Reflections: Hospice UK’s annual conference

Sara Burns, co-founder and director of Triangle and one of the authors of the Outcomes Stars reflects on her attendance at Hospice UK’s annual conference in Liverpool.

We recently launched the Preparation Star – developed to empower patients to share what is important to them when approaching end of life. We were invited by Hospice UK to exhibit a poster at their two-day annual conference, to demonstrate the development and design behind the publication of this new Outcomes Star.  

Conversations had at the conference

Smiling retired senior man sitting on sofa with female home carer at care home

I spent a large proportion of my time talking to delegates and learning more about them, their work and experiences. End of life is a conversation that many people struggle with or avoid altogether, so it was refreshing to meet people at the conference who were open to talking about this topic in a straightforward, confident and relaxed way.    

I shared detail on the Preparation Star and the background as to how it became to be: I was personally pleased when North London Hospice approached us three years ago to develop a Star for end of life. The Department of Health and Social Care’s guidance, based on research, recommends and stresses the importance of a conversation about end of life. Outcomes Stars enable and support good conversations – which support better outcomes – and I felt honoured to be developing a version for what is often the most difficult conversation there is.

86% of people helped by hospices receive ‘hospice at home’1

I had previously thought of a hospice as a safe and relatively pleasant place where people went to die, until learning of this fact. I explained this to conference delegates and that most hospice support is now provided in day centres and the community. This is where the Preparation Star is best used as a tool to enable patients to talk about their wishes and develop a plan with 6-12 months still to live, maybe longer, and provide services with a measure of patient well-being outcomes. I also explained to delegates that it was clear from our pilot that the Preparation Star isn’t suitable for hospice inpatient services – most patients were too close to end of life to use the Star.

Wider conversations about Outcomes StarTM

I met people who already knew the Outcomes Star from previous roles, including in homelessness and family support, and were excited to see one designed for end of life. Others new to the concept could easily recognise it as a visually engaging way to support a conversation and for managers to get some much-needed information on service outcomes. Although I saw some other excellent tools to start a conversation, the Star fills a gap in focusing a conversation to give a picture of how things are, to support planning, and measure outcomes.

How to find out more about the Preparation Star:
You can download a preview version of the Preparation Star and explore the nine areas covered in conversation. To talk to Sara Burns or another member of the Triangle team, call 020 7272 8765 or email info@triangleconsulting.co.uk.

*****

1 Hospice UK conference presentation

Pathway Star points the way for person-centred employment services

For people who are unemployed and struggling with mental illness, addiction, homelessness, family difficulties, trauma or other complex issues, the idea of finding a job can seem very far away. Traditional employment support often fails these people, and no wonder. If your life is upside down, classes in CV writing or job search can feel irrelevant, out of reach or even downright insulting.

That’s why “person-centred” support – a term widely used in care services – is becoming more widespread in employment services. A number of innovative programmes now offer bespoke one-to-one help for people with complex needs, with advocates focusing on helping individuals to overcome the specific challenges they face. It takes a high level of investment, but it’s increasingly seen as the best way to help vulnerable people take steps towards the world of work.

An outcomes tool for vulnerable people

The Pathway Star has been created for services and programmes like this. Launched this month by Triangle Consulting Social Enterprise, it’s an outcomes tool that helps guide keywork and conversations, with the focus on helping people move towards work rather than necessarily finding a job. Above all, it’s person-centred. It’s structured around the individual and the barriers they face to employment – things like stability at home, household finances, family and relationships and emotional well-being.

People who have been out of work for years may be facing multiple issues, from mental health problems to abuse. For a person with high anxiety, perhaps facing the threat of eviction, it’s hard to find the energy or motivation to attend an appointment, let alone take part in a group class – even if failing to turn up means losing benefits. Being required to search for work can add to an already huge burden of worries.

Using the Pathway Star, a worker can start with any area the person feels able to talk about. It’s completed collaboratively, and the person is free to place themselves on the scales, with the worker supporting, asking questions or challenging if that feels appropriate.

“It’s not a question of ticking boxes,” says Triangle director Sara Burns, who developed the Pathway Star in partnership with Liverpool Households into Work (HiW). “It’s a conversation, and as people get some of the support they desperately need, they’re more able to engage with it and see where they are now and how their lives can improve.” 

