Local Area Coordination: the new front door for care and health

Local Area Coordinators work in a small neighbourhood and have an open door for individuals and families at risk of developing greater support needs. They have the time and space to get to know people and help them identify what a good life looks like to them and how best to achieve it. LACs don’t just look at a person or family’s needs, but also at their capabilities and potential. Their goal is to help people to find practical ways of doing the things they want or need to do, developing and using supportive relationships and being part of community life. Where community connections or activities aren’t available, the LAC has a community development role, as well as helping formal services to reach those who most need them and to shape support around people’s capabilities. So where an older person who is struggling to live well and independently, has become isolated and reluctant to accept formal help, the LAC approach would be help that individual identify the things they want to change, build connections with those around them and think about the contribution they want to make to their community. One older person who was isolated, in decreasing health and struggling to maintain a safe home, turned out to have been a keen angler. The LAC didn’t look for a befriender to take him fishing, but someone who wanted to learn to fish. Making that connection and contributing to someone as their teacher, was the key to that individual taking control of many other aspects of their life and avoiding the path to hospital or residential care.

This week I chaired Capita and the LAC Network’s national LAC conference hosted by Capita Conferences. We heard strong support for LAC from NHS England, local areas including the Isle of Wight vanguard and Derby, and we heard from LAC founder Eddie Bartnik. Here are my opening remarks:

Services which aim to prevent people developing significant support needs have always wrestled with a paradox, often without realising it. The paradox is that the act of offering support can in itself reduce, rather than help build, an individual’s resilience.

Too many information and advice services are a collection of signposts into service land. Many interventions begin with assessment of need. But often, the more accurately and comprehensively we define a person’s needs, the less we can know of their capabilities, strengths and potential.

Often the very processes we use to help people stay or return to independence become the funnels into our service pipelines. This is particularly stark in hospital discharge processes, where a detailed picture can be built of an older person’s fragility post-operation, but nothing may be known of the independence they were achieving only a few days before. The longer the risks are assessed, the more muscle strength that older person loses to their hospital bed, until the risk assessment becomes a self-fulfilling prophecy of service need.

Keeping the faith in prevention is hard at the best of times, and these are not the best of times. It is even harder when it’s unclear whether problems and greater support needs are genuinely being prevented.

We are here today because Local Area Coordination has demonstrated that it is possible to intervene early in a way which helps individuals stay strong and connected. Which builds resilience and confidence. This is not just a new intervention to resource in an already-stretched system. It can be the key to reforming the whole system around the capabilities of individuals, families and communities. Systems which start with LAC are more likely to build in asset-based approaches like peer-support, time banking, community enterprise, Shared Lives and Homeshare further down the road, because they will be the natural fit for the goals people identify.

LAC has a long history in Western Australia from which a growing number of areas are drawing in the UK. This conference comes as some of those areas are coming together to build the new national LAC Network, so let’s think about what kind of national network we need to develop LAC in the UK, but given this is all about an asset-based approach, mainly what you and I are willing to contribute to it.

http://lacnetwork.org/

Future social work

The Think Local, Act Personal partnership has published a paper which I helped to author: Developing a Wellbeing and Strengths-based Approach to Social Work . Here is my foreword to the paper which looks at how social work could change to deliver the Care Act’s vision for wellbeing, drawing on Asset Based Community Development thinking and similar ideas:

Talk to social workers of a certain vintage about community development and many will begin to recall fondly the days of ‘community social work’, when social workers were expected to think whole-community in their approach to supporting people and perhaps even had the time and freedom to do so. Since that period, pressures upon social workers have increased with rising demand and falling budgets. The professionalisation of social work took the sector away from community social work, which was sometimes seen as hazily defined and weak on evidence of outcomes. It would be foolish to believe there was a ‘golden age’ and this paper is not a call to return to the past. Despite increasing pressures, social care can claim to have reformed itself more radically than any other public service sector. The concept of ‘personalisation’ is still contested and imperfectly implemented, but it is unarguable that thousands of disabled and older people have a level of choice and control which was unheard of until recently. Half a million people have personal budgets and a fifth of those have taken their personal budget as a cash Direct Payment, enabling them to create and manage an entirely new workforce of Personal Assistants. There are hundreds of innovative small and microscale enterprises, helping people to live well through interventions which look nothing like traditional services. Community-based interventions like Shared Lives are growing rapidly despite the pressures of austerity. So there is much innovation in services and support, alongside much-raised standards of skill and accountability amongst social workers, but we are also starting to understand the limitations of services acting on their own and the huge potential for support which fits around and enables people’s informal support relationships with their families and communities. That change does not make social work any less important, but it will require a new (or rediscovered) set of social work skills and attitudes: a social care workforce with the humility to use its power and access to resources not to take charge, but to enable people and families to take charge. It will need to be a workforce confident in its expertise but also more confident in the expertise and potential of individuals, families and communities. Models like Local Area Coordination and community navigators create the space in which professionals can get to know individuals and families well enough to understand what their goals and capabilities are, as well as their needs. Making those deeper relationships the norm will be a huge challenge in a financially stressed social care system, but meeting that challenge is the only way to a sustainable system, good lives for people with long term conditions and a workforce which is the best it can be.

