Latest Shared Lives news

Cathy Newman of Channel 4 News met a Shared Lives household: https://www.youtube.com/watch?v=wb_DyYvE9zE

Our £1.75m partnership with NHS England has been launched with funding awarded to five areas and their Clinical Commissioning Groups to develop Shared Lives as a form of healthcare.

The Shared Lives Incubator social investment programme developed in partnership with Social Finance and Community Catalysts is investing in Shared Lives in three areas.

Sceptical Trust

This blog first appeared in New Local Government  Network:

I know someone who’s renowned for his scepticism. The only problem is, he’s now so sceptical that he doesn’t feel able to trust anything. People who post videos on YouTube seem to have as much, or little, credibility as professional journalists. After all, journalists can succumb to group think. And who’s paying them, anyway?

The results of blanket scepticism look surprisingly similar to the results of blanket credulity. But in a corruptible world, where fake news looks ever more real and we are weary of being let down, how can we trust each other? Why should we?

I work with people who are temperamentally inclined to trust other people. They open up their own homes and lives to people who they have not known for very long. And sometimes it doesn’t work and they cope with this, but I hear constantly that living this way makes them happy. They are realistic about the people they live with, but often able to see and value them in ways that others cannot. Those who are considered vulnerable – the very young and the old – could be most at risk from this openness, but they are also those who appear to benefit most.

For instance, Homeshare organisations help older people to take an unusual risk: to let someone they have only recently met into their homes. There are police checks, references, interviews, but the core of the model is about helping two people establish trust. Recently I was also talking to two young women whose parents were Shared Lives carers. They had valued the experience so much that both were now involved in Shared Lives as adults, contributing untold amounts to those around them and their communities. If Shared Lives or Homeshare arrangements don’t work out, the local organisation steps in to help, but there is always an element of risk.

The risks of trusting no one, however, are stark. When we start to avoid the risk of trusting others, it can give us a short term sense of safety, but everything we value is corroded. Loneliness not only crushes happiness; it is in the same bracket of health risk as smoking. It is now endemic amongst older people, and even the best health or care service can’t fix it.

I also spend quite a bit of my time with a group of people who generally come quite low down on people’s trust list: politicians. My experience of them is that, whilst I often disagree with them on lots of things and sometimes feel we have very different life experiences and world views, they are generally people who believe they are helping other people. They work ridiculous hours and a lot of what they do is not at all glamorous, but is absolutely necessary in a democracy. They are as flawed as the rest of us, but based on having met quite a few, I am inclined to approach them with an attitude of sceptical trust, because without it we have no democracy worth the name. And of course, because I hope they will approach me and others who work for charities with something like the same attitude.

This seems a strange time to be suggesting that we all trust each other – whether we are Shared Lives carers or politicians – more. As 2017 picks up where 2016 left off, I am not completely confident that I will be able to practice what I preach on this, all of the time. But if you’re willing to try to approach me with something like sceptical trust, most of the time, I will do the same for you.

It is, I think, from small acts of trust that functioning communities, organisations and even nations are built.

“I want to inspire other people to learn to read”

Ursula has been in the news, having been learning how to read through the help of her Shared Lives carer, Lesley, who is part of Shared Lives South West. Ursula is 87. The education system of her childhood had little ambition for Ursula and at school, she would sit at the back of the classroom with a friend that could read, turning the page when she did. One of the reasons Ursula has learned to read is because she loves knitting but was unable to read the knitting patterns. As so often happens in a Shared Lives household, Lesley got to know Ursula well enough to see her capabilities and potential, not just her needs. Rather than Ursula’s support being arranged around a busy shift work pattern, they have the time to spend together to learn at Ursula’s pace, as well as Ursula being supported by Learn Devon. Ursula says she hopes to inspire other people to read from her example.