At the beginning of each of the Pathway Star’s eight scales, people are held back by issues such as poor health, poor housing, money problems or family culture, and are not able to talk about them. At the top of each scale they have been able to address the problem, with support, and while it may still be there, it no longer represents a barrier to work for that individual.

For service users, seeing their situation and their progress in a simple visual form can be powerful. “I got a surprise regarding my progress over the last few months,” said one person on the HiW pilot. “I’m pleased I’ve got some change in my life where I wanted help.”

Work Star™ or Pathway Star™?

Many employment support services already use the Work Star to support people to return to work or to find a job for the first time. It covers the traditional areas of employment support – skills and experience, aspiration and motivation, job search skills and the like, but also has two areas for drilling down into the person’s context – their health and well-being and the level of stability they have in their life.

“The Work Star is ideal for mainstream services or for people who need help with navigating job search or brushing up on skills,” says Juliet Kemp, Star implementation lead at Triangle.  “But if you’re a service working with people who are far from being job-ready and you’re offering in-depth, holistic support, take a look at the Pathway Star. From what we’ve seen so far, it’s a really persuasive tool in helping people to change.”

Triangle recently presented the Pathway Star at the British Association for Supported Employment’s annual conference, along with a workshop to demonstrate the benefits of using the tool. The Pathway Star and the Work Star are available to all organisations with a Star licence and full training can be given for workers and managers. Find out how to get started .

If you have any questions about our new Stars, any queries about the Pathway Star, or you would just like find out more about how the Stars can support your service users, keyworkers and organisation, please contact us on info@triangleconsulting.co.uk or +44 (0) 207 272 8765.


September newsletter round-up

Our September newsletter included updates on the Star Online system. We also introduced two new Outcomes Stars for mental health, the My Mind Star and the new and improved edition of the Recovery Star as well as updated research for the new edition of the Recovery Star™

Find out more

  • My Mind Star™ is an Outcomes Star for building and tracking well-being and resilience in young people and is for young people’s mental health and well-beining
  • The new and improved edition of the Recovery Star™: the Outcomes Star for mental health and well-being. This Star has been designed to support and measure progress towards recovery for adults experiencing mental health issues and contains changes to make the Star more appropriate, accessible and effective.
  • The updated Psychometric validation of the Recovery Star.

Read the full newsletter here.

Contact Triangle at info@triangleconsulting.co.uk or +44(0) 20 7272 8765 for more information on our Outcomes Stars or to find out more about how the Star can empower service users and keyworkers to make and measure positive change. Sign up for our newsletter here.

Think holistically: Act holistically

Joy MacKeith, Co-Founder and Director of Triangle, and one of the authors of the Outcomes Stars reflects on the Mental Health 2019 conference.

By Joy MacKeith, Director and Co-Founder of Triangle.

This was my second time at this conference bringing together senior NHS policy makers and service providers to chew over the state of the nation’s mental health. There certainly was a lot to think about….

Integration, integration, integration

The strongest message throughout the day was to think holistically about mental health. Duncan Selbie, CEO of Public Health England kicked things off by reminding us that the biggest determinants of mental health are income, housing, work and social connection. This was then driven home by Andrew Herd from the Department of Health and Social Care who is engaged in the mammoth task of rallying all government departments around the cause of mental health and inspiring, cajoling and sometimes requiring them to factor mental health into their policy-making. It was refreshing to hear this holistic drum being banged, music to my ears as one engaged in creating tools which attempt to provide a map for the person’s whole life, not just the problem that brought them through the door.

Young people on the top of the agenda

Most of the conversations that we had on our Outcomes Star stand were about My Mind Star – our newly published tool for early intervention with young people with mental health issues. There was real excitement about the strengths-based focus and intuitive visuals. The fact that it also provides service-wide distance travelled information was usually not the focus of the conversation, but nevertheless seen as an important plus. There is a big scale of up services for this group, Phoebe Robinson, Health of Mental Health for NHS England told us. That isn’t surprising given that a shocking one in three children and young people now have a diagnosable mental health issue.

Get ready for growth in social prescribing

GP, David Smart shared his experience of creating an integrated depression pathway in Northampton. What inspired me about this case study was seeing just how much difference can be made when people step out of their normal ways of doing things and look at a problem freshly. Social prescribing plays an important part in their approach and is an example of integration in action. It was mentioned often through the day as an approach that is on the rise. I was extra pleased when I heard that they are exploring the use of the Well-being Star to collaboratively assess needs and the measure outcomes of their social prescribing work.

*****

Interested in finding out more about the Outcomes Stars for mental health and well-being?

The Recovery Star Fourth Edition is a new edition of the Outcomes Star for working with mental health and well-being. My Mind Star is the new Outcomes Star for young people young people’s mental health and well-being. Find out more here. To find out more about which which other Outcomes Stars are suitable for organisations working with mental health and well-being, please take a look at our sector page. For more information on the Outcomes Stars and our licensing and training options please contact us: email Triangle at info@triangleconsulting.co.uk, or call on +44 (0) 202  7272 8765.

*****

Joy MacKeith: Joy is a co-creator of the Outcomes Stars. She leads on innovation, data, research and the theory behind the Star. For more information on the evidence and research that underpins the Outcomes Stars visit our evidence and research library. Please contact us for any further information: email Triangle at info@triangleconsulting.co.uk.

New Outcomes Stars for mental health

Introducing the new My Mind Star and a new, improved edition of the Recovery Star

My Mind Star – a much needed and timely tool for early intervention with young people

My Mind Star was developed in collaboration with managers, service users and professionals at leading UK children’s charity, Action for Children. It was also piloted by:

The results of the pilot were very positive, with 94% of young people agreeing that their complete Star was ‘a good summary of my life right now”.

94% of practitioners agreed that My Mind Star gave them a better idea of the support needs of the young people they support.

“Often young people have not been listened to or given control: completing the Star gives them space and lets them take the lead.” 

 Grainne Hart, Manager of the Choices Service, part of the My Mind Star pilot

Find out more about the My Mind Star here.

The Recovery Star (4th Edition)

This is a new and improved edition, drawing on independent research and feedback from service users, keyworkers and organisations.

The new edition retains the person-centred, strengths based approach of previous editions but with even more accessible language, incorporating trauma-informed thinking and fuller acknowledgement of the impact of external factors.

There is fuller recognition of the necessity of on-going support for enduring and severe conditions. It is backed by a report on independent research into the psychometric properties and a review of literature supporting the Journey of Change and choice of outcome areas.

Find out more about the new Recovery Star here.

Both Stars were launched at the Govconnect Mental Health 2019 Conference at the Royal Society of Medicine on 26th September.

If you have any questions about our new Stars, any queries about transitioning between the Recovery Star 3rd Edition and the new Edition, or you would just like find out more about how the Stars can support your service users, keyworkers and organisation, please contact us on info@triangleconsulting.co.uk or +44 (0) 207 272 8765.

An update on our redevelopment of the Star Online

Our progress so far and what we’re learning along the way

By Sarah Owen, Product Manager at Triangle

As we explained in our last blog post in June 2019, we’re currently in the middle of a big project to redevelop our widely used online system for the Outcomes Star, working with our partners QES.

With the bulk of the project kicking off at the start of this year, we now have just under 3 months before the new product will go live for those new to the Star Online (existing accounts will be migrated from the old system to the new between January and March 2020).

Work-in-progress preview of the new design and interface for the Star Online – with a streamlined homepage featuring easy-to-access actions and notifications

Making progress

During the last 9 months, we’ve made some significant progress:

  • Establishing an Agile process – using the iterative, user-focused development approach but in a way that fits with redeveloping an existing, established product already on the market
  • Weekly (and sometimes daily) sessions between Triangle and QES, to flesh out the specification and turn it into well over 100 user stories – a simple way of capturing what the system needs to do from the point of view of its users 
  • A high-level prototype of the key elements of the system, to ensure a shared understanding between everyone working on the development and to iron out key design decisions
  • A work in progress site, developed with over 10 sprints so far (a sprint is a two or three week chunk of time with planned goals and tasks) – iterated and improved as we go
  • Ongoing input and direction from a Think Tank made up of practitioners, managers and data analysts – reviewing key decisions and the prototype as it developed
Work-in-progress screen from the Star Online prototype – with a new Summary page for each person being supported with the Star

You can see screenshots of the work-in-progress prototype dotted throughout this blog – or download our new PDF ‘Coming soon…Introducing the new Outcomes Star Online’ here.

A work-in-progress example of the new Star data reports that will be available through the new system – focusing on distance travelled and the outcomes being achieved

What we’re learning

It has been a fascinating project for us so far.  As a social enterprise our expertise is not in software development, but in building tools that help organisations to create change and help people to achieve the outcomes that matter to them.  We knew that building an effective relationship with our new partner QES was vital both for the short and long term.

In the early stages, we had to learn how best to communicate our ideas and requirements. Taking the time to do this has paid dividends now that we are in the thick of the detailed development, with greater understanding from both sides. Our experience of working closely with our existing partners, Jellymould and TappetyClick, has also proved invaluable, especially as we balance continuing to support the current system and preparing for the new one.

Next steps

We are running a period of testing with practitioners, managers and commissioners, as well as our team across Triangle, into October.  We’ll then be busy incorporating that feedback and finishing the development up to the end of November.   

In parallel, our Helpdesk team will be working closely with organisations already using the Star Online, to share information and plan the migration of each account.

If you have any questions about the new system, please contact us on info@triangleconsulting.co.uk or +44(0)20 272 8765.

Exciting news about the Star Online system

Introducing our new vision for the digital home of outcomes-focused keywork

By Sarah Owen, Product Manager at Triangle

Screenshot of the existing Star Online system showing a Star visual with 2 sets of ‘completion lines’ representing 2 Stars completed with a service user over time

The Star Online web application for the Outcomes Star was first launched by Triangle in 2011. As the Star has grown in popularity and in use across different sectors and services, so has the Star Online. 

Today the system is used by over 800 organisations and 45,000 frontline practitioners, to support over half a million people and to record nearly 900,000 completed Stars.

Listening and responding to feedback

Over the last 8 years, we have heard from many of the practitioners, managers and commissioners that use the system.  You told us that, although many aspects of the original design still hit the mark, there are frustrations with the system, such as the limited range of reports available and the lack of flexibility in how services can be configured.

Alongside this feedback, technology has improved exponentially since the original development, with digital service design now utilising cutting edge, user focused tools and programming approaches.   

To respond to this, we have committed to a significant level of investment in the Star Online, and since last year, we have been working with QES to completely redevelop the system. 

Collaborating with specialists and practitioners

Logo for QES – specialist developer of web based and offline apps

QES is a specialist developer of web based and offline apps, supporting secure digital data solutions to a diverse range of public and private sector clients. Other QES developments include the eCDOP (online recording, casework and reporting for child deaths) and Holistix Early Help case management system.

The development of the new system is well underway.  We’re retaining a focus on intuitive, simple design whilst also radically improving what is on offer – for example, with a complete overhaul of reports and tools for analysing Star data, and by introducing more options for how services, teams and people can be configured.  Throughout the process, we are collaborating with a small group of practitioners, managers and Star Leads – also known as our Think Tank – who represent a broad selection of organisations using the current system in the UK and in Australia, and who are reviewing our plans and testing out the system.  

Timings and next steps

Our timeline is to launch at the end of November 2019 for new users, and to support existing clients using the current Star Online to migrate over to the new system by March 2020.  We will have more information for existing clients soon and are working to make the migration from old to new as straightforward as possible.  We will of course be providing guidance and support throughout the process.

For more information

If you have any questions or any ideas you’d like to share with us, contact us on info@triangleconsulting.co.uk or +44(0)20 272 8765.

Triangle and our social enterprise model

Sara Burns, Director and Co-Founder of Triangle, and one of the authors of the Outcomes Stars™ explores what it means to Triangle to be a social enterprise.

By Sara Burns, Director and Co-Founder of Triangle, June 2019.

When we incorporated “social enterprise” into our name in 2009, it seemed entirely natural and obvious to me, yet I gave it little thought and there were few guidelines at the time. Fast forward 10 years and I find myself passionate about the concept and practice of social enterprise, as well as better informed and in a sector that is becoming more defined.

In our case, the expression of our social mission and our enterprise (business activity) are one and the same thing. There are many types of social enterprise, including those who raise money through a neutral business activity in order to fund a separate social mission. As Triangle, we develop Outcomes Stars and other tools and help organisations use them because we believe in their transformative potential. We witness time and again in many sectors how the right tool can support people to really listen, have good conversations, plan and deliver support, gather meaningful information and learn about what works. Like so many people, we are operating in a world where services and funding are severely squeezed, and our aim is to keep listening and learning, so we can continue to innovate and make a contribution.

So why am I passionate about social enterprise?

There are a number of reasons.

We make choices and decisions based on what is helpful at a sector level, not what will bring in the most money. This has been the case since we started. It provides a refreshing clarity and simplicity; even though the choices are not always immediately obvious, we are able to focus on the question of what will be most helpful. Somehow the big decisions and changes of direction over the years have always been made easily and harmoniously, and I believe that is because of this clarity of purpose.

Receiving an income from the expression of our social mission in the world, rather than relying on grants or other funding, gives us relative freedom and independence. Ultimately, the majority of our income from training and licenses can be tracked back to the UK government, we collaborate widely in developing Stars and other tools and respond as best we can to different needs and agendas. Yet, at the end of the day, we are the authors and can make decisions based on our learning and experience of what works. And we can plan ahead without the limiting factor of short term funding and the inevitable uncertainties that brings. 

Similarly, because we have an income and are committed to reinvesting at least half of the surplus each year, we have some freedom to be generous and experiment. We offer training and licenses at (often below) cost to enable small organisations to use the Outcome Stars if it’s right for them. We provide implementation support according to need, not based on what people pay. We take risks and invest in new developments before there is a market for them.

All this contributes to a working life that is more fun and meaningful. Money is powerful and I enjoy the potential it affords to be successful in making a contribution – to use the very particular expertise we have built up over the years for good.

My anecdotal impression is that some people who enter the social enterprise sector, while passionate about their social mission, feel ambivalence or even resistance to the enterprise/business aspect, to money and charging. Ultimately, this can result in lack of sustainability and good ideas not getting off the ground. When everything feels too tight financially, that can be stressful and less enjoyable. Being confident about embracing the enterprise aspect and charging realistically for services and products can open some space. Space is important for people to be able to move freely, take risks, be creative and innovate. That is the culture we seek to develop and maintain within Triangle, so that everybody working with us feels able to contribute ideas and enjoy the sense of purpose, clarity and independence, so that we can be as helpful as possible in the challenged world of health and social care.

Interested in finding out more about Triangle’s mission and values?

For more information on Triangle, please take a look at our Values. For more information on the Outcomes Stars and our licensing and training options please contact us: email Triangle at info@triangleconsulting.co.uk, or call on +44(0)202  7272 8765.

*****

Sara Burns: Sara is co-creator of the Outcomes Stars. She leads on and is continually inspired by developing new versions for new sectors, as well as overseeing all the other ways Triangle can be helpful and support people to use the Star well.

For more information on Triangle and the team behind the Outcomes Stars, please take a look at our About Triangle pages. For more information on the Outcomes Stars and the values that underpin each version, or explore the history of the Star at About the Star or please contact us with any questions: email Triangle at info@triangleconsulting.co.uk.

Christmas newsletter round-up

This month’s newsletter round-up includes news on new reports; two new Outcomes Star case studies; new Star research and pyschometric findings; links to Family Nurse Partnership’s newly published blog post on the development of our upcoming New Mum Star and an interview with Clare Burrell, Head of Strategic Commissioning and Policy for Children and Families at Essex County Council on the Family Star (Relationships) the new Star for reducing inter-parental conflict.

New resources and reports

We have recently published a new set of psychometric factsheets as well as a short blog on the role of psychometric testing and why it matters. We also introduced new resources including:

Read the full newsletter here.

 

 

 

Protecting children and young people from relationship conflict

The Family Star (Relationships) was one of two new Stars published by Triangle in September 2018.  It is designed for services working with families where inter-parental conflict is a major focus, with the aim of protecting their children from the harmful effects and enabling them to thrive.  We recently interviewed Clare Burrell, Head of Strategic Commissioning and Policy for Children and Families at Essex County Council, who was one of the key collaborators spearheading the development, to find out why they invested in the development of this new Outcomes Star and to hear her thoughts on Triangle’s collaborative process.

Clare, could you tell us a bit about your role and how you first came across the Outcomes Stars?
I lead on Early Intervention where, like others, we take a holistic approach to our work.  Five years ago, we set up our Family Innovation Fund which is delivered by voluntary and community providers across Essex.  It is important for commissioners to understand and know that the right outcomes are being delivered and to evaluate the impact of the work.  It was then we took the decision to ensure that all the providers of these services would use the same outcomes tools, so that we could measure apples with apples rather than apples with pears!  The aim was that doing this would strengthen the case for what works and help us develop the economic case for early intervention.  Our intendent evaluators, Traverse, reviewed the outcomes tools available and they recommended we adopt the Outcomes Stars.  As a result we prescribed the Family Stars to our providers and over time, they have come to realise the potential and usefulness of them as tools.

How did your focus around inter-parental conflict develop?
The primary outcome of our work was family stability and through our work with whole families, it became increasingly evident within the early intervention space that if we were going to improve outcomes for children, we needed to focus more sharply on parental relationships.  At the same time, we became one of 11 Local Authorities working with the Department for Work & Pensions, to develop the evidence for what works to reduce inter-parental conflict.  It was then that we partnered with colleagues at Hertfordshire County Council and with DWP, to commission an Outcomes Star that would support our work in this area.  We needed something different to any of the Stars which already existed, to take in the specific intricacies of relationships.

Did you find anything challenging about the collaborative process to develop a Star?
Inter-parental conflict is a relatively underdeveloped area of practice, so there was quite a bit of interesting discussion and some challenges for everyone to agree on the focus and content for the Star. A couple of providers decided not to continue with the process and pilot because the Star didn’t fit with their way of working with families – they didn’t have enough time with parents in conflict or were solely focused on getting an agreement for contact with children rather than working holistically, for example. It was helpful to have a provider with vast experience and knowledge of domestic abuse – they made an invaluable contribution to ensure that the Star didn’t inappropriately stray into that space and that it was clear where practitioners using the Star would draw the line.

What would your top tips be for anyone considering collaborating with Triangle to develop a Star?
I would say there are two main areas.  The first is getting the right people around the table.  It can be hard at times, but it is important that the right voices and heads are in the room for the key Star development sessions.  I focused on the ‘unusual suspects’ – people who came from all different perspectives but who would challenge and mix up our thinking.  It was also important to get people who were committed to the whole of the process, as it takes a considerable amount of time – over a year in our case.

The second is to plan your pilot upfront and think about how you will get buy-in from practitioners.  It’s more than just being in the sessions, it’s about committing to piloting the tool and feeding back throughout the process.  We piloted with our commissioned providers, and some of our in-house services.  This particular Star brought a challenge because it was used only as and when an inter-parental conflict focused case came up, so that limited the amount of data and feedback and made it more difficult to evaluate in a meaningful way, beyond case studies.  That said, practitioners love the new Star and are using it in their work, including in unexpected circumstances – as an example one practitioner has recently used the Star to support a teenager and parent in conflict.

And lastly Clare, what are your hopes for the Family Star (Relationships)?
My plan is that this Star is embedded in practice.  Essex is a big place, but we are doing a lot to make sure that our practitioners know about this Star and that it is part of their toolkit to use with families and that they can draw on it when inter-parental conflict is the main issue for a family they support.

 

Many thanks to Clare for her time for this interview.

*****

The Family Star (Relationships) is designed for practitioners working to identify and support the resolution of inter-parental conflict so that outcomes for children and young people are improved. It was developed by Triangle in 2017 – 2018 in collaboration with Essex County Council and Hertfordshire County Council.  Please see the Family Stars page for more information about the new variant for supporting parents to manage conflict: the Family Star (Relationships).

94% of practitioners piloting the Star indicated they found the Family Star (Relationships) described the situation, strengths and needs of the service users they worked with either well (either fairly or very well). 80% of parents who completed feedback about the Family Star (Relationships) said it helped them understand what they needed in the way of support.¹  For more information about how Stars are developed, and Triangle’s collaborative process please see our Star Development page.

For an example of Star data in action, please see the recently published evaluation report from OPM Group for Essex County Council’s Early Help Programme, the Family Innovation Fund (FIF). FIF used the Family Star Plus and My Star as primary evaluation tools, with practitioners completing Stars in collaboration with service users, as an integrated part of the Early Help support being provided. Star data was used to demonstrate change, as part of an economic evaluation, and to make the case for early help provision.

Contact Triangle at info@triangleconsulting.co.uk or +44(0) 20 7272 8765 for more information.

[1] 44 initial Star readings were completed during the 6 months pilot period, in frontline services in Essex and Hertfordshire.