Full paper here: bit.ly/1TTo3P3

Back off! (a little bit)

This is a guest blog written by three of our seven new Ambassadors, Dipan, Phoebe and Paul, who were working with Lyn Griffiths, our Support and Engagement Manager. The Ambassadors are our first team members who use Shared Lives themselves. Their roles include peer review, raising awareness and improving the Shared Lives model. They write:

We are writing this in the Shared Lives Plus office, it feels like our first day at work. Is it good? It feels a bit strange, but Paul thinks it’s like home from home! Lyn worries about us being supported in the right way so we can all be part of the team. Lyn worries way too much LOL! We are part of the team. Lyn needs to back off a little bit, because she worries too much about us, but it’s part of her job.

Lyn is learning to understand how we like to be supported. As Ambassadors we are all becoming more independent and more confident.

Yesterday we were working on a charter for people who use Shared Lives. People like us. This is so Shared Lives carers can understand how people who use Shared Lives want to be supported.

It will be called My rights in Shared Lives: the Ambassadors’ test.

We have been thinking a lot about rights and responsibilities.

This has been making us think about Shared Lives and how we are supported.

Last night we had a laugh but we also had an interesting conversation with some Shared Lives carers.

They said we are vulnerable adults.

We said everyone is vulnerable in certain situations.

Sometimes the people paid to care for us worry too much. They need to back off too, just a little bit.

We have a right to be treated like any other adult.

We know you worry but you are not our parents. You are not our mum and dad!

We are adults not children.

One of the things we decided yesterday was all professionals need to back off a little bit and treat us like adults.

Being an adult is taking responsibility for ourselves.

If you back off just a little bit we can do this and we can be responsible for learning how to be the best that we can.

Join Shared Lives Plus as our new NHS Programme Director!

We are advertising an exciting £50k p.a. Programme Director post (Deadline 29th March, location flexible), leading a major three year investment and development programme to develop and scale up Shared Lives as a healthcare service in partnership with the NHS and NHS England. We have not launched the programme yet, so watch this space for more details but we need to find a Director  who has a strong track record of developing projects within or in partnership with the NHS. Here is a link to our recent reports on Shared Lives and healthcare and on Collaborative Healthcare which will give you a sense of the potential.

No evidence for personal budgets?

The National Audit Office (has published a fairly scathing report on what it sees as the lack of evidence being gathered on the impact of implementing personal budgets. It recognises that personal budgets have wide support and that most people (but not all) benefit from the policy, and it notes the number of anecdotes of positive experience, but it does not accept that the national surveys of outcomes associated with personal budget use are robust enough as a national evidence base, because they rely on councils choosing to take part.

The NAO is right to suggest that with £6.3bn spent on long term community care and 88% of it spent via personal budgets in 2014-15 (after which personal budgets in theory became the only way it was spent), the Department of Health (DH) and councils have a responsibility to develop an evidence base on how the policy is implemented. The NAO was surprised to find that policy makers were still relying on research done in 2007, pre-crash, but it could have said much more about the worrying lack of evidence when it comes to the impact of cuts on people taking personal budgets. It highlights an obvious but unexplained discrepancy between individual level studies showing personalisation benefitting people which is not reflected in area level data. It also highlights the discrepancy between the DH’s expectation of making no savings through personalisation and the large proportion of council bosses who see increasing personalisation as a key source of savings. When changes labelled ‘personalisation’ are seen as a route to savings, they rarely feel very personalised to the individuals involved.

The variation from council to council in whether personal budgets were being offered (as low as 10% of people in some areas) is shocking, as is the variation in the proportion of people taking their personal budget as a cash Direct Payment, which the In Control POET survey has consistently associated with better experiences and outcomes: from only 5% to 57% (average 22%). There is no good reason why people in some areas have ten times the likelihood of taking full control of their personal budget compared to others.

The report is a useful challenge to lazy thinking about personal budgets and personalisation, which is complex and has suffered from over-simplification both from some of its advocates who sold it as the solution to every social care problem and budget challenge, and from detractors who talk as if it ended a golden age in which enlightened professionals knew best and always ensured disabled and older people lived great lives (with one or two commentators jumping between one extreme and the other).

But the report relies itself on a number of assumptions Continue reading

Life is not as scary as I thought

Here is Matt’s Shared Lives story: more stories on our website.

Matt Sheppard 

“My name is Matthew Sheppard and I have lived in Shared Lives for five years.

I live with Chris and Denis my carers and two other guys. I like living here because they respect my own space as it is very important to me and I am able to live as independently as possible and experience live to the fullest and days out, events, meetings and making friends.”

How long have those who support you been involved in Shared Lives?
Chris my carer grew up in a Shared Lives setting as his parents and grandparents are Shared Lives carers too. Chris and Denis have been Shared Lives carers for five years now.

What do you like about living in Shared Lives?
I used to find new things, new people, and experiences difficult as change was hard for me to understand but since living with Chris and Denis I have watched and experienced everyday life and seen life is not as scary as I thought. I now love meeting people and doing new things.

How has your lifestyle/health changed since living in Shared Lives?
I’m very healthy. Chris and Denis help me plan my weeks ahead for appointments such as doctors, dentist, days out and visitors and I have a calendar so I can keep track of what’s going on so I am able to understand better, and I get to experience lots of new things.

Tell us about your screwball rally races!
I love going on the screwball rally as I love cars. When we all go its great fun as everyone is in fancy dress and the cars are too and I get to see friends which I made the year before and get to check out their new car or see what they have done to the old car and then we all meet up for drinks and food and a party at the end of the day. We also meet up with my mum and her partner as they go ahead and meet us at new destination and I get to see lots of new places on the way. On the last rally, our car was in the French newspaper it was very exciting as all the people were waving at me as we drove through the villages.

What do you use to decorate the cars?
One year we painted our hands and put hand prints all over the car and the last car we did was my favourite because I love teddy bears. We stuck 200 teddy bears all over the car, we made it the teddy bears picnic and had picnics all over Europe – the best one was in the Pyrenees Mountains.

Is there anything else you would like to tell us about yourself?
I have lots of new hobbies too, I like computers, taking photos, and fishing trips. I use the net to pick up fish, my next aim is to try the fishing rod and this year I did the London to Brighton Land Rover run which was good fun and I did Brighton Colour Run – great fun, I got covered in lots of colour.

I also love to travel. Chris took me to Turkey which I loved especially going to all the different temples, sights, smells, sounds and different people that spoke funny and made me laugh and very different food. I especially loved it when we went to Miletus as an old lady made me a special breakfast and we sat on the floor to eat and share. After breakfast and lots of tea and laughter, she gave me a gift – a Turkish eye which was for good luck. She said it was a long time since she had had so much fun and laughter and was happy that I took the time to stop and have breakfast with her.”

Click here to see a collage of Matthew’s trips around Europe on the screwball rally!

Thank you to Lucy West and the Shared Lives Scheme in West Sussex, visit their website to discover more on becoming a Shared Lives carer or using Shared Lives:
Shared Lives West Sussex Website

The power of communities

This is a guest blog by our Director of Support and Development, Anna McEwen (@annasharedlives) who writes:

The other day I was walking down my street on the way to the station to go to work. As I passed my neighbours a few houses down from my house an old man leaning on his zimmer frame was calling for help from his front door.  As I went over, he told me that his wife had had a fall and he needed help.

So, I went in and found his wife on the floor in the front room (their bedroom) where she’d fallen out of bed.  She was ok, but dazed and confused so I called an ambulance and made sure they were ok before I left for work.  All day I was thinking about them wondering what had happened so on my way home I stopped to check and was greeted with a very different scene – their homecare worker answered the door, they were both dressed and sitting at the table eating dinner.  They didn’t know who I was or what had happened that morning, but they were obviously fine and being looked after.  I felt slightly uncomfortable being neither a paid worker or family, just a concerned neighbour so I wished them well and left.

It got me thinking… there must be thousands of homes like that around the country where bedrooms and a bathroom are untouched upstairs while people who can no longer use the stairs move beds downstairs and live on the ground floor.  There is also a housing crisis – surely there is a way to marry these things up.  Well there is: Homeshare.  Homeshare matches a householder who can offer accommodation to someone who needs it, with a person who needs a home and can offer a bit of support in return.  That support might be a bit of shopping, cooking a meal, changing the lightbulb or be someone to call on when you have a fall.  It’s not regulated and homesharers do not provide personal care, but could be coupled with a homecare arrangement if needed.  It’s still relatively unknown in the UK, but growing.  I was lucky enough to go to the Homeshare International World Congress in Melbourne last year where Homeshare schemes from all over the world were represented.  In other places in the world Homeshare is much larger scale and we have a lot to learn from these countries.

I also got to thinking about the power of communities, I’m not unusual or exceptional wanting to help my neighbours and I can’t imagine many people would not go to help when called.  With the number of older people rising, and people wanting to stay in their own homes surely we need to harness the power of the community in a coordinated way that makes it ok for neighbours to show concern and look out for each other and for more flexible and personal support solutions like Homeshare and Shared Lives.  There is a huge social care crisis but so much is achievable if we harness the power of our communities.