experience The future
Our discussions were based around 3 areas.
• What life is like now for people
• A recent experience involving a review of their care or change in situation
• And peoples thoughts and feelings on Bristol City Councils ideas for the future and the
three tier model of support and care which looked at independence, well being and choice.

36. The structure of the sessions were printed out to make it transparent to participants what
we are going to ask them. There were no secrets and no surprises. We used a talk and draw
approach so we could share what people said with them and check that we had got it right.

37. We began to group what we were hearing into themes and then plotted this onto experience
maps for both carers and service users.
During the research sessions post it notes were annotated by the whole team (including
social workers, people from public health and service managers.)

38. Service User
Carer
A difference in experience for service users and carers
For service users they was an over whelming feeling of passiveness. Many could not
remember how their care had been arranged or who by. Carers were at the other end of the
scale - bombarded with appointments, people they had to liaise with and decisions they felt
ill equipped to make on behalf of their loved ones. It was highly stressful, overwhelming and
disjointed experience.

39. Lesley
John
CARE PATHWAY
The importance of taking a 360. view
If we’d of only talked to service providers, or just service users or just carers we would’t have
got the full picture of what was happening. We may have misinterpreted key pieces of
information. In the example of someone who experiences Bipolar, their carers are often key
in supporting their independence and well being and the carers needs have to be recognised
so that they can keep providing this vital role.

40. We grouped people with the same needs together and created compound profiles
to tell their stories. Compound profiles allowed us to reframe the problem. To tell
the rich narratives of peoples experiences whilst protecting peoples identity and
removing the biases that might come from using real cases.

41. Here’s an example of a compound profile for John. He has been caring for his wife Lesley
who has Bipolar for the past 50 years.

42. Service usersCarers
We had to make sure we had captured the nuances of peoples needs, so that we could
appropriately stress test any ideas for Care Services in the future. From someone like Sarah
who wanted to be actively involved in the planning of their care to someone like Bill who had
been in care his whole life and was terrified by words such as Independence and choice.

43. Organisation Customers
Promise
Value
Feedback
live|work
What we heard
It’s a very complex and disjointed experience. People are not sure who they
should go to for what. It was hard to distinguish who is from where e.g NHS,
voluntary, Council and people didn’t understand why they had to repeat their
story all the time.

44. Organisation Customers
Promise
Value
Feedback
live|work
With such a complex system of services working together there is the
opportunity for things to get lost in translation. If people weren't sign
posted to the right services and support at the start of their journey it could
lead to an escalating series of events which meant they were more
dependent on care services than they needed to be.

45. Co-design
workshop
We used the experience maps and compound profiles in a co-design
workshop with the Better care team (a multidisciplinary team including
front line workers, partners and service delivery teams). We asked teams to
use the profiles to plot out the services and people they engaged with, their
questions and pain points.

46. Rewriting
people’s stories
We then asked the teams to imagine they had no budget or infrastructure constraints
and think about how they would improve each of the compound profiles stories. This
allowed them to remove themselves from the day to day and imagine what could be
in the future. It was really exciting to see people from different disciplines working
together to think how they could improve peoples lives.

47. 47
Sonia Moore, Care act lead from BCC talks through the value of involving
carers and service users from the beginning
This process was really valuable for us and was the cause of several ‘eureka’
moments although there were some hard messages for us to hear.

48. How complex?
This is one of the two final ‘maps’ that cxpartners produced for us.
There is a lot of information on there. But what this shows us very clearly is
quite how complex the customer journey is for people who access social care
services. Being able to see it mapped out like this really hit home in a way
that we wouldn’t have experienced without seeing it in this format.

49. There were some key themes
that emerged from the
compound profiles.
The health and social care
system is very complex. Even
those of us who work in it don’t
always know our way round the
whole thing – we know our
specialist areas and the ones
that touch them. If we find it
complex imagine how
convoluted it is for the public.
Key messages
Being informed
& guided through
options
Holistic
assessments for
carer & cared
for
Having a single
point of contact
Transparency
about what’s
happening
Make me feel like
I matter -
familiarity to
my old life
Keeping the
person I care
for happy
Consistency;
Choice; Control;
Trust
Carers: being
able to self-refer;
time for me
Receiving
information at
the right time

50. The key messages that we
need to embed are all about
how we communicate with our
citizens. People need to know
their options, and be
supported through them.
People need to know exactly
what’s going on – if there’s
something we can’t do we need
to be upfront about that. And
people need to feel that they
are in control of their own lives
– the way to do this is by giving
people consistent messages,
that they can trust and use to
inform their own choices.Key messages
Being informed
& guided through
options
Holistic
assessments for
carer & cared
for
Having a single
point of contact
Transparency
about what’s
happening
Make me feel like
I matter -
familiarity to
my old life
Keeping the
person I care
for happy
Consistency;
Choice; Control;
Trust
Carers: being
able to self-refer;
time for me
Receiving
information at
the right time

51. Help to Help yourself
Help when you need it
Help to live your life
Safeguarding
Rightskills,rightpeople
Promoting wellbeing
Early help and
prevention, enabling
people to live more
independently
for longer
Directing people to
lower cost options
and solutions
Delaying or avoiding
the needs for more
intensive, higher cost
care and support
The three tier model of care and support
The Care Act has given us the biggest change to social work practice in 30
years. The focus on wellbeing and prevention underpins everything that we
need to do differently, while balancing reducing resources and increasing
demand. We need to change from social care as an assessment factory, to social
care as an enabler of solutions.

52. Self Assessment
Carers Pathway
Information, Advice and Guidance
Reviews Pathway
Direct Payments
Prison Pathway
Care act / Children and Families Act
Charging Policy
Safeguarding Pathway
Market Shaping and Commissioning
Culture change
LAS / ContrOCC Development
Discharge to Asess
First Contact
Resource Allocation System
We have a range of projects that
we are working on in order to
deliver this wholescale change to
how we deliver Social Care for
Adults in Bristol. Each of these are
important, but allow us
to highlight the foundation
projects.
All of these projects are part of
the bigger national picture,
considering things like the
Integration agenda under
Better Care Bristol.

53. Self Assessment
Carers Pathway
Information, Advice and Guidance
Reviews Pathway
Direct Payments
Prison Pathway
Care act / Children and Families Act
Charging Policy
Safeguarding Pathway
Market Shaping and Commissioning
Culture change
LAS / ContrOCC Development
Discharge to Asess
First Contact
Resource Allocation System
3 critical areas to focus on
Self Assessment
Tools to help people assess their own needs.
Information and Guidance
Enabling people to find their own solutions
through effective and timely IAG.
Culture Change
Fundamentally changing the culture within
our front line practitioners so that they can
have very different conversations with people.
Key challenges for us are:
• Transforming 30 years of social work
practice.
• Heading back to basics of social work
training.
• Managing expectations of current and
future users of services.

54. Photo courtesy of LinkAge Bristol
We have some really valuable insight that we are actively using to inform the
most fundamental change to Social Care for Adults in decades, with a vision
for the future that works towards supporting our most vulnerable citizens and
ultimately not just changing services but improving people’s lives.
We’ve been doing things better for a while and now its time to start doing
Better things.

55. 55
Tracy Dodds
Service Manager
Bristol City Council
Sonia Moore
Care Act Project Manager
Bristol City Council
Amy McGuinness
Senior UX Consultant
cxpartners