We see people achieving extraordinary things all the time in Shared Lives arrangements, often in later life. I always have mixed emotions about these stories: inspired that people have rejected a lifetime of assumptions about what they cannot do, but angry thinking about the decades of expensive support services and ranks of experts who were either unable to see the person, or content with a lack of ambition. In the field of psychotherapy, there is research to suggest that the quality of people’s relationships with professionals has at least as much impact upon the outcomes of support as the technical skill of the practitioner. Shared Lives is implicitly built upon this insight: most of the investment is in getting the right people involved as Shared Lives carers and then matching them with people with whom they may be able to form a unique connection. Not every match works out, but when it does, the results can be astounding. Shared Lives carers will often report that it was not a complex intervention which helped someone change, but simply their relationship with a family member or even a pet. We often hear that the Shared Lives carer’s children are the ones who successfully encouraged their new household member to learn a new skill such as riding a bike.

Recently, another Shared Lives carer, Sarah told us about one of the men who lives with her: “One of our housemates has had his art etched on the glass walls of a newly renovated crypt at Rochester Cathedral- and he is soon to embark on his first solo exhibition … aged 70!”

The Budget

The budget includes the promise of £2bn of new money to fund social care over three years. This is a welcome response to the current crisis in social care which is seeing care homes, home care businesses and other crucial forms of support for adults and older people going bust, or suffering unacceptable levels of failure. The gap between what is currently spent on social care and what is needed is more than £1bn, so this will not on its own bring back support for the 1.2m older people who no longer get support (an increase of around half in recent years).

The money is a grant so, according to Richard Humphries at the King’s Fund, is unlikely to be ongoing and is likely to have ‘strings attached’. I have mixed feelings about this. On the one hand, councils, particularly in the poorest areas where cuts have been greatest (according to the cross party Public Accounts Committee), badly need the freedom to prop up existing services which are collapsing under the opposing pressures of budget cuts, increasing numbers of older and disabled people and increasing costs of providing care (not least the hundreds of millions needed to fund the – very welcome – national living wage in this traditionally low-pay sector). But on the other hand, the Better Care Fund experiment showed that well-intentioned but un-ringfenced money put into a stressed system results in little transformation: the crisis subsides and then reappears. Our forthcoming report on the national picture of Shared Lives development will show widening divergence between places investing heavily in Shared Lives because it offers them a sustainable model which fits with people’s lives, and areas apparently unable to invest in anything new.

Already the HSJ is calling for the new grant to be allocated to initiatives which focus on getting older people out of hospital. A narrow focus on what forms of social care will immediately alleviate the current pressures in the NHS will not ultimately achieve its goals. The models which work are those co-designed by social care providers, including the voluntary and social enterprise sector, and the people and families who make most use of services themselves. They are built around goals like wellbeing, independence and resilience. By putting people’s needs (and capabilities) at the centre, rather than services’ needs, they ultimately lead to benefits for the NHS which would not be achieved if benefiting the NHS was the starting point.

The budget also promises a Green Paper which will consider how to put social care on a sustainable footing. It is impossible to answer that pressing question without giving equal consideration to the question of what the money will be spent on in future. This cannot be ‘a more efficient version of what usually do’. It must be a social care system built around serious ambition for the scale and effectiveness of community-based models which have been considered add-ons for too long. As this SCIE paper outlines, it’s time for the models with most chance of success to become core business.

Response to the CLG Select Committee pre budget report on social care

In its Pre-Budget report for their Adult Social Care inquiry today, the Communities and Local Government select committee calls for The Chancellor to bring forward £1.5bn funding from the ‘Better Care Fund’ to plug the hole in social care funding in the year ahead (2017/18). The Better Care Fund is a national funding pot which was intended to be spent on improving adult social care and bringing social care and health together, easing pressure on hospitals and the NHS. It has been announced but is not due to be released until 2019-20, despite the current crisis in social care funding which is seeing care homes and home care businesses closing and worrying signs of quality and safety dropping. The Committee also calls on the Government to commit to closing the funding gap for the rest of the Parliament through to 2020.

We gave written and oral evidence to the Select Committee about the role which innovations like Shared Lives and Homeshare could play in transforming social care. I agree with the committee that the Better Care Fund should be brought forward. But this would be to plug a current gap between what is being spent and what would be needed to achieve anything approaching minimum standards. It would not result in ‘Better Care’, but a slightly eased crisis. For better care, we also need a national vision for social care which has real ambition, which is prepared to take some sensible risks in scaling up the most promising models and significant additional investment. Programmes like Nesta’s Realising the Value and our work with SCIE and PPL on Total Transformation point the way towards a health and social care system which would work and be affordable long term, rather than relying on crisis handouts year after year. We all deserve better than that.

All people really need

Our Executive Director of Support and Development, Anna McEwen, spoke at a Westminster Forum event on Transforming Care last week, at which it was announced there has been a 12% reduction in ATU usage for the first time. Anna spoke about how Shared Lives can contribute to the Transforming Care agenda, saying:

I’d like to start by introducing you to James. James lived in a residential hospital for people with learning disabilities for many years and was discharged home with depo medication to control psychotic episodes.  He was severely abused and set on fire by family members and so needed to find somewhere new to live. Shared Lives was one of the options he was given.

James decided Shared Lives was a good option for him and was matched with Shared Lives carer Phil who supported him to experience lots of new things, including supported employment, independent travelling, greyhound racing and fishing.  James also went on holiday with Phil and his family which he really enjoyed.

While living with Phil, James’ medication was reviewed ad discontinued but then his mental health deteriorated and his psychotic episodes returned.  When James is unwell he has occasionally been readmitted to hospital.

When well, James lives very happily with Phil. He has a robust support plan, with additional Shared Lives support carers who know him well so that Phil can have a break too. Good support systems are in place to reassure Phil and James, both value the family life they share and neither could imagine James living anywhere else now.

Shared Lives is a family based model of care that supports older and disabled people to be supported within family homes in the community.  Shared Lives is delivered by 125 CQC registered Shared Lives schemes in England who recruit, train and support Shared Lives carers.

Shared Lives carers, like Phil, go through a rigorous assessment process before being approved as a Shared Lives carer.  They are then matched with an older or disabled person who may move in and live as part of the family, or visit the family home regularly for support during the day or short break (for example if they live with a family carer). The matching process is very important in Shared Lives, if you’re going to share your life with someone it’s important that you get on.

As in James’ story showed, Shared Lives has demonstrated it can be part of the solution, it is adaptable and flexible for people with complex needs and has a twin focus on great care and a great life. If you think about your own life, usually the things that define you and are most important to you are the relationships you have and the people you share your life with, Shared Lives enables people who need support to develop these same relationships that are fundamental to our human needs and make us feel secure and loved.

Shared Lives also brings a different ethos to traditional service types,. It’s about having a good life with a purpose, having relationships and based on an asset based approach where people contribute to a household and community.  Being independent doesn’t have to mean living alone, in fact most of us would say we’re hugely independent but few of us choose to live alone.

Shared Lives carers often have a background or experience in working in health or social care.  They may have been nurses, social workers or support staff so they already have a lot of experience in working with and supporting people who have very specific and often intense needs.

We know that Shared Lives isn’t for everyone, that it is one of a suite of more community based options that should be available for people to choose.  It also can’t be a service in isolation, and needs to work together with other community services to ensure wrap around support for both the individual and the Shared Lives carer.

We’ve recently launched our NHS programme funded by NHSE which is providing match funding to six CCG areas to develop Shared Lives in the healthcare sector.  We’ll work with CCGs and local schemes to develop new pathways and opportunities for people with healthcare needs to be supported in Shared Lives. Some have a focus on developing Shared Lives for people from the Transforming Care cohort.

At Shared Lives Plus we think that solutions like Shared Lives and other community asset based approaches should be considered as part of a range of options available to people in the Transforming Care cohort when they are considering how they receive their care and support.  Sometimes, being part of a family, feeling loved and secure is all people really need to transform their lives.