Charity rebranding on less than a shoe string

Unless you’re one of my regular readers (Hi Mum!), the chances are you’ve never heard of NAAPS UK, which for almost 20 years had been the national network for an equally under-appreciated form of social care which used to be known as Adult Placement (the ‘AP’ in NAAPS), but more recently as ‘Shared Lives’. (In Shared Lives, an adult in need of support is matched with a compatible registered Shared Lives carer, and they share family and community life, in relationships which can be life-long.)

NAAPS had 4,000 members but was always a very small organisation, and never broke into the public consciousness. When I became Chief Exec in June 2010, it was no surprise to hear calls for a re-brand. It also didn’t take long to tire of people asking if it was a charity for sleep disorders, or a kind of Danish biscuit. This is my first Chief Exec’s role, but I’d been in the sector long enough to know that rushing into a rebrand  was not an uncommon way for new CEOs to wade into poorly understood politics and end up leaving rapidly, pursued by angry members.

So I approached the prospect of rebranding with caution. Soon after joining the organisation, I attended a seminar on rebranding. Two charities talked about their rebranding experiences. The “shoe string” example had cost around £50,000; a not unreasonable amount given that charity’s strong reliance on individual giving, but still about £50,000 more than we had available. The speaker from a large national charity declined to give a figure, but said it ran into the low millions. It was hard not to wonder whether the large charity couldn’t have raised more awareness of its brand (which remains relatively under-exposed) by spending millions on its core work, rather than on brand research and a rather low key change of name.

Some years ago I lived through a disastrous top-down re-branding attempt, which started with name and logo, at a time when stakeholders were concerned about quality and direction

Three questions

The closure of day centres  – and other ‘building-based’ services – continues apace. I subscribe to a popular email group run by the Foundation for People with Learning Disabilities (http://www.choiceforum.org) and there has been a spate of messages recently from family carers and professionals raising concerns about this. There’s even a report of an area opening up a new day centre for people with complex needs, having closed the old one and decided that alternatives weren’t working.

The debate about day centres quickly becomes ideological and couched in black and white terms. One side believes that the alternative to day centres is casting people with learning disabilities out into a solitary existence in a ‘community’ that turns out to be at best elusive, and at worst, openly hostile. The other side believes that day centres are evidence that segregation and institutionalisation are far from the memories they should be.

I’m reminded of the anecdote a former colleague told me of a visit by an ageing member of the House of Lords to the day centre for older people my colleague was running. It became clear that Lord X might himself be in the early stages of dementia and also that he was having a very enjoyable time, chatting with people his own age. My colleague said to Lady X, as she was thanking him for his hospitality, that his Lordship would be welcome to drop in and use the facilities whenever he wished. “That’s awfully kind of you, but my husband is already a member of the most exclusive day centre in the world”.

Most of us belong, or would like to belong, to clubs and groups of one kind or another. The difference being, that most people have choices about what to belong to and to opt out of. Clubs and groups which want us as – usually paying  – members, have to design themselves around our changing wishes and needs. We often get to contribute as well as to recieve something. And we get the option of spending time on our own as well, when we wish.

I believe that the painful and often angry debates about building-based services could nearly always be avoided if, instead of asking “Should this day centre close?”, decision-makers always asked everyone concerned these three questions:

Are Social Impact Bonds (SIBs) the Next Small Thing (NST)

I sometimes think we need a name for those ideas which, whilst they are not necessarily nonsense, get blown up on rather shaky evidence, into the next big thing. They are usually ideas that:

• have a cool-sounding, or failing that mystifying name, usually reduced to an acronym
• apparently have the potential to solve a dizzying range of problems
• are a neat fit with the prevailing political ideology of the day
• have found an articulate advocate or two
• have shaky or limited evidence, and often holes that look bigger the closer you look…

Social Impact Bonds (SIBS) tick all of those boxes. The idea of SIBs is that someone, ideally a private sector investor or even hedge fund, puts up some money to invest in a promising new approach to, say, reducing re-offending, or truancy, or anti-social behavoiur. If the approach works, it generates some savings to the local council, NHS or government. Crime costs the country, so reducing re-offending cuts those costs. The investor gets paid a return on their investment from those savings. The more effective the approach, the bigger the payment. If the approach fails, the investor doesn’t get paid, so it’s the investor who has found the money and taken the risk, not the government. A win all round. Neat.

Here’s where the holes appear.

User-led brokerage

Here’s a guest blog from Simon Taylor (Simon@sharedlivesplus.org.uk),  who supports our micro-enterprise members:

“It’s sometimes hard to stay positive about the changes in social care, but meeting Becky Daykin from Notts Independent Living Consultancy ensures that you will. Despite the challenges, along with her business partner Sarah Moakes, Becky has stepped from the world of social work to be a part of the practical changes ensuring personalisation can offer real choice.

Together they now run a new micro-enterprise which combines their thirteen years of experience to assist people in setting up and manage Direct Payments. They offer support and advice on being an employer, recruitment, setting up payroll and employment contracts etc. They also offer training for personal assistants, organisations and corporate businesses about disability, equality and deaf awareness. All their staff are disabled and receive either Direct Payments, a Personal Budget or Disabled Students Allowance.

Becky herself is Deaf.  Others often see this as a barrier but it is not the barrier she is most concerned about when she speaks of her experience in running her business, where the real struggle is with Local Authorities to make better use of micro-enterprises in delivering small local services.

She commented, “Too often Deaf People are seen as not able to manage their own budgets and are directed by the social work professionals towards managed budgets

Joining up health and social care?

There’s been lots of discussion of the Nuffield and King’s Fund report on integrating health and social care, which came out this week.

Two personal thoughts on integration of health and social care: one is the view of Richard Jones, one of the most effective social services directors (and our newest Trustee), who says something like, Don’t ask us to integrate our structures, because we will. But it will take up all our attention and on past experience it’s doubtful whether end users will notice the difference.

The other is, do we need integration at the level of structures, at the level of communities (perhaps through GP practices and their colleagues commissioning jointly on a small scale), or at the level of the individual. If individual payment by results support contracts were based on a unified outcomes framework (across health and wellbeing) and if people with long term support needs had the opportunity to pool personal budgets awarded by both social care and the NHS, how much would it matter whether the area’s head honchos were part of one organisation, or just good friends?

All parties have to work together this time

As a member of the Care and Support Alliance, Shared Lives Plus was one of the signatories of the letter in today’s Telegraph which has generated lots of coverage across the media. The letter says,

SIR – As a society we face a growing care challenge. We should celebrate the   fact that we are all living longer lives, particularly disabled people and   those with long-term conditions. But the unavoidable challenge we face is   how to support the increasing number of people who need care. It is a   challenge which we are failing to meet – resulting in terrible examples of   abuse and neglect in parts of the care system.

This comes at huge cost to the dignity and independence of older and disabled   people, but also to our society, family life and the economy. An estimated   800,000 older people are being left without basic care – lonely, isolated   and at risk. Others face losing their homes and savings because of soaring   care bills.

Disabled people are unable get the support they need to live their lives   independently and be part of society.

Businesses are losing increasing numbers of experienced staff who are forced   to give up work to care for older or disabled relatives. These carers can   then be pushed to breaking point, providing round-the- clock care. Our NHS   is also paying the price, as a lack of support leads to avoidable hospital   admissions and then keeps older and disabled in hospital beds because they   cannot be cared for at home.

We have a duty as a nation to change this – but it requires political   leadership.

This summer, the independent Dilnot Commission into Funding of Care and   Support published its recommendations. In response, the Government has   committed to publishing a White Paper on Social Care by April. With new   cross-party talks on the future of care, we are closer than ever to reaching   a new consensus.

We urge the Government and the other party leaders to seize this opportunity   for urgent, fundamental and lasting reform: delivering a social care system   which can provide the well-funded and high-quality care and support we would   all expect for ourselves and our families.

After the engagement

I spent the Autumn as co-lead on the theme of ‘Prevention’, which was one of six themes identified by the government in their engagement exercise, seeking ideas from the sector to feed into a White Paper on social care which is due to be published in the Spring. I spoke at lots of events and co-authored a letter with the other co-leads which was reported on the front page of The Times. The letter called for no delays in the timetable for care reform, as had been reported in some sectors of the press. Encouragingly, the government have reaffirmed their commitment to reform and Labour called for cross-party talks.

The presentation the co-leads gave to Andrew Lansley MP and Paul Burstow MP is now publicy available. It outlines a future care and support system which would have moved from a crisis service focused mainly on high end services, to a well-being service which gave people opportunities to plan for their future at a much earlier stage and which focused on people’s gifts, skills and assets as much as their needs. The co-leads saw the Dilnot proposals as an important lever for change of this kind, as they would reduce the fear associated with older age and give people more chance to plan.

Whilst expensive services may always be rationed, community-development based approaches such as Local Area Coordination show that access to support to think through non-service solutions need not be. The prevention group heard that there is no prevention and therefore no real savings without focusing on people’s abilities and potential, not just on their needs. It questioned whether there is such a thing as a preventative service, or whether it was more important that every intervention has a focus on reducing the risk of dependency. To do this, you have to think about the whole person, not just concentrate on one set of needs. For instance, aiming for a health intervention with a focus on NHS savings may well simply shunt costs to social care or housing, and vice versa, whereas looking at the whole person within the context of their relationships, family and community has a real chance of achieving outcomes, whilst also making a saving to the public purse as a whole. This made integration at the level of the individual (integrated outcomes frameworks, pooled budgets) and the community (jointly commissioned, home-based health, care and housing contracts) seem more important than structural integration.

You can read my blogs about the future of social care on the government website and elsewhere, such as this one for the Campaign to end loneliness in older age: Is ending loneliness a preventative service?  http://bit.ly/vh7DqX

The government has said it wants the co-leads to stay involved in drafting the White Paper, so although the engagement process has officially closed, I remain, as ever, interested in your views.

Direct Payments and care homes

One of the questions being considered for inclusion in next Spring’s social care White Paper is whether people should be able to use Direct Payments to pay for residential care, which at the moment is unlawful. The personalisation group of the White Paper engagement team is leading on this issue, so I’m very much writing about this with my own views, not in any way as co-lead of the prevention group.

My understanding of the rationale for excluding residential care users from Direct Payments, was that people may have been encouraged to buy the same old thing they were being offered before, which would not then amount to a radical change in the choice of provision out there. I’ve written a number of times about the ways in which the state and professionals have proved adept at assimilating the mechanisms of personalisation into their existing world view; I’m sure that having the option of transferring residential care users onto Direct Payments would have added to that problem.

I’m equally sure that the two-tier system which has resulted, with people who continue to use residential care excluded from one of the key aspects of personalisation cannot continue. It just doesn’t feel fair that I should lose a key route to choice and control when I move from receiving home care to a care home. However, I’m equally sure that opening up Direct Payments won’t by itself transform residential care. It will need to be part of re-thinking how care homes work. Community Care’s recent article on care provider Dimensions, which attempted to introduce more choice and control in one of its care homes, shows that addressing staff expectations and practice was more important than introducing an individual service fund approach to personal budgets.

It’s also worth noting that older people have been spending their own money on care homes for years, without the private care homes market establishing a reputation for forging ahead on choice, quality and value. As the Southern Cross debacle demonstrated, being an individual consumer of the product of an uncompetitive industry is not a very empowered place to be.

A colleague objected to a recent tweet in which I asked whether introducing Direct Payments for over and under 65s who use care homes would have very different connotations.

A new Trustee for Shared Lives Plus

Richard Jones, Director of Lancashire’s Adult Services and our newest Trustee, says that when he thinks of Shared Lives, he thinks of a young man who used to live in services and now lives with a family and as a result he is loved and can give love. He matters and can contribute to family life. He is part of that family’s holidays, weddings and funerals. He has the opportunity to feel responsible for those around him, not just reliant on them.

We had our board and team planning day this week. It was fantastic to be part of a group of people bringing the same passion, but from very different viewpoints, to thinking about Shared Lives and other small community approaches to care and support. Part of the thinking was about how we ensured that Shared Lives and micro-enterprises became much better understood. We decided that our offer was about citizens, communities and costs: our members help people to become citizens, who can contribute in all kinds of ways, as well as receive great support. Our members build upon relationships and communities. And doing this isn’t more expensive than traditional care: increasing numbers of areas are using it as a way of bringing down costs whilst helping people to live better lives.

Some of the discussion was about the place of Shared Lives and micro-enterprises within the personalisation reforms (which I’ve written about a number of times below).

 I’m not sure it’s a coincidence that we latched onto personal budgets as the key driver for personalisation at a time when we are all more consumerist than we’ve ever been. And I’m sure it’s no coincidence that the rise of consumerism has been accompanied by a rise in loneliness and isolation

Is ending loneliness a preventative service?

My latest Caring for our Future blog is about loneliness and what you should measure when you measure ‘prevention’: savings or outcomes such as reduced isolation:

http://www.campaigntoendloneliness.org.uk/guest-blogger/caring-for-our-future/