Evaluation of KeyRing Networks Plus in

Walsall
By Alder
31st December 2013

Independent Review of KeyRing Networks Plus in Walsall

Page 1

Executive Summary
Introduction:
In September 2011 Walsall Council commissioned an adapted form of the traditional KeyRing
peer support model. The plan was to gradually expand the number of networks from two to ten.
The aim was to support the Walsall Adult Social Care Operating Model (see Appendix 1) which
includes moving people living in residential care (often out of area) to appropriate independent
community based living within Walsall. KeyRing’s new adapted model was to provide a:

Holistic person centred alternative to residential care i.e. to reduce new admissions,

Step down support service from residential care to sustainable community living, and

Prevention service for vulnerable people not currently eligible for support.

In December 2012 KeyRing commissioned Alder to carry out an independent evaluation of the
new and expanded KeyRing model. This concluded that it had started well, but that, at such an
early stage, the sustainability remained unproven. KeyRing, therefore, invited Alder to update its
assessment one year later. This report describes Alder’s findings and conclusions.
Alder commenced the fieldwork for the study at the beginning of November 2013. At that time
KeyRing was supporting 88 people in 10 networks:

20 Members would have required residential care (or similar) if the “Networks Plus”
model had not been available as an alternative to help support them in the community.
Most were former care home or hospital residents. These are termed “Plus” Members.

13 Members had a community support package from Walsall MBC that had reduced as
a result of KeyRing’s alternative support. These are termed “Care Reduction” Members

55 Members were referred to KeyRing under the “Prevention” agenda with KeyRing
helping to mitigate risks that could cause their support needs to escalate. These are
termed “Traditional” Members.

The Financial Case:
The financial case is based on data at 1st September 2013 as it was the most up to date
available. At that time KeyRing Membership included 22 “Plus” Members who were formerly
supported in care homes or hospitals but now supported in a community at a far lower cost and
11 people whose community support packages had been reduced (Care Reduction Members).
This data shows that although the savings from these two sources go a long way towards
paying for the low level/preventative work with 53 “Traditional” Members, but the savings no
longer cover the full costs of running the 10 networks as was the case in 2012. KeyRing,
therefore, needs to review with Walsall MBC its Membership to ensure the balance between
different types of Members is appropriate. In particular to ensure that the contract is
maximising its potential to Walsall MBC to generate savings, this may include whether there
are enough “Plus” Members to deliver the savings needed to pay for all the prevention work
with the “Traditional” Members.

Independent Review of KeyRing Networks Plus in Walsall

Page 2

Savings Summary (Based on Membership at 1st September 2013)
Reduced NHS/ASC Support costs for 22 “Plus” Members*
Reduced NHS/ASC Support costs for 11 “Care Reduction” Members
Less: Annual fee to run 10 KeyRing Networks Plus
Net Annual Extra Cost for the Health and Social Care System

£
£
£336,691
£87,497 £424,388
£503,600
£79,212

Outcomes Achieved: In the two years since the new model started:

The community support arrangements for the “Plus” Members have been sustainable:
o

Only one person has relapsed so badly that they have had to return to a
residential care setting while being supported by KeyRing.

o

A second person has also experienced a serious mental Health breakdown and
has been admitted to an acute hospital, but this was actually after KeyRing had
stopped supporting him as he had made so much progress that he was deemed
to no longer need its support.

Almost 100% of planned outcomes for “Prevention” Members have either been achieved
or are being actively worked on i.e. KeyRing “Networks Plus” also works well for them.

Discussions with KeyRing case workers about the support for each of the 88 Members
indicated that all Members, not just the “Plus” Members benefit from KeyRing
Membership and that the benefits are not restricted to housing related support and
facilitating access the community. The benefits for KeyRing Members (not including the
20 Plus Members) include nine other members who have been supported to move
home, often from an unsuitable place and 11 who had been helped to develop new daily
living skills. The prevention role was also evident as:
o

16 Members were helped when subject to, or at risk of, abuse, bullying etc.

o

9 Members were helped to maintain healthy relations with family members.

o

8 Members were helped to avoid a potentially serious mental health escalation.

Feedback about KeyRing from Stakeholders

Network Members were very positive about KeyRing 71% of 41 Members who
responded to a questionnaire about their quality of life said it was better since they had
joined KeyRing, 17% said some aspects of their life were better and some were worse
and 12% said their quality of life was the same. Crucially no one said life was worse.

Social workers also gave positive feedback. This was in marked contrast to their
feedback at the initial review a year ago when they were sceptical about the
sustainability and value for money of the model. The concept now seems to be proven in
their eyes and as long as the right service users join KeyRing they say it is good value
for money (vfm).

Independent Review of KeyRing Networks Plus in Walsall

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Overall Assessment:
Overall the picture is very positive, but financial breakeven needs to be achieved. The KeyRing
“Networks Plus” model is now firmly established in Walsall. It is delivering good outcomes for all
categories of Members and it has proved that it can help to sustain “Plus” Members in the
community. Often the community support packages cost less than the previous residential or
hospital packages and. Members, social workers and commissioners all give positive feedback.
However, to achieve the original financial aim, which was for savings from reduced care
packages for “Plus” Members to pay for the costs of running the 10 networks, the balance of
current Membership and the priorities for Walsall MBC needs to be jointly reviewed by Walsall
MBC and KeyRing. It is essential that Walsall MBC get the maximum value from the potential of
KeyRing and to do this it may need to substitute a few Members who could be supported more
cost effectively by alternative support providers with “Plus” Members whose costs of support
can be reduced as a result of the “Networks Plus” model so that savings from their reduced care
packages will fund the full costs of the 10 networks.
Summary of Recommendations:
To ensure the “Networks Plus” model continues to be financial viability and can continue to
deliver excellent outcomes we recommend:
1. Walsall MBC Joint Commissioning Unit (JCU) and KeyRing agree an overall profile of the
mix of Members needs that they expect KeyRing to support to either address a further
strategic aim and/or be financially viable i.e. they should specify target numbers of “Plus”,
“Care Reduction” and “Traditional” Members. (We would think 25 “Plus” Members is the
minimum needed to be financial sustainable).
2. Walsall MBC JCU and KeyRing need to jointly:

Review the current Membership and identify any Member who could be more cost
effectively supported by an alternative provider (We think there may be eight such
Members) and begin a consultation process to substitute the current support by KeyRing
with a more suitable/ cost effective provider.

Undertake case finding activity so that the places freed up are filled by people who are
individually suited and likely to engage with the full range of support by KeyRing and
who collectively alter the mix of needs supported over the 10 networks is in line with the
targets agreed at recommendation 1 above.

3. To ensure new voids are filled with Members who meet the strategic aims of the
service (and guard against supporting people who could best supported by
alternative arrangements):

Management at both Walsall and KeyRing need to formally state that holding a small
number of voids so there is capacity to support new “Plus” Members that emerge is part
of the strategic approach to reduce reliance on residential care,

Social Workers at Walsall need better guidance to help ensure they only refer people to
KeyRing who have needs that can be cost effectively supported by KeyRing, and

KeyRing needs to more actively screen potential future Members to ensure that
individually their support will represent good value for money and that the target mix of
needs supported is retained at all times.

Independent Review of KeyRing Networks Plus in Walsall

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Contents

Page
Executive Summary

2

Summary of Recommendations

4

Introduction

6

What is a KeyRing Network?

6

What is “KeyRing Networks Plus” and does it fit with the Walsall ASC
Operating Model?

6

What was the outline financial business case?

7

The evaluation method used

7

Findings:
-

Development of “Networks Plus” in Walsall

8

-

Is there a financial case for “Networks Plus” in Walsall?

8

-

Is there an outcomes case for “Networks Plus” in Walsall?

9

-

Does “Networks Plus” Sustain Community Living in Walsall?

9

-

Outcome monitoring reports

10

-

Extra value added

11

-

Feedback from Members

12

-

Feedback from Social Workers

21

Appendix 1: Walsall ASC Operating Model

Independent Review of KeyRing Networks Plus in Walsall

23

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Introduction:
Like many other local authorities Walsall needs to improve the outcomes for vulnerable
adults, meet demographic challenges, deliver substantial cost savings and maintain good
quality service provision. To achieve this the Council has put, at the heart of its strategy, a
commitment to:

Enable and maximise independence for as long as possible,

Exhaust all options for younger adults before placement in long term residential care,

Bring people currently out of area back into community settings within Walsall,

Use prevention and early intervention to avoid support needs escalating, and

Safeguard EVERYONE who needs it.

Before September 2011 KeyRing ran just two of its traditional Networks in Walsall. These
supported 18 Members. Most Members had relatively low support needs. KeyRing then began
to work in partnership with Walsall’s Joint Commissioning Unit (JCU) to adapt its traditional
Network model. The new model is called the KeyRing “Networks Plus” model. The plan was to
establish 10 Networks, initially with 8 members by October 2012 and then expand to 9 Members
by March 2013.
What is a KeyRing Network?
Traditional KeyRing Networks support people with low/moderate support needs. Normally a
Network has 9 Members who live in properties of any tenure in a defined geographic area. A
Community Living Volunteer (CLV) lives, rent-free, in a tenth property and provides, free of
charge, at least 12 hours of their time each week to:

Support the Members flexibly using an “enablement” rather than “do for” ethos,

Facilitate Members to support each other, using their particular skills, and

Build links with neighbours, community organisations e.g. local clubs, CAB, Police.

Each CLV is supported by a Supported Living Manager (SLM). Each SLM is responsible for a
number of Networks. Members can also have direct support from the SLM (when needed) and
access to the KeyRing “Out of Hours” telephone help line. Networks also have access to a paid
Community Support Worker (CSW). The CSW provides variable levels of more intensive
‘floating’ support to Members who need more intensive support regularly or temporarily.
What is “KeyRing Networks Plus” and does it fit with the Walsall ASC Operating Model?
In Walsall the traditional KeyRing Network model has been adapted to be part of a wider health
and social care system. It aims to enable people currently inappropriately placed in residential
care placements (often out of area) or at risk of escalating into residential care to move into
more independent community based living within Walsall. Crucially, a tailored support package
is developed around each individual, to ensure the new community support arrangements work.
The main change is the addition of “transitional step down” floating support. This is the “Plus”
element. The “Plus” element is resourced by a Network Link Worker (NLW). They provide
targeted “transitional step down” support to Members of the Network who have relocated from a
residential placement. This includes helping to co-ordinate support from other agencies e.g.
Social Workers, Psychiatric Services, Occupational Therapists, Probation, Welfare Benefits, etc.
Independent Review of KeyRing Networks Plus in Walsall

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The KeyRing “Networks Plus” model fits in well with Walsall’s Adult Social Care (ASC)
Operating Model in that it aims to provide a holistic, person-centred and community based:

Alternative to residential care - So there are less new long term residential care entries.

Step down support service from residential care - To support the repatriation plan.

Prevention service for people not currently eligible for statutory support, but who are
vulnerable – So less develop support needs that eventually become eligible for support.

What was the Outline Financial Business Case?
The original outline financial business case was for the combined community based NHS/ASC
support costs for the Members who “step down” from residential/ hospital care will be lower than
the residential/hospital care costs before they moved. These are termed “Plus” Members.
The plan was to use the net savings from the “Plus” Members care costs to fund “prevention”
work with other Network Members who will not normally, in the main, have support needs
currently deemed to be eligible, but where there is a risk that their needs could increase and
therefore require support if needs were allowed to escalate unchecked e.g. after a crisis event.
Two years after the launch of the model the aims of the basic financial case remains roughly the
same. However, as there are now less people in need of “step down” support the financial case
has evolved and KeyRing is now also expected to support some Members who have community
support packages. The aim for these so called “Care Reduction” Members is that KeyRing’s
involvement will:

Initially substitute for some community based support and, therefore, lower the cost of
the existing support package, and

In the longer term, benefit from KeyRing’s “enablement” based approach and to learn to
do more for themselves and so become more independent. The expectation is that their
support needs (and associated support costs) will, therefore, reduce over time.

Evaluation Method:
To evaluate KeyRing “Networks Plus” in Walsall we visited Walsall for 3 days at the beginning of
November 2013. This was 1 year after our initial review of the new “Networks Plus” model and
two years after the new model had first operated. While we were on site we:

Met the JCU representative to ask if and how Walsall’s aims for working with KeyRing
have evolved over the last two years and to validate costs, Membership numbers, etc.

Collected performance monitoring data for analysis e.g. quarterly outcome monitoring
reports and the financial tracker showing support costs “before” and “after” KeyRing.

Interviewed KeyRing staff about the support for each Member to identify, discuss and
agree what value KeyRing adds to the overall support for each Member.

Visited 6 KeyRing Members at their homes to ask their opinions about KeyRing.

Interviewed 6 Walsall social workers to ask their views KeyRing?

Reviewed the results of 41 responses to a Member questionnaire we had prepared for
completion before we arrived on site. It asked for individual Member’s views about
KeyRing and about the quality of their life “before” and “after” joining KeyRing?

Independent Review of KeyRing Networks Plus in Walsall

Page 7

Findings:
Development of the Networks in Walsall:
When we visited (beginning of November 2013) KeyRing supported 88 people in 10 networks:

20 Members would have required residential care for if the “Plus” model had not been
available as an alternative to sustain them in a community setting. Most were formerly in
residential care or in hospital. These are the “KeyRing Plus” Members.

13 Members had a community support package from Walsall MBC which has been
reduced as a result of KeyRing offering alternative support. These are the “Care
Reduction” Members

55 Members were referred to KeyRing as a preventative measure, using the KeyRing
model to help mitigate risks that could cause their support needs to escalate. These are
the “Traditional” Members

Is there a Financial Case for the “Networks Plus” in Walsall?
In summary the financial case for the “Network Plus” model is that savings from reduced health
and social care costs for the “Plus” and the “Care Reduction” Members$ are sufficient to fund
the 10 KeyRing networks in Walsall which provide flexible preventative support and social
opportunities for up to 90 vulnerable adults Members.
Savings Summary (Based on Membership at 1st September 2013)
Reduced NHS/ASC Support costs for 22 “Plus” Members*
Reduced NHS/ASC Support costs for 11“Care Reduction” Members
Less: Annual fee to run 10 KeyRing Networks Plus
Net Annual Extra Cost for the Health and Social Care System

£
£
£336,691
£87,497 £424,388
£503,600
£79,212

* Note: Support costs do not reduce for all Members after they move to the community. In fact 4 cost more to
support after moving into a community setting than when in a residential support setting, but 18 cost the same or less.

Conclusion about the Financial Case:
The financial case has weakened in the past year. The initial evaluation concluded that the
“Network Plus” model in Walsall was, at least, self-financing and there was a strong probability
that it was delivering savings to the “whole system” of care and support.in Walsall.
Now two years since its launch the KeyRing “Networks Plus” the model appears to be costing
the health and Social care system around £79,000 per annum. This is because the savings from
“Plus” and “Care Reduction” Members no longer cover the full costs of the 10 networks.
The main reason for the difference appears to be that at the first evaluation 26 Members were
“Plus” Members whereas; at 1st September 2013, only 22 were “Plus” Members i.e. the
proportion of Members with the potential to be supported at much lower cost has reduced.
The substitution of “Plus” members by “Care Reduction” Members in the last year has reduced
the savings potential of the new model and some of the “Care Reduction” Members could
probably be more cost effectively supported by a lower cost alternative to KeyRing i.e. to place
the “Networks Plus” Model back on to the planned “self-funding” basis new referrals need to be
examined to ensure (a) there are enough “Plus” Members being supported at lower cost to fund
the prevention work with the “Traditional” Members and (b) to ensure KeyRing is the most cost
effective support model for individual, notably “Care Reduction”, Members.
Independent Review of KeyRing Networks Plus in Walsall

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Is there an Outcomes Case for the “Networks Plus” in Walsall?
To be considered successful the “KeyRing Networks Plus” model must deliver good life
outcomes for the network Members in addition to being self-funding i.e. it needs to:

Enable the Members who have higher support needs (i.e. those being helped to step
down from residential/ hospital care or prevented from entering it) to sustain community
living. Hence, length of stay in the community by “Plus” Members is a key indicator.

Ensure that agreed outcomes are achieved or continue to be supported e.g. where:
o
o

Members can “progress” to greater level of independence outcomes should be
achieved, and
Members need on-going support for “maintenance” outcomes like staying safe,
staying healthy, maintaining a tenancy they should be consistently worked on.

Demonstrably “add value” in key areas.

Does “Networks Plus” Sustain Community Living?
So far the community support arrangements set up for the “Plus” Members have, in the main,
proved to be sustainable. The evidence for this is that 14 of the 22 “Plus” Members at the 1st
September 2013 had been successfully supported for more than 1 year and the shortest period
of time anyone had been supported was 7 months.
"Plus" Members at 1st September 2013 - Time Supported by KeyRing in a Community
Setting
5
4
3
2
1
0
7 months 9 months

10
months

11
months

14
months

15
months

20
months

21
months

22
months

23
months

In addition 5 out of the 11 “Reduced Care” Members at 1st September 2013 had been
supported for 12 months or more. Additionally an analysis of the reasons “Plus” Members
had left KeyRing showed that:

Only one person had needed to return to a residential care setting while being supported
by KeyRing. This was due to an alcohol related relapse.
A second person has also experienced a serious breakdown in mental Health requiring
acute admission to hospital, but this was actually after KeyRing had ceased as he had
made so much progress that he was deemed to no longer need its support.

Independent Review of KeyRing Networks Plus in Walsall

Page 9

In Summary:
The “KeyRing Networks Plus” model, in conjunction with other support providers, has now
proved that it can help support people, who until recently would have been placed in residential
care, to safely/ effectively sustain their life in a community setting in the medium term at least.
Outcome Monitoring Reports:
Each Member has an individual outcome based support plan based on the St Andrew’s
Outcome Star. Each support plan details the outcomes that each Member is working towards
with the support of KeyRing. For monitoring purposes the individual outcomes achieved or being
worked towards are mapped in to 5 main domain areas as follows.

Achieving Economic Wellbeing

Enjoying and Achieving

Being Healthy

Staying Safe

Making a Positive Contribution

Under its contract with Walsall KeyRing has to have evidence that more than 80% of outcomes
have been achieved or are being actively supported. In fact monitoring reports show
performance levels for the last 2 years have been almost 100% and there is a healthy balance
between “achieved” outcomes where Members have been helped to “progress” in some way
and on-going support to achieve “maintenance” outcomes.
Q3
2011/
12

Q4
2011/
12

Q1
2012/
13

Q2
2012/
13

Q3
2012/
13

Q4
2012/
13

Q1
2013/
14

Q2
2013/
14

Achieved Outcomes

249

111

106

303

180

300

125

176

On-going Outcomes

490

1160

935

876

1135

1052

376

379

Outcomes not achieved

0

0

0

0

0

0

1

0

Number of Members

33

50

51

64

77

83

84

87

Achieved per Member

7.5

2.2

2.1

4.7

2.8

4.7

2.0

2.8

On-going per Member

14.8

23.2

18.3

13.7

17.7

16.4

5.9

5.9

% Achieved or On-going

100%

100%

100%

100%

100%

100%

99%

100%

Outcomes Data

Note: In 2013/14 the format for the performance returns was improved. 17 outcome domains that mapped to the 5
key outcome areas were reduced as KeyRing found that one intervention counted in two or more places i.e. the
actual number of outcomes was being over counted. This explains why outcome numbers reduce from Q1 2013/14.

Independent Review of KeyRing Networks Plus in Walsall

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Extra Value Added:
The “KeyRing Networks Plus” model is more expensive than the traditional KeyRing Network
model. To assess whether the higher cost represents good value for money it was important to
assess how it adds value for all its Members, not just the “Plus” Members. To do this we
interviewed KeyRing staff about the support given to each of the 88 Members supported at the
beginning of November 2013. The aim was to identify significant support areas and major risks
that the support from KeyRing helps to achieve or mitigate and show how this varied between
the three categories of Members:

55 “Traditional” KeyRing Members

13 “Care Reduction” Members

20 “Plus” Members

All 88 Members benefitted from low level tenancy support; help to avoid debt and maximise
income; support to socialise and to access the local community. The 2nd most significant
support was for 29 Members to move home. As expected, this included all 20 “Plus” Members,
but 9 other members had also been supported to move home, often from unsuitable
accommodation and 11 Members had been helped to develop new skills of daily living. Most of
the other “Value Added” categories were “Preventative” by nature e.g.:

16 Members had been helped when subject to or at risk of abuse such as bullying,

9 Members had been helped to maintain healthy relations with family members,

8 Members had been helped to avoid a potentially serious mental health escalation,

8 Members had been helped to avoid tenancy loss/homelessness, and

At the low end 3 Members were vulnerable, but their support needs could not be met by
any other support organisation i.e. in these cases KeyRing was filling a gap in the care
system, which if not filled could result in support needs escalating.

Analysis of "Value Added" by KeyRing by Category of Member
Maintain healthy family contacts
Develop key daily living skills
Member did not fit other services
Support to family/ carer
Help with addiction
Medicine, appoint-ment prompts
Prevent homeless-ness
Abuse/ Safeguard-ing support
Prevent MH escalation
Helped move home
Helped Improve health
0

5
Traditional

10
15
Cost reduction
Plus

Independent Review of KeyRing Networks Plus in Walsall

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25

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In Summary:
The Analysis of the different types of “Value Added” demonstrates that the KeyRing “Networks
Plus” Model adds value for all categories of Member. Notably, it is effectively enabling its
Members to become more independent over time and it is playing an effective “Prevention” and
“Early Intervention” role. KeyRing is therefore helping to mitigate the risks associated with
vulnerable adults living independently in the community as well as the high risk “Plus” Members.
Feedback from Members:
Feedback Questionnaire:
Before we arrived on site we asked Members to complete a questionnaire seeking their views
about how well KeyRing was supporting them and to gather their ideas about how KeyRing
could improve. Recognising that some Members would need support with this, but to maintain
independence a former KeyRing Member was asked to support some current Members to
complete their questionnaire.
Who Responded?
Nearly 50% of members (41 to be precise) responded. The sample was reasonably
representative as it included responses from:

All age groups and from male and female members, although female Members
responded in greater numbers as shown by the first graph below.

All three categories of Members (e.g. 10 Plus, 11 Care Reduction and 20 Traditional
Members) and Members who live in a wide variety of accommodation settings as shown
by the second graph below.

Age and gender of 41 Members who responded to
questionnaire
7
6

6

6

6
5

5

5
4

4

4
3
3
2
1

1

1
0

0

0
20-29

30-39

40-49

Male

50-59

60-69

70+

Female

Independent Review of KeyRing Networks Plus in Walsall

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Classification of 41 Members who repsonded to the
questionnaire
Shared lives

3

Sup living - drop in support

3

Sup living - 24/7 support

3

Sup hsg - drop in support

2

Parents house / flat

2

Own house / flat

1

10
0

Plus

5

17
10

Reduced Care

15

20

25

30

Traditional

What the Members who responded said:


71% of Members who responded said their quality of life was better since they joined
KeyRing
17% said some aspects of their life were better and some were worse
12% said their quality of life was the same but nobody said their overall life quality was
worse i.e. a very positive overall assessment by the Members.

Overall Quality of Life after joining KeyRing reported by 41 Members
who responded to our questionnaire
17%
12%

Better
Same
71%
Some is better / some is
worse

Interestingly the “Plus” Members were the most positive with 80% saying their life was better
after joining KeyRing. They were closely followed by “Traditional” Members with 75% saying
their life was better after joining KeyRing. The least satisfied group was “Reduced Care”
Members as only 55% of them reported that there life was better after joining KeyRing and 18%
reporting that while some aspects of their life were better some were actually worse.
Independent Review of KeyRing Networks Plus in Walsall

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Impact of KeyRing on overall quality of life by classification
of Member
Traditional

15

Reduced Care

6

Plus

1

3

2

8
0

1

4

1

8

Better

Same

4

12

16

20

Some is better / some is worse

Why did Members give this overall positive assessment?
To better understand why the Members had given their overall assessment we asked each
Member to name up to three things about their life that have been:

Better since they became a KeyRing Member and

Worse since they became a KeyRing Member.

Better things identified by Members:
The 41 Members who responded made 99 positive comments. The most common response
was “a better social life” (given by 63% of respondents). 37% and 32% of respondents gave
“more freedom” and “more independence”, which are similar responses. This may suggest, if
these two responses are added together, that increased choice and control may be seen as
being equally if not more important than a better social life. These two main themes were then
followed by a range of reasons about their new more independent life being quieter, safer, less
overlooked and away from other people who were not liked etc.

Better things about my life since joining KeyRing
KeyRing is very helpful
More opportunities to see friends

1st Answer
2nd Answer
3rd Answer

Support more tailored to my needs
Not overlooked by support staff
Better family contact
Away from people I dislike
I feel safer
Quieter Environment
More Independence / choice
More Freedom
Better social life
0

5

10

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Worse things identified Members:
Of the Members who responded, fewer identified things about their lives that were worse since
becoming a KeyRing Member. e.g. 29 could not identify anything that was worse and each of
the 12 people who did indicate an aspect of their life that was worse listed only one issue even
though there was the possibility to record up to three. The weight of responses was very much
towards the “Positive”.
Of the 12 negative responses, the most common was from three Members who felt their family
contact had reduced while two people found waiting in at certain times when KeyRing was due
to visit frustrating. No other response was made more than once.

Worse things about my life since joining KeyRing
Little adult conversation with other members

1

My support is not as good

1

Miss people I lived with / liked

1

Less opportunities to see friends

1

Like support workers to see me more

1

Feel lonely / isolated

1

Don't like some people in the network

1

Have to wait in for support staff

2

Less family contact

3

Nothing is worse

29
0

10

20

30

40

What support Members say they value most?
To find out what members value to most about KeyRing we asked them an open question - “Say
the two best things about how KeyRing supports me?” Between them the 41 Members gave 62
responses - an average of 1½ response’s per Member:

Contact with the support worker on at least a weekly basis was by far the most valued
aspect of the KeyRing model with 24 (59%) of Members citing this.

Second (mentioned by 7 Members) was the organised social events that are open to the
Members from all 10 Networks in Walsall e.g. weekly activities at Manor Farm, weekly
bowling and the weekly board games group.

Surprisingly, given it is usually a highly valued part of the KeyRing model, only 4 (10%)
of Members named the network meetings or other network Members in their two most
valued features.

Independent Review of KeyRing Networks Plus in Walsall

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Analysis of things Members said they liked most about KeyRing
Too many to mention!!!

1

Nothing

1

Network meetings/other members

4

Home/Shopping/cooking

5

Prompts re appointments/medication/calls

5

Money management

5

Members' Conference

5

Help to socialise

5

Organised social activities

7

Support worker/weekly visits

24
0

5

10

15

20

25

30

What do Members want KeyRing to improve?
To find out what Members feel would improve how KeyRing supports them we asked them an
open question – “Say the two things KeyRing could improve to support me better?”

Only 19 improvement suggestions were made.

This equates to approximately one for every two Members who responded to the
questionnaire.

The improvements wanted were mainly about the social aspects of network life i.e. more than
half of the improvements identified were about more or improved social activities or trips. Two
people responded there was nothing that needed improvement and the remaining seven
responses seem to be mainly about further tailoring of support to meet the individual Member’s
personal/specific needs/wants i.e. there is an important message here for KeyRing which prides
itself on tailoring its support for individual Members that on some occasions it could do this
better.

Independent Review of KeyRing Networks Plus in Walsall

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Improvements KeyRing Members would like
More support - not just once a week

1

More information on holidays

1

More activities of my interest

1

Support me better

1

More Meetings

1

Same support worker consistently

1

Help with cleaning

1

Nothing

2

More/Better Social Activities

3

More trips out

7
0

1

2

3

4

5

6

7

8

In Summary:
The 41 one Members who responded to the questionnaire identified far more things that they
liked about KeyRing (62 things) compared to things they thought needed to be improved (19
things). The range and significance of the 62 things they liked/valued also seemed wider and
more significant than the 19 things that need to be improved. That said, KeyRing does need to:

Examine why the network meetings and other network members were seldom identified
as a thing Members like or value highly as peer support can be equally as valuable as
support from the KeyRing Volunteer or Community Support Worker, and

Ensure that its support is being tailored in all cases as 7 out of 19 improvement
suggestions seem to us to identify opportunities to tailor its support better.

Home visits to meet Members:
We visited a cross section of six Network Members at home to hear their views first hand:

2 were “Plus” Members who had previously lived in residential care,

2 were “Care Reduction” Members where KeyRing was part of a fuller community
support package and where KeyRing substitute for support from others providers, and

2 were “Traditional” Members with no other social services support and we presumed
had lower/less complex support needs.

Independent Review of KeyRing Networks Plus in Walsall

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Visits to “Plus” Members:
The visits to the two “Plus Members” confirmed they did have support needs that are
significantly higher than those usually met by KeyRing in other areas. It was particularly useful
that we had visited both the “Plus” Members a year before as this allowed us to gauge their
progress in the last 12 months i.e. the:

First Member was a recovering alcoholic with diabetes. Their condition was transformed
compared to a year before. They had energy and a motivation not previously seen. They
were sorting out their health problems, attending college to improve literacy/ numeracy
skills and they had an active social life. Crucially, their drinking was under control, and

Second Member was an older person with significant learning disabilities. They had lived
in residential care for years before KeyRing supported them. In this case there was no
transformation, but the individual was proof that people previously considered too risky
or too institutionalised to live independently in the community could be supported safely
with the right tailored community support package.

Visits to “Care Reduction” Members:
The visits to the two “Care Reduction” cases highlighted that KeyRing, although it may be
valued by the Member, can be expensive compared to alternatives if that Member does not
benefit from the multi-dimensional nature of network based support. This emphasises the
importance of improving:

Decisions about who should be referred to KeyRing by social workers, and

Acceptance criteria for new Members to ensure each individually “fits the service model”
i.e. will engage in a range of activities and that collectively the mix of needs supported
“fits the business model” whereby enough “Plus” Members are supported so that savings
from their reduced support packages funds the “prevention” work with other Members.

Both of the “Care Reduction” Members were physically disabled, but quite capable in most other
respects. Both felt they had little in common with the other KeyRing Members they had met.
Consequently, neither had much interest in the network meetings and group social events
organised by KeyRing nor in engaging with peer support for or from others so their only real
contact with KeyRing was two hours of contact with the Community Support Worker each week.
In both cases this helped to guard against loneliness and each Member was very enthusiastic
about the support from KeyRing. However, given the cost of KeyRing is roughly £5,600 per
Member per year for on average two hours 1:1 contact per week, plus mutual support, Member
involvement and a range of group activities, if a Member is only benefitting from 2 hours of 1:1
support it is not good value for money. It would be more cost effective to buy 2 hours from an
alternative support provider at £14 per hour the annual cost would be just £1,460 p.a. This
would also free up network places for KeyRing to support more people with higher needs and
who would be more likely to benefit from the holistic range of support it enables.

Independent Review of KeyRing Networks Plus in Walsall

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How many cases may not be good value for money?
We interviewed KeyRing staff to find out what support each Member benefitted from. The main
purpose was to identify the range of “value added”, by KeyRing, for its Members. However,
having met two Members during the home visits that it appeared could be supported adequately
at a lower cost by an alternative support provider we also used this exercise to identify other
Members who did not seem to be benefiting from their Membership except from weekly visits.
This exercise identified 8 out of 88 Members who we think could probably be supported at a
lower cost by an alternative provider:

One was a “Plus” Member,

Five were “Care Reduction” Members and

Two were “Traditional” Members.

We have supplied the names of these Members to Walsall and KeyRing to investigate further so
if they agree that KeyRing is not the best value support solution, this will create significant
capacity to support other people with higher and more appropriate support needs.
Visits to “Traditional” Members:
The visits to the two “Traditional” Members challenged the notion that they only had lower level
support needs and highlighted how effective KeyRing can be at preventing needs escalating to
a crisis point. For example, one of the “Traditional” Members was a young person recovering
from a serious drug addiction. It was clear from what they said that without KeyRing’s support
there was a high risk that their situation would have escalated out of control leading to serious
physical and mental health issues and probable homelessness. All this would have been very
harmful for the young person and would have cost health, housing and social services dearly.
It is important to note that as a “Traditional” Member this young person does not appear on the
cost tracker maintained by Walsall Council to monitor the financial impact of the new model i.e.
any potential savings from the valuable “Prevention” work was not included in the financial case
presented above.
Quotes from the Members visited at home:
Having challenged the cost effectiveness of the support for the two “Care Reduction” cases
above, it is important to be clear that ALL six Members were very positive about KeyRing’s
support to them. Notable quotes included:

“I would be lonely without KeyRing”

“Every day I am on the up thanks to KeyRing keeping me busy and my mind off you
know what?””

“KeyRing is very open and easy to talk to”

“I like living here much more. It is nice. Before people used to wear my clothes and I
used to have a small bed …. now my things are my own”

“KeyRing stood by me when I was at my lowest point, they were the only ones that
listened to me and they gave practical help like attending meetings, reading letters …. I
can’t think of anything KeyRing could have done better”

Independent Review of KeyRing Networks Plus in Walsall

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Comparison with what Members said at home visits 1 year ago:
The visits to the Members in their homes were in many ways similar at both evaluations. The
one notable difference was that the six people met at this second review gave fewer examples
of peer support by Members. We took this feedback to staff at KeyRing to see if they thought
this was a fair observation or whether it just reflected the sample visited. There feedback was:
First, they noted that Walsall was different to most other parts of the country i.e. because it has
10 networks KeyRing can run a range of activities on a weekly basis that ALL Members can
attend. This is a strength of the Walsall model that can’t be replicated in areas with just one or
two networks, but they noted it may mean some Members in Walsall identify less with their own
network of 8 or 9 people and more with the broader KeyRing brand than in other areas.
Second, they observed that two of the people we visited were not engaging much with KeyRing
beyond the 2 hourly visits by the CSW i.e. the sample was not representative and they expected
a different sample of six would have provided us with more examples, and
Third they gave a number of examples of excellent peer support to prove that, whilst slightly
less evident in Walsall, peer support remains a strength of “Network Plus”. They described how:

Three Members had helped another Member clear his garden when he moved into new
accommodation,

Two Members who get on very well have pooled their support hours so rather than
getting two hours each per week, they now share four hours together,

One Member who hoarded things at home was helped by other Members identify things
they could sell, take them to a summer fair and set up a stall to sell the items.

One Member has meals cooked for her regularly by other Members of her network,

One Member keeps a spare key for another Member who often locks themselves out,

One Member regularly helps other Members plan their journeys to/from KeyRing
activities

One able bodied but learning disabled Member helps a Physically disabled Member get
to/ from and around KeyRing Area Forum Meetings

In Summary:
Member’s feedback was very positive. This was consistent with the initial evaluation a year ago,
but this time Members’ feedback has highlighted a particular strength of having several
networks concentrated in a relatively small area i.e. it gives opportunity to run centrally located
activities on a regular basis with open access for all KeyRing Members. This strength only exists
because there are the larger number of Members in Walsall justifies the central activities.
This positive effect appears to lessen the extent to which some Members identify with their
individual local network compared to other parts of the country, but the networks remain a vital
part of the overall model and peer support remains a strength of the “Networks Plus” Model.
The central activities open to all Members should, therefore, be seen as an additional benefit of
the “Network Plus” Model over and above the “Traditional” Model and potentially reduces usage
at traditional day services.

Independent Review of KeyRing Networks Plus in Walsall

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Feedback from Walsall Social Workers:
To maximise their contribution KeyRing needs to work in close partnership with each Member’s
Social Worker. We therefore, asked six social workers for their opinions about KeyRing. The
responses detailed in the table below show that the social workers were positive about KeyRing.
Importantly, in comparison with a year ago at the first review, the Social Workers were far more
positive, suggesting initial scepticism has been replaced with enthusiasm now that the benefits
of the model are proven, rather than theoretical. On the few occasions where a social worker did
not feel they had enough evidence to give a firm answer they normally expressed a view of, “so
far so good”. One possible reason for this positive feedback is that all six social workers said
that KeyRing saves them time because the volunteer or support worker is often able to deal with
issues that otherwise would be raised with them by their client.

Good

Hard to say,
but good so
far

Good
and bad

Can't
say

2

2

1

1

0

Is KeyRing good value for money?

2

2

2

0

0

How good is KeyRing to work with?

3

2

0

0

1

How good is the "Plus" element?

5

0

0

0

1

Six social workers were asked:

Very
Good

Overall opinion about KeyRing?

To gain more insight into the detailed views of the social workers we asked them to reflect on
their experience of working with KeyRing “Networks Plus” Model. Positive quotes included:

“They have matched their support worker very well to the needs of my service user”

“They can build a level of trust and rapport with service users that it is hard for me to
match as I have less contact with my service user”

“It is a valuable prevention service that helps avoid trigger events by supporting
wellbeing and befriending vulnerable people”

“Their work on prevention and enablement is very effective .… and you can’t put a
monetary value on this”

“They really help make people more independent”

“It really helps manage family anxiety …. helps break down their understandable fear of
change”

“It seems to work well from what I see, people are being sustained and there are very
few failures to my knowledge”

“They seem good at what they do .… even other support agencies give good feedback
about them”

“Communications have been very good. They do return calls, e-mails etc. and they give
me important feedback”

“Based on Walsall KeyRing is easy to contact, helpful, open and has a good attitude”

“I find KeyRing ever so helpful …. And other colleagues say nice things about them”

Independent Review of KeyRing Networks Plus in Walsall

Page 21

Negative quotes were much rarer and tended to be quite specific. Examples, included:

“If people are not on benefits they are excluded from KeyRing. Why?”

“While it was growing it was not always able to meet specific requests, but it seems
better now”

“There is scope for KeyRing to work with people before they leave the family home”

“Sometimes they take ages to answer or return my calls”

“It is expensive for a few members who just get 2 hours drop in support per week”

In Summary:
Twelve months after the first independent review of KeyRing in Walsall the social workers were
far more positive about KeyRing and convinced about the sustainability of the “Networks Plus”
Model. However, the social workers occasionally find that KeyRing is not able to meet the
requirements of some specific service users and this can frustrate them.
There was also some evidence of a lack of a full understanding by some Social Workers about
what KeyRing can/can’t do i.e. the comment that KeyRing should work with people before they
leave the family home was made by a social worker who believed they would not work with
people living with parents. In fact KeyRing do to prepare people to move out i.e. there is
constantly a need to keep ensuring that social workers understand what KeyRing does and
when it is appropriate to refer people to it.
Another area of misunderstanding was the cost of KeyRing support i.e. we discussed the small
number (we identified 8 above) of Members who do not fully engage with KeyRing and only
benefit from two hours of “drop in” support per week. Not all the social workers appreciated this
was poor value for money. A couple actually said it did not matter as “KeyRing is free”.
We believe this false perception is born out of a lack of understanding about the financial
implications of the “Block Contract” funding arrangement and is a likely reason why some
people supported are referred to by KeyRing when they could probably be supported more cost
effectively by an alternative provider.

Independent Review of KeyRing Networks Plus in Walsall

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Appendix 1: Walsall Operating Model

Independent Review of KeyRing Networks Plus in Walsall